Depression 3–5 years

Depression 3–5 years

CLINICAL PEARLS

The presence of preschool depression can be an indicator of increased risk for Major Depressive Disorder (MDD) in adolescence. 1

Prevalence of depression in preschoolers is approximately 2%.

Psychotherapy is first and second-line treatment options and children should be referred to an infant mental health provider for further evaluation and treatment.

Medications should be considered a last resort for anxious or depressed preschoolers who continue to have severe and impairing psychopathology after failing an adequate course of therapy. 2,3,5

Clinicians can utilize the OSU Infant Mental Health ECHO or the OSU Pediatric and Behavioral Health ECHO for further consultation.

￮ OSU ECHO Lines

RATING SCALES

Preschool Feelings Checklist

￮ A brief and valid screening measure for depression in young children. ￮ https://medicine.tulane.edu/sites/g/files/rdw761/f/pictures/Preschool%20feelings%20 checklist.pdf

Survey of Well-Being of Young Children ￮ Screens three domains—developmental, emotional/behavioral, and family context. Includes depression and internalization questions.

ƒ Includes the Baby Symptom Checklist for ages two months to 18 months and the Preschool Pediatric Symptoms Checklist for ages 18–60 months. ￮ https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-Children/Overview

Strengths and Difficulties Questionnaire

￮ Behavioral screening (emotion, conduct, hyperactivity, peer problems, prosocial behavior) for children over age two, including depression and internalization questions. ￮ http://www.sdqinfo.com

Children age four and over

￮ Pediatric Symptoms Checklist ƒ https://www.brightfutures.org/mentalhealth/pdf/professionals/ped_sympton_chklst.pdf

Treatment Approach for Preschool Children (3–5 Years Old)

Hierarchy Treatment Comments

1st -Line Treatment Psychotherapy – Parent-Child Psychotherapy Targeting Emotion Development (PCIT-ED) 3,4,5 Strong Recommendation

2nd -Line Treatment Play Therapy or Cognitive Behavioral Therapy with the caregiver 2

Opinion/limited evidence-based research for age group Re-evaluation by a child psychiatrist should be done if the above therapies are ineffective. 3 rd -Line Treatment Fluoxetine 2,6

starting dose 2.5-5mg daily, increasing per practice guidelines Opinion/limited evidence-based research for age group

FDA Black box warning: SSRI increases the risk for suicidal thinking.

REFERENCES

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6. Gaffrey, M., Tillman, R., Barch, D., Luby, J. (2018) Continuity and stability of preschool depression from childhood through adolescence and following the onset of puberty. Comprehensive Psychiatry, 86:39–46.

Gleason, M., et al. (2007) Psychopharmacological treatment for very young children: Contexts and guidelines. Journal of the American Academy of Child & Adolescent Psychiatry, 46:1532–1572.

Luby, J. (2013) Treatment of anxiety and depression in the preschool period. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4):346–358.

Luby, J., Barch, D., Whalen, D., Tillman, R., Freedland, K. (2018) A Randomized controlled trial of parent-child psychotherapy targeting emotion development for early childhood depression. American Journal of Psychiatry, 175:1102–1110.

Whalen, D., Sylvester, C., Luby, J. (2017) Depression and anxiety in preschoolers: A review of the past 7 years. Child and Adolescent Psychiatric Clinics of North America, 26:503–522.

Qin, B., et al. (2014) Selective serotonin reuptake inhibitors versus tricyclic antidepressants in young patients: A meta-analysis of efficacy and acceptability. Clinical Therapeutics, 36(7):1087–1095.