Major Depression Be Diagnosed in Preschoolers?
DSM-IV criteria for Major Depressive Disorder (MDD) are designed
mainly for adults. Because several of the criteria are not appropriate
for very young children, it has not been clear whether preschoolers
manifest disorders that correspond to the DSM-IV diagnostic construct
of MDD. To evaluate developmentally modified criteria for MDD,
a team of researchers led by psychiatrist Joan L. Luby (2002)
conducted comprehensive assessments of 136 3- to 5-year-old children
for signs of MDD. The assessments included a structured diagnostic
interview in which caregivers were asked about manifestations
of depression and other problems. Caregivers were also interviewed
about family history of psychiatric disorders, and they completed
the CBCL and the Socialization subscale of the Vineland Screener.
The children were observed in interaction with their caregivers
and were interviewed about their affective states by means of
the Berkeley Puppet Interview Symptom Scales. When developmentally
modified versions of DSM-IV criteria were applied, 49 of the 136
children were diagnosed as having MDD. However, 37 (76%) of these
children failed to meet the standard DSM-IV criteria for MDD.
When Luby et al. compared the 49 children diagnosed as having
MDD with children who met criteria for either Attention Deficit
Hyperactivity Disorder or Oppositional Defiant Disorder (ADHD/ODD
group) or for no disorders (normal control group), they found
that the MDD children had significantly higher CBCL Internalizing
scores than both the ADHD/ODD group and the normal control group.
The Externalizing scores of the MDD group were also significantly
higher than those of the normal control group. However, the Externalizing
scores of the MDD group did not differ significantly from those
of the ADHD/ODD group. The MDD children were thus elevated with
respect to CBCL Externalizing problems as well as Internalizing
problems. The puppet interviews of the children also revealed
similarly high levels of diverse symptoms in the MDD and ADHD/ODD
groups. The authors concluded that "The current formal DSM-IV
criteria require modification for application to preschool children,"
and that "developmentally modified criteria for MDD are valid
and necessary to capture this disorder in preschool children"
Reference: Luby, J.L., Heffelfinger, A.K., Mrakotsky,
C., Hessler, M.J., Brown, K.M., & Hildebrand, T. (2002). Preschool
major depressive disorder: Preliminary validation for developmentally
modified DSM-IV criteria. Journal of the American Academy of
Child and Adolescent Psychiatry, 41, 928-937.