Can Major Depression Be Diagnosed in Preschoolers?

The 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” (p. 935).

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.