Promising New Parent-Child Therapy Offers Early Intervention Technique for Depression

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Joan Luby, M.D. of Washington University in St. Louis
Joan Luby, M.D.

Recent research has shown that children as young as 3 years old can experience symptoms of clinical depression. Research has also shown that half of all cases of depression arise during childhood. While evidence suggests that early behavioral interventions can mitigate the lifetime course of mood disorders, and possibly other neurodevelopmental disorders such as autism, it is yet to be established as to which treatments might work best. Treating the very young with drugs is not considered advisable.

Now, a novel approach called Parent Child Interaction Therapy-Emotion Development (PCIT-ED), being tested by Brain & Behavior Research Foundation Independent Investigator Grantee Joan Luby, M.D., and colleagues at Washington University in St. Louis, has shown promise in an early trial of improving mood and behavior in very young children with depression. The results of the pilot study were reported online on Oct. 31, 2011 in the Journal of Child Psychology and Psychiatry.

PCIT-ED is a dyadic psychosocial intervention with two components. The PCIT part is aimed at strengthening the parent-child relationship by teaching positive play techniques and training parents in ways to handle children’s noncompliant and disruptive behavior. PCIT has previously been shown to be effective for treating disruptive disorders among preschoolers. The new ED component was designed to help parents enhance their children’s ability to recognize their own emotions as well as emotions in others and to more effectively regulate intense emotions.

In the preliminary trial, conducted over a 3-year period, Dr. Luby and her team worked with a small sample group of parents and their depressed children, aged three to seven. The participants were randomly assigned to either PCIT-ED over 12 weeks or another psycho-education program of equal length. The researchers report that both groups showed meaningful improvement in a number of areas, but PCIT-ED appeared to be considerably more effective overall than the psycho-education program.

Depression symptoms declined significantly in both groups of children, and both groups showed improvement in anxiety levels. The children receiving PCIT-ED also showed improvements in reducing hyperactivity, conduct problems and expressions of hostility. The PCIT-ED group improved in executive functioning, specifically in their ability to recognize and regulate their emotions. The PCIT-ED parents reported reduced levels of stress and of maternal depression, which was not the case with parents in the psycho-education group.

In their report, Dr. Luby and her co-authors write that the preliminary data “suggest that PCIT-ED may be a promising early intervention for depression,” and that “larger scale randomized controlled trials of PCIT-ED for depressed preschoolers are now warranted.”

A professor of psychiatry and director of the Early Emotional Development Program at Washington University, Dr. Luby is a leader in studies of preschool mood disorders and in the use of functional and structural neuroimaging of depressed preschool populations. In 2004, she received the Gerald L. Klerman Award for Exceptional Clinical Research by a Young Investigator from the Brain & Behavior Research Foundation.

Article comments

I have chronic, treatment refractory depression. I was definitely a depressed child starting at least by the age of 6; many of my few early memories from before that are of situations in which I was acutely anxious. As the field has come to recognize that children can be depressed, I have wondered how my life might have been different for some form of early therapeutic intervention. But I also know that a contributing factor to my depression was that my parents were people who would never have admitted that their child had a psychiatric problem or sought professional help. I was not an acting out child, I was instead overly docile. How do we educate pediatricians & teachers to recognize the signs of depression in children and encourage them to tell parents when I child needs help? A pediatrician made my situation worse by attributing one of my symptoms to simple laziness.

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