Depressie in de vroege kinderjaren

Depressie in de vroege kinderjaren

augustus 14, 2019 0 Door admin

Translating…


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Parental neglect

Source: Pixabay

I recently heard Joan Luby, a child psychiatrist from Washington University, St. Louis, discuss early childhood depression. Although not listed in the DSM, the symptoms are similar to depression in general, such as hopelessness, low self-esteem, and low energy. But, what’s noteworthy, Luby found these symptoms present in preschoolers from age 3 to age 6. 

How is this possible, we might ask, for children from age 3 to age 6 to be depressed? Could it be due to genetics? Luby is open to epigenetics, the effect of early environment on genes, as more plausible. Then it must be due to poverty. Again, although poverty and deprivation have proven a causal factor for over two decades, she also found early childhood depression among middle and upper income families. The culprit, she believes, is the early relationship, the support, warmth, and reassurance that the toddler receives from one’s mother. 

According to Luby, the interaction between the mother and infant/toddler determines the child’s later neurodevelopment. For instance, longitudinal studies from 2002 found the hippocampus of those with symptoms of depression had less volume and lower cortical volume as young adults, influencing their psychosocial interactions, emotional regulation, and cognitive function. 

Luby sees early childhood depression as an unmistakable predictor of adult depression, including Major Depression Disorder. At her clinic, she provides a variation of Parent Child Interaction Therapy-Emotional Development (PCIT-ED). A filmed example pictures a therapist sitting on one side of glass partition, observing and coaching mother how to provide comfort for child’s extreme frustration over being unable to grab a hanging desirable object manipulated by the therapist.

The visible symptoms of early childhood depression are intense irritability, negative affect, anhedonia (inability to enjoy things), not participating in play, and indifference to behavioral rewards. Comorbidity rates run about 45 percent with attention-deficit/hHyperactivity disorder (ADHD), oppositional defiant dDisorder (ODD), and conduct disorder (CD).

A key issue in the assessment of internalized disorders, particularly depression, in young children is that caregivers may fail to spontaneously report symptoms (changes in play, social interest, sleep, and so on) or may unwittingly accommodate these behaviors and thereby fail to regard them as symptoms (e.g., anxious rituals, rigidities, and social withdrawal). 

Intense irritability and disruptive behavior are probably the most common symptoms that prompt parents and primary-grade teachers to refer a young child to undergo a mental health evaluation. While irritability is nonspecific and may be a symptom of a variety of early childhood disorders, when it presents along with social withdrawal and anhedonia and/or excessive guilt, early depression should be considered.

Identification of preschool depression in the clinical setting remains challenging. Common symptoms such as irritability and even sadness, when present without other depressive symptoms, are relatively nonspecific markers and cannot be used to differentiate preschool depression from other disorders. Further work is needed to educate parents and primary care physicians about early signs and symptoms of depression in young children.

Adding to the confusion are the high rates of comorbidity with other, more commonly occurring behavioral disorders, such as attention deficit hyperactivity disorder and oppositional defiant disorder. These disorders are characterized by disruptive symptoms and more readily apparent, increasing the risk that such symptoms will overshadow co-occurring depression.

If Luby’s thesis holds, there will be a lot of catch-up to do—training preschool daycare staff, primary grade teachers, school counselors, parents, and caregivers, as well as DSM recognition and application of criteria for reliable and valid diagnoses.

I see Luby’s research as a possible major breakthrough for pointing the way to better understanding and prevention of depression. However, there is the possibility that the etiology is more likely to be congenital rather than lack of mother’s warmth and support. 

*This blog was co-published with PsychResilience.com


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