Can Preschoolers Be Depressed?

Kiran didn’t seem like the type of kid parents should worry about. “He was the easy one,” his father, Raghu, a physician, says. “He always wanted to please.” Unlike other children in his suburban St. Louis preschool, Kiran (a nickname his parents asked me to use to protect his identity) rarely disobeyed or acted out. If he dawdled or didn’t listen, Raghu (also a nickname) had only to count to five before Kiran hastened to tie his shoes or put the toys away. He was kind to other children; if a classmate cried, Kiran immediately approached. “Our little empath!” his parents proudly called him.

But there were worrisome signs. For one thing, unlike your typical joyful and carefree 4-year-old, Kiran didn’t have a lot of fun. “He wasn’t running around, bouncing about, battling to get to the top of the slide like other kids,” Raghu notes. Kiran’s mother, Elizabeth (her middle name), an engineer, recalls constant refrains of “Nothing is fun; I’m bored.” When Raghu and Elizabeth reminded a downbeat Kiran of their coming trip to Disney World, Kiran responded: “Mickey lies. Dreams don’t come true.”

Over time, especially in comparison with Kiran’s even-keeled younger sister, it became apparent that guilt and worry infused Kiran’s thoughts. “We had to be really careful when we told him he did something wrong, because he internalized it quickly,” Raghu says. He was also easily frustrated. He wouldn’t dare count aloud until he had perfected getting to 10. Puzzles drove him nuts. After toying with a new set of Legos, he told his father, “I can’t do Legos.” He then roundly declared: “I will never do them. I am not a Legos person. You should take them away.”

One weekend when he was 4, Kiran carried his blanket around as his mother ferried him from one child-friendly place to the next, trying to divert him. But even at St. Louis’s children’s museum, he was listless and leaned against the wall. When they got home, he lay down and said he couldn’t remember anything fun about the whole day. He was “draggy and superwhiny and seeming like he was in pain.” Elizabeth remembers thinking, Something is wrong with this kid.

After talks with the director of Kiran’s preschool, who was similarly troubled by his behavior, and a round of medical Googling, Kiran’s parents took him to see a child psychiatrist. In the winter of 2009, when Kiran was 5, his parents were told that he had preschool depression, sometimes referred to as “early-onset depression.” He was entered into a research study at the Early Emotional Development Program at Washington University Medical School in St. Louis, which tracks the diagnosis of preschool depression and the treatment of children like Kiran. “It was painful,” Elizabeth says, “but also a relief to have professionals confirm that, yes, he has had a depressive episode. It’s real.”

Is it really possible to diagnose such a grown-up affliction in such a young child? And is diagnosing clinical depression in a preschooler a good idea, or are children that young too immature, too changeable, too temperamental to be laden with such a momentous label? Preschool depression may be a legitimate ailment, one that could gain traction with parents in the way that attention deficit hyperactivity disorder (A.D.H.D.) and oppositional defiant disorder (O.D.D.) — afflictions few people heard of 30 years ago — have entered the what-to-worry-about lexicon. But when the rate of development among children varies so widely and burgeoning personalities are still in flux, how can we know at what point a child crosses the line from altogether unremarkable to somewhat different to clinically disordered? Just how early can depression begin?

The answer, according to recent research, seems to be earlier than expected. Today a number of child psychiatrists and developmental psychologists say depression can surface in children as young as 2 or 3. “The idea is very threatening,” says Joan Luby, a professor of child psychiatry at Washington University School of Medicine, who gave Kiran his diagnosis and whose research on preschool depression has often met with resistance. “In my 20 years of research, it’s been slowly eroding,” Luby says of that resistance. “But some hard-core scientists still brush the idea off as mushy or psychobabble, and laypeople think the idea is ridiculous.”

For adults who have known depression, however, the prospect of early diagnosis makes sense. Kiran’s mother had what she now recognizes was childhood depression. “There were definite signs throughout my grade-school years,” she says. Had therapy been available to her then, she imagines that she would have leapt at the chance. “My parents knew my behavior wasn’t right, but they really didn’t know what to do.”