Novel Parent-Child Interaction Therapy Targets Preschool-Aged Depression

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Depression in early childhood bears behavioral and brain similarities to depression in adolescents and adults, but few interventions have been substantiated for that age group.
Depression in early childhood bears behavioral and brain similarities to depression in adolescents and adults, but few interventions have been substantiated for that age group.

A modified version of parent-child interaction therapy showed promise in a randomized controlled trial, according to results published in the American Journal of Psychiatry.

Parent-child interaction therapy has been validated as a method of addressing disruptive behavior in early childhood. The authors of the study titled their additional module "emotion development" and designed it to target depression in preschool-aged children (ClinicalTrials.gov identifier: NCT02076425). Depression in early childhood bears behavioral and brain similarities to depression in adolescents and adults, but few interventions have been substantiated for that age group.

Parent-child dyads were recruited from St Louis preschools, daycare centers, medical practices, and mental health facilities. Children whose scores were ≥3 on the Preschool Feelings Checklist were screened further, using the Preschool Age Psychiatric Assessment.

Children who had no other major neurologic or developmental issues and were not receiving other treatment were included in the final 229 pairs, who were randomly assigned to a treatment and control group. (The control group was placed on a waiting list for the 18-week treatment period and received the same course after the trial's conclusion.)

At baseline, clinicians administered the Schedule for Affective Disorders and Schizophrenia-Early Childhood, Preschool Feelings Checklist, Children's Global Assessment Scale, Clinical Global Impressions improvement scale, and Preschool and Early Childhood Functional Assessment Scale/Child and Adolescent Functional Assessment Scale. Caregivers completed the Emotion Regulation Checklist, My Child questionnaire, Parenting Stress Index, Coping With Children's Negative Emotions, and Beck Depression Inventory-II.

Parent-child interaction therapy entails coaching parents over an audio device worn in the ear as they interact with their children. The 8-session emotion development module focused on strengthening the child's emotion regulation and emotional competence.

Children in the waiting list group exhibited significantly worse impairments on the Preschool Feelings Checklist at the study's end, but children who completed the therapy showed improvements in emotion regulation and guilt processing. Additionally, parents were found to be less stressed and had improved depressive symptoms after treatment.

As parent-child interaction therapy has only been validated as an intervention for disruptive behavior, the findings should be interpreted with caution. Future investigations of the module will need to evaluate the sustained effects of treatment.

Reference

Luby J, Barch D, Whalen D, Tillman R, and Freedland K. A randomized controlled trial of parent-child psychotherapy targeting emotion development for early childhood depression [published online June 20, 2018]. Am J Psychiatry. doi:10.1176/appi.ajp.2018.18030321

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