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Baby blues

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 pre-school, Kiran (name changed to protect identity) rarely disobeyed or acted out. If he dawdled or didn’t listen, Raghu (name changed) had only to count to five before Kiran hastened to tie his shoes or put the toys away.

health and fitness Updated: Aug 28, 2010 23:05 IST
NYT

Pamela Paul

weekendht@hindustantimes.com

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 pre-school, Kiran (name changed to protect identity) rarely disobeyed or acted out. If he dawdled or didn’t listen, Raghu (name changed) had only to count to five before Kiran hastened to tie his shoes or put the toys away.

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.” Elizabeth remembers thinking, something is wrong with this kid.

After 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 pre-school depression, sometimes referred to as early-onset depression. “It was painful,” Elizabeth says, “but also a relief to have professionals confirm that, yes, he has had a depressive episode. It’s real.”

How young is too young?

The answer seems to be earlier than expected. Today a number of child psychiatrists 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 lay people think the idea is ridiculous.”

Like many who treat depression, Daniel Klein, a professor of clinical psychology at State University of New York in Stony Brook, repeatedly heard from adult patients that they had depression their whole lives. “I’ve had this as long as I can remember,” Klein told me they said. “I became convinced that the roots of these conditions start very early.” So Klein turned to the study of temperament and depressive tendencies in young children.

The most obvious and pervasive symptom, not surprisingly, is sadness. It’s not enough just to be sad; after all, sadness in the face of unachieved goals or a loss of well-being is normal. But the depressed child apparently has such difficulty resolving the sadness that it becomes pervasive and inhibits his functioning.

Further complicating the picture is that three-fourths of depressed children had some additional disorder.

In Luby’s study, about 40 per cent also had Attention-Deficit Hyperactivity Disorder or Oppositional Defiant Disorder — disruptive problems that tend to drown out signs of depression. Though it looks as if only the children with depression experience anhedonia, other symptoms like irritability and sadness are shared across several disorders.

No clear solution

Treatments help prevent depression from interfering with a child’s development, ensuring that she functions socially, cognitively and emotionally, alongside her peers. One established method is called Parent-Child Interaction Therapy (PCIT), which is a short-term programme, usually 10 to 16 weeks under the supervision of a trained therapist, with ongoing follow-up in the home. During each weekly hour-long session, parents are taught to encourage their children to acquire emotion regulation, stress management, guilt reparation and other coping skills. The hope is that children will learn to handle depressive symptoms and parents will reinforce those lessons.

This doesn’t leave parents with a very clear road map. “We don’t know if Kiran will be at risk of depression as an adult,” Raghu said. In the study that Kiran participated in, because he was part of the control group, he did not get to go through PCIT. Nevertheless, Raghu and Elizabeth found the general parent training they received as part of the control helpful. And in the months following the study, Kiran’s mood seemed to have improved. But by this past winter, he seemed to be slipping and prone to bouts of anger and frustration; depression, it was explained to them at Luby’s lab, tends to be episodic. “We worry that it’s a lifelong thing,” Elizabeth told me.

Pamela Paul is the author of Parenting, Inc., a book about the business of child-rearing.