Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria.
OBJECTIVE
To investigate the validity of developmentally modified DSM-IV criteria for preschool major depressive disorder (MDD).


METHODS
Subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview with the parent about the child. Minor developmental modifications to the formal DSM-IV MDD criteria were tested, including translations of symptoms to describe age-appropriate manifestations and setting aside the duration criterion. Preschool children who met modified criteria were compared with psychiatric and normal control groups.


RESULTS
Validation for the modified criteria was supported by a specific and stable symptom constellation, social impairment, greater family histories of affective disorders, and higher child-reported symptoms of depression on an age-appropriate puppet interview. Preschool children with MDD displayed "typical" symptoms of depression, as well as vegetative signs. Standard DSM-IV criteria failed to capture 76% of children who met these modified criteria.


CONCLUSIONS
Evidence that preschool children can manifest typical symptoms of MDD when age-adjusted symptoms states are assessed is provided. Findings also suggest that standard DSM-/V criteria may not be sufficiently sensitive for preschool children, as they failed to capture a substantial proportion of symptomatic children. Minor modifications to DSM-IV criteria are recommended to capture clinically significant preschool MDD.
Luby
Joan L
JL
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA. lubyj@psychiatry.wustl.edu
Heffelfinger
Amy K
AK
Mrakotsky
Christine
C
Hessler
Martha J
MJ
Brown
Kathy M
KM
Hildebrand
Tammy
T
D002675:Child, Preschool; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales