title: The clinical picture of depression in preschool children.
abstract: OBJECTIVE
  To investigate the clinical characteristics of depression in preschool children.
  
  
  METHODS
  One hundred seventy-four 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 for parents. Modifications were made to the assessment of major depressive disorder (MDD) criteria so that age-appropriate manifestations of symptom states could be captured. Typical and "masked" symptoms of depression were investigated in three groups: depressed (who met all MDD criteria except duration criterion), those with nonaffective psychiatric disorders (who met criteria for attention-deficit/hyperactivity disorder and/or oppositional defiant disorder), and those who did not meet criteria for any psychiatric disorder.
  
  
  RESULTS
  Depressed preschool children displayed "typical" symptoms and vegetative signs of depression more frequently than other nonaffective or "masked" symptoms. Anhedonia appeared to be a specific symptom and sadness/irritability appeared to be a sensitive symptom of preschool MDD.
  
  
  CONCLUSIONS
  Clinicians should be alert to age-appropriate manifestations of typical MDD symptoms and vegetative signs when assessing preschool children for depression. "Masked" symptoms of depression occur in preschool children but do not predominate the clinical picture. Future studies specifically designed to investigate the specificity and sensitivity of the symptoms of preschool depression are now warranted.
authors.affiliation: Washington University School of Medicine, Department of Psychiatry, St. Louis, MO 63110, USA. lubyj@psychiatry.wustl.edu
authors.forename: Joan L
authors.initials: JL
authors.lastname: Luby
authors.forename: Amy K
authors.initials: AK
authors.lastname: Heffelfinger
authors.forename: Christine
authors.initials: C
authors.lastname: Mrakotsky
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Brown
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Hessler
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Wallis
authors.forename: Edward L
authors.initials: EL
authors.lastname: Spitznagel
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index