Up until 1980, few experts believed that young children were capable of experiencing depression or anxiety. But by the ’90s, it was clear that depression and anxiety could be experienced and expressed by children as young as three. But for many young children, the symptoms of depression show up in odd ways, such as aggression, hyperactivity, or difficulty eating. Because of this, depression or anxiety are more likely to go undiagnosed in young children.

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Though estimates vary widely between experts, somewhere between 10 and 20 percent of kids through kindergarten age are thought to suffer from an anxiety disorder, and about two percent of children through that age are thought to suffer from depression, with some even expressing suicidal thoughts or feelings.

The real rates of these emotional disorders in children, though, are likely much higher. Because children under the age of eight or so can’t articulate their own feelings, doctors must rely on the caregiver’s account of a child’s behavior and the child’s limited ability to express themselves to diagnose what are already difficult to diagnose disorders. The problem with relying on caregiver accounts lies in the fact that children with anxiety or depression are frequently so quiet and passive that their caregivers often overlook their difficulties.

The kids that struggle with these disorders  “are not the squeaky wheels,” observed Ellen McGinnis, a clinical psychologist at the University of Vermont Medical Center in Burlington.

McGinnis and others have focused their research on finding more objective ways to identify children with these conditions. But this research can be labor-intensive and time-consuming. It took McGinnis two years to assess just ten children, for example.

So in an effort to find a faster, more efficient way to identify children with anxiety or depression, McGinnis teamed up with her husband, a UVM biomedical engineer. The result was a pairing of the classic “snake test” (a commonly used test to identify emotional disorders in children) with a motion sensor (one that’s commercially available).

Of the 63 children recruited to take the test, 21 had been diagnosed with anxiety or depression using the gold standard for assessment: a 90-minute interview between a trained clinician and the child’s caregiver.

The researchers were able to use the sensor data to correctly flag 14 of the 21 children. Notably, the rate of false positives was also low, with the sensors categorizing only five children without a clinical diagnosis as having anxiety or depression. That’s better than the standard; the Child Behavior Checklist only identified eight of the 21 children with diagnoses.

Because of the success and simplicity of this method, both Ellen and Ryan McGinnis believe that coupling technology with behavioral tasks has great potential.

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Many researchers working to identify mental health problems in children go on to follow those children for years so they can see if and how mental health problems in early childhood carry over to later in life. In 2014, Sara Bufferd, a clinical psychologist at California State University San Marcos, and her team proved that children with signs of depression at age three were more likely to be depressed three years later. Related research on older children has shown a similar connection.

Early Discovery May Lead to Early Treatment

With the mounting evidence that mental health problems in preschool-age children carry over into adulthood, researchers have begun looking into treating these very young mental health sufferers.

In 2016, Joan Luby, a psychiatrist at the Washington University School of Medicine in St. Louis, showed that children with depression had a reduced reaction to rewards when compared to their peers without depression.

Luby’s team looked at 78 children ranging in age from four to seven. They hooked the children to an electroencephalogram (EEG), a non-invasive testing machine that measures electrical activity in the brain. Fifty-three of the children had been diagnosed with depression.

While hooked up to the EEG, the children played a guessing game on a computer. The children who gave more right answers gained more points and ultimately won better prizes. The EEG revealed that even after choosing the correct answer, the depressed children showed less brain activity than their healthy peers, which signaled that their reward response was muted, Luby reported in October 2016 in the Journal of the American Academy of Child and Adolescent Psychiatry. Similarly, inhibited reward responses have been linked with depression in teens and adults.

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Meanwhile, psychiatrist Luby also studied young children who were receiving a modified form of psychotherapy known as Parent-Child Interaction Therapy, or PCIT. In this early intervention for children suffering from mental health problems, a therapist coaches the child’s caregivers on how to manage the child’s disruptive tantrums and misbehavior.

During sessions of PCIT, a therapist observes the parent and child’s interaction through a one-way mirror and communicates instructions to the adult through an in-ear microphone. Similarly, in Luby’s 2016 study, the children received PCIT, but with a focus on reducing the feelings of guilt and shame that often accompany depression.

The children receiving the treatment showed lower rates of depression and less severe depression than the children placed in a separate group waiting for the treatment, Luby found. In addition to these findings, Luby found that the children who received the modified PCIT began to show an increased reception to rewards, similar to their peers without depression.

Luby and her team hope that they’ll have answers to the question of long-term results once these children are old enough. Further studies are being conducted on other treatment options for these young children in hopes of helping them as they develop.