Effectiveness of Parent-Child Interaction and Emotion Development Therapy in Treating Preschool Children With Depression

While growing up, children experience a range of emotions that change with development and
environment. Although all young children experience sadness at times, a main characteristic
of young children is their ability to experience joy and excitement in pleasurable childhood
activities. When a child seems perpetually sad and no longer seems interested in previously
enjoyed activities, the child may be showing signs of early onset depression. Children who
are depressed are at increased risk for a wide range of social, psychological, physical, and
achievement-related problems. Two previous studies have established the validity of early
onset depressive syndrome in preschoolers, confirming the need for treatment during the
preschool period. This study will specifically adapt parent child interaction therapy
(PCIT), a proven effective treatment for preschool disruptive disorders, for use in
preschoolers with depression and will include an additional component to focus on emotion
development (ED). The study will evaluate the effectiveness of PCIT-ED in treating
depression in preschool children.

Participation in this two-stage study will last 16 weeks and will consist of initial
assessments, 14 weeks of therapy, and a final assessment. Stage I will be used to assess the
acceptability and reliability of the PCIT-ED manual, which will guide the treatment
sessions. The protocol and assessment schedule will be the same for Stage I participants and
Stage II participants assigned to PCIT-ED.

The initial assessments will include both child and parent participants. Child participants
will be asked to complete a series of tasks, which will include playing with games and toys,
making selections based on feelings, completing stories started by a research assistant, and
participating in other activities designed to be fun and exciting. Parents will be
interviewed about their child's feelings, emotions, behaviors, and development and also
about how their child gets along at home, in school, and with friends. Parents will also
answer questions concerning their own mental health and drug history, parenting style, and
moods.

Participants will then be randomly assigned to receive PCIT-ED or Developmental Education
Parenting Intervention (DEPI). Participants in both groups will attend fourteen 1-hour
therapy sessions over a period of 14 weeks. For those assigned to PCIT-ED, most sessions
will include both parent and child participants, but some will include parents only. During
the parent-only sessions, the goals and procedures of upcoming therapy visits will be
explained to parents. During sessions with both parent and child, participants will be
taught positive parent-child interaction skills, ways to manage emotions, and relaxation
techniques. After each therapy session, participants will be given homework that will
involve practicing the skills learned in therapy sessions at home. At three points during
the study, parents will also be asked to complete a brief questionnaire about their thoughts
and feelings toward the therapy process. The therapy sessions for the participants assigned
to DEPI will provide basic education in all areas of preschool development, with emphasis on
social and emotional development. The initial assessments will be repeated for all
participants at the end of treatment.

Inclusion Criteria:

- Meets DSM-IV symptom criteria for MDD based on parent report on PAPA

- Currently resides and has resided with primary caregiver for more than 6 months prior
to study entry

Exclusion Criteria:

- Neurologic disorder (e.g., seizure disorder, closed head injury)

- Autistic spectrum disorder

- Has an IQ of less than 70, based on past testing or clear marked developmental delay

- Currently participating in psychotherapy

- If taking a psychotropic medication, must remain on stable dose of that medication
throughout the course of study participation