ST. LOUIS, Missouri — While every toddler has tantrums and mood swings, some have more serious mental health problems, including depression and anxiety. Researchers at Washington University are enrolling preschoolers and young children in a study on therapy designed to treat depression without drugs.
The university’s early emotional development program hopes to recruit 250 children ages 3 to 7 for the study. The children must meet criteria for depression through assessments — they are socially withdrawn, disengaged, fatigued and unable to shake feelings of guilt. The children may have problems with sleep and appetite and usually are not enthusiastic about playtime. Eligible children must not have a diagnosis of autism or take any medications for mood disorders.
The treatment, called parent-child interaction therapy and emotion development, involves 18 weeks of one- to two-hour sessions in three parts. In each phase, the parent and child are together in a room while a therapist watches through one-way glass, sending directions to the parent’s earpiece.
One of the parents — the researchers requested anonymity for participants because the study is ongoing — said her 4-year-old daughter has reduced her defiant behaviors from 75 percent of the time to 25 percent since starting the therapy in May.
“It took our life from being very, very difficult, where everything you do is a struggle, to suddenly now your child is able to brush their teeth,” the mother said. “I was constantly searching for the better way to do things. Now I don’t have to do that because I know this works.”
The first six sessions focus on child-directed interaction. The parent is coached to follow the child’s lead as they play and give lots of praise and positive feedback. If the child colors, for example, the parent colors, too, while giving a running commentary: “You’re coloring the sun with a yellow crayon. Now you’re stacking the blue blocks.”
The focus is “to let the child know that the parent is paying attention and really approves of the child’s play,” staff therapist Mary Grace Portell said.
In the next phase, the activity is led by the parent, who gives the child specific commands to set expectations. The child is told to sit in the chair or clean up the toys, for example. Parents are coached on fair, consistent and structured discipline.
For the final six weeks, the sessions are focused on emotional development and symptoms of depression. The children learn how to regulate their emotions with help from the parents. They learn kid-friendly relaxation and breathing techniques.
Several of the exercises in the last phase are designed to provoke frustration, anger or guilt in the child. They’ll get a see-through lock box with an attractive toy in it, but the key won’t work. Or, during a tea party, the child’s cup is rigged to break.
Parents are taught to physically connect with the child by getting down to their level and putting a hand on their back. They validate the child’s feelings but don’t try to fix the situation right away. Eventually, the correct key or a new cup is offered. Other tasks are aimed at helping the child sustain joyful emotions, such as a bubble machine.
During the study’s first year, 35 children are expected to complete the therapy and receive evaluations four months later. So far, parents have reported fewer tantrums and decreased irritability. And the children are better able to express their feelings, Portell said.
“We are seeing dramatic declines in problematic behavior,” Dr. Joan Luby, who directs the study, said. “Every single kid is improving.”