The clinical significance of preschool depression: impairment in functioning and clinical markers of the disorder

Dimensions of Depressive Symptoms in Young Children: Factor Analysis of the Preschool Feelings Checklist-Scale

The current study is an investigation of the dimensionality of the Preschool Feelings Checklist-Scale (PFC-S), a caregiver-report questionnaire of early childhood depressive symptom severity. Caregivers of 450 young children, ages 3-8 years (M = 5.62, SD = 0.95; 49% female; 7% Hispanic; 66% White), completed the PFC-S and questionnaires on child emotion regulation and expression and self-reported depressive symptomatology. Confirmatory factor analyses indicated that a one-factor structure did not adequately fit the current PFC-S data. Using exploratory factor analysis, a three-factor structure emerged as interpretable and structurally sound, yielding reliable factors related to social and behavioral anhedonia, emotional and behavioral dysregulation, and excessive guilt and sadness. This factor structure showed configural and scalar invariance across preschool-aged and early middle childhood-aged children as well as children assigned male and female sex at birth. Correlations between the three factors and constructs related to depression suggested preliminary construct validity. The current study provides initial evidence for a multidimensional structure of the PFC-S and improves our understanding of early childhood depressive symptoms.

Comparison of the Clinical Spectrum of Juvenile- and Adult-Onset Huntington Disease: A National Cohort and Enroll-HD Observational Study

BACKGROUND AND OBJECTIVES

Differences in clinical characteristics between juvenile-onset Huntington disease (JHD) and adult-onset HD (AHD) are hypothesized but not directly compared. This study compares clinical characteristics occurrence and severity across age-at-onset (AO) subtypes.

METHODS

Using the national juvenile-onset HD patient cohort and the international Enroll-HD registry (NCT01574053), we compared childhood-onset JHD (cJHD; AO 0-10), adolescent-onset JHD (aJHD; AO 11-20), and adult-onset HD (AHD; AO 21-65) on proportions of clinical characteristics at onset and psychiatric characteristics in pooled datasets. Kruskal-Wallis test was applied to UHDRS-Total Motor Score (UHDRS-TMS) items of the Enroll-HD dataset to compare the severity of motor disease characteristics 6-10 years after onset.

RESULTS

The combined datasets provided data from 46 patients with cJHD (mean AO 6.70, 45% female), 243 patients with aJHD (mean AO 16.70, 46% female), and 9,504 patients with AHD (mean AO 44.70, 51% female). At onset, neurocognitive symptoms occurred in 47.50% of patients with cJHD (n = 46; 95% CI 31.80%-63.70%), significantly more often compared with 24.88% of patients with aJHD (n = 209; 19.30%-31.40%) and 15.02% of those with AHD (n = 8,177; 14.30%-15.80%). Psychiatric symptoms occurred in 47.12% of patients with aJHD (95% CI 40.20%-54.10%), significantly more compared with 31.04% of patients with AHD (30.10%-32.00%). Throughout the disease, aggressive behavior occurred in 73.91% of patients with cJHD (n = 46; 95% CI 58.60%-85.20%) and 55.88% of those with aJHD (n = 238; 49.30%-62.30%), significantly more compared with 40.65% of patients with AHD (n = 9,501; 39.70%-41.70%). Psychosis occurred in 23.53% of patients with aJHD (95% CI 18.40%-29.50%), significantly more compared with 12.77% of those with AHD (12.10%-13.50%). The Kruskal-Wallis test revealed significantly higher median UHDRS-TMS scores in one or both JHD subtypes compared with AHD for dysarthria (AHD: n = 4,163, median 1.00, interquartile range (IQR) 0.70; cJHD: n = 12, 2.20, 2.00, p = 0.039; aJHD: n = 93, 1.00, 1.00, p = 0.031), parkinsonism (AHD: n = 4,158, median 6.00, IQR 4.70; cJHD: n = 12, 11.00, 9.40, p = 0.008; aJHD: n = 93, 8.50, 6.80, p < 0.001), and dystonia (AHD: n = 4,161, median 2.00, IQR 5.20; cJHD: n = 12, 6.50, 8.20, p = 0.141; aJHD: n = 93, 4.00, 7.20, p = 0.015) and significantly lower median scores for chorea (AHD: n = 4,163, median 9.20, IQR 7.00; cJHD: n = 12, 5.00, 4.20, p = <0.001; aJHD: n = 93, 6.30, 9.50, p < 0.001).

DISCUSSION

This study highlights distinct clinical patterns in JHD subtypes compared with AHD. Stratification by age at onset-defined HD subtypes is needed in future studies.

Social anxiety moderates the association between adolescent irritability and bully perpetration

BACKGROUND

Preliminary work suggests anxiety moderates the relationship between irritability and bullying. As anxiety increases, the link between irritability and perpetration decreases. We hypothesize that any moderation effect of anxiety is driven by social anxiety symptoms. We sought to explicate the moderating effect of anxiety, while clarifying relations to other aggressive behaviors.

METHODS

A sample of adolescents (n = 169, mean = 12.42 years of age) were assessed using clinician rated assessments of anxiety, parent reports of irritability and bullying behaviors (perpetration, generalized aggression, and victimization). Correlations assessed zero-order relations between variables, and regression-based moderation analyses were used to test interactions. Johnson-Neyman methods were used to represent significant interactions.

RESULTS

Irritability was significantly related to bullying (r = .403, p < .001). Social, but not generalized, anxiety symptoms significantly moderated the effect of irritability on bully perpetration (t(160) = -2.94, b = -.01, p = .0038, ΔR2 = .0229, F(1, 160) = 8.635). As social anxiety symptoms increase, the link between irritability and perpetration decreases.

CONCLUSIONS

Understanding how psychopathology interacts with social behaviors is of great importance. Higher social anxiety is linked to reduced relations between irritability and bullying; however, the link between irritability and other aggression remains positive. Comprehensively assessing how treatment of psychopathology impacts social behaviors may improve future intervention.

Preschool Mood Disorders: A Review of the Literature from 2017 to 2024

Depression symptoms that onset during early childhood are increasingly recognized as a significant public health concern. A proliferation of research over the last 2 decades has identified preschool depression as a diagnostic reality that is associated with a severe and persistent course of depression throughout the lifespan. The current review summarizes the research on preschool depression from the last 7 years (2017-2024), with a particular focus on the assessment of, factors and outcomes associated with, neurobiological underpinnings of, and treatments for preschool depression. We also discuss potential avenues of inquiry that further elucidate the nature of preschool depression.

Association Between Early Childhood P300 Deficits and Risk for Preadolescence Depressive Disorder Mediated by Responsiveness to PCIT-ED Treatment

Preschool-onset major depressive disorder (PO-MDD) is an impairing pediatric mental health disorder that impacts children as young as three years old. There is limited work dedicated to uncovering neural measures of this early childhood disorder which could be leveraged to further understand both treatment responsiveness and future depression risk. Event-related potentials (ERPs) such as the P300 have been employed extensively in adult populations to examine depression-related deficits in cognitive and motivational systems. Few studies examine the prospective relationships between depression and P300, especially in young children. Moreover, limited research examines the relationship between P300 with psychotherapy treatment responsiveness in youths. The current study sought to examine the prospective relationships between pre-intervention P300 (i.e., choice-locked) elicited from the doors task in depressed preschool children (i.e., PO-MDD; ages 3-to-6) with reductions in depressive symptoms after completing an 18-week long dyadic psychotherapy intervention (n = 59). We also explored relations to risk for depression assessed at a follow-up visit during preadolescence (ages 8-to-12; n = 82). Those with PO-MDD exhibiting reduced choice (doors)-locked P300 demonstrated worse treatment response to psychotherapy and were more likely to meet criteria for depression during preadolescence. Moreover, the relationship between pre-intervention P300 and later preadolescence depression was significantly mediated by response to treatment. These findings suggest that deficits in brain systems linked to the choice-locked P300 component (i.e., cognitive and motivational) might be indicative of non-responsiveness to early dyadic psychotherapeutic intervention efforts for depression which impacts risk for recurrent patterns of depression in youths.

Psychometric properties of an Arabic translation of the 13-item short mood and feelings questionnaire- parent version (SMFQ-P) to screen for depression in children

BACKGROUND

Understanding the connection between parental wellbeing and its impact on childhood depression is crucial in order to develop targeted interventions and support systems that can mitigate potential long-term effects on mental health. This study focuses on examining the properties of an Arabic translation of a questionnaire called Short Mood and Feelings Questionnaire Parent Version (SMFQ-P) as a preliminary step toward validating a culturally relevant screening tool for childhood depression in Lebanon.

METHODS

A total of 502 parents, recruited through a snowball method, took part in the survey with an age of 36.24 years (SD ± 8.29). Among them 74.5% were females 88.8% were married and 72.9% had completed university level education. The children's mean age was 7.95 ± 1.14 years. The SMFQ-P was evaluated using confirmatory factor analysis (CFA), reliability measures, and correlations with parental distress using the Depression Anxiety Stress Scale-8 (DASS-8).

RESULTS

Confirmatory factor analysis (CFA) demonstrated an excellent fit for the one-factor model of SMFQ-P scores (RMSEA = 0.059, 90% CI [0.049, 0.070]; SRMR = 0.034; CFI = 0.967; TLI = 0.960), with standardized factor loadings ranging from 0.58 to 0.82. Male parents reported more depression in their child than female parents (p = .016). Parental distress levels (r = .60, p < .001) correlated strongly with SMFQ-P scores, suggesting indirect concurrent validity.

CONCLUSION

The SMFQ-P shows promise as a screening tool for childhood depression, offering preliminary evidence of its reliability and validity in the Lebanese context. Limitations, including reliance on parent-reported distress and the lack of a direct child-report validation, should be addressed in future studies.

Neighborhood Resource Deprivation as a Predictor of Bullying Perpetration and Resource-Driven Conduct Symptoms

OBJECTIVE

Resource deprivation is linked to systemic factors that disproportionately impact historically marginalized communities, and theoretical work suggests that resource deprivation may increase risk for bullying behaviors. Bullying perpetration is an intransigent social problem and an early risk factor that perpetuates the school-to-prison pipeline. This study explored how resource deprivation (family- and neighborhood-level metrics) was associated with early childhood bullying behaviors and clinician-rated symptoms of psychopathology, while accounting for other known risk factors (early life stressors, traumatic events, parental arrest, domestic violence).

METHOD

Participants (306 children, mean age = 4.45 years) were enrolled in a longitudinal study (Preschool Depression Study) where demographics, clinician-rated assessments of psychopathology, and parent reports of social functioning were collected. Measures of bullying behaviors (bullying perpetration, generalized aggression, and victimization) were constructed. A cross-sectional approach was employed, and analyses examined the interrelations between race, bullying-related behaviors, resource deprivation, and psychopathology, while accounting for confounding variables, at the baseline assessment time point.

RESULTS

The bullying measure showed acceptable model fit (comparative fit index = 0.956, Tucker-Lewis index = 0.945, root mean square error of approximation = 0.061, standardized root mean residual = 0.052, normed χ2 ratio = 2). Neighborhood resource deprivation was more strongly associated with bullying perpetration (r = 0.324, p < .001) than generalized aggression (r = 0.236, Williams t303 = 2.11, p = .036) and remained significant when controlling for other known risk factors (parental arrests, domestic violence, stressors, traumas) and demographic factors. Bullying perpetration was linked with racial category, but the relation was fully mediated by neighborhood resource deprivation. Linear regression including bullying behaviors and symptoms of clinical psychopathology suggested that resource deprivation specifically led to increases in bullying perpetration (t = 2.831, p = .005) and clinician-rated symptoms of conduct disorder (t = 2.827, p = .005), which were attributable to increased rates of resource-driven conduct symptoms (bullies, lies to obtain goods, stolen without confrontation).

CONCLUSION

Resource deprivation is strongly and specifically associated with increases in bullying perpetration. Children growing up in impoverished neighborhoods show significant increases in resource-driven conduct behaviors, yet interventions often target individual-level factors. These results highlight the need to target social inequity to reduce bullying perpetration and suggest that interventions targeting neighborhoods should be tested to reduce bullying in early childhood.

PLAIN LANGUAGE SUMMARY

Resource deprivation disproportionately impacts historically marginalized communities and may increase risk for bullying behavior. This study explored the relationships between neighborhood resource deprivation and social health behaviors and psychopathology in preschool-aged children (N = 306) in the St. Louis metropolitan area. Neighborhood resource deprivation was significantly linked to increased bullying perpetration (r = .324, p <.001) and accounted for other conduct symptoms. Results highlight the need to view neighborhood resources as a treatment target for reducing bullying perpetration in young children.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper received support from a program designed to increase minority representation in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Mapping the duration and severity of preschool-aged children's depressive moods and behaviors

BACKGROUND

Depressive moods and behaviors are developmentally normative, yet potentially impairing, in preschool-aged children. In addition to frequency, duration of behavior is an important parameter to consider when characterizing risk for worsening mood dysregulation. The goal of this study was to identify the duration and severity of depressive moods and behaviors and associations with impairment in a large community sample of preschool-aged children using an online parent-report daily diary.

METHODS

Primary caregivers (N = 900) of 3-5-year-old children reported the daily duration of each instance of seven depressive moods and behaviors for 14 days. We used item response theory analyses to examine duration item characteristics.

RESULTS

Moods and behaviors occurred at specific durations to be considered psychometrically severe/rare; for example, instances of sadness had to last an average total of 32 min per day or more, irritability at least 38 min, tantrums at least 30 min, and tearfulness/sensitivity at least 35 min. Longer durations of mood and behavior were associated with daily impairment, as well as older child age and less parental education.

CONCLUSIONS

To our knowledge, this is the first study to delineate specific duration ranges for depressive moods and behaviors in preschool-aged children. These data, coupled with information about the frequency of mood-related behaviors, can assist child practitioners in differentiating normative patterns from less normative mood problems to evaluate which children may be at risk. Future work should identify the duration of depressive moods and behaviors in early childhood that predict clinically significant psychopathology over time.

Depression symptoms, communication and cooperation skills, and friendship: longitudinal associations in young Norwegian children

Introduction

Symptoms of depression in early childhood have been linked to interpersonal difficulties, whereas friendships serve a protective function.

Methods

In the present study, we examined depression symptoms in preschool age (4 years) in relation to social skills (communication and cooperation), and friendships into early school age (Grades 1 and 2) in a large subsample (n = 943) of Norwegian children.

Results

The results indicated that preschool depression symptoms negatively predicted Grade 1 communication skills, which in turn predicted Grade 2 depression symptoms. This pathway suggests that communication skills may be a maintenance factor for depression symptoms in young children. In addition, preschool depression symptoms predicted lower Grade 1 cooperation skills, which in turn predicted lower Grade 2 communication skills, suggesting that preschool depression symptoms may begin a cascade of social skill problems that affect cooperation and communication skills into early school years. Best friendships were negatively related to depression symptoms in preschool and Grade 2.

Discussion

Given that preschool depression symptoms impact the development of social skills and friendships, it is important to attend to depression symptoms in early childhood.

Coding of Childhood Psychiatric and Neurodevelopmental Disorders in Electronic Health Records of a Large Integrated Health Care System: Validation Study

Background

Mental, emotional, and behavioral disorders are chronic pediatric conditions, and their prevalence has been on the rise over recent decades. Affected children have long-term health sequelae and a decline in health-related quality of life. Due to the lack of a validated database for pharmacoepidemiological research on selected mental, emotional, and behavioral disorders, there is uncertainty in their reported prevalence in the literature.

objectives

We aimed to evaluate the accuracy of coding related to pediatric mental, emotional, and behavioral disorders in a large integrated health care system's electronic health records (EHRs) and compare the coding quality before and after the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding as well as before and after the COVID-19 pandemic.

Methods

Medical records of 1200 member children aged 2-17 years with at least 1 clinical visit before the COVID-19 pandemic (January 1, 2012, to December 31, 2014, the ICD-9-CM coding period; and January 1, 2017, to December 31, 2019, the ICD-10-CM coding period) and after the COVID-19 pandemic (January 1, 2021, to December 31, 2022) were selected with stratified random sampling from EHRs for chart review. Two trained research associates reviewed the EHRs for all potential cases of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety disorder (AD), and disruptive behavior disorders (DBD) in children during the study period. Children were considered cases only if there was a mention of any one of the conditions (yes for diagnosis) in the electronic chart during the corresponding time period. The validity of diagnosis codes was evaluated by directly comparing them with the gold standard of chart abstraction using sensitivity, specificity, positive predictive value, negative predictive value, the summary statistics of the F-score, and Youden J statistic. κ statistic for interrater reliability among the 2 abstractors was calculated.

Results

The overall agreement between the identification of mental, behavioral, and emotional conditions using diagnosis codes compared to medical record abstraction was strong and similar across the ICD-9-CM and ICD-10-CM coding periods as well as during the prepandemic and pandemic time periods. The performance of AD coding, while strong, was relatively lower compared to the other conditions. The weighted sensitivity, specificity, positive predictive value, and negative predictive value for each of the 5 conditions were as follows: 100%, 100%, 99.2%, and 100%, respectively, for ASD; 100%, 99.9%, 99.2%, and 100%, respectively, for ADHD; 100%, 100%, 100%, and 100%, respectively for DBD; 87.7%, 100%, 100%, and 99.2%, respectively, for AD; and 100%, 100%, 99.2%, and 100%, respectively, for MDD. The F-score and Youden J statistic ranged between 87.7% and 100%. The overall agreement between abstractors was almost perfect (κ=95%).

Conclusions

Diagnostic codes are quite reliable for identifying selected childhood mental, behavioral, and emotional conditions. The findings remained similar during the pandemic and after the implementation of the ICD-10-CM coding in the EHR system.

Infant hedonic/anhedonic processing index (HAPI-Infant): Assessing infant anhedonia and its prospective association with adolescent depressive symptoms

BACKGROUND

Anhedonia, an impairment in the motivation for or experience of pleasure, is a well-established transdiagnostic harbinger and core symptom of mental illness. Given increasing recognition of early life origins of mental illness, we posit that anhedonia should, and could, be recognized earlier if appropriate tools were available. However, reliable diagnostic instruments prior to childhood do not currently exist.

METHODS

We developed an assessment instrument for anhedonia/reward processing in infancy, the Infant Hedonic/Anhedonic Processing Index (HAPI-Infant). Exploratory factor and psychometric analyses were conducted using data from 6- and 12-month-old infants from two cohorts (N = 188, N = 212). Then, associations were assessed between infant anhedonia and adolescent self-report of depressive symptoms.

RESULTS

The HAPI-Infant (47-items), exhibited excellent psychometric properties. Higher anhedonia scores at 6 (r = 0.23, p < .01) and 12 months (r = 0.19, p < .05) predicted elevated adolescent depressive symptoms, and these associations were stronger than for established infant risk indicators such as negative affectivity. Subsequent analyses supported the validity of short (27-item) and very short (12-item) versions of this measure.

LIMITATIONS

The primary limitations of this study are that the HAPI-Infant awaits additional tests of generalizability and of its ability to predict clinical diagnosis of depression.

CONCLUSIONS

The HAPI-Infant is a novel, psychometrically strong diagnostic tool suitable for recognizing anhedonia during the first year of life with strong predictive value for later depressive symptoms. In view of the emerging recognition of increasing prevalence of affective disorders in children and adolescents, the importance of the HAPI-Infant in diagnosing anhedonia is encouraging. Early recognition of anhedonia could target high-risk individuals for intervention and perhaps prevention of mental health disorders.

Comparison of Global and Daily Ratings of Associations between Anxiety and Depressive Behaviors and Impairment in Preschool-Aged Children

Anxiety and depressive difficulties can emerge during early childhood and cause impairment in functioning. Anxiety and depressive behaviors and impairment are typically assessed with global questionnaires that require recall of children's behavior over an extended period which could reduce the accuracy of parent report of children's behavior and functioning. The current study compared parents' report of children's anxiety and depressive behaviors and impairment when evaluated with global measures versus a daily diary measure. Participants (N = 901 parents of 3-5-year-old children) completed global and daily measures of children's behavior and impairment during enrollment to the study. Global measures were completed at baseline and the 14 daily diary measures were completed consecutively for two weeks. Across most measures, daily associations between parent-reported anxiety and depressive behaviors and impairment were stronger compared to associations with global measures. These results suggest that daily measures may better capture links between young children's typical behavior and functioning compared to global measures. In addition, daily assessment might be more effective for measuring mild to moderate yet still impairing behaviors that may be missed on global reports that require longer periods of recall.

Self-Reported Gonadal Pubertal Timing Predicts Adolescent Borderline Personality Symptoms: Two Extended Replications With Prospective and Cross-Sectional Data

The current study investigated the understudied relationship between pubertal timing and borderline personality disorder (BPD) symptoms in males and females. We conducted hierarchical linear regressions in a longitudinal Cohort 1 (N = 117) and a cross-sectional Cohort 2 (N = 127). Cohort 1: Pubertal timing was self-reported at age 10; BPD symptoms and covariates were assessed between ages 13 and 19. Cohort 2: All assessments were between ages 8 and 12. Covariates: race, age, internalizing and externalizing symptoms, and income-to-needs ratio. Sex differences were examined post hoc. In Cohort 1, early gonadal timing was associated with more BPD symptoms in females (beta = .46, p = .002), and late gonadal timing was associated with more BPD symptoms in males (beta = -.23, p = .035). In Cohort 2, early gonadal timing was associated with more BPD symptoms (beta = .21, p = .033) without sex moderation. Results indicate that early gonadal development could be a risk indicator for the emergence of BPD in adolescence, particularly in females, which could inform causal mechanisms and intervention targets.

Developmental pathways from preschool temper tantrums to later psychopathology

Temper tantrums are sudden, overt negative emotional displays that are disproportionate to the eliciting event. Research supports that severe temper tantrums during the preschool period are associated with preschool psychopathology, but few studies have identified which characteristics of preschool tantrums are predictive of distal psychopathological outcomes in later childhood and adolescence. To examine this question, we used a prospective, longitudinal dataset enriched for early psychopathology. Participants (N = 299) included 3-to 6-year-old children (47.8% female) assessed for tantrums and early childhood psychopathology using diagnostic interviews and then continually assessed using diagnostic interviews over 10 subsequent time points throughout childhood and adolescence. We identified two unique groupings of tantrum behaviors: aggression towards others/objects (e.g., hitting others) and aggression towards self (e.g., hitting self). While both types of tantrum behaviors were associated with early childhood psychopathology severity, tantrum behaviors characterized by aggression towards self were more predictive of later psychopathology. Children displaying high levels of both types of tantrum behaviors had more severe externalizing problems during early childhood and more severe depression and oppositional defiant disorder across childhood and adolescence. Findings suggest that tantrum behaviors characterized by aggression towards self are particularly predictive of later psychopathology.

Functional connectivity analysis of childhood depressive symptoms

BACKGROUND

Childhood depression is a highly distinct and prevalent condition with an unknown neurobiological basis. We wish to explore the resting state fMRI data in children for potential associations between neural connectivity and childhood depressive symptoms.

METHODS

A longitudinal birth cohort study with neuroimaging data obtained at 4.5, 6.0 and 7.5 years of age and the Children Depression Inventory 2 (CDI) administered between 8.5 and 10.5 years was used. The CDI score was used as the dependent variable and tested for correlation, both simple Pearson and network based statistic, with the functional connectivity values obtained from the resting state fMRI. Cross-validated permutation testing with a general linear model was used to validate that the identified functional connections were indeed implicated in childhood depression.

RESULTS

Ten functional connections and four brain regions (Somatomotor Area B, Temporoparietal Junction, Orbitofrontal Cortex and Insula) were identified as significantly associated with childhood depressive symptoms for girls at 6.0 and 7.5 years. No significant functional connections were found in girls at 4.5 years or for boys at any timepoint. Network based statistic and permutation testing confirmed these findings.

CONCLUSIONS

This study revealed significant sex-dependent associations of neural connectivity and childhood depressive symptoms. The regions identified are implicated in speech/language, social cognition and information integration and suggest unique pathways to childhood depressive symptoms.

Using A Thin Slice Coding Approach to Assess Preschool Overweight and Obesity

Obesity is a major public health problem and cause of significant burden across the lifespan. Longitudinal samples, beginning in early childhood offer an advantageous approach to studying obesity, given the potential to observe within-individual changes over time. Yet among the many available longitudinal studies of children, particularly those studying psychological disorders, do not assess for overweight/obesity status or related constructs necessary to compute BMI. We offer a unique thin slice approach for assessing obesity/overweight status using previously collected video data. The current study observationally coded overweight/obesity status in a clinically enriched sample of preschoolers oversampled for depression (N=299). Preschoolers (ages 3-6 years) completed 1-8 structured observational tasks with an experimenter. Overweight/obesity was coded using a "thin slice" technique with 7,820 unique ratings available for analysis. Parent-reported physical health problems were assessed throughout the study and BMI percentiles were available from ages 8-19 years. Thin-slice ratings of overweight/obesity were reliably observed in preschoolers' ages 3-6 years. Thin-slice ratings of overweight/obesity during preschool significantly predicted adolescent BMI percentiles at six separate assessments spanning ages 8-19 years. Further, preschool overweight/obese thin-slice ratings were associated with more physical health problems over time and less sport/activity participation during preschool. Overweight/obesity can be observationally identified in preschool-age children and offers a reliable estimate of future BMI percentile. Study findings highlight how previously collected data could be utilized to study the developmental trajectories of overweight/obesity to inform this critical public health problem.

Sad, Sadder, Saddest: Recognition of Sad and Happy Emotional Intensity, Adverse Childhood Experiences and Depressive Symptoms in Preschoolers

Adverse childhood experiences (ACES) have repeatedly been associated with depression. The ability to differentiate emotional intensity is a protective factor for psychopathology and in the context of life stressors, poor negative emotion differentiation (ED) is associated with depressive symptoms. However, little is known about whether the ability to recognize negative emotional intensity, a theorized developmental prerequisite of ED, influences the relationship between ACES and depressive symptoms in early childhood. The current study examined the interactive effects of ACES, the ability to recognize emotional intensity and depressive symptoms in 249 preschoolers enriched for depression. Findings demonstrated that when experiencing ACES, sad (not happy) emotion recognition was associated with elevated depressive symptoms. Specifically, when facing multiple ACEs, preschoolers with poor and moderate ability to recognize sad emotional intensity exhibited elevated depressive symptoms. Findings demonstrate that when experiencing elevated ACES, sad emotion recognition may be a protective factor for depression in early childhood.

Preschool Depression and Hippocampal Volume: The Moderating Role of Family Income

OBJECTIVE

Depression and low socioeconomic status have both been associated with hippocampal volume alterations. Whether these factors interact to predict neurobehavioral outcomes has not been adequately studied. The authors investigated family income as a moderator of the relationship between depression and hippocampal volume in a longitudinal sample.

METHOD

Longitudinal behavioral data, beginning at preschool age, and behavioral and neuroimaging data from school age to adolescence were used to assess the impact of preschool only and total preschool to adolescent depression symptoms on hippocampal volumes using family income as a moderator (N = 176).

RESULTS

Depression severity during the preschool period interacted with family income to predict hippocampal volumes at the intercept (ie, age 13 years; B = -0.078, p = .003). Interaction decomposition revealed that only individuals with relatively high family income exhibited smaller hippocampal volume with increasing depression severity (B = -0.146, p = .005). Family income was associated with hippocampus volumes only in individuals with low to moderate preschool depression severity (B = 0.289, p = .007 and B = 0.169, p = .030, respectively).

CONCLUSION

Preschool depression severity interacts with family income to predict hippocampal volume across development, such that the effects of early depression are evident only in those with higher income. These findings suggest that hippocampal volume may not be an effective marker of risk for depression at different levels of socioeconomic status, and emphasizes the importance of the environmental context when assessing risk markers for depression. Future research should explore how socioeconomic stress may eclipse the effects of depression on hippocampal development, setting alternative neurodevelopmental risk trajectories.

Picky Eating in Childhood: Associations With Obsessive-Compulsive Symptoms

OBJECTIVE

To test whether childhood picky eating (PE)-a behavior previously linked to many forms of psychopathology-is specifically associated with symptoms of obsessive-compulsive disorder (OCD).

METHODS

We investigated the relationship between PE and symptoms of several forms of psychopathology in two separate observational samples: a sample of 110 children (5 and 6 years old) and a sample of 210 children (8 and 9 years old) drawn from a longitudinal study. In each sample, regression models based on psychiatric symptoms or diagnoses were used to assess the specificity of PE associations while accounting for cooccurring symptoms or comorbidities.

RESULTS

Although bivariate associations emerged between PE and multiple forms of psychopathology, multivariate analyses revealed these associations were driven by a strong and specific association between PE and symptoms of OCD in both samples. Moreover, PE among 8- and 9-year-olds in the longitudinal study predicted emergence of additional later psychopathology, specifically attention-deficit/hyperactivity disorder (ADHD).

CONCLUSIONS

Findings suggest that PE, an easily identifiable clinical presentation, is also a specific marker for obsessive-compulsive symptomatology in school-age children and may impart risk for ADHD later in childhood.

Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence

OBJECTIVE

Suicidal thoughts and behaviors (STBs) represent a significant and escalating public health concern in youth. Evidence that STBs can emerge in the preschool years suggests that some pathways leading to clinically significant STBs begin early in life.

METHOD

This prospective longitudinal study examined the developmental trajectories of STBs in children from ages 3 to 17, oversampled for preschool-onset depression.

RESULTS

Three unique trajectories of STBs across childhood and adolescence were identified: low class (n = 273) characterized by low rates of STBs, early-persistent class (n = 21) characterized by steadily increasing STBs, and late-onset class (n = 21) characterized by low rates of STBs through age 10 followed by a dramatic increase from ages 11 to 14 years. Preschool measures of depression symptoms, externalizing symptoms, impulsivity, and lower income relative to needs were associated with both high-risk STB classes. Both high-risk STB classes reported greater functional impairment, more externalizing symptoms, and more cumulative stressful life events in adolescence relative to the low class; the late-onset class also reported poorer academic functioning relative to both the early-persistent and low classes.

CONCLUSION

A significant minority of this prospectively followed group of preschool children evidenced STBs by and/or after age 10. Although relatively rare before age 10, approximately half of the children who experienced STBs in adolescence first exhibited STBs in early childhood and comprised a trajectory suggesting increasing STBs. In contrast, approximately half of children first exhibited STBs in early adolescence. Early screening and identification of at-risk youth during both preschool and late childhood is important for early intervention regarding STBs.

Multi-Omics Characterization of Early- and Adult-Onset Major Depressive Disorder

Age at depressive onset (AAO) corresponds to unique symptomatology and clinical outcomes. Integration of genome-wide association study (GWAS) results with additional “omic” measures to evaluate AAO has not been reported and may reveal novel markers of susceptibility and/or resistance to major depressive disorder (MDD). To address this gap, we integrated genomics with metabolomics using data-driven network analysis to characterize and differentiate MDD based on AAO. This study first performed two GWAS for AAO as a continuous trait in (a) 486 adults from the Pharmacogenomic Research Network-Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS), and (b) 295 adults from the Combining Medications to Enhance Depression Outcomes (CO-MED) study. Variants from top signals were integrated with 153 p180-assayed metabolites to establish multi-omics network characterizations of early (<age 18) and adult-onset depression. The most significant variant (p = 8.77 × 10−8) localized to an intron of SAMD3. In silico functional annotation of top signals (p < 1 × 10−5) demonstrated gene expression enrichment in the brain and during embryonic development. Network analysis identified differential associations between four variants (in/near INTU, FAT1, CNTN6, and TM9SF2) and plasma metabolites (phosphatidylcholines, carnitines, biogenic amines, and amino acids) in early- compared with adult-onset MDD. Multi-omics integration identified differential biosignatures of early- and adult-onset MDD. These biosignatures call for future studies to follow participants from childhood through adulthood and collect repeated -omics and neuroimaging measures to validate and deeply characterize the biomarkers of susceptibility and/or resistance to MDD development.

Origins of Anhedonia in Childhood and Adolescence

Anhedonia reflects a reduced ability to engage in previously pleasurable activities and has been reported in children as young as 3 years of age. It manifests early and is a strong predictor of psychiatric disease onset and progression over the course of development and into adulthood. However, little is known about its mechanistic origins, particularly in childhood and adolescence. In this chapter, we provide a socio-cognitive model of the development of anhedonia. This model is substantiated by past literature presented in this chapter to account for how the individual trajectories of emotion knowledge, autobiographical memory, and self-concept representations contribute to the onset, persistence, and progression of anhedonia from early childhood through adolescence.

Transactions between Maternal and Child Depressive Symptoms Emerge Early in Life

Maternal depression is a robust risk factor for children's internalizing symptoms; however, the intergenerational transmission of mood disorders is likely more complex than unidirectional parent-directed effects. Theoretical models support transactional associations between maternal and child symptomatology over time but have not been well examined, especially in younger high-risk samples. The present investigation examined predictive transactional relations between maternal depression and children's internalizing in toddlerhood and early childhood using a cross-lagged panel model. Participants were 162 low-income, largely racial/ethnic minority mothers and their offspring (32% African American, 16% White, 52% Other/Multiethnic; 53% female) who were assessed when children were 18 months and 4 years old. There were significant cross-sectional relations between maternal depressive and child internalizing symptoms when children were 18 months but not 4 years of age. Cross-lagged associations were evident such that maternal depression symptoms at 18 months were positively associated with internalizing symptoms among children at 4 years, adjusting for prior maternal symptom levels and the cross-sectional correlations between maternal-child symptoms at 18 months. Within the same model, children's internalizing symptoms at 18 months were also positively associated with maternal depressive symptoms at 4 years, adjusting for prior child symptom levels and cross-sectional correlations. This study is among the first to demonstrate that transactional relations between maternal and child mood symptoms occur as early as toddlerhood/early childhood. Findings highlight the potential utility of inclusive, family-focused interventions that support both parents and children in the treatment of early emotional problems.

Preschool sleep and depression interact to predict gray matter volume trajectories across late childhood to adolescence

There is a close relationship between sleep and depression, and certain maladaptive outcomes of sleep problems may only be apparent in individuals with heightened levels of depression. In a sample enriched for preschool depression, we examined how sleep and depression in early childhood interact to predict later trajectories of gray matter volume. Participants (N = 161) were recruited and assessed during preschool (ages 3–6 years) and were later assessed with five waves of structural brain imaging, spanning from late childhood to adolescence. Sleep and depression were assessed using a semi-structured parent interview when the children were preschool-aged, and total gray matter volume was calculated at each scan wave. Although sleep disturbances alone did not predict gray matter volume/trajectories, preschool sleep and depression symptoms interacted to predict later total gray matter volume and the trajectory of decline in total gray matter volume. Sleep disturbances in the form of longer sleep onset latencies, increased irregularity in the child’s sleep schedule, and higher levels of daytime sleepiness in early childhood were all found to interact with early childhood depression severity to predict later trajectories of cortical gray matter volume. Findings provide evidence of the interactive effects of preschool sleep and depression symptoms on later neurodevelopment.

Mechanisms of neuroplasticity linking early adversity to depression: developmental considerations

Early exposure to psychosocial adversity is among the most potent predictors of depression. Because depression commonly emerges prior to adulthood, we must consider the fundamental principles of developmental neuroscience when examining how experiences of childhood adversity, including abuse and neglect, can lead to depression. Considering that both the environment and the brain are highly dynamic across the period spanning gestation through adolescence, the purpose of this review is to discuss and integrate stress-based models of depression that center developmental processes. We offer a general framework for understanding how psychosocial adversity in early life disrupts or calibrates the biobehavioral systems implicated in depression. Specifically, we propose that the sources and nature of the environmental input shaping the brain, and the mechanisms of neuroplasticity involved, change across development. We contend that the effects of adversity largely depend on the developmental stage of the organism. First, we summarize leading neurobiological models that focus on the effects of adversity on risk for mental disorders, including depression. In particular, we highlight models of allostatic load, acceleration maturation, dimensions of adversity, and sensitive or critical periods. Second, we expound on and review evidence for the formulation that distinct mechanisms of neuroplasticity are implicated depending on the timing of adverse experiences, and that inherent within certain windows of development are constraints on the sources and nature of these experiences. Finally, we consider other important facets of adverse experiences (e.g., environmental unpredictability, perceptions of one's experiences) before discussing promising research directions for the future of the field.

No associations in preregistered study of youth depression and functional connectivity of fronto-parietal and default mode networks

Adolescence is characterized by vulnerability to the onset of major depressive disorder (MDD). The goal of this preregistered study was to assess neural correlates of depression symptoms in young adolescents, both cross-sectionally and longitudinally. The default mode network (DMN) is believed to support internal attention towards self-referential thoughts, while the fronto-parietal network (FPN) is theorized to support cognitive control and regulation of attention. As MDD diagnosis has been associated with heightened connectivity within DMN regions and diminished connectivity within FPN regions relative to healthy controls, our study builds upon group-difference analyses by using dimensional measures of depression severity. Our preregistered hypotheses were that within-DMN functional connectivity would be positively associated with concurrent depression severity, while within-FPN functional connectivity would be negatively associated with concurrent depression severity. Preregistered analyses also examined between DMN-FPN connectivity as an alternative predictor variable, and assessed the longitudinal associations between all three functional connectivity measures and change in depression severity over three subsequent waves. Multiple regression models tested cross-sectional analyses and hierarchical linear models tested longitudinal analyses. One hundred and twenty-four youth completed a resting state functional MRI. Their depression severity was assessed at the time of the scan and at three follow-up sessions. None of the predictor variables were associated with concurrent depression severity, nor with the slope of depression symptom trajectories in longitudinal analyses. These negative results add to extant cross-sectional studies, and may inform future investigations of brain correlates of depression psychopathology in youth.

Sleep problems in preschool-onset major depressive disorder: the effect of treatment with parent-child interaction therapy-emotion development

In school-aged children, adolescents, and adults, more than 72% of individuals diagnosed with major depression report co-occurring sleep problems, but little is known about sleep problems in the context of preschool-onset major depressive disorder (PO-MDD). The current study examined the prevalence of various sleep problems in a sample of young children diagnosed with PO-MDD and explored how the treatment of depression, using a modification of parent-child interaction therapy focused on emotional development (PCIT-ED), affects sleep problems. Participants included 229 preschoolers (ages 3-6 years) who met criteria for PO-MDD and participated a single-blind, randomized control trial comparing PCIT-ED to a waitlist control condition. Children were randomly assigned to either PCIT-ED (n = 114) or the waitlist condition (n = 115). Children were assessed at baseline, immediately after PCIT-ED, and 3 months after treatment completion for parent-reported sleep problems across the domains of insomnia, hypersomnia, daytime fatigue, and a total sleep problem index. In our sample, 45% of children had at least one subthreshold sleep problem, 38.4% had at least one threshold sleep problem, and 72.5% had at least one sleep problem (either threshold or subthreshold). Treatment with PCIT-ED significantly reduced sleep problems, including insomnia, daytime fatigue, and total sleep problems, compared to a waitlist condition, even when controlling for child depression. This reduction was maintained at a 3-month follow-up. Sleep problems are a prevalent co-occurring condition with PO-MDD. Interventions such as PCIT-ED that also effectively reduce sleep problems may be particularly beneficial for recovery from PO-MDD.Clinical trial registration information: a randomized control trial of PCIT-ED for preschool depression; https://clinicaltrials.gov/NCT02076425 .

A Brief Early Childhood Screening Tool for Psychopathology Risk in Primary Care: The Moderating Role of Poverty

OBJECTIVES

To evaluate the Preschool Feeling Checklist (PFC) utility for predicting later mental disorders and functioning for children and assess whether the PFC's predictive utility differs as a function of childhood poverty.

STUDY DESIGN

We analyzed data from a prospective longitudinal study of preschoolers in St Louis. Preschoolers (N = 287) were recruited from primary care sites and were assessed annually for 10-15 years. The PFC screened for depressive symptoms. Later age-appropriate psychiatric diagnostic interviews were used to derive Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnoses. Regression and moderation analyses, and multilevel modeling were used to test the association between the PFC and later outcomes, and whether this relationship was moderated by income-to-needs.

RESULTS

The PFC predicted major depressive disorder (OR 1.13, P < .001), attention deficit hyperactivity disorder (OR 1.16, P < .001), and mania (OR 1.18, P < .05) in adolescence and early adulthood. Income-to-needs was a moderator in the predictive pathway between the PFC and later major depressive disorder (OR 1.10, P < .05) and mania (OR 1.19, P < .001) with the measure less predictive for children living in poverty. The PFC predicted worse functioning by the final assessment (b = 1.71, SE = 0.51, P = .001).

CONCLUSIONS

The PFC served as an indicator of risk for later attention deficit hyperactivity disorder and impairment in all children. It has predictive utility for later mood disorders only in children living above the poverty line. Predicting depression in children living below the poverty line may require consideration of risk factors not covered by the PFC.

Digital Phenotype for Childhood Internalizing Disorders: Less Positive Play and Promise for a Brief Assessment Battery

Childhood internalizing disorders, like anxiety and depression, are common, impairing, and difficult to detect. Universal childhood mental health screening has been recommended, but new technologies are needed to provide objective detection. Instrumented mood induction tasks, designed to press children for specific behavioral responses, have emerged as means for detecting childhood internalizing psychopathology. In our previous work, we leveraged machine learning to identify digital phenotypes of childhood internalizing psychopathology from movement and voice data collected during negative valence tasks (pressing for anxiety and fear). In this work, we develop a digital phenotype for childhood internalizing disorders based on wearable inertial sensor data recorded from a Positive Valence task during which a child plays with bubbles. We find that a phenotype derived from features that capture reward responsiveness is able to accurately detect children with underlying internalizing psychopathology (AUC = 0.81). In so doing, we explore the impact of a variety of feature sets computed from wearable sensors deployed to two body locations on phenotype performance across two phases of the task. We further consider this novel digital phenotype in the context of our previous Negative Valence digital phenotypes and find that each task brings unique information to the problem of detecting childhood internalizing psychopathology, capturing different problems and disorder subtypes. Collectively, these results provide preliminary evidence for a mood induction task battery to develop a novel diagnostic for childhood internalizing disorders.

[Evaluation of Short-term Psychoanalytic Child Therapy (PaCT) for Young Children with Depressive Disorders: Results from a Pilot Study]

Depressive disorders in early childhood are associated with high psychosocial impairment and tend to remain stable over time without adequate treatment. Short-term psychoanalytic therapy is a common form of child psychotherapy, yet there is a lack of empirical evaluation of this approach for young children with depressive disorders. Therefore, this secondary evaluation of a study on the treatment of anxiety disorders used an uncontrolled pre-post design in a clinical setting to investigate whether children with depressive comorbidity would evidence significant diagnostic and symptomatic remission after treatment with manualized short-term Psychoanalytic Child Therapy (PaCT). Nineteen children who had an anxiety disorder and a (subclinical) depressive disorder (assessed with the Preschool Age Psychiatric Assessment using DSM-IV criteria) were treated with PaCT. After treatment, 15 of 19 children (78.94 %) were remitted and 15 of 17 children (88.24 %; 2 were lost to follow-up) were free of depressive disorders at the 6-month follow-up. Further analyses revealed significant effects for pre- to post and pre- to follow-up comparisons regarding internalizing symptoms and overall problems using parent- and (nursery-)teacher-ratings. These results suggest that short-term PaCT shows promise as a treatment for childhood depressive disorders.

Thin slice derived personality types predict longitudinal symptom trajectories

Resilient, undercontrolled, and overcontrolled personality types have been identified across the life span and are associated with psychiatric symptoms and functioning. However, it is unknown whether these types are identifiable in preschool-aged children using observational indices or whether they predict longitudinal outcomes. The current study used observationally coded five-factor model (FFM) traits in a sample of preschoolers to identify whether personality traits cluster into types, whether types predict psychiatric symptoms and impairment across development, and whether types better predict outcomes than trait dimensions. Using a validated "thin slice" approach, preschool personality was observationally coded in a clinically enriched sample oversampled for depression (N = 299). Latent class analysis tested how FFM dimensions organized into types, identifying resilient, undercontrolled, and overcontrolled preschoolers. Types demonstrated baseline diagnostic differences and multilevel models indicated above baseline diagnoses, undercontrolled children exhibited elevated externalizing symptoms and worse functioning across development, whereas overcontrolled and resilient children did not differ. Personality types and dimensions both provided similar predictive utility. Resilient, undercontrolled, and overcontrolled personality types are identifiable using FFM observational coding in clinically heterogeneous preschoolers and undercontrolled children demonstrated the most severe trajectories. Findings highlight that personality types are detectable at early ages and have unique predictive power for psychiatric outcomes across development compared with dimensions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Bivariate latent change score analysis of peer relations from early childhood to adolescence: Leading or lagging indicators of psychopathology

Understanding longitudinal associations between problematic peer relations and psychopathology are needed to inform public health. Three models have been proposed: poor peer relations i) lead or are a risk factor for psychopathology; ii) lag or are a consequence of psychopathology; iii) both lead and lag psychopathology. Another model is that poor peer relations lead or lag psychopathology depending upon the developmental period. To test these models, youth's peer relations and clinical symptoms were assessed up to 6 times between ages 3-11 in 306 children. Bivariate latent change score models tested leading/lagging longitudinal relationships between children's peer relations (peer victimization/rejection, peer-directed aggression, social withdrawal, prosocial behavior) and psychopathology (depression, anxiety, and externalizing symptoms). Peer victimization/rejection was a leading indicator of depression from early childhood into preadolescence. Peer-directed aggression was a leading indicator of externalizing symptoms (in late childhood).

Prevalence of depressive symptoms among older children and young adolescents: a longitudinal population-based study

Introduction

This paper investigates levels of depressive symptoms among older children and young adolescents, 11-14 years of age. The population-based sample was assessed twice during a 12-month period. Point-prevalence, 12-month prevalence, and 12-month incidence were measured by a validated self-reported scale (SFMQ) and are presented in this paper.

Methods

A total of 2148 pupils were invited to participate in this study, and 1748 pupils and at least one parent/guardian provided informed consent. The population was assessed twice within one 12-month period resulting in 1439 participants at both data collection points. Depressive symptoms were measured by a validated self-reported scale, The Short Mood and Feelings Questionnaire (SMFQ).

Results

The results indicate that the point-prevalence was just under 10% in 6^th to 10^th grade with a 12-month prevalence at almost 3%. The results also indicate an incidence rate of 4.5% over 12-months. This study confirms that girls report a higher range of point prevalence, 12- month-prevalence, and 12-month incidence compared to boys.

Conclusions

The results indicate that depressive symptoms among children and young adolescents is a serious health challenge. The results demonstrate substantial gender differences even at an early age (11-14 years), where girls report significantly higher point prevalence, 12-month-prevalence, and 12-month incidence compared to boys. Results from this study suggest that depressive symptoms are an important problem that young adolescents face, and the study underlines the need for more intervention tailored to gender at the middle-school level, especially with respect to those children and adolescents who experience persistent depressive symptoms.

Using a Thin Slice Coding Approach to Assess Preschool Personality Dimensions

A large literature assessing personality across the lifespan has used the Big Five as an organizing framework, with evidence that variation along different dimensions predicts aspects of psychopathology. Parent reports indicate that these dimensions emerge as early as preschool, but there is a need for objective, observational measures of personality in young children, as parent report can be confounded by the parents' own personality and psychopathology. The current study observationally coded personality dimensions in a clinically enriched sample of preschoolers. A heterogeneous group of preschoolers oversampled for depression (N = 299) completed 1-8 structured observational tasks with an experimenter. Big Five personality dimensions of extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience were coded using a "thin slice" technique with 7,820 unique ratings available for analysis. Thin slice ratings of personality dimensions were reliably observed in preschoolers ages 3-6 years. Within and across-task, consistency was also evident, with consistency estimates higher than found in adult samples. Divergent validity was limited, with coders distinguishing between three (extraversion/openness; agreeableness/conscientiousness; and neuroticism) rather than five dimensions. Personality dimensions can be observationally identified in preschool-age children and offer reliable estimates that stand across different observational tasks. Study findings highlight the importance of observational approaches to assessing early personality dimensions, as well as the utility of the thin slice approach for meaningful secondary data analysis.

Reliability and Validity of Preschool Feelings Checklist

The Preschool Feelings Checklist (PFC) is a 16-item parent report measure of depressive symptoms in young children. However, data on its reliability and validity are limited. We examined the internal consistency and convergent, discriminant, and predictive validity of the PFC in an unselected community sample of 490 3-year old children. Child psychopathology was assessed using semi-structured diagnostic interviews conducted with a parent at ages 3 and 6 (the Preschool Age Psychiatric Assessment) and with the child and a parent at ages 9, 12, and 15 (the Kiddie Schedule for the Affective Disorders and Schizophrenia, Present and Lifetime Version). The PFC exhibited good internal consistency. It was concurrently associated with depression, as well as a wide range of other psychiatric disorders and functional impairment. Similarly, the PFC at 3 years independently predicted depression and a range of other disorders and global functioning in subsequent assessments later in childhood and in adolescence. Finally, the PFC outperformed the longer Child Behavior Checklist in predicting diagnoses and functioning. Results support the concurrent and predictive validity of the PFC in preschoolers. However, it also exhibited concurrent and predictive associations with a number of other disorders, suggesting that it indexes a broad transdiagnostic liability for psychopathology and impairment.

Neural Indicators of Anhedonia: Predictors and Mechanisms of Treatment Change in a Randomized Clinical Trial in Early Childhood Depression

BACKGROUND

Early childhood depression is associated with anhedonia and reduced event-related potential (ERP) responses to rewarding or pleasant stimuli. Whether these neural measures are indicators of target engagement or treatment outcome is not yet known.

METHODS

We measured ERP responses to win and loss feedback in a guessing task and to pleasant versus neutral pictures in young (4.0-6.9 years of age) depressed children before and after randomization to either 18 weeks of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) or waitlist.

RESULTS

Analyses included reward positivity (RewP) data from 118 children randomly assigned to PCIT-ED (n = 60) or waitlist (n = 58) at baseline and late positive potential (LPP) data from 99 children (44 assigned to PCIT-ED vs. 55 assigned to waitlist) at baseline. Children undergoing PCIT-ED showed a greater reduction in anhedonia (F_1,103 = 10.32, p = .002, partial η² = .09). RewP reward responses increased more (F_1,86 = 5.98, p = .02, partial η² = .07) for PCIT-ED, but a greater change in RewP was not significantly associated with a greater reduction in major depressive disorder symptoms (r = -.12, p > .4). Baseline RewP did not predict treatment change. LPPs to positive pictures did not change across treatment, but greater baseline LPPs to positive pictures predicted a higher likelihood of remission from major depressive disorder in children undergoing PCIT-ED (B = 0.14; SE = 0.07; odds ratio = 1.15; p = .03).

CONCLUSIONS

The ERP reward response improved in young children with depression during a treatment designed to enhance emotion development, providing evidence of target engagement of the neural systems associated with reward. Further, greater baseline LPP responses to positive pictures was associated with a greater likelihood of depression remission, suggesting that this ERP measure can predict which children are most likely to respond to treatment.

Cortical thinning in preschoolers with maladaptive guilt

Maladaptive guilt is a central symptom of preschool-onset depression associated with severe psychopathology in adolescence and adulthood. Although studies have found that maladaptive guilt is associated with structural alterations in the anterior insula (AI) and dorsomedial prefrontal cortex (dmPFC) in middle childhood and adolescence, no study has examined structural neural correlates of maladaptive guilt in preschool, when this symptom first emerges. This study examined a pooled sample of 3-to 6-year-old children (N = 76; 40.8% female) from two studies, both which used the same type of magnetic resonance imaging scanner and conducted diagnostic interviews for depression that included clinician ratings of whether children met criteria for maladaptive guilt. Preschoolers with maladaptive guilt displayed significantly thinner dmPFC than children without this symptom. Neither children's depressive severity nor their vegetative or other emotional symptoms of depression were associated with dmPFC thickness, suggesting that dmPFC thinning is specific to maladaptive guilt. Neither AI gray matter volume or thickness nor dmPFC gray matter volume differed between children with and without maladaptive guilt. This study is the first to identify a structural biomarker for a specific depressive symptom in preschool. Findings may inform neurobiological models of the development of depression and aid in detection of this symptom.

Brain Reward System Dysfunction in Adolescence: Current, Cumulative, and Developmental Periods of Depression

OBJECTIVE

Reward system dysfunction is a well-known correlate and predictor of depression in adults and adolescents, with depressed individuals showing blunted (hyporeactive) striatal response to monetary rewards. Furthermore, studies of remitted depression suggest network-wide hyporeactivity of striatal (caudate, putamen, nucleus accumbens) and cortical (insula, anterior cingulate cortex [ACC]) regions even in the absence of current symptoms. Thus, it remains unclear which patterns of hyporeactivity represent a trait-like indicator of depression and which represent a current depressed state. The authors examined the relationships between regions of a cortico-striatal circuit supporting reward processing and both current depression and cumulative depression history.

METHODS

Using a functional MRI monetary reward task, the authors measured brain response to monetary gains and losses in a longitudinal sample of adolescents (N=131) who had been annually assessed for psychiatric symptoms since ages 3-5 years.

RESULTS

Current depression severity was associated with hyporeactivity exclusively in the nucleus accumbens in response to the anticipation of a reward, while cumulative depression severity was associated with blunted response to anticipation across a cortico-striatal circuit (striatum, ACC, insula). Follow-up analyses investigating the effects of depression on reward processing at different developmental stages revealed a similar pattern: recent depression severity during adolescence was associated with more focal hyporeactivity in the nucleus accumbens, while depression severity during early childhood (i.e., preschool) was associated with more global hyporeactivity across the cortico-striatal circuit.

CONCLUSIONS

The study findings indicate important distinctions between disruptions in reward system neural circuitry associated with a history of depression (particularly early-onset depression) and current depression. These results have implications for understanding the etiology and treatment of reward processing deficits in depression.

Early socioemotional competence, psychopathology, and latent class profiles of reparative prosocial behaviors from preschool through early adolescence

Children who have difficulty using reparative behaviors following transgressions display a wide range of poorer social and emotional outcomes. Despite the importance of reparative skills, no study has charted the developmental trajectory of these behaviors or pinpointed predictors of poorer reparative abilities. To address these gaps in the literature, this study applied growth mixture modeling to parent reports of children's reparative behaviors (N = 230) in a 9-year longitudinal data set spanning from preschool to early adolescence. Three distinct trajectories of reparative behaviors were found: a low-stable, moderate-stable, and high-stable latent class. Poorer emotion understanding, social withdrawal, social rejection, and maladaptive guilt in the preschool period predicted membership in a low-stable reparative trajectory. Externalizing diagnoses, particularly conduct disorder and oppositional defiant disorder, also predicted membership in a low-stable reparative trajectory. Preschool-onset depression predicted membership in a low-stable reparative trajectory through high levels of maladaptive guilt. The findings from this study suggest that socioemotional deficits in the preschool period set children on longstanding trajectories of impaired reparative responding. Thus, emotion understanding, social functioning, maladaptive guilt, and early psychiatric symptoms should be targeted in early preventive interventions.

Emotion Identification in Preschool and Early Adolescent Body Mass Index: Exploring the Roles of Depressive Symptoms and Peer Relations

The ability to identify and label emotions may represent an early-life risk factor that relates to excess weight gain during childhood. The current study investigates the relationships between preschool emotion identification and early adolescent body mass index (BMI), as well as the mediating role of two variables: depressive symptoms and peer relations. In a longitudinal study, preschoolers completed an emotion identification task, and parents completed psychiatric assessments and a peer-relations questionnaire about their child. BMI percentile was measured at later time points in early adolescence. Poor emotion identification during preschool predicted increases in BMI percentile over time, with greater deficits in emotion identification ability relating to steeper increases in BMI percentile across early adolescence. Peer relations in preschool partially mediated the relationship between preschool emotion identification ability and adolescent BMI. This study provides novel information about potential targets for early interventions in the service of obesity prevention.

Le bien-être de l’enfant : évolution d’une notion, ambiguïtés des dimensions et mesures

Cadre de la recherche : Cet article propose une revue de la littérature sur les déterminants et la mesure du bien-être des enfants, et une analyse secondaire de bases de données internationales dans le but de repérer des questions encore relativement inexpliquées.

Objectifs : Il vise à proposer des hypothèses pour expliquer les écarts entre le niveau d’investissement public dans des politiques visant les enfants et leur niveau de bien-être subjectif.

Méthodologie : Cette enquête repose sur une revue de questions et des analyses secondaires de bases de données internationales.

Résultats : L’article met en lumière l’importance de la communication entre parents et adolescents dans le sentiment de bien-être subjectif exprimé par les adolescents.

Conclusions : Des recherches qualitatives et comparatives sont nécessaires pour mieux saisir les mécanismes en cause.

Contribution : Les travaux de la chaire CNAF-EHESP « Enfance, bien-être, parentalité » sur lesquels s’appuient cet article permettent de s’interroger sur l’engouement actuel pour les questions de bien-être et de bonheur des populations afin d’améliorer leur compréhension par les sciences sociales

Prevalence and correlates of maladaptive guilt in middle childhood

BACKGROUND

Maladaptive guilt can develop by age three and is associated with severe affective psychopathology in adolescents and adults. Yet, little is known about its prevalence prior to adolescence, or which children are at greatest risk of developing this symptom. This study examined the prevalence and correlates of maladaptive guilt in middle childhood.

METHODS

This study examined a large community sample of 9-to 10-year-old children (N = 4485) from the Adolescent Brain and Cognitive Development (ABCD) study. Maladaptive guilt was assessed through the Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5. Parental rejection, family conflict, and parental depression were assessed via questionnaires.

RESULTS

In depressed children, a 1-month prevalence of maladaptive guilt of 18.4% and a lifetime prevalence of 30.8% was found. Lifetime rates ranged from 1.8 to 4.1% in children with other psychiatric disorders. Cross-sectionally, maladaptive guilt was associated with lower family income-to-needs, greater family conflict, a history of maternal depression, and greater parental rejection. These findings held when controlling for children's depressive severity, indicating that these associations are specific to maladaptive guilt.

LIMITATIONS

Maladaptive guilt was assessed through one item, though many studies of maladaptive guilt measure the symptom in this manner.

CONCLUSIONS

Findings suggest that it may be beneficial for clinicians to assess for maladaptive guilt beyond the context of assessment for depression, particularly with children of low socioeconomic status and children of depressed mothers, whom this study suggests are at higher risk. Negative family climates and parenting might also be important targets of preventative interventions.

Preschool-Onset Major Depressive Disorder is Characterized by Electrocortical Deficits in Processing Pleasant Emotional Pictures

Reductions in positive affect are a salient feature of preschool-onset major depressive disorder. Yet, little is known about the psychophysiological correlates of this blunted positive affect and whether reduced physiological responding to pleasant stimuli may differentiate depressed and healthy young children. 120 four-to-seven year old children with current depression and 63 psychiatrically healthy 4-to-7 year old children completed a simple picture-viewing task of pleasant and neutral pictures while event-related potentials (ERPs) were recorded. The early-childhood version of the Kiddie Schedule for Affective Disorders and Depression was used to establish psychiatric diagnoses. A one-way ANCOVA was used to test for group differences in response to pleasant and neutral pictures. Young children with depression showed a reduced response to pleasant vs. neutral pictures (LPP), after controlling for children's age (F(1,180) = 4.15, p = 0.04, η2 = 0.02). The LPP for the children with preschool-onset depression (M = 0.99, SE = 0.65) was significantly smaller than the LPP in the healthy group of young children (M = 3.27, SE = 0.90). This difference did not vary as a function of depression or anhedonia severity within the group with depression or the healthy children. Similar to older children and adolescents with depression, young children with depression display reductions in responsivity to pleasant stimuli as indexed by the LPP. These findings extend prior findings indicating a blunted response to pleasant stimuli in preschool- onset depression. Given the greater neuroplasticity of emotional response and regulation, these findings suggest clinical attention to emotional response to pleasure is an important target in preschool-onset depression. Clinical trial registration information: A Randomized Control Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov/;NCT02076425.

Observed Personality in Preschool: Associations with Current and Longitudinal Symptoms

Personality is consistently associated with psychopathology across the lifespan. However, little is known of how observed personality dimensions in preschoolers are associated with concurrent or longitudinal symptoms across development. Spectrum, vulnerability, and pathopolasty models theorize how child personality and psychopathology are related across development. The current study tests these three models using observationally coded personality dimensions in a longitudinal sample of preschoolers. A validated 'thin slice' technique was used to code observed Five Factor Model (FFM) personality dimensions of extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience in a clinically enriched preschool sample oversampled for depression (N = 299). Children were followed longitudinally for 9 years while assessing dimensional psychological symptoms and global functioning. Longitudinal multilevel models testing the spectrum, or shared underlying factor model, indicated depressive symptoms in adolescence were predicted by higher preschool extraversion and lower agreeableness and conscientiousness, externalizing symptoms were predicted by lower agreeableness and higher neuroticism, and worse global functioning was predicted by higher extraversion and neuroticism, and lower agreeableness and conscientiousness. Some associations held after accounting for the influence of baseline psychological symptoms, indicating support for a vulnerability relationship between personality and later psychopathology. No support was demonstrated for pathoplasty models such that personality did not influence the developmental course or change of psychopathology over time. Findings indicate personality dimensions measured as early as the preschool period prospectively impact psychopathology and functioning across child development, demonstrating support for both a spectrum and vulnerability relationship between youth personality and psychopathology.

Preschool Depression: a Diagnostic Reality

PURPOSE OF REVIEW

We review findings related to predictors, correlates, outcomes, and treatment of preschool depression that have been published in the last 3 years.

RECENT FINDINGS

Preschool depression displays a chronic course through late adolescence and is associated with temperamental and personality traits, poorer physical health, and negative parenting practices. Preschool depression predicts deficits into adolescence, including social difficulties and blunted neural response to rewards. Depressed preschoolers can experience suicidal ideation and behaviors and display an accurate understanding of the finality of death. A treatment for preschool depression has now been validated that uses the parent-child relationship to enhance emotion development and reduce depressive symptoms. Preschool depression is homotypic with depression that occurs later in life. Future work elucidating mechanisms through which preschool depression develops and informs the sub-groups for which particular treatments may be most effective will have considerable implications for prevention and early intervention.

Giving Voice to Vulnerable Children: Machine Learning Analysis of Speech Detects Anxiety and Depression in Early Childhood

Childhood anxiety and depression often go undiagnosed. If left untreated these conditions, collectively known as internalizing disorders, are associated with long-term negative outcomes including substance abuse and increased risk for suicide. This paper presents a new approach for identifying young children with internalizing disorders using a 3-min speech task. We show that machine learning analysis of audio data from the task can be used to identify children with an internalizing disorder with 80% accuracy (54% sensitivity, 93% specificity). The speech features most discriminative of internalizing disorder are analyzed in detail, showing that affected children exhibit especially low-pitch voices, with repeatable speech inflections and content, and high-pitched response to surprising stimuli relative to controls. This new tool is shown to outperform clinical thresholds on parent-reported child symptoms, which identify children with an internalizing disorder with lower accuracy (67-77% versus 80%), and similar specificity (85-100% versus 93%), and sensitivity (0-58% versus 54%) in this sample. These results point toward the future use of this approach for screening children for internalizing disorders so that interventions can be deployed when they have the highest chance for long-term success.

Excitability and irritability in preschoolers predicts later psychopathology: The importance of positive and negative emotion dysregulation

Emotion dysregulation is a risk factor for the development of a variety of psychopathologic outcomes. In children, irritability, or dysregulated negative affect, has been the primary focus, as it predicts later negative outcomes even in very young children. However, dysregulation of positive emotion is increasingly recognized as a contributor to psychopathology. Here we used an exploratory factor analysis and defined four factors of emotion dysregulation: irritability, excitability, sadness, and anhedonia, in the preschool-age psychiatric assessment collected in a sample of 302 children ages 3-5 years enriched for early onset depression. The irritability and excitability factor scores defined in preschoolers predicted later diagnosis of mood and externalizing disorders when controlling for other factor scores, social adversity, maternal history of mood disorders, and externalizing diagnoses at baseline. The preschool excitability factor score predicted emotion lability in late childhood and early adolescence when controlling for other factor scores, social adversity, and maternal history. Both excitability and irritability factor scores in preschoolers predicted global functioning into the teen years and early adolescence, respectively. These findings underscore the importance of positive, as well as negative, affect dysregulation as early as the preschool years in predicting later psychopathology, which deserves both further study and clinical consideration.

Hippocampal volume and depression among young children

Clinical depression can occur in young children as early as age three. This very early onset variant of depression shows the same clinical features with developmental adjustments as depression that onsets later in life. One robust neural feature of adult depression is reduced hippocampal volume. We measured hippocampal volume in a sample of 35 children aged 4-7 who were either in a clinical trial for preschool onset depression or were recruited from the community. We used T1 MPRAGE acquisitions on a Siemen's Scanner, with Freesurfer 5.3 used to segment the hippocampus. Depression was measured using the K-SADS early childhood (K-SADS-EC) to create a dimensional depression severity score and the Child Behavior Checklist (CBCL) Depression T-Score. Multilevel models indicated that greater depression severity as measured by either the CBCL Depression Score or the K-SADS-EC was associated with lower hippocampal volume, even controlling for total gray matter, maternal depression, income-to-needs ratio, and stressful life events. These data indicate evidence for reduced hippocampal volume among children with PO-MDD who were more severely depressed. Findings are consistent with the idea that hippocampal volume reductions are an early occurring associated neural marker of MDD, particularly for more severe depression.

Deficient Emotional Self-Regulation in Preschoolers With ADHD: Identification, Comorbidity, and Interpersonal Functioning

OBJECTIVE

This study aims to develop an age-adjusted Child Behavior Checklist- (CBCL) and Teacher Report Form (TRF)-based method for the detection of deficient emotional self-regulation (DESR) in preschoolers with ADHD and to assess its incidence, comorbidities, and consequences on interpersonal functioning.

METHOD

Eighty-six ADHD preschoolers and 104 controls were assessed using CBCL, TRF/1½ to 5, Psychiatric Interview With Preschool Age Psychiatric Assessment, Leiter-R, and ADHD rating scales.

RESULTS

Greatest sensitivity and specificity were obtained applying slightly lower threshold scores compared with school-age children (CBCL: Anxiety/Depression [A/D] ≥ 59, Attention Problems [AP] ≥ 60, Aggression Behaviors [AB] ≥ 58; TRF: A/D ≥ 59, AP ≥ 60, AB ≥ 60). DESR was detected in 33/86 (38.4%) and in 16/54 (29.6%) ADHD preschoolers versus 2/104 (1.9%) controls using CBCL and TRF, respectively. DESR is associated with significantly greater comorbidity and impairment in interpersonal functioning.

CONCLUSION

Among ADHD preschoolers, DESR (a) requires lower CBCL and TRF threshold scores for detection, compared with school-age children, (b) displays similar incidence rates, and (c) is associated with enhanced psychiatric comorbidity and interpersonal difficulties.

Neural Indicators of Anhedonia: Predictors and Mechanisms of Treatment Change in a Randomized Clinical Trial in Early Childhood Depression

BACKGROUND

Early childhood depression is associated with anhedonia and reduced event-related potential (ERP) responses to rewarding or pleasant stimuli. Whether these neural measures are indicators of target engagement or treatment outcome is not yet known.

METHODS

We measured ERP responses to win and loss feedback in a guessing task and to pleasant versus neutral pictures in young (4.0-6.9 years of age) depressed children before and after randomization to either 18 weeks of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) treatment or waitlist (WL) control condition.

RESULTS

Analyses included reward positivity (RewP) data from 118 children randomized to PCIT-ED treatment (n = 60) or WL control condition (n = 58) at baseline and late positive potential (LPP) data from 99 children (44 PCIT-ED treatment vs. 55 WL control condition) at baseline. Children in the PCIT-ED group showed a greater reduction in anhedonia (F1,103 = 10.32, p = .002, partial η2 = .09). RewP reward responses increased more (F1,87 = 5.45, p = .02, partial η2 = .06) for PCIT-ED and a greater change in RewP was associated with a greater reduction in major depressive disorder symptoms (r = -.24, p = .05). Baseline RewP did not predict treatment change. LPPs to positive pictures did not change across treatment, but greater baseline LPPs to positive pictures predicted a higher likelihood of remission from major depressive disorder in the PCIT-ED group (B = 0.14; SE = 0.07; odds ratio = 1.15; p = .03).

CONCLUSIONS

The ERP reward response improved in young children with depression during a treatment designed to enhance emotion development, providing evidence of target engagement of the neural systems associated with reward. Further, greater baseline LPP responses to positive pictures were associated with a greater reduction in depression, suggesting that this ERP measure can predict which children are most likely to respond to treatment.