Over in the Sunday New York Times Magazine: "Can Preschoolers Be Depressed?"
Here is a 4-year-old thought to be suffering clinical depression:
When Raghu and Elizabeth reminded a downbeat Kiran of their coming trip to Disney World, Kiran responded: “Mickey lies. Dreams don’t come true.”
Raghu and Elizabeth may want to consider the idea that their 4-year-old is just smart—maybe weird, yes, but obviously ahead of the curve on apprehending reality.
These parents also say that their kid "internalizes" things quickly, feels excess guilt and worry (the building blocks of many a fine adult), and that he's easily frustrated and a perfectionist (ditto). Segue to this:
After toying with a new set of Legos, he told his father, “I can’t do Legos.” He then roundly declared: “I will never do them. I am not a Legos person. You should take them away.”
"I am not a Legos person"? This sounds more like mimicry, like something mom or dad might say. (It is also pretty hilarious.)
This kid aside, some say depression may start as early as age 2 or 3, and:
Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.”
So your solemn, weird, perfectionist little kid might be depressed—all right. But the fact that people are giving preschoolers seratonin reuptake inhibitors and/or other antidepressants is deeply messed up. We don't have enough long-term data on them in adults as it is; the idea of the pharmaceutical industry working backwards from wanting to make more money into finding new drug indications for tiny kids is depraved. But some sort of play therapy would be a good idea, wouldn't it?
Maybe so, maybe not.
I observed one session in which a therapist deliberately invoked feelings of guilt in the same blond 5-year-old who told the puppets “When bad things happen, I do feel bad.” Seated at a table with his mother, he turned to greet a therapist carrying a tray with two teacups, one elaborately painted. She told him that they were to have a tea party, pointing out her favorite teacup and describing the time it took to decorate it. “I’ll let you use my favorite today,” she beamed. As he gingerly took the rigged cup, its handle snapped off. His face darkened. The therapist lamented the break, ostensibly distraught, and excused herself from the room. The boy’s mother, guided via earset by a therapist watching through a two-way mirror, helped her child work through and resolve his feelings.
“Do you feel like you’re a bad boy?” his mother asked. Most parents want to distract their kids from negative emotions rather than let them process the feelings. “They want to wipe it away and move on,” Luby says. In this session, the mother was instead encouraged to draw the child out.
The boy nodded tearfully. “I feel like I’m going to go into the trash can,” he said.
“Who would put you in the trash can?” his mother asked.
“You would,” he replied in an accusatory voice.
“I would never do that,” she said. “I love you. Accidents happen.” The boy seemed to recover, and they chatted about her earrings, which he flicked playfully with a forefinger. Then his face drooped again.
“Are you mad at me?” he asked, and then added, almost angrily, “I never want to do this activity again.”
“You’re not a bad boy,” she consoled him. Often, parents don’t realize that their children experience guilt or shame, Luby says. “In response to transgression, they tend to punish rather than reassure.”
“I am a bad boy,” the boy said, ducking under the table. “I don’t think you love me now.” He started to moan from the floor, whimpering: “I’m so sad. I’m so sad.”
This seems wrong in so many ways. Take the kid to a strange environment—one where he's clearly the center of attention—and set him up to break something, something precious to an authoritative adult figure, who then acts "distraught." Introduce immediately the idea that he's "a bad boy." Draw this idea out a bit, in order to "process." Add belated reassurance and further attention to the whole episode. Mix well, and the kid ends up under the table crying. This is modern psychiatry?
Back to the kid who called Mickey Mouse a liar:
Recently, Elizabeth asked Kiran what the happiest time in his life had been. He told her about the trip they took to Spain when he was 8 months old. Elizabeth asked if he remembered going. “No,” he said. “But I looked really happy in the picture.” She pressed him for another answer, a time that he could actually remember. He thought hard. “I haven’t had my happiest time yet,” he said.