What’s New in Psychology

Early Treatment Has Long-Term Results for Children with Depression   

Jim Windell

            Depression in young children, especially preschoolers, can be subtle. Sometimes the signs are mistaken for typical developmental behavior.

           However, there are key signals to watch for – particularly if they persist for more than two weeks. For instance, frequent sadness or appearing unhappy most of the time, excessive worry or fearfulness, irritability or frequent anger outbursts, and such behavior changes as withdrawal from play or social interaction, frequent tantrums or defiance beyond typical age expectations, and aggressive behavior.

           Depression affects one to two percent of children younger than 13 in the U.S. and can arise as early as age three.

           But is there any treatment that is effective with young children?

           As it turns out, there is a highly successful treatment that not only has a high success rate but also provides lasting benefits.

           Called Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), and developed by Joan Luby, M.D., the Samuel and Mae S. Ludwig Professor of Psychiatry at Washington University School of Medicine, it is the first and only psychotherapeutic intervention designed to treat depression in preschoolers that has been rigorously tested in a large-scale trial.

           In PCIT-ED, therapists coach caregivers in real-time interactions with their children, helping them reinforce positive behaviors, develop effective parenting skills and build a supportive and nurturing environment. The focus is on improving the child’s emotional awareness and expression, fostering a secure parent-child relationship and mitigating early symptoms of depression.

           A new study on the effectiveness of PCIT-ED was recently published in the Journal of the American Academy of Child and Adolescent Psychiatry. In the study, researchers, led by Luby and Mei Elansary, M.D., an attending developmental behavioral pediatrician at Boston Medical Center, measured the long-term effects of PCIT-ED.

           Luby and Elansary found the treatment to be effective in achieving long-term remission in a majority of children. They also found that the children in remission had lower rates of mental health service and psychiatric medication use compared to kids who didn’t achieve remission from depression after treatment.

           “The beauty of this therapy is that it’s a short-term, parent-child interaction therapy that’s delivered by a master’s level clinician, so it’s very accessible, very low risk, and it’s literally changing the trajectory of mental health over four years,” said Luby, who also directs the Department of Psychiatry’s Early Emotional Development Program at Washington University School of Medicine. “From a public health perspective, it’s a really good early investment, and, in terms of return on investment, it’s huge.”

           Prior work by Luby’s team has shown children receiving PCIT-ED had remission rates of 73% after the 18-week intervention compared to 23% of children who were on a waiting list for treatment. Several months after treatment, the vast majority of children remained in remission.

           This latest study is the first follow-up examining the long-term effects of PCIT-ED for children and their families. It included 105 children who received a full course of PCIT-ED in the earlier trial and were reassessed four years after the end of treatment, at which point they were 8 to 12 years old. To measure depression, the researchers conducted diagnostic interviews with the children and their primary caregivers. The interviewers assessed symptoms of major depressive disorder, such as guilt, sadness, aggression and sleep problems. They also looked at other family characteristics, such as parenting strategies and whether caregivers had depression.

           They found that 57% of 3- to 7-year-olds with major depressive disorder were in remission four years later, without any follow-up or booster sessions.

           “One of the reasons why this therapy has such enduring efficacy is because it trains the parent to interact differently with the child in the emotional domain,” Luby said. “After the treatment ends, the parent continues to interact with the child with greater sensitivity, and that becomes a draw to the child. The truth is there’s nothing a child wants more than a validating, nurturing caregiver. It’s like the foundation of a house. That’s what it’s all built on.”

           The findings underscore the value of early diagnosis and intervention for young children with depression, said Elansary, who is also an assistant professor of pediatrics at Boston University Chobanian & Avedisian School of Medicine. “Our results offer promising evidence that PCIT-ED can reduce the risk of future mental health challenges into preadolescence,” she noted. “Perhaps most strikingly, children who achieved remission required significantly less use of psychotropic medications and intensive mental health services, suggesting a more favorable long-term trajectory.”

           To read the original article, find it with this reference:

Elansary, M., Barch, D. M., Tillman, R., Dandrea, C. B., Vogel, A. C., Donohue, M. R., ... & Luby, J. L. (2025). Preadolescent Benefits of Parent-Child Interaction Therapy Emotion Development for Preschool Depression: 4 Year Follow Up. Journal of the American Academy of Child & Adolescent Psychiatry.