Depression influences 1%-2% of minors under 13 in the U.S. and can manifest as early as age 3. However, a targeted therapeutic approach can assist preschool-aged children in alleviating this issue — with advantages persisting for at least four years, as highlighted in a recent study spearheaded by scholars at Washington University School of Medicine in St. Louis.
The investigation, directed by Joan Luby, MD, the Samuel and Mae S. Ludwig Professor of Psychiatry at WashU Medicine, alongside Mei Elansary, MD, a developmental behavioral pediatrician at Boston Medical Center, evaluated the prolonged impacts of a dyadic (parent-child), 18-week intervention designed by Luby. They discovered the method to be successful in securing long-term remission for a majority of the participants. Both Luby and Elansary further noted that the children who achieved remission exhibited decreased reliance on mental health services and psychiatric medications compared to those who didn’t attain remission post-treatment.
The findings were published on June 27 in the Journal of the American Academy of Child and Adolescent Psychiatry.
“The brilliance of this therapy lies in its brief, parent-child interaction approach that’s facilitated by a master’s level clinician, making it highly accessible and minimal in risk, truly altering the mental health landscape over four years,” asserted Luby, who also leads the Department of Psychiatry’s Early Emotional Development Program at WashU Medicine. “From a public health angle, it represents an excellent early investment, and its return on investment is substantial.”
Emotional Intervention
Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), which Luby conceptualized and employed in this research, is the inaugural and sole psychotherapeutic strategy aimed at addressing depression in preschoolers that has undergone thorough testing in a large-scale trial. PCIT-ED is an adaptation of PCIT, a standard method for managing children facing behavioral issues. In PCIT-ED, therapists mentor caregivers during real-time interactions with their children, aiding in the reinforcement of positive behaviors, nurturing effective parenting skills, and fostering a caring and supportive atmosphere. The emphasis is on enhancing the child’s emotional awareness and articulation, strengthening the parent-child bond, and alleviating early depression symptoms.
Previous research conducted by Luby’s team indicated that children undergoing PCIT-ED had remission rates of 73% following the 18-week intervention, compared to only 23% among children waiting for treatment. Several months post-treatment, the majority of children maintained their remission.
This recent study serves as the initial follow-up investigating the lasting effects of PCIT-ED on children and their families. It involved 105 children who completed the full PCIT-ED course in the earlier trial and were re-evaluated four years after treatment concluded, by which time they were aged 8 to 12 years. To assess depression, the researchers performed diagnostic interviews with the children and their primary caregivers. The interviewers evaluated symptoms of major depressive disorder, including guilt, sadness, aggression, and sleep issues. They also considered other familial factors, such as parenting strategies and whether caregivers experienced depression.
The analysis revealed that 57% of 3- to 7-year-olds with major depressive disorder were in remission four years later, with no additional follow-ups or booster sessions.
“One reason this therapy exhibits such lasting efficacy is that it instructs parents to engage differently with their child emotionally,” Luby stated. “Once treatment concludes, parents continue to interact with enhanced sensitivity, creating a bond with the child. Ultimately, a child craves a validating, nurturing caregiver above all else. That support forms the very foundation of a home.”
The results highlight the significance of early identification and intervention for young individuals facing depression, remarked Elansary, who also serves as an assistant professor of pediatrics at Boston University Chobanian & Avedisian School of Medicine. “Our findings offer encouraging evidence that PCIT-ED can diminish the likelihood of future mental health difficulties into preadolescence,” she noted. “Perhaps most notably, children who achieved remission required considerably less use of psychotropic medications and intensive mental health resources, indicating a more positive long-term outlook.”
Moreover, parents of preadolescent children in remission reported experiencing less parenting stress in Luby and Elansary’s follow-up study, showcasing the comprehensive benefits to the family.
Comprehensive Family Behavioral Health
The Hermann Center for Child and Family Development, a research entity within the Children’s Discovery Institute, a cooperative endeavor between St. Louis Children’s Hospital and WashU Medicine, offers mental and emotional support to children and families — including PCIT-ED — while emphasizing preventive care to reduce future psychiatric necessities. For the center’s co-executive directors Luby and Cynthia Rogers, MD, the Blanche F. Ittleson Professor of Psychiatry, the outcomes from Luby’s study reinforce the center’s foundational belief: early diagnosis and intervention yield the most successful results.
The Hermann Center combines top-tier research with a groundbreaking model for whole-family behavioral health treatment. Established in 2022 through a $15 million donation from Bob and Signa Hermann, it stands as the first of its kind to embrace a transgenerational strategy to alleviate severe childhood behavioral health challenges, engaging the entire family and tracking the results of this support for ongoing years.
With the confirmed long-term benefits of PCIT-ED, Luby expressed her expectation that providers across the nation will utilize downloadable training resources she has created and begin offering the protocol at their facilities. Additionally, she intends to develop supplementary modules to assist individuals who require further support, such as enhanced emotional development for caregivers.
Elansary M, Barch DM, Tillman R, Dandrea CB, Vogel AC, Donohue MR, Hennefield L, Gilbert K, Luby JL. Preadolescent benefits of parent child interaction therapy – emotion development for preschool depression: 4-year follow up. JAACAP. June 27, 2025. DOI: 10.1016/j.jaac.2025.06.01
This research was funded by the National Institute of Mental Health grant nos. 5R01MH117436-05 (to J.L.L. and D.M.B.) and 5R01MH098454-05 (to J.L.L and D.M.B). The funding source had no influence over the study’s design or execution; data collection, management, analysis, and interpretation; manuscript preparation, review, or approval; and the decision to submit the manuscript for publication. The funders did not contribute to the study design. The content reflects solely the authors’ views and does not necessarily represent the official perspective of the NIH.
About Washington University School of Medicine
WashU Medicine is a prominent institution in academic medicine, encompassing biomedical research, patient care, and educational programs featuring 2,900 faculty members. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools, having increased by 83% since 2016. Alongside institutional investment, WashU Medicine allocates over $1 billion annually to innovative basic and clinical research and training. Its faculty practice consistently ranks among the top five nationally, with over 1,900 faculty physicians operating in 130 locations, who also serve as the medical staff for Barnes-Jewish and St. Louis Children’s hospitals under the umbrella of BJC HealthCare. WashU Medicine has a notable legacy in MD/PhD training, having recently designated $100 million for scholarships and curriculum enhancements for its medical students, and boasts exceptional training schemes across all medical subspecialties, as well as physical therapy, occupational therapy, and audiology and communications sciences.
Originally published on the WashU Medicine website
The post Early intervention alters trajectory for depressed preschoolers appeared first on The Source.