AS A PEDIATRICIAN who has listened to countless stories from distraught parents, I have no doubt that there are children who, even from infancy, are chronically unhappy. In documenting her struggle with depression in a recent New York Times Magazine article, Daphne Merkin wrote, “It is an affliction that often starts young and goes unheeded - younger than would seem possible, as if exiting the womb I was enveloped in a gray and itchy wool blanket instead of a soft, pastel-colored bunting.’’ My concern, however, with the study in the August issue of Archives of General Psychiatry describing preschool depression is that by saddling these young children with a major psychiatric diagnosis, our thinking will stop. Under the pressure of the powerful pharmaceutical industry, a direct line from diagnosis to drug will be the path of least resistance.
My sense is that these children process the world differently. One mother described carrying her screaming son for hours until she realized that he didn’t want to be held. Another mother said her daughter was “not cuddly’’ and difficult to feed. As they become toddlers, the issues change. I hear about what I call “sock bump anxiety,’’ where many changes of socks are required to find the one with the right seam in the toes. “Fun’’ family outings to a county fair can end in disaster as kids become overwhelmed by all of the sights and sounds. Intense tantrums and meltdowns are frequent.
When I talk with parents of these young children, I often discover that Mom, or Cousin John, or some other relative was just like this as a child, and now has a diagnosis of depression or bipolar disorder. They fear their child will have the same fate. Certainly I cannot claim to know what the future holds for these children.
However, I do have ideas about how to help these families in the present, ideas that are informed by contemporary research at the interface of developmental psychology, neuroscience, and behavioral genetics. This research shows that a child’s mind grows and develops when the people who are most important to the child are able to think about the child’s experience without becoming overwhelmed or shutting down. A parent’s capacity to “hold a child in mind’’ can help that child learn to manage difficult emotions and may actually change the way his brain handles stress.
To help parents with this task, which is more difficult than is generally acknowledged, I first validate their experience. One mother was beaten down by the constant comparisons to her sister’s angelic, easygoing child. “You are not a bad parent,’’ I tell them. “Life is really more challenging for you and your child.’’ If one parent suffers from depression, the strain of such a child can be particularly intense, and that parent will need help for him- or herself.
The normal stress that a child places on a marriage is significantly magnified. One mother of a 6-month-old felt a transformation in her relationship with her daughter simply because her husband came to the visit with me. He finally appreciated what she was experiencing at home while he went to work. With his support she had more energy to be fully present with her child.
All of the burden need not be on the parents. As these children get older, certain types of activities can be particularly helpful. These include martial arts, music, swimming, and horseback riding. I guide parents in finding what is right for their child. One boy at the age of 6 discovered a love for the stage. I joked with his parents that he might grow up to be a great actor, if they could just survive his childhood!
It is quite possible that if I were to list these children’s symptoms, or administer a standardized assessment tool, as was done in the recent study, they would meet diagnostic criteria for “major depressive disorder.’’ But such an approach is oversimplified and misses the nuances and complexities of human relationships. I would offer the same help with or without the label. In my opinion, labeling these young children serves only one purpose: to provide a new market for the pharmaceutical industry.
Claudia Meininger Gold, MD, is a pediatrician in Great Barrington. 
