Prepubertal depression: diagnostic and therapeutic dilemmas.

Childhood depression is underrecognized. Longitudinal studies have found that depression is a chronic and relapsing disorder in children aged 6 years and older. Now there is evidence that a depressive syndrome can occur in preschool children. Defining depressive syndromes in preschool and elementary-school children has been a challenge. Children should be seen in the context of their social environment (ie, family and peer group) and their larger physical and cultural surroundings. A developmental perspective is important in diagnosing psychopathology in children. Evaluation should include a complete medical assessment to rule out underlying medical causes. A structured clinical interview and rating scales are helpful in determining whether a child or adolescent is depressed. Evidence-based treatment guidelines are limited. The diagnosis of depression in young children remains an active area of debate and study. Clearly more research is needed.