Early intervention changes trajectory for depressed preschoolers

Depression affects 1%-2% of children younger than 13 in the U.S. and can arise as early as age 3, but a specialized therapeutic intervention can help preschool-aged children find relief from this condition — with benefits lasting at least four years, according to a new study led by researchers at Washington University School of Medicine in St. Louis.

The researchers, led by Joan Luby, MD, the Samuel and Mae S. Ludwig Professor of Psychiatry at WashU Medicine, and Mei Elansary, MD, an attending developmental behavioral pediatrician at Boston Medical Center, measured the long-term effects of a dyadic (parent-child), 18-week intervention developed by Luby. They found the treatment to be effective in achieving long-term remission in a majority of children. Luby and Elansary 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 results were published June 27 in the Journal of the American Academy of Child and Adolescent Psychiatry.

“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 WashU Medicine. “From a public health perspective, it’s a really good early investment, and, in terms of return on investment, it’s huge.”

Emotional intervention

Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), which Luby developed and applied in this study, is the first and only psychotherapeutic intervention designed to treat depression in preschoolers that has been rigorously tested in a large-scale trial. PCIT-ED was modified from PCIT, which is a standard intervention for treating children experiencing behavioral difficulties. 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.

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.”

Furthermore, parents of preadolescent children in remission reported less parenting stress in Luby and Elansary’s follow-up study, highlighting the holistic benefits to the family.

Behavioral health for the whole family

The Hermann Center for Child and Family Development, a research center housed within the Children’s Discovery Institute, a collaboration between St. Louis Children’s Hospital and WashU Medicine, provides mental and emotional health support to children and families — including PCIT-ED — with a focus on preventive care to decrease psychiatric needs later in life. For the center’s co-executive directors Luby and Cynthia Rogers, MD, the Blanche F. Ittleson Professor of Psychiatry, the results of Luby’s study validate the founding principle of the center: that early diagnosis and intervention is most effective in achieving the best outcomes.

The Hermann Center blends world-class research with a revolutionary model for whole-family behavioral health care. The Hermann Center, established in 2022 by a $15 million gift from Bob and Signa Hermann, is the first of its kind to adopt a transgenerational approach to reducing the burden of serious behavioral health conditions of childhood, one that engages the whole family and that will track the results of this care for years to come.

With the long-term benefits of PCIT-ED established, Luby said she anticipates that providers nationwide will take advantage of downloadable training materials she has developed and start offering the protocol at their facilities. She also plans to develop additional modules to help people who would benefit from further support, such as extra 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.

This work was supported 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 role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and the decision to submit the manuscript for publication. The funders had no role in the design and conduct of the study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

About Washington University School of Medicine

WashU Medicine is a global leader in academic medicine, including biomedical research, patient care and educational programs with 2,900 faculty. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools and has grown 83% since 2016. Together with institutional investment, WashU Medicine commits well over $1 billion annually to basic and clinical research innovation and training. Its faculty practice is consistently within the top five in the country, with more than 1,900 faculty physicians practicing at 130 locations and who are also the medical staffs of Barnes-Jewish and St. Louis Children’s hospitals of BJC HealthCare. WashU Medicine has a storied history in MD/PhD training, recently dedicated $100 million to scholarships and curriculum renewal for its medical students, and is home to top-notch training programs in every medical subspecialty as well as physical therapy, occupational therapy, and audiology and communications sciences.