Depressed preschool children: The role of shame and guilt.

By Nestor Lopez-Duran PhD

Dr. Joan Luby is one of the worlds leading experts in early childhood depression. Her work has shown that children as young as 3 can become clinically depressed. She is not just redefining sadness in young kids and calling it depression. Instead, she has demonstrated that some young children can, and do, experience clinical depression with the same constellation of symptoms and severity as the type of depression observed in adults.

A review of: Luby, J., Belden, A., Sullivan, J., Hayen, R., McCadney, A., Spitznagel, E. (2009). Shame and guilt in preschool depression: evidence for elevations in self-conscious emotions in depression as early as age 3 Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2009.02077.x

Dr. Luby and her colleagues at the Washington University in St. Louis just published an examination of complex self-conscious emotions among young children with clinical depression. Just as once we wrongly believed that children could not experience depression, we also once believed that young children did not have the capacity to experience complex self-conscious emotions, such as guilt, shame, and pride. However, recent research have shown that children in early childhood have a well developed sense of self and readily experience these emotions. Actually, after reading this study I shared the findings with a colleague and she replied Do you mean to tell me that developmentalists once didnt believe 4-year-olds couldnt feel shame and pride? All you have to do is toilet train a kid and you will see both!

The examination of shame and maladaptive guilt in depressed children is highly relevant because theories of depression indicate that these complex emotions play an important role in maintaining depressogenic states. Shame is usually viewed as a maladaptive emotion. Shame refers to a negative focus on aspects of the self in response to a wrongdoing (Im a horrible person for doing that). In contrast, guilt can be adaptive or maladaptive. Guilt refers to a focus on the wrongdoing which, in adaptive guilt, leads to reparation (e.g., I feel bad for what I did and I should apologize).

In order to explore the presence of guilt and shame in depressed kids, the authors examined 75 clinically depressed preschool children, 39 children with anxiety but not depression, 40 children with disruptive problems, and 146 healthy children. The children underwent a series of laboratory games intended to elicit responses of shame or guilt in reaction to specific vignettes. The vignettes consisted of short stories that the children had to complete, such as You are at the grocery store with your mom and you have lost your favorite teddy bear, show me what happens next. The parents of these children also completed a questionnaire that assesses feelings of guilt and guilt reparation.

The results:

Depression was significantly associated with high levels of shame themes expressed by the children during the stories. However, depression was not associated with guilt themes during the stories. This is consistent with the idea that shame is usually a maladaptive emotion associated with depression, while guilt can be adaptive if it is accompanied by reparation. However, the story became a bit more complex after examining the parental reports. As you can see in the graphic below, depressed kids showed high levels of guilt feelings but low levels of guilt reparation. This pattern was the opposite of what was observed in the healthy children. So it is possible that the parent-reported measure was more sensitive to the presence of more maladaptive guilt (high levels of guilt feelings without reparation) than the vignettes.

In sum, the findings suggest that the presentation of depression in early childhood, at least concerning the presence of guilt and shame, appears to be very similar to adult depression. The authors indicated that the examination of shame and guilt should be part of the clinical assessment of depression in young children, and that early intervention strategies should target these complex emotions.

On a final unrelated note, I was intrigued by the pattern of guilt presented by the kids with disruptive behaviors (see graph above). These children had very low levels of guilt and guilt reparation. The lack of guilt, and especially adaptive guilt, by children with disruptive behavior problems is one common predictor of negative outcomes. Children with conduct disorders show a pattern consistent with psychopathy with limited emotional reactions in response to the distress of others. Following on this theme, tomorrow I will review a study examining one possible mechanism by which these troubled kids are unable to respond to the distress of others.