The understanding of internalizing disorders in young children has lagged behind advances in our understanding of other areas of psychopathology in this age group. One factor contributing to the relatively slower progress in this domain might be that, as a group, internalizing disorders tend to be viewed as less problematic by parents, teachers, and other caregivers. This may be related to the fact that such disorders are most often characterized by quiet, internal distress sometimes referred to as "intropunitive," rather than overtly, socially negative, or disruptive behavior. Such features may also make these disorders more difficult to detect in the very young who have less well-developed verbal skills in general and specifically an even more limited capacity to describe internal feeling states.Despite these impediments, a major shift, and advance in this area, has been the study of more discrete differentiated disorders instead of lumping of all internalizing symptoms into one broad category of the two-dimensional internalizing versus externalizing taxonomy of childhood psychopathology. This shift in the conceptualization and categorization of psychopathology, although still an area of considerable debate, has allowed systematic investigation of diagnostic nosologic classifications used in older children and adults and has contributed to our understanding of the differentiation between mood and anxiety disorders in early childhood and differences between preschoolers and school-age children. In older children, some investigations have provided data that dispute this distinction, suggesting that some anxiety disorders (eg, generalized anxiety disorder) should be categorized with major depressive disorder (MDD).1 , 2 However, several investigations in young children have supported a meaningful distinction between mood and anxiety disorders in general.3 , 4 The question of whether to lump or split mood and anxiety disorders, and how to split them in early childhood, remains a relatively empirically unexplored area in need of further study.The shift to a categorical and more differentiated view of mood and anxiety disorders in early childhood has also created a gap in our ability to link this newer literature to the large and rich older body of literature on young children that used these broader dimensional measures of psychopathology.5 -7 As in other areas of young child psychopathology, the recent development of age-appropriate measures of psychopathology has catalyzed this area of research, with findings moving beyond the traditional two-dimensional taxonomy as offered by the widely used Child Behavior Checklist (CBCL). In addition to the

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We conducted exit interviews with a random sample of 39 predominantly Central American immigrant mothers who had completed a longitudinal randomized controlled trial to prevent perinatal depression. We found that rates and levels of perinatal depression in the intervention and control groups were lower than expected and did not differ between groups at 1 year postpartum. Therefore, we conducted extensive semistructured interviews to (a) understand why these high-risk women had such low rates of major depressive episodes and depressive symptoms, and (b) determine if the mechanisms responsible for reductions in depression differed between the intervention and usual care groups. We discovered that the intervention group learned specific mood-management skills from their participation in the intervention, and that the control group experienced their participation in the study as a "low-dose" intervention. Our experience highlights the importance of conducting qualitative studies to understand quantitative outcomes of intervention studies.