Neural Correlates of Reward Processing in Depressed and Healthy Preschool-Age Children

Abstract

Objective Adults and adolescents with major depressive disorder (MDD) show a blunted neural response to rewards. Depression has been validated in children as young as age 3; however, it remains unclear whether blunted response to reward is also a core feature of preschool-onset depression. If so, this would provide further validation for the continuity of the neural correlates of depression across the life span and would identify a potential target for treatment in young children. Method Fifty-three 4–7-year-old children with depression and 25 psychiatrically healthy 4–7-year-old children completed a simple guessing task in which points could be won or lost on each trial while event-related potentials (ERPs) were recorded. Psychiatric diagnosis was established using a preschool version of the Kiddie Schedule for Affective Disorders and Depression. Results Young children with depression showed a reduced differentiation between response to gains and losses, and this finding was driven by a blunted response to reward (i.e., the reward positivity [RewP]). These findings held even when controlling for co-occurring attention-deficit/hyperactivity disorder, oppositional defiant disorder, and generalized anxiety disorder. The RewP did not vary as a function of depression severity within the group with depression. Conclusion Similar to adults and adolescents with depression, preschoolers with depression display reductions in responsivity to rewards as indexed by the RewP. These findings provide further evidence for continuity in the neural mechanisms associated with depression across the lifespan, and point to altered reward sensitivity as an early-emerging potential target for intervention in preschool-onset depression. Clinical trial registration information A Randomized Controlled Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov/; NCT02076425.

Neural reactivity to reward and internalizing symptom dimensions

“…We first sought to replicate the previously demonstrated two-factor model of internalizing psychopathologies (i.e., fear-based anxiety and distress-misery) in a treatment-seeking population utilizing a principal components analysis (PCA) on several well-validated self-report measures of IPs. Consistent with previous studies (e.g., Belden et al, 2016; Bress et al, 2013b, 2015a, 2015b; Foti & Hajcak, 2009; Kessel et al, 2015; Liu et al, 2014), we hypothesized that less differentiation between gains and losses (i.e., the RewP) would be more strongly associated with symptoms of distress and misery, relative to fear-based symptoms of psychopathology. Specifically, we expected that there would be a negative relation between RewP and distress-misery symptoms, whereas there would be no relation between the RewP and fear-based symptoms of anxiety.…”

“…As previously discussed, the RewP has been robustly linked to depressive symptoms and diagnoses among young children and adults (e.g., Bress et al, 2013b, 2015a, 2015b; Belden et al, 2016; Foti & Hajcak, 2009; Liu et al, 2014). In the current sample, depressive symptoms (e.g., BDI, IDAS dysphoria, lassitude) had the highest loading on the distress/misery factor but the factor also included symptoms of worry and trait anxiety.…”

“…For instance, less differentiation between gains and losses (i.e., a reduced RewP) has been shown to be related to concurrent symptoms of depression among youth (Bress et al, 2015b) and adults (Foti & Hajcak, 2009), and also future depressive symptoms and diagnoses among youth in a prospective study (Nelson et al, in press). An attenuated RewP to gains has also been observed in preschoolers (Belden et al, 2016) and adults (Liu et al, 2014) with depression, and shown to prospectively predict future depressive symptoms and diagnoses in children and adolescents (Bress et al, 2013b; 2015a). …”

Depression and Anxiety in Preschoolers

“…Other work has focused on neural reactivity assessed using event-related potentials (ERPs) in preschoolers with depression 82 and using ERP as an indicator of risk for depression 65 . For example, children (n= 84) participating in a larger ongoing randomized controlled trial (RCT) study (PCIT-ED [Parent-Child Interaction Therapy-Emotion Development]) for Preschool Onset Major Depressive Disorder (PO-MDD) completed a guessing game while ERPs were recorded 82 .…”

“…For example, children (n= 84) participating in a larger ongoing randomized controlled trial (RCT) study (PCIT-ED [Parent-Child Interaction Therapy-Emotion Development]) for Preschool Onset Major Depressive Disorder (PO-MDD) completed a guessing game while ERPs were recorded 82 . Of these, n=53 depressed preschoolers (ages 4–7) and n=25 matched, healthy control children had usable data.…”