IPT for Young Children

Family Based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents is a primary intervention to reduce the burden of early-onset depressive disorders in children between the ages of 8-12 years, with a secondary focus on preventing or delaying depression recurrence in adolescence for this high risk group.    FB-IPT directly addresses two domains of interpersonal impairment associated with preadolescents’ depressive symptoms: parent-child conflict and peer impairment.  FB-IPT focuses on improving communication and problem solving skills in the parent-child relationship, the primary context for children’s social and emotional development to improve the quality of the parent-child relationship and to buffer depressed preadolescents from the effects of peer stress, as well as to rehearse effective interpersonal behavior with peers.

Adapted from IPT-A, FB-IPT includes several developmental modifications for 8-12 year-olds: 1) increased parental involvement and structured dyadic sessions, with individual meetings with parents and parent-child sessions for teaching and role-playing communication and problem solving skills, 2) an expanded Limited Sick Role, to shape parental expectations for depressed preadolescents’ performance across contexts and provide parenting strategies for decreasing conflict, and 3) an increased focus on comorbid social anxiety, to decrease depressed preadolescents’ interpersonal avoidance and to enhance their communication and interpersonal problem solving skills with peers.

As in adult and adolescent protocols, FB-IPT structures treatment around an identified “problem areas” temporally associated with the onset of depressive symptoms (loss, disputes, transitions, and interpersonal deficits) and structures treatment into 3 phases.  Initial Phase (sessions 1-5):  Sessions are divided between individual meetings with the preadolescent and the parent).  In meetings with preadolescents, FB-IPT therapists explore the relationship between depressive symptoms and negative experiences in family and peer relationships, and complete the Closeness Circle/ Interpersonal Inventory.  Parent meetings focus on psychoeducation about depression, helping preadolescents maintain routines with reasonable expectations for their performance, and parenting strategies for responding to increased irritability, interpersonal avoidance, and/ or anergia in preadolescents (“Parenting Tips”). Middle Phase (sessions 6-11):  Sessions are divided between individual meetings with the preadolescent and then with the parent-child dyad.  The primary interventions of FB-IPT include teaching communication and problem solving skills to preadolescents and parents.  During dyadic sessions, preadolescents and parents role-play communication and problem solving skills that are relevant to the identified problem area.  Termination Phase (sessions 12-14):  Sessions are divided between individual meetings with the preadolescent and then with the dyad to review progress and consolidate skills, discuss prevention strategies, and identify a plan for depression recurrence.

FB-IPT has been developed and tested with preadolescents diagnosed with depressive disorders and has demonstrated feasibility and acceptability with patients and their families in both an open treatment and randomized controlled trial (Dietz, Mufson, Irvine, & Brent, 2007; Dietz, Weinberg, Brent, & Mufson, 2015).  In our efficacy trial of 42 depressed preadolescents (Dietz et al., 2015), preadolescents receiving FB-IPT evidenced higher remission rates (60% vs. 30%) and significantly lower depression severity scores posttreatment than did depressed preadolescents receiving supportive therapy.  FB-IPT was also associated with large effect sizes for decreasing parent-child conflict (effect size of Cohen’s f2 = 1.3) and improving peer relationships (effect size of Cohen’s f2 = 0.7) as compared to supportive therapy.  Furthermore, decreases in interpersonal impairment with peers mediated the association between FB-IPT and preadolescents’ post-treatment outcomes (z = 1.92, p = 0.05), providing support for improving peer relationships as a mechanism of action of FB-IPT.

To date, FB-IPT is one of the few psychosocial interventions for depression in preadolescent children that has demonstrated superior outcomes when compared to an active comparison treatment condition.  As such, FB-IPT has promise as an efficacious intervention with readily measurable targets and mechanisms of action.  Future directions include implementation and effectiveness trials in community settings to expedite the dissemination of this promising intervention for depressed preadolescents.