Digital CBT to be offered to children as young as five
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Digital CBT to be offered to children as young as five

by Freya Lucas

January 24, 2019

Children as young as five can be offered digital cognitive behaviour therapy (CBT) as a first step in treating mild depression, UK agency the National Institute for Care and Excellence (NICE) has said.


Recent research seem to indicate that depression can begin in children as young as two or three, with a number of child psychiatrists and developmental psychologists supporting the theory.

The New York Times quotes Professor of Child Psychiatry, Joan Luby, as saying the idea of preschool depression is often met with resistance.


“In my 20 years of research, it’s been slowly eroding,” Luby says of that resistance. “But some hard-core scientists still brush the idea off as mushy or psychobabble, and laypeople think the idea is ridiculous.”


Australian website, Raising Children, says it can be hard to tell the difference between sadness and depression in children aged 3-8 years, providing indicators to guide early childhood education and care (ECEC) professionals and parents as to when to seek further assistance:


  • how long has the child has been ‘feeling down’?


  • how negative is the child’s thinking?


  • how interested is the child in daily activities?


  • how big of an effect the thoughts and feelings are having on the child’s everyday life?


NICE noted that digital CBT, which is delivered on mobile phones, tablets or computers, means those wishing to seek assistance can access help quickly, avoiding waiting lists.


Alongside digital CBT, group CBT, group interpersonal psychotherapy and group mindfulness are also recommended as first-line treatments.


NICE says that the choice of treatment should be based on clinical need and patient and carer preferences. The child or young person’s history, circumstances and maturity should also be considered.


Paul Chrisp, director of the Centre for Guidelines at NICE, said: “In this update to our depression in children guideline, we reviewed evidence for the most effective psychological interventions for children and young people with depression. The guideline update emphasises the importance of a child or young person’s personal choice when receiving treatment for depression.


“We want to ensure children are offered a range of therapies to suit their needs and individual preferences are placed at the heart of their care. The evidence showed digital CBT and group therapy were most effective at reducing depressive symptoms and we have recommend these as first-line options for children and young people with mild depression.”


Claire Murdoch, NHS England’s national mental health director said: “Given how quickly technology is constantly evolving and the fact that young people are usually at the forefront of this change, updating this draft guidance is another step forward. Digital and online interventions can play an effective and important role in treatment, particularly when backed up by face to face support, and the NHS Long Term Plan makes clear that the health service will continue to look to harness the benefits these advancements can bring.”


This draft recommendation is made in a fast-tracked update to NICE’s existing guideline on depression in children and young people aged 5 to 18. It follows a recent trial which showed the benefits young people can gain from psychological therapies.


More information about NICE can be found on their website


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