One hundred and twenty-three children, 2 to 3 years of age, were assessed using two structured, behavioral observation systems: in a psychiatric play interview in the absence of mother, (see ZO1 MH 02170-03), and in interaction with mother (see Z01 MH 02230- 02). Twenty-two mothers had Bipolar Disorder, 45 Major Depressive Disorder, 11 Minor Depressive Disorder, and 45 with no history of psychiatric disorder. All children were assigned a rating (1 to 4) of degree of risk for later development of psychopathology based on their performance in each setting. This produced four groups of children: a low risk group with low risk ratings in both assessments, two mixed-risk groups with ratings of 1 or 2 in one setting, and 3 or 4 in the other, and a high risk group with ratings of 3 or 4 in both assessments. From a case-by-case analysis of the 16 children in the high risk group, three major constellations of behavioral symptoms were discernible: one was seen in a boy from a healthy home who displayed little affect, had a very distant type of relationship with his mother, and would not speak with the psychiatrist in the play session. A second pattern was seen in three girls from relatively poor families in which mother suffered from major depression. This pattern consisted of a distant type of relationship with mother, dysphoria, and anhedonia. The third pattern was seen in the remaining group of twelve children (4 girls and 8 boys). These children came from homes that varied in social class, and diagnostic status of the parents. The behavior consisted of an angry relationship with mother, and predominantly angry mood. The children in all three groups demonstrated dysregulation of emotions under stress, and little or no interest in play.
