Child Psychopathology Negative Affectivity Depression in children Videotape on Child Depression Reading for today: Chapter 8

Negative Affectivity Definition: The tendency to experience aversive emotional states; best predicted by Trait Anxiety and internalizing behavior problems Evidence: Comorbidity of child anxiety and child depression Anxiety Scores Depression scores Dx of Anxiety Yes No Dx of Depression R=.75

Depression in children Mood disorders underdetected because other problems may be more obvious, e.g., conduct, substance abuse, general malaise of youth Debate over whether it even exists, or whether it pervasively accounts for other disorders How does it differ from adult forms of depression? Is the same neuroendocrinology in place? Importance of family factors Assessment: Observations & self-report measures -- see RADS overhead

Major depressive disorder in children Feelings of sadness, irritability, guilt, shame Restlessness, agitation, reduced activity & speech, withdrawal, aggression Feelings of worthlessness and low self esteem Self-critical and self-conscious; pessimism, distorted views of the future, difficulty concentrating or remembering, self-blame Disruptions in eating or sleeping; physical complaints; diffuse physical symptoms Prevalence: 2 to 8% of children age 4 to 18; more common in late adolescence, females > males

Early onset depression is related to other problems Youth under stress who experience a loss or who have attention, learning, or conduct disorders are at a higher risk for depression. (American Academy of Child & Adolescent Psychiatry [AACAP], 1995) Almost one-third of six- to twelve-year-old children diagnosed with major depression will develop bipolar disorder within a few years. (AACAP, 1995) Four out of every five runaway youths suffer from depression. (U.S. Select Committee on Children, Youth & Families) Clinical depression can contribute to eating disorders. On the other hand, an eating disorder can lead to a state of clinical depression. (Stellefson, Medical University of South Carolina, 1998)

Causes Psychodynamic theory not useful Attachment theory: parental separation and anxious attachment as predisposing factors Behavioral theories: Lack of positive reinforcement or uncontrollable negative events Cognitive theories: Negative perceptual and attributional styles, learned helplessness Self-control theory: Behavior and long-term goals Diathesis-stress models: biological strata and environmental stressors Fitting theories together: Figure 8.3

Treatment for depression Depression Cognitive-Behavior Therapy has shown most short-and long- term success 70% of children with MDD respond to treatment imipramimine (tricyclic) and prozac (SSRI) are used, but there has been a failure to show advantage of antidepressants over placebo in carefully controlled studies What is a double-blind study? Family therapy, Interpersonal Behavior Therapy Bipolar Disorder, marked by manic and depressive stages Lithium is the first treatment of choice High genetic loading of biploar disorder No research on psychosocial interventions with biploar disorder Regarding all depressive disorders, what community- based interventions are useful?

Case of Anne What is her diagnosis? What other diagnoses did you consider, or could be confused Treatment plan If this were your daughter, what would you do?