1. Anxiety and Depressive Disorders
Child and Adolescent
Psychopathology

2. Historical Context: Separation anxiety disorder (DSM-III-R)
Overanxious disorder (DSM-III-R)
Avoidant disorder (DSM-III-R)
Only separation anxiety disorder now (DSM-IV)

3. Definition 1) Dysregulation of normal response system
2) Intense, disabling worry that does not help to anticipate true future danger
3) Intense fear reactions in the absence of a true threat

4. Definition: Primary and Secondary features of anxiety
Primary: not specific to any particular diagnosis
Secondary: content features of specific anxiety disorders:
SAD: worry about separation from parents
Social anxiety disorder: interpersonal concerns
Panic disorder: uncued panic attacks

5. Definition
(Cont’d)
5) Expression of anxiety: behavioral, cognitive, physiological, social
6) High degree of comorbidity
Prevalence:
Short-term prevalence: 2-4%
Lifetime prevalence: 10-20%

6. Risk Factors Biological processes:
Behavioral approach system: involved in approach behaviors
Behavioral inhibition system: anxiety to novelty or impending punishment and avoidance

7. Risk Factors
Hypothalamic-pituitary-adrenal axis (HPA) axis: release of cortisol, which regulates behavioral and emotional responding

8. Risk Factors Cortisol secretion protects when exposed to danger
Prolonged exposure is neurotoxic and related to anxiety:
“D” attachment
Maltreated children diagnosed with PTSD

9. Risk Factors Genetic Influences:
1) 33% of variance accounted for by genes:
physiological reactivity
avoidance behaviors
2) Temperamental inhibition: avoidance of novelty, dependence on parents, fearfulness, autonomic hyperarousal

10. Risk Factors Psychophysiology:
1) Anxiety sensitivity: belief that anxiety sensations (e.g. heart beat awareness, increased heart rate, trembling, shortness of breath) have negative social, psychological, or physical consequences
2) Interpretation of arousal symptoms influence experience of anxiety

11. Behavioral Learning Processes
Six Pathways:
1) Classical aversive conditioning (Wolpe & Rachman, 1960)
Exposure to traumatic events
25-55% of maltreated children develop PTSD
Pre-existing trait anxiety or D attachment?

12. Behavioral Learning Processes
2) Vicarious acquisition through observational learning or modelling (Bandura, 1982)
3) Verbal transmission of information
4) Operant conditioning (Mowrer, 1960): withdrawal negatively reinforced by reduction of anxiety

13. Behavioral Learning Processes
5) Stages in cognition: encoding, interpretation, recall
interpretation and memory biases
attentional selectivity: over-allocating intellectual resources toward threat
6) Lack of control over external and
internal threats: affect dysregulation
because events and sensations are
uncontrollable

14. Social and Interpersonal Processes
Attachment theory: anxiety related to insecure relationships to primary caregiver
Separation anxiety disorder related to C attachment
Overcontrolling parental behaviors influence childhood anxiety
prevent children from facing fear-provoking events
conveys message that fear-provoking events are threatening
Short allele for serotonin transporter X low social support  behavioral inhibition

15. Developmental Progression (heterotypic continuity)
Childhood anxiety disorders are correlated with adult anxiety and depressive disorders
Anxiety content related to development
separation or loss of parents (6-9 years old)
mortality, broader concerns (10-13 years old)
social and performance concerns (adolescence)

16. Comorbidity
ADHD: 0-21%
CD and ODD: %
Depression: %

17. Culture
Collectivist societies expect conformity and social inhibition, increasing anxiety
Control of emotions stifles children's understanding and managing of internal states

18. Sex Differences Girls to boys: 2:1 ratio
Higher heritability estimates for girls than boys
Girls more willing to report symptoms
Girls more likely socialized to internalize symptoms

19. Theoretical Synthesis
Dysregulation of anxiety response system
Negative affect and distress/impairment from physiological arousal
Contents of anxiety are developmentally based

20. Depressive Disorders
Depression is characterized by equifinality and multifinality
Controversies in diagnosis of depression:
Continuity: childhood depression does not predict adolescent or adult depression
Discreteness and boundaries
depression is continuous
are thresholds too narrow or two broad?
adolescents have normal negative mood states

21. Subtypes a) Unipolar versus bipolar disorder
b) Psychotic versus not psychotic
c) Course (e.g. age of onset, recurrent or chronic, seasonal)

22. Age-specific manifestations
Younger children might appear sad but do not report their mood
Pre-pubertal children might
lose interest in friends,
not libido
Depression in very young children:
shorter duration requirement
modified DSM-IV criteria

23. Assessment: Prevalence: Low concordance among informants
Self-reports more valid than reports by other informants
Parents' reports more valid for children than adolescents
Prevalence:
Preschool children: 3 to 6 month prevalence = 1-2%
Adolescents: lifetime prevalence = 15-20% (like adults)

24. Sex Differences
Biological changes in hormones (increases in estrogen and testosterone)
Physical changes associated with body dissatisfaction
Adolescent females experience more interpersonal stress than adolescent males
Adolescent females have greater pre- existing vulnerabilities than males
adolescent females have greater affiliative needs than males
adolescent females cope with adversity in passive, ruminative way, while adolescent males cope in active, avoidant way

25. Comorbidity
Comorbidity might represent a different disorder (e.g. MDD and CD) 
Common etiological factors between the two disorders 
Causal influence of one disorder over another (e.g. anxiety in childhood predicts depression in adulthood)

26. Course and Outcome Mean duration of MDD: 7-8 months
Mean duration of DD: 48 months 
Double depression: superimposed episodes of MDD in DD 
40-70% of depressed adolescents experience MDD in adulthood 
Predictive of recurrence: severity, psychotic symptoms, suicidality, DD, subthreshold symptoms, depressotypic cognitive style, recent stressful life events, adverse family environments, family history of MDD

27. Risk Factors Genetics:
a) Genetics plays a greater role in adolescent and adult depression than childhood depression
b) Reuptake of serotonin 
c) Brain-derived neurotrophic factor (BDNF) 

28. Risk Factors
d) Passive gene- environment correlations: genotype and environments are correlated e) Evocative gene- environment correlations: genotype evokes reactions in others f) Active gene-environment correlations: genotype selects environments (niche-picking)

29. Risk Factors
g) Genes interact with environment to increase susceptibility to stress (diathesis- stress hypothesis) 
h) Environment influences expression and regulation of genes (epigenesis) 
Genes  Temperament
( negative emotionality,  positive emotionality  depression)

30. Risk Factors Maladaptive parenting and abuse:
Low parental warmth, high intrusiveness 
Childhood depression:
low emotional support, abuse,
family stress
Adolescent depression: early lack of emotional support

31. Risk Factors
Biological Factors:  a) Neuroendocrinology – dysregulation of HPA axis   cortisol production  b) Sleep architecture – increased REM density  c) Neurotransmitters – dysregulation of serotonin and norepinephrine   d) Structural and functional brain correlates  smaller frontal white matter volume  larger frontal grey matter volume  larger left PFC white matter volume

32. Risk Factors
Cognitive factors:  a) Memory biases for negative information  b) Low self-esteem, self-efficacy, self- perceived competence  c) Are these factors antecedents or sequalae?

33. Risk Factors
Peer Relationships:  a) Peer rejection  b) Social skills deficits  c) Are these factors antecedents or sequalae?

34. Risk Factors
Life Stress: a) Triggers depression in children with pre-existing disposition  b) Depression can produce impaired functioning, which produces stress  c) Negative interpersonal life events are particularly potent risk factors

35. Protective Factors:
Variables that reduce risk in high- risk contexts:  1) Presence shifts high-risk trajectory in a more positive direction  2) Absence has no influence on risk trajectory

36. Fin