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Child depression is a mood disorder that affects children under the age of 18.

The symptoms of child depression are similar to adult major depressive disorder, with the exception that children may also may exhibit an extended irritable mood rather than sadness or anhedonia.[1] Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Child depression is often comorbid with other mental disorders, most commonly anxiety disorder or conduct disorder. Depression also tends to run in families.[2] Psychologists have developed different treatments to help assist children and adolescents suffering from child depression. Throughout the emergence of this disorder, there have been multiple controversies that have surfaced, such as the legitimacy of the diagnosis, as well as the most effective assessment and treatment.

Base Rates and Prevalence[edit]

About eight percent of children and adolescents suffer from child depression. [3] Data suggests that the prevalence for children suffering from depression in Western culture ranges from 1.9-3.4% in primary school children and from 3.2 to as high as 8.9% in adolescents. [4] Also, studies have reported that among children diagnosed with depression, there is a 70% rate of children experiencing depression again within five years. [4] Furthermore, 50% of children with depression will continue to have recurrences in adulthood. [5] While children show difference in rates of depression between gender before teenage years, after the age fifteen, girls are about twice as likely as boys to be diagnosed with depression. However, in terms of recurrence and symptom severity, there is no gender difference. [6] Currently, this fact is thought to be due to a model that asserts that girls carry more risk factors for depression before early adolescence, on average, than boys. These risk factors lead to depression with the occurrence of challenges that become more prevalent during early adolescence. [7]

Comorbidity[edit]

Research has shown that there is substantial comorbidity with anxiety disorders, conduct disorder, and impaired social functioning. [1] Beyond other clinical disorders, there is also an association between child depression and poor psychosocial and academic outcomes as well as a higher risk for substance abuse and suicide. [1]

Diagnosis and Symptoms[edit]

In order to be diagnosed with depression, according to the DSM-IV, children must exhibit either a depressed mood or a loss of interest or pleasure in normal activities, such as school or extracurricular activities or peer interactions. In terms of a depressed mood, in children it can be expressed as unusually irritable as well, which may be exhibited by “acting out,” behaving recklessly or reacting often with anger or hostility. Children who do not have the cognitive or language development to properly express mood states, can also exhibit their mood through physical complaints, including sad facial expressions and poor eye contact. A child must also exhibit four other symptoms in order to be clinically diagnosed.These symptoms include significant increase or decrease in appetite, daily issues of insomnia or hypersomnia, fatigue, exhibited as dissociation from peers and multiple absences from school, self-depreciation, loss or decrease in attention and concentration or poor school performance, thoughts of suicide or potentially suicidal behavior, and the presence of clinically significant impairment in school or social functioning due to symptoms. [8] These symptoms must also not be accounted for by other disorders or explanations. Symptoms must be present in the child for at least two weeks and there must be a change in functioning prior to the expression of symptoms. The symptoms are sometimes hard to recognize, as children often internalize their feelings and emotions more than adults.

Distinction from Major Depressive Disorder in Adults[edit]

While there are many similarities to adult depression, especially in expression of symptoms, there are many differences that create a distinction between the two diagnoses. Research has shown that when a child’s age is younger at diagnosis, typically there will be a more noticeable difference in expression of symptoms than from the classic signs in adult depression.[9] One major difference in the symptoms exhibited in adults and in children is that children have higher rates of internalization; therefore, symptoms of child depression are more difficult to recognize [10]. One major cause for this difference is that many of the neurobiological effects within the brain that have been shown in adults with depression are not fully developed until adulthood. So, neurologically, children and adolescents express depression differently.

Treatment[edit]

There are multiple treatments that can be effective in treating children diagnosed with depression. However, the family plays a greater role in the child's treatment than it would in an adult's. (Citation, find support). Psychotherapy and medication are two commonly used treatment options. However, adolescents showed a preference for psychotherapy rather than antidepressant medication for treatment.[11] For adolescents, Cognitive Behavioral therapy and interpersonal therapy has been empirically supported as effective treatment options. [1] The use of antidepressant medication in children is often seen as a last resort; however studies have shown that a combination of psychotherapy and medication is the most effective treatment.[12] Pediatric massage therapy may have an immediate impact on a child's emotional state at the time of the massage, but sustained effects on depression have not been identified.[13]

Treatment programs have been developed that help reduce the symptoms of depression. These treatments focus on immediate symptom reduction by concentrating on teaching children skills pertaining to primary and secondary control. While much research is still needed to confirm this treatment program’s efficacy, it has shown to be effective in children with mild or moderate depressive symptoms in a study [14]

Controversies[edit]

Throughout the development and research of this disorder, controversies over the legitimacy of child depression as a diagnosis, the proper measurement and validity of scales to diagnose, and the safety of particular treatments, have surfaced among psychology.

Legitimacy as a Diagnosis[edit]

In the early research of depression in children, there was argument as to whether children could clinically fit the criteria for Major Depressive Disorder. [15]. However, since the 1970s it has been accepted among the psychological community that depression in children can be clinically significant [16] However, the more pertinent controversy in psychology today centers around the clinical significance of subthreshold mood disorders. This controversy stems from the current debate as to what the definition of the specific criteria for a clinically significant depressed mood in relevance to the cognitive and behavioral symptoms. Some psychologists argue whether the effects of mood disorders that exist but do not fully meet the criteria for child depression have severe enough risks if untreated that it is almost dangerous to not include. Children in this area of severity, they argue, should also receive some sort of treatment since the effects could still be severe. [17] However, since there has yet to be enough research or scientific evidence to support that children that fall within the area just shy of a clinical diagnosis, other psychologists are hesitant to support treatment to be dispensed.

Diagnosis Controversy[edit]

In order to diagnose a child with depression, different screening measures and reports have been developed to help clinicians make a proper decision. However, the accuracy and effectiveness of certain measures that help psychologists diagnose children have come into question.

Measurement Reliability[edit]

When reviewing dimensional child self-report checklists, the actual effectiveness of this measure has been criticized. Despite the fact that literature has documented strong psychometric properties, other studies have shown a poor specificity at the top end of scales, resulting in most children scoring high not meeting the diagnostic criteria for depression. [18] . Another issue with reliability of measurement for diagnosis occurs in parent, teacher and child reports. The main controversy is caused by uncertainty about how the data from these multiple informants can or should be combined to determine whether a child can be diagnosed with depression. [19].

References[edit]

  1. ^ a b c d Birmaher, B., Ryan, N.D., Williamson, D.E. Brent, D.A., Kaufman, J., Dahl, R.E., Perel, J. & Nelson, B. (1996). Childhood and adolescent depression: A review of the past 10 years. Part I. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1427-1439.
  2. ^ American Academy of Child & Adolescent Psychiatry. The Depressed Child, “Facts for Families,” No. 4 (5/08)
  3. ^ Eapen, Valsamma. (2012). Strategies and challenges in the management of adolescent depression. Current Opinion in Psychiatry, 25(1), 7-13.
  4. ^ a b Kovacs, M., Feinberg, T.L., Crousenovak, M.A., Paulauskas, S.L., & Finkelstein, R. (1984). Depressive-disorders in childhood. 1. A longitudinal prospective-study of characteristics and recovery. Archives of General Psychiatry, 41(3), 229-237. Cite error: Invalid <ref> tag; name "Kovacs" defined multiple times with different content (see the help page).
  5. ^ Kessler, R.C., Avenevoli, S., & Merikangas, K.R. (2001). Mood disorders in children and adolescents: An epidemiological perspective. Biological Psychiatry, 49(12), 1002-1014.
  6. ^ Hankin, B.L., Abramson, L.Y., Moffitt, T.E., Siilva, P.A., McGee, R. Angell, K.E. (1998) Development of depression from preadolescence to young adulthood: Emerging gender differences in a 10-year longitudinal study. Journal of Abnormal Psychology, 107(1), 128-1140.
  7. ^ Nolen-hoeksema, S. & Girgus, J.S. (1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin, 115(3), 424-443.
  8. ^ American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
  9. ^ Kaufman, J., Martin, A., King, R.A., & Charney, D. (2001). Are child-, adolescent-, and adult-onset depression one and the same disorder? Biological Psychiatry, 49(12), 980-1001.
  10. ^ Zahn-Waxler, C., Klimes-Dougan, B., & Slattery, M.J. (2000). Internalizing problems of childhood and adolescence: Prospects, pitfalls, and progress in understanding the development of anxiety and depression. Development and Psychopathology, 12(3), 443-466.
  11. ^ Bradley, K.L., McGrath, P.J., Brannen, C.L., & Bagnell, A.L. (2010). Adolescents’ attitudes and opinions about depression treatment. Community Mental Health Journal, 46(3), 242-251.
  12. ^ Chakraburtty, Amal. "Depression in Children". WebMD. WebMD, LLC. Retrieved 15 September 2011. 
  13. ^ Jorm AF, Allen NB, O'Donnell CP, Parslow RA, Purcell R, Morgan AJ (2006). "Effectiveness of complementary and self-help treatments for depression in children and adolescents". Med. J. Aust. 185 (7): 368–72. PMID 17014404.  Unknown parameter |month= ignored (help)
  14. ^ Weisz, J.R., Thurber, C.A., Sweeney, L., Proffitt, V.D., & LeGagnoux, G.L. (1997). Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. Journal of Consulting and Clinical Psychology, 65(4), 703-707.
  15. ^ Puig-Antich and Gittleman, 1982 (FINISH CITATION)
  16. ^ same as before
  17. ^ Kessler, Avenevoli, Merikangas (2001)
  18. ^ Kessler, Avenevoli, Merikangas (2001)
  19. ^ see above

Category:Mental health Category:Pediatrics Category:Child and adolescent psychiatry Category:Mood disorders Category:Stub-Class psychiatry articles