Beruflich Dokumente
Kultur Dokumente
and Adolescence
Depression in Childhood
and Adolescence
A Guide for Practitioners
Rebecca A. Schwartz-Mette
Hannah R. Lawrence
Douglas W. Nangle
Cynthia A. Erdley
Laura A. Andrews
Melissa S. Jankowski
Abstract
Depression in Childhood and Adolescence: A Guide for Practitioners fills a
gap in the literature by providing practitioners with a go to resource
for understanding, assessing, and treating youth depression. All in one
source, practitioners will find easy-to-follow and clearly worded coverage
of diagnosis, biopsychosocial conceptualization, assessment, and treatment, as well as special topics including gender and developmental differences, suicidality, and the use of antidepressant medication in treatment.
Cutting-edge information is supplemented with illustrative case studies
designed to bring key points to life. This volume is an excellent resource
for practitioners and trainees across a variety of fields including child/
adolescent psychology and psychiatry, developmental psychology, clinical
social work, and school psychology.
Keywords
Depression, Children, Adolescence, Diagnosis, Assessment, Conceptualization, Evidence-Based Treatment, Case Studies
Contents
Acknowledgments....................................................................................ix
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
References..............................................................................................75
Author Biographies................................................................................97
Index....................................................................................................99
Acknowledgments
The authors thank Dr. Samuel Gontkovsky and Momentum Press for their
enthusiasm and energy in developing this important series of practitioner
resources. The authors also acknowledge the researchers, study participants, therapists, and therapy clients that contributed to the development
of their knowledge base regarding child and adolescent depression.
CHAPTER 1
What is Depression?
Prevalence
Course and Chronicity
Symptoms and Diagnosis
Differential Diagnosis
Associated Conditions
What Is Depression?
Depression affects millions of children and adolescents each year (Center for Behavioral Health Statistics and Quality, 2015). A diagnosis of a
depressive disorder represents a distinct set of clinical symptoms involving disturbances of mood, cognitions, and behavior. As will be discussed,
depression leads to functional impairment across multiple domains (e.g.,
school, family, social; Nagar etal. 2010) and confers risk for continued
emotional problems as youth enter adulthood (Pine etal. 1999; Weissman
et al. 1999). As such, understanding how best to conceptualize, assess,
and treat depression in childhood and adolescence is critical to preventing
long-term distress.
Although decades of theory and research have been dedicated to understanding depression in adults, our knowledge about depression in children and adolescents has developed only recently. In fact, until about 25
years ago, many experts did not recognize that youth could experience
depression at all (Weissman and Klerman 1992). Since the realization
that youth could present with mood disorders, a wide body of research
has attempted to clarify the experience of depression in childhood. This
text synthesizes current research for practitioners and provides the nutsand-bolts of diagnosing, conceptualizing, assessing, and treating depression in children and adolescents.
Prevalence
Prevalence rates of clinical depression in children are quite low, at less
than 1 to 2 percent (Birmaher etal. 1996; Costello etal. 2003). However, risk for depression increases sharply at adolescence (Hankin etal.
1998). Prevalence rates during adolescence can vary widely across studies
(Roberts, Attkisson, and Rosenblatt 1998), but generally speaking, 7 to 8
percent of adolescents meet diagnostic criteria for a depressive disorder, a
rate similar to that of depression in adults.
Risk for depression is especially pronounced for adolescent girls.
Although girls are equally likely to experience depression as boys in childhood (Birmaher etal. 1996), by adolescence, the risk for depression increases dramatically for girls but remains stable for boys (Nolen-Hoeksema
2001). The greatest gender discrepancy occurs between ages 15 and 18
years (Hankin et al. 1998) with uneven gender ratios continuing into
adulthood. Many factors contribute to girls increased risk, including
unique biological and social changes (Thapar etal. 2012; see Chapter 2 for
an extended discussion of gender differences).
Despite the sizeable percentage of youth with identifiable depressive disorders, these prevalence estimates underestimate the scope of the
problem. Depression goes underdiagnosed more frequently in youth
than adults (Thapar etal. 2012), and less than 40 percent of youth diagnosed with mood disorders actually receive treatment (Merikangas etal.
2011). Additionally, many more youth do not meet diagnostic criteria
for a depressive disorder, but nevertheless experience considerable distress
and impairment related to subclinical depressive symptoms (Merikangas,
Nakamura, and Kessler 2009). Estimates of the prevalence of subclinical depressive symptoms range from 5 to nearly 30 percent, depending
on the study (Balazs et al. 2013; Wesselhoeft et al. 2013). Youth with
subclinical symptoms are also at increased risk for later development of a
depressive disorder (Thapar etal. 2012).
Differential Diagnosis
Major depression is often difficult to distinguish from other, closely
related conditions and disorders that also feature depressed mood as a
prominent symptom. This section discusses multiple diagnoses that may
also present with accompanying depressed mood in children and adolescents. Prior to discussion of differential diagnosis, however, it is important to acknowledge that periods of sadness in response to even minor
hardships or daily hassles are a normal part of human living and especially
common in adolescence. These periods of sadness should not be characterized as depression unless diagnostic criteria are met.
Intense sadness and other symptoms of depression may follow a loss,
as in bereavement. Grief and depression indeed share many symptoms,
including sadness, disturbed sleep, and change in appetite. Children and
adolescents dealing with grief may also have thoughts of death related to
their desire to be reunited with the person who died (Dowdney 2000).
However, grief and depression are considered distinct constructs. This is
not to say, however, that bereavement cannot precede a major depressive
episode; in fact, loss often does trigger clinical depression (Lloyd 1980).
An individual who experiences depressive symptoms following a loss
could be diagnosed with MDD if and only if his or her symptoms meet
full diagnostic criteria (American Psychiatric Association 2013).
In addition to developmentally normal periods of sadness and
grief following loss, short periods of depressive symptoms may arise in
Finally, depression also can be induced by substance use (substanceinduced mood disorder) and certain medical conditions (mood disorder
due to another medical condition).
Depression or Bipolar?
Clinicians can struggle to differentiate depression from bipolar disorder in youth, as many symptoms associated with these syndromes can
overlap, be a part of normal development, or both.
When considering a diagnosis of bipolar I or II disorder, remember
that youth with bipolar disorders tend to have circumscribed periods
of grandiose, elated, or irritable mood accompanied by (hypo)manic
symptoms such as:
Significantly decreased need for sleep w/o fatigue
Pressured speech
Engagement in risky behavior
and separate periods of depressed mood or anhedonia accompanied by:
feelings of worthlessness/guilt
changes in sleep/appetite
fatigue.
Remember that youth with bipolar disorders also can have mixed
episodes (i.e., periods of both depressive and (hypo)manic symptoms).
For more information, see the Bipolar Disorder Resource Center at
www.aacap.org.
Associated Conditions
Unfortunately, depression in childhood and adolescence places youth
at heightened risk for the development of many associated problematic
conditions (i.e., comorbidity; Costello et al., 2003). Between 40 and
70percent of depressed youth have one comorbid condition and 20to
Index
Academic impairments, 8
ACTION program, 4647, 59, 63
Adjustment disorder, 6
Adolescents, 1, 5, 13, 34, 44, 57
issues in assessing, 3536
depressed, 8, 22, 49, 5152
Affect identification, 4950
Affective, Biological, Cognitive (ABC)
Model of depression, 11,
2223
American Academy of Child and
Adolescent Psychiatry
(AACAP), 55, 57
American Psychological Association
(APA), 55
And approach, 36
Antidepressant treatment, 54, 55
conclusions regarding, 56
Anxiety, 8, 31, 70
Assessment, in depression, 2537
for adolescents, 6970
for children, 6162
diagnostic, 3132
practices, 26
purposes of, 3035
types of, 2630
Associated problems, assessing, 3334
Attention-deficit/hyperactivity
disorder (ADHD), 8
Behavioral activation, 4445, 48
Behavioral conceptualizations, 1214
Best estimate approach, 36
Biological conceptualizations, 1922
Bipolar disorders, 6, 7
Black-box warning, 55
Brain-derived neurotrophic factor
(BDNF), 20
Brain development, 2122
Broad assessment, 33
Bupropion (Wellbutrin), 53
100 INDEX
biological, 1922
for children, 6263
cognitive, 1417
of distress, 57
interpersonal, 1719
Confirmatory bias, 26
Conversational self-focus, 18
Coping skills, 47
adaptive, 4546
training, 64
Coping strategies, 4546
Coping with Depression-Adolescents
(CWD-A), 42, 46, 4748
Core beliefs, 15
Co-rumination, 1819
Current assessment practices, 26
Cyclothymia, 7
Decision analysis, 50
Dehydroepiandrosterone (DHEA), 21
Depression
causes of, 1122
characteristics of, 31
in childhood and adolescence, 34
assessing, issues in, 3536
assessment of, 2537
associated conditions of, 79
case studies of, 5974
conceptualization, 1123
description and diagnosis of, 19
differential diagnosis of, 57
symptoms and diagnosis of, 45
treatment of, 3957
cognitive models of, 14
contagion, 17, 19
course of, 34
description of, 2
evidence-based psychosocial
treatments for, 4252
family history of, 34
versus grief, 5
rating scales, 2930, 31, 32
risk for, 23
unipolar, 7
youth, pharmacological treatment
for, 54
Depressive disorders, 4
criteria for, 3, 36
development of, 39
diagnosis of, 2
persistent, 67
Depressive symptoms, 3, 56, 1417,
19, 30, 32, 33, 35
Depressogenic attributional style, 15
Diagnosis, of depression, 19, 31
for adolescents, 7071
for children, 6263
differential, 57, 26
symptoms and, 45
Diagnostic and Statistical Manual of
Mental Disorders (DSM-5),
4, 26
Diagnostic assessment, 3132
Diagnostic interviews, 2629, 34
Diagnostic Interview Schedule for
Children (DISC-IV), 29,
70, 71
Diagnostic tool, 29
Diathesis-stress models, 14
Disruptive behavior disorder, 8
Distorted thoughts, 15
Dysthymia, 67
Education, affective, 45, 64
Effectiveness studies, 42
Efficacy studies, 42
Emotional self-awareness, 47
Emotion detectives, 47
Empirically supported treatments, 41
Escitalopram (Lexipro), 53
Estrogen, 20
Evidence-based assessment (EBA),
25, 27
Evidence-based psychosocial
treatments, for depression,
4252
Evidence-based psychotherapy, 41
Evidence-based treatments, 41
Fluoxetine (Prozac), 53, 5455
Food and Drug Administration
(FDA), 53, 55
Goal setting, 64
Grief, versus depression, 5
Group therapy
for adolescent, 44
for children, 43
INDEX
101
Parent education/training, 46
Parent training component, 46
Paroxetine (Paxil), 53
Peer relationships, 13
Persistent depressive disorder, 67
Pharmacological treatment, for youth
depression, 54
Placebo effect, 53
Prevalence rates, 23
Probably efficacious CBT
programs, 43
Probably efficacious treatments, 41
Problem area identification, 49
Problem solving skills, 45
Psychoeducation, 43, 44, 49, 51, 72
Psychology, profession of, 26
Psychopathology, 26, 32
Psychosocial treatments, 4252
Psychotherapy, 4142
Psychotropic medication, 5356
Puberty, atypical, 21
Randomized clinical research trials
(RCTs), 40, 53
publication biases of, 56
Rating scales, 2930, 31, 32
Reassurance seeking, excessive,
1718
Recurrence, rates of, 3
Relapse prevention, 57
Relaxation training, 48
Research evidence, 42
Reynolds Adolescent Depression
Scale-2nd edition (RADS-2),
30, 31
Reynolds Child Depression Scale-2nd
edition (RCDS-2), 30, 31
Role playing, treatment components
of IPT, 50
Romantic relationships, 14
Rumination, 1516
School-based assessment, 60
Screening, 3031
Selective serotonin reuptake inhibitors
(SSRIs), 53, 56
Self-control therapy, 43
Self-criticism, 1617
Self-esteem, 16
102 INDEX
Self-reports, 3132
Semistructured interviews, 28,
32, 34
Sertraline (Zoloft), 53
Skill deficits, 44, 48
Social impairments, 89
Social relationships, 14
Social skills, 48
Social stress, 34
Sociotropy, 16
Somatic symptoms, of depression, 5
Stress, 17
chronic, 3334
hormone, 21
role of, 20
social, 34
Stressors, 3334
Structured interviews, 28
Substance-use disorder, 8
Subthreshold depression, 32
Suicidality, 35, 5556
Suicide risk, 3435, 5556
Symptoms
reviewing, 50
severity, 32
Synaptic pruning, 21
Testosterone, 21
Texas Childrens Medication
Algorithm Project, 57
Treatment-as-usual (TAU), 40
Treatment for Adolescents with
Depression Study (TADS),
54, 56
Treatment, of depression, 3957
for adolescents, 7173
for children, 6366
Treatment of Resistant Depression in
Adolescents (TORDIA), 54
Treatment progress and outcomes, 33
for adolescents, 7374
for children, 6667
Tricyclic antidepressants, 53
Unipolar depression, 7
Unstructured interviews, 28
Venlafaxine ER (Effexor XR), 53
Victimization, 13
Well-established CBT programs, 43
Well-established treatments, 41
Well-rounded assessment, 33