Transcript Child and Adolescent Psychopathology

Chapter 9:
Depressive Disorders in Children
Winnie W. Chung
Mary A. Fristad
Overview
 Childhood depression can lead to lifelong physical and
mental health concerns
 Major Depressive Disorder (MDD): affects 2.8% of
children under 13 years old
 Children experiencing depressive symptoms or disorders
are at greater risk for:
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Attention and behavioral problems
Disruptions in family functioning
Academic difficulties
Social problems
Suicide
Alcohol or drug abuse
Depression in Childhood
 Longer depressive episode duration and
relapse/recurrence predicted by:
 Greater depression severity
 Conflict with parents
 Comorbid conditions
 Lower socioeconomic status
 Family history of mood disorders
 Negative patterns of cognition
 80–85% of children with MDD experience a comorbid
condition (e.g., anxiety or behavioral disorder)
Evidence-Based Approaches
 All child treatment studies are downward extensions of
adult approaches
 Cognitive behavioral therapy (CBT): well-established
treatment approach
 Child-only group CBT and child group CBT with parent
component are well-established
 Behavior therapy as a theoretical approach is
considered probably efficacious
 Nondirected support, psychoeducational, and family
systems are deemed experimental
Child-Only Group CBT
 Penn Prevention Program: designed to prevent depressive
symptoms, and relates impairment in at-risk children with
elevated depressive symptoms and perception of parental
conflict
 12-week group treatment in school
 Cognitive component and social problem solving
 Decreases in depressive symptoms post intervention; results maintained
at 6-month follow-up; 3 years post treatment effects diminished
 Primary and Secondary Control Enhancement Training
program (PASCET): designed to reduce elementary-aged
children’s elevated depressive symptoms by increasing primary
and secondary coping strategies
 School setting
 Children with mild to moderate depressive symptoms showed
improvement in depressive symptoms, psychosocial functioning, coping,
and the caregiver-child relationship
Group CBT
 Coping with Depression: purpose is to treat
moderate to severe depressive symptoms in 6th to 8thgrade students
 12 sessions, small group
 Self-change skills, pleasant activities scheduling, cognitive
techniques
 Self-Control Therapy: group CBT with parental
involvement
 Stress-Busters Intervention: 10-session after-school
group intervention that includes general skill-building,
depression-specific CBT, creation of a videotape
Parent-Child CBT
 CBT via Videoconferencing (CBT-VC)
 8-week CBT protocol using videoconferencing
 Therapist meets with target child and his/her parent
separately
 Children (8 to 14 years old) in CBT-CV showed
significantly greater rate of decline in symptoms than
children in traditional CBT
Individual Therapy With
Parent Component
 Contextual Emotion-Regulation Therapy
(CERT)
 30-session problem-focused and developmentally
sensitive treatment targeting children’s self-regulation
distress and dysphoria
 Parents serve as “assistant coaches” and improve their
relationship with their child
 Children’s depressive and anxiety symptoms decreased
significantly post treatment
Family-Based Therapy
 Family-Focused Treatment for Childhood Depression
(FFT-CD): treat school-aged children with depressive
disorders in the clinic setting
 Includes family systems and cognitive-behavioral approaches to
interrupt and reverse negative emotional spirals
 9 to 14-year-old children diagnosed with depressive disorder had
significant reduction in depression severity and improvements in
global functioning
 Multi family Psychoeducational Psychotherapy (MF-
PEP): 8-session manualized intervention to use as an
adjunctive treatment for children with unipolar depressive or
bipolar disorders
 RCT with 165 8 to 12-year-olds diagnosed with MDD, DD, or bipolar
spectrum exhibited lower levels of mood severity over a year long
follow-up period compared to TAU
Parenting-Based Treatment
 Parent-Child Interaction Therapy Emotion
Development (PCIT-ED): treat depression in 3 to
7-year-old children
 Parents and children attend sessions: child-directed
interaction and parent-directed interaction
 Improve and strengthen parent-child relationship through
in-vivo coaching
 Emotionally Attuned Parenting: improve parents’
empathy toward children with severe depression
and anxiety disorders
Psychodynamic Approaches
 Systems Integrative Family Therapy:
emphasizes interpersonal relationships, stressful
life events, and problematic attachments using
psychodynamic principles
 Psychodynamic Psychotherapy: identify core
conflictual themes and point out their relations to
target children’s symptoms as well as to their
parents’ representational world
Parental Involvement
 AACAP recommends that families be centrally involved in
the treatment of their child with depression
 Parents serve as gatekeepers for the types and levels of care their
child receives
 They play a vital role in monitoring their child’s progress and acting
as a safety net
 Parental characteristics/behaviors hypothesized to
contribute to children’s depressive symptoms:
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Inconsistent and hostile parenting
Insecure attachment
Inattentiveness to the child’s needs
High maternal criticism
Poor interpersonal skills
Ineffective coping styles
Adaptations and Modifications
 Adaptations made for different cultural backgrounds
 ACTION: for 9 to 13-year-old girls diagnosed with
depressive disorder and their parents; positive results
with an ethnically diverse sample
 PRP: adapted for low-income Latino and African
American 5th- to 8th-grade children; content adapted for
children in low-income communities and urban settings
 Also has been adapted for Chinese children
Measuring Treatment Effects
 K-SADS: semi structured interview that incorporates
information from parents, children, and clinical
judgment to determine pre- and post-treatment
diagnoses based on DSM-IV
 Preschool Age Psychiatric Assessment: parent
interview to determine psychiatric diagnoses in
children ages 2 to 5 years old
 ChiPS: structured interview with child and parent
forms; assesses 20 behavioral, anxiety, mood, and
other syndromes according to DSM-IV
Assessing Symptoms
and Global Functioning
 CDI: self-report measure of children’s depressive
symptoms in the previous 2 weeks
 Mood and Feelings Questionnaire: parent- and
child-report rating scale that assesses symptoms
of depression
 CBCL: parent-, child-, teacher-report checklist
 CDRS-R: semi-structured interview that combines
parent and child input
 CGAS: overall summary score that ranges from 0
to 100. Clinicians rate children’s functioning.
Assessing Targeted Treatment
Outcomes
 CASQ: child-report measure to assess children’s
explanatory styles
 ATQ: self-report measure to assess the frequency
at which children make negative self-statements
and have negative automatic thoughts
 FES: used to assess family functioning on three
dimensions: interpersonal relationship, personal
growth, and system maintenance
Clinical Case Example: Janelle
 9-year-old girl
 Symptoms: dysphoric mood, irritable mood, withdrawn
behavior, fatigue, feelings of worthlessness
 Diagnosis: Depressive Disorder Not Otherwise Specified
(D-NOS)
 Treatment goals:
 1) Reduce the frequency and intensity of Janelle’s depressed and
irritable moods
 2) Improve Janelle’s self-esteem
 3) Equip Janelle with coping skills to manage her moods
 4) Improve Janelle’s social relationships
Clinical Case Example (Cont’d)
 Therapy: 18 sessions over 4 months
 Results: Steady improvements in Janelle’s moods
and behaviors; Janelle no longer exhibited
frequent periods of dysphoric and irritable moods,
seldom made negative self-statements, but rather
began describing positive characteristics of herself
 Became engaged in extracurricular activities