Transcript 4053X1 1999 Oct7

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
Dx of
depression
Depression
Yes
Dx of
Anxiety
R=.75
Anxiety Scores
Yes
No
No
50
10
25
150
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 longterm 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 communitybased 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?