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1. The absence of joy and interest in activities that were previously enjoyable is called ____.
a. dysphoria
b. dysthymia
c. anhedonia
d. depression
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Overview of Mood Disorders
KEYWORDS: Bloom’s: Understand
2. ____ is one of the most common symptoms of depression in children, occurring in about 80% of clinic-referred
youngsters with depression.
a. Irritability
b. Anger
c. Grandiosity
d. Inattention
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Overview of Mood Disorders
KEYWORDS: Bloom’s: Understand
3. The earlier and mistaken belief that children could not suffer from depression was rooted in ____.
a. biological findings
b. psychoanalytic theory
c. behavioral theory
d. cognitive theory
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Understand
4. The earlier concept of “masked” depression was that ____.
a. children wear a characteristic “mask” of depression, including downcast eyes and downturned mouth
b. depression is difficult to diagnose in children because they “mask” their feelings with a happy face
c. children purposely conceal or “mask” their depression so as to avoid treatment
d. depression could be “masked” or concealed by a variety of other behaviors, and thus, any clinical symptom
could be evidence of underlying depression
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Understand
5. Children who experience depression ____.
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a. rarely attempt suicide
b. rarely relapse
c. typically make a full recovery on their own
d. are at risk for future depressive episodes
ANSWER:
d
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
6. The increase in depression in young people has been attributed, at least in part, to:
a. poorer childhood nutrition leading to disrupted neurological development
b. media influences leading children to feel hopeless about the future
c. rapid social change leading to increased stress levels for young people
d. increased awareness of symptoms of depression in youth leading to an increase in the number of children seen
in clinics for diagnoses
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Understand
7. Anaclitic depression was the term used by Renee Spitz in the 1940s to describe the pattern of behavior he saw in ____.
a. emotionally deprived infants
b. abused toddlers
c. pregnant adolescents
d. bereaved children
ANSWER:
a
DIFFICULTY: Moderate
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Understand
8. Young people suffering from severe depression often exhibit symptoms on a spectrum that include ____ in levels of
severity.
a. co-morbid behavior problems
b. sleep difficulties
c. suicidal ideation
d. suicidal ideation
ANSWER:
d
DIFFICULTY: Moderate
REFERENCES: Overview of Mood Disorders
KEYWORDS: Bloom’s: Understand
9. A ____ refers to a group of symptoms that occur together more often than by chance.
a. disorder
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b. cluster
c. syndrome
d. condition
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Understand
10. The lifetime prevalence rate of depression in adolescents is as high as ____.
a. 5%
b. 7%
c. 20%
d. 40%
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Understand
11. Which of the following occurs more frequently in younger than older individuals?
a. depressed appearance
b. irritability
c. somatic complaints
d. phobias
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Overview of Mood Disorders
KEYWORDS: Bloom’s: Understand
12. Children with major depressive disorder are at greater risk than adults for developing ____.
a. bipolar disorder
b. somatoform disorder
c. schizophrenia
d. panic disorder
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
13. Prevalence estimates for major depressive disorder in all children ages 4 to 18 range from ____.
a. 0.3% to 1%
b. 2% to 8%
c. 10% to 15%
d. 20% to 25%
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ANSWER:
DIFFICULTY:
REFERENCES:
KEYWORDS:
b
Easy
Major Depressive Disorder (MDD)
Bloom’s: Understand
14. The increase in depression from preschool to elementary school is not likely to be a reflection of ____.
a. biological maturation
b. growing self-awareness
c. growing cognitive capacity
d. increased performance and social pressures
ANSWER:
a
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
15. The increase in depression from childhood to adolescence appears to be largely a result of ____.
a. biological maturation
b. increased cognitive capacity
c. growing self-awareness
d. substance use
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
16. The most frequent co-occurring disorder(s) in clinic-referred youngsters with major depressive disorder is/are ____.
a. conduct disorders
b. ADHD
c. anxiety disorders
d. somatoform disorders
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
17. Which of the following is least likely to co-occur with major depressive disorder in young people?
a. conduct problems
b. ADHD
c. autism
d. substance abuse
ANSWER:
c
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder (MDD)
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KEYWORDS:
Bloom’s: Understand
18. Major depressive disorder in children is more likely to occur after the onset of all other psychiatric disorders, except
for ____.
a. bipolar disorder
b. separation anxiety disorder
c. ADHD
d. substance abuse
ANSWER:
d
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
19. Prospective studies of children and adolescents have found that the age of onset for the first depressive episode is
usually ____ years.
a. 7 to 10
b. 10 to 12
c. 13 to 15
d. 16 to 18
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
20. Depression in children is characterized by ____.
a. helplessness
b. apathy
c. contentment
d. mania
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Overview of Mood Disorders
KEYWORDS: Bloom’s: Understand
21. A history of depression during the school years increases the risk for later ____.
a. resilience
b. suicidal behavior
c. underemployment
d. aggressive behavior
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Understand
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22. Youngsters who have an onset of depression prior to age 15 and a recurrent episode prior to age 20 are likely to ____.
a. have mild depression as a younger teen
b. recover from their depressive episode faster in adulthood
c. have mild depression as a teen, but chronic depression as an adult
d. have severe depression as a teen and poor psychosocial outcomes as a young adult
ANSWER:
d
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
23. Which of the following is true regarding gender differences in the prevalence of depression among males and females?
a. Throughout the lifespan, females are more likely to suffer from depression than males.
b. Depression is equally common among preadolescent boys and girls, but after about age 13 the rate is higher
for females.
c. Depression is equally common among boys and girls in childhood and adolescence, but after about age 18 the
rate is higher for females.
d. Females are more likely to suffer from depression at all ages, but only when there is a co-morbid anxiety
disorder.
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
24. The increased risk for depression among adolescent girls compared to boys has been attributed to ____.
a. changes in brain structure
b. gender identity issues
c. their tendency to use ruminative coping styles to deal with stress
d. less willingness to cooperate
ANSWER:
d
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
25. Adolescent girls may be at higher risk for depression if they have a history of ____.
a. interpersonal stress and lack of social support
b. under average height
c. lower levels of testosterone and estrogen at puberty
d. longer friendships with others who are depressed
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
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26. A recent study found that in transition from adolescence to young adulthood depressive symptoms were highest for
which ethnic/racial groups?
a. Hispanic and Asian
b. Caucasian and African American
c. Hispanic and African American
d. Caucasian and Asian
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Major Depressive Disorder (MDD)
KEYWORDS: Bloom’s: Understand
27. Successful treatment rates of dysthymic disorder are ____.
a. lower than those of major depressive disorder
b. greater than those of major depressive disorder
c. equal to those of major depressive disorder
d. lower than those of major depressive disorder in adolescence, but not in childhood
ANSWER:
a
DIFFICULTY: Moderate
REFERENCES: Persistent Depressive Disorder
KEYWORDS: Bloom’s: Understand
28. The most prevalent co-occurring disorder/s with dysthymic disorder is/are ____.
a. anxiety disorders
b. ADHD
c. conduct disorders
d. major depressive disorder
ANSWER:
d
DIFFICULTY: Moderate
REFERENCES: Persistent Depressive Disorder
KEYWORDS: Bloom’s: Understand
29. Someone who focuses narrowly on negative events for long periods of time has a:
a. negative attitude
b. depressive manner
c. negative focus
d. depressive ruminative style
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Persistent Depressive Disorder
KEYWORDS: Bloom’s: Understand
30. The symptom most specifically related to depression in adolescents is ____.
a. low self-esteem
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b. sleeplessness
c. substance abuse
d. suicidal ideation
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Associated Characteristics of Depressive Disorders
KEYWORDS: Bloom’s: Understand
31. Which symptom interferes with normal youth development of interpersonal relationships?
a. sleeplessness
b. agitation
c. social withdrawal
d. somatic complaints
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Associated Characteristics of Depressive Disorders
KEYWORDS: Bloom’s: Understand
32. Which of the following statements about suicide is true?
a. Suicidal attempts are only specific to depression.
b. Overdose and wrist-cutting are the most common means for adolescents who successfully complete suicide.
c. Most youngsters with depression report suicidal thinking.
d. Suicide attempts of youngsters with depression almost never occur during times when they are symptom-free.
ANSWER:
b
DIFFICULTY: Moderate
REFERENCES: Associated Characteristics of Depressive Disorders
KEYWORDS: Bloom’s: Understand
33. The most common suicide method/s in suicide attempts is/are ____.
a. firearms
b. overdose and wrist-cutting
c. hanging or suffocating
d. household poison
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Associated Characteristics of Depressive Disorders
KEYWORDS: Bloom’s: Understand
34. The fact that depression occurs in many youngsters who do not experience loss or rejection, and does not occur in
many children who do, is support against which theory of depression?
a. psychodynamic
b. cognitive
c. behavioral
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d. attachment
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
35. The ____ theory of depression focuses on parental separation and disruption of a bond as predisposing factors for
depression.
a. psychodynamic
b. behavioral
c. cognitive
d. attachment
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
36. Which theory of depression claims that depression is related to a lack of response-contingent positive reinforcement?
a. psychodynamic
b. behavioral
c. cognitive
d. attachment
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
37. Depression prone individuals tend to make ______ attributions for the causes of negative events.
a. external, unstable, and global
b. external, stable, and specific
c. internal, stable, and global
d. internal, unstable, and specific
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
38. ____ are the negative perceptual and attributional styles and beliefs associated with depressive symptoms.
a. Depressed thoughts
b. Cognitive delusions
c. Depressogenic cognitions
d. Destructive cognitions
ANSWER:
c
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DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
39. Information-processing biases displayed by depressed individuals ____.
a. are errors in thinking in specific situations
b. are negative effortful thoughts
c. often include thoughts of past accomplishments
d. are based on poor faulty memory systems
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
40. The “cognitive triad” refers to ____.
a. the three parts of the brain that process information
b. attending to, processing, and interpreting information
c. the three cognitive theorists who have advanced our understanding of depression
d. a depressed individual’s negative outlook about one’s self, the world, and the future
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
41. ____ view youngsters with depression as having difficulty organizing their behavior in relation to long-term goals.
a. Interpersonal models
b. Self-control theories
c. Socioenvironmental models
d. Neurobiological models
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
42. The single best predictor of a child’s risk for Major Depressive Disorder is ____.
a. drug use
b. family history of depression
c. psychosocial problems
d. academic problems
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Understand
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43. Children of depressed parents have a higher rate of ____.
a. conflict with siblings
b. eating disorders
c. physical injuries
d. sexual abuse
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Understand
44. The diathesis-stress model of depression explains the onset of the disorder as ____.
a. linked directly to the occurrence of stressful life events
b. dependent upon the interaction between personal vulnerability and life stress
c. resulting from stressors caused by impaired functioning
d. biologically based
ANSWER:
b
DIFFICULTY: Moderate
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
45. What is not a typical characteristic of families of children with depression?
a. less warmth
b. less support
c. poor communication
d. underinvolvement
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Understand
46. In comparison to nondepressed children, those with depression experience ____ in the year preceding their depression.
a. fewer friendship changes
b. fewer daily hassles
c. more severe stressful events and more daily hassles
d. more resilience
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Understand
47. The most successful treatment/s for major depressive disorder is/are ____.
a. nondirective supportive therapy
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b. family therapy
c. psychoanalytic therapy
d. CBT and IPT-A
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Treatment of Depression
KEYWORDS: Bloom’s: Understand
48. The most efficacious preventative intervention for children at risk for depression is ____.
a. low doses of fluoxetine (Prozac)
b. residential placement
c. cognitive-behavioral therapy
d. electroconvulsive therapy
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
49. The only SSRI that is currently FDA approved for the treatment of depression in children is ____.
a. paroxetine (Paxil)
b. fluoxetine (Prozac)
c. sertraline (Zoloft)
d. none are approved
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
50. Due to recent findings of possible increased risk of suicide and self-harm of young people using SSRIs to treat
depression, the FDA has mandated ____.
a. parents be well-informed and monitor their children closely
b. warning labels on medication and patient education guides
c. that children and adolescents should not be prescribed SSRIs
d. that SSRIs be prescribed in combination with psychotherapy
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Theories of Depression
KEYWORDS: Bloom’s: Understand
51. Which of the following regarding bipolar disorder in young people is false?
a. Manic episodes in their fully developed state are clearly different usual behavior.
b. Girls are more commonly diagnosed with bipolar disorder than boys.
c. Bipolar disorder is extremely rare in young children.
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d. Rates of bipolar disorder are higher in clinical samples.
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
52. Regarding bipolar disorder, boys display ____.
a. more depressed mood than girls
b. later onset than girls
c. more severity than girls
d. more manic behaviors than girls
ANSWER:
d
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
53. Children (and adults) who experience a clinical course of one or more major depressive episodes accompanied by at
least one hypomanic episode are diagnosed with ____.
a. bipolar I disorder
b. bipolar II disorder
c. double depression
d. cyclothymic disorder
ANSWER:
b
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
54. Which diagnosis is a child least likely to receive?
a. major depressive disorder
b. bipolar I disorder
c. bipolar II disorder
d. cyclothymic disorder
ANSWER:
b
DIFFICULTY: Moderate
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
55. Which statement regarding the prevalence of bipolar disorder is false?
a. Bipolar disorder is less common than major depressive disorder in young people.
b. Bipolar disorder is extremely rare prior to puberty.
c. The prevalence of bipolar disorder during adolescence is at least as high as it is for adults.
d. Children often experience hypomanic episodes that meet duration requirements of DSM-5.
ANSWER:
d
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DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
56. Which disorder is least likely to co-occur with bipolar disorder in young people?
a. mental retardation
b. ADHD
c. anxiety disorders
d. substance abuse
ANSWER:
a
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
57. Bipolar disorder appears to be the result of ____.
a. genetic vulnerability
b. environmental factors
c. genetic vulnerability in combination with environmental factors
d. untreated major depressive disorder
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
58. Brain imaging studies in adolescents with bipolar disorder point to abnormalities in parts of the brain that ____.
a. regulate emotion
b. plan executive functions
c. control memory
d. regulate sleep patterns
ANSWER:
a
DIFFICULTY: Moderate
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
59. In general, ____ is the first choice in the treatment of bipolar disorder.
a. cognitive-behavioral therapy
b. interpersonal therapy
c. lithium
d. family therapy
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
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60. Dr. Smith prescribes Sally a certain medication for the treatment of bipolar disorder; it causes weight gain. Which
treatment is Sally taking?
a. risperidone
b. alprazolam
c. valproate
d. fluoxetine
ANSWER:
c
DIFFICULTY: Easy
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Understand
61. Why do mood disorders in children frequently go undetected?
ANSWER:
Many young people with depression express these combined feelings of sadness and loss of interest or
pleasure. However, some may never report feeling sad. Rather, they express their depression through
their irritable mood. This is not something people would normally associate with depression.
DIFFICULTY: Moderate
REFERENCES: Overview of Mood Disorders
KEYWORDS: Bloom’s: Analyze
62. How do the symptomatic presentations of depression in preschoolers, school-aged children, preteens, and teens differ?
How are they the same?
ANSWER:
Children express and experience depression differently at different ages (Weiss & Garber, 2003). An
infant may show sadness by being passive and unresponsive; a preschooler may appear withdrawn and
inhibited; a school-age child may be argumentative and combative or complain of feeling sick; a
teenager may express feelings of guilt and hopelessness, sulk, or feel misunderstood. These examples are
not various types of depressions, but likely represent different stages in the developmental course of the
same process.
DIFFICULTY: Moderate
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Analyze
63. Distinguish between depression as a symptom, syndrome, and disorder.
ANSWER:
As a symptom, depression refers to feeling sad or miserable. Depressive symptoms often occur without
the existence of a serious problem, and they are relatively common at all ages. As a syndrome,
depression is more than a sad mood. A syndrome refers to a group of symptoms that occur together more
often than by chance. Along with sadness, the child may display a reduced interest or pleasure in
activities, cognitive and motivational changes, and somatic and psychomotor changes. As a syndrome,
depression represents an extreme on a dimension reflecting the number or severity of co-occurring
symptoms that the child displays. As a disorder, depression comes in several forms. We will consider
three types. The first, major depressive disorder (MDD), has a minimum duration of 2 weeks and
includes low mood, loss of interest or pleasure, other symptoms (e.g., sleep disturbances, difficulty
concentrating, feelings of worthlessness), and significant distress or impairment in functioning. The
second, persistent depressive disorder (PDD), or dysthymia, is associated with depressed or irritable
mood, generally fewer, less severe, but longer-lasting symptoms (a year or more in children) than MDD,
and significant impairment in functioning. The third, disruptive mood dysregulation disorder (DMDD),
is a recently introduced depressive disorder characterized by: 1. frequent and severe temper outbursts
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that are extreme overreactions to the situation or provocation; and 2. chronic, persistently irritable or
angry mood that is present between the severe temper outbursts.
DIFFICULTY: Moderate
REFERENCES: Depressive Disorders
KEYWORDS: Bloom’s: Understand
64. What reasons have been put forth for the increase in depression from the preschool to elementary school years, and
from childhood to adolescence?
ANSWER:
The modest increase in depression from preschool to elementary school is likely not biologically based,
but rather is a reflection of the school-age child’s growing self-awareness and cognitive capacity, verbal
ability to report symptoms, and increased performance and social pressures. In contrast, the sharp
increase in depression in adolescence appears to be the result of biological maturation at puberty
interacting with important developmental changes that occur during this tumultuous period. This
hypothesis is supported by the emergence of large sex differences in depression after puberty, the
emergence of bipolar disorder, and the relative stability in rates of depression through adolescence
(Birmaher et al., 1996).
DIFFICULTY: Moderate
REFERENCES: Major Depressive Disorder
KEYWORDS: Bloom’s: Analyze
65. Distinguish between major depressive disorder and dysthymic disorder.
ANSWER:
Young people who suffer from persistent depressive disorder (PDD) experience symptoms of depressed
mood that occur for most of the day, on most days, and persist for at least 1 year. They are unhappy or
irritable most of the time. (The sad and gloomy life of Eeyore the donkey in the 100 Acre Wood likely
qualifies for a diagnosis of PDD.) Combined with their chronic depressed (or irritable) mood, these
children also display at least two somatic (e.g., eating problems, sleep disturbances, low energy) or
cognitive symptoms (e.g., lack of concentration, low self-esteem, feelings of hopelessness) that are
present while they are depressed. Although the symptoms of PDD are chronic, they are less severe than
those for children with MDD. PDD is a “new” category in DSM-5; it combines the previous DSM-IV
categories of Dysthymic Disorder and MDD—Chronic. This was done because of the lack of differences
between youths with a dysthymic disorder and those with a chronic type of major depression. In
comparison to nonchronic MDD, chronic forms of depression, whether referred to as dysthymic
disorder, chronic major depression, or PDD are associated with a poorer response to treatment, greater
long-term morbidity at follow-up, and greater familial loading for affective disorders (McCullough et al.,
2003).
DIFFICULTY: Moderate
REFERENCES: Persistent Depressive Disorder
KEYWORDS: Bloom’s: Understand
66. What role do cognitive deficits and cognitive distortions play in depression?
ANSWER:
Many children with depression experience biases, deficits, and distortions in their thinking (Lakdawalla,
Hankin, & Mermelstein, 2007). These children commonly notice depression-relevant cues such as sad
facial expressions more often than positive cues such as happy facial expressions (Ehrmantrout et al.,
2011; Hankin et al., 2010). Given the importance of accurately reading emotional cues for successful
social relationships, these selective attentional biases can contribute to adverse relationships with family
members and peers.
DIFFICULTY: Moderate
REFERENCES: Associated Characteristics of Depressive Disorders
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KEYWORDS:
Bloom’s: Analyze
67. How is self-esteem related to depression in children?
ANSWER:
Almost all young people with depression experience negative self-esteem. In fact, low self-esteem is the
symptom that seems most specifically related to depression in adolescents (Lewinsohn et al., 1997). Selfesteem in children with depression is also highly reactive to daily life events, and such daily fluctuations
in self-esteem appear to be related to depression following exposure to major life stresses (Roberts &
Gotlib, 1997). Thus, both low self-esteem and unstable self-esteem seem to play an important role in
depression.
DIFFICULTY: Moderate
REFERENCES: Associated Characteristics of Depressive Disorders
KEYWORDS: Bloom’s: Analyze
68. What is the role of the family in the development and maintenance of depression in young people?
ANSWER:
Youngsters with depression experience less supportive and more conflictual relationships with their
mothers, fathers, and siblings than do children who do not have depression. They report feeling socially
isolated from their families and prefer to be alone rather than with them. In family situations, the child’s
social isolation may not be a social skill deficit, but rather a reflection of the child’s desire to avoid
conflict. Family relationship difficulties have been found to persist even when children are no longer
clinically depressed (Sheeber et al., 2007).
DIFFICULTY: Moderate
REFERENCES: Associated Characteristics of Depressive Disorders
KEYWORDS: Bloom’s: Analyze
69. Explain some of the concerns of treating young people with depression with medications.
ANSWER:
The main concerns are possible serious side effects such as suicidal thoughts and self-harm and a lack of
information about the long-term effects of these medications on the developing brain. Related to these
concerns and warnings by the FDA, the use of SSRIs with young people has decreased by about 20% in
more recent years (Gibbons et al., 2007; Libby et al., 2007). In 2004, the FDA asked all manufacturers of
antidepressant medications to include in their labeling a boxed warning (black box) and Patient
Education Guide to alert consumers about the increased risk of suicidal thinking and behavior in
youngsters treated with these medications.
DIFFICULTY: Moderate
REFERENCES: Treatment of Depression
KEYWORDS: Bloom’s: Understand
70. Give three areas in which depressed individuals show cognitive problems, according to Aaron Beck.
ANSWER:
First, they display information-processing biases, or errors in their thinking in specific situations, called
negative automatic thoughts. Second, depression is believed to be associated with a negative outlook in
the following three areas, referred to as the “negative cognitive triad.” Third, depressed youngsters have
negative cognitive schemata, which are stable structures in memory that guide information processing,
including self-critical beliefs and attitudes.
DIFFICULTY: Moderate
REFERENCES: Treatment of Depression
KEYWORDS: Bloom’s: Understand
71. What are some of the characteristics of a family with a depressed child? Of a family with a depressed parent?
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ANSWER:
Families of children with depression display more critical and punitive behavior toward their depressed
child than toward other children in the family. As compared with families of youngsters without
depression, these families display more anger and conflict, greater use of control, poorer communication,
more overinvolvement, and less warmth and support (Sheeber et al., 2007; Stein et al., 2000). They often
experience high levels of stress, disorganization, marital discord, and a lack of social support (Messer &
Gross, 1995; Slavin & Rainer, 1990). Depression interferes with a parent’s ability to meet the basic
physical and emotional needs of a child, including feeding, bedtime routines, medical care, and safety
practices. Mothers who suffer from depression also create a child-rearing environment teeming with
negative mood, irritability, helplessness, less emotional flexibility, and unpredictable displays of
affection. When their children display negative emotions and distress, mothers with a history of
depression are less likely to respond supportively with comfort, empathy, or assistance and are more
likely to disapprove, dismiss, punish, or ignore their child’s negative emotions (Silk et al., 2011).
Depressed mothers also display less energy in stimulating play, less consistent discipline, less
involvement, poor communication, lack of affection, and more criticism and resentment of their children
than mothers without depression (Goodman, 2007).
DIFFICULTY: Moderate
REFERENCES: Causes of Depression
KEYWORDS: Bloom’s: Apply
72. What approach is used in “The Action” for treating children with depression and their families? Describe the “The
Action” program.
ANSWER:
The ACTION acronym is used to nourish the idea that youngsters can have an impact on their (Stark &
Kendall, 1996, p. 14): A Always find something to do to feel better. C Catch the positive. T Think about
it as a problem to be solved. I Inspect the situation. O Open yourself to the positive. N Never get stuck in
the negative muck. Multiple treatment procedures are used to reduce the child’s mood disturbances,
behavioral deficits, and cognitive symptoms: Dysphoria, anger, anhedonia, and excessive anxiety are
treated by educating the child about the relation between mood, thinking, and behavior, and by using
anger management procedures, scheduling pleasant activities, and relaxation training. Interpersonal
deficits are treated using social skills training. Cognitive distortions and negative and self-critical
thinking are addressed by using cognitive restructuring procedures and training in effective problemsolving and self-control procedures.
DIFFICULTY: Moderate
REFERENCES: Treatment of Depression
KEYWORDS: Bloom’s: Apply
73. Distinguish between manic, mixed, and hypomanic episodes.
ANSWER:
A manic episode, which is the hallmark feature of BP, involves a discrete period of a week or more
during which the youngster displays an ongoing, pervasive, and unusually elevated or irritable mood and
persistently increased goal-directed activity or energy. This episode is accompanied by the types of
symptoms we have been describing such as an exaggerated self-esteem, a reduced need for sleep, racing
thoughts, rapid and frenzied speech, attention to irrelevant details, increased activity, or overinvolvement
in pleasurable but often reckless and risky behaviors. A hypomanic episode has features that resemble a
manic episode in quality but are less intense—the mood disturbance and increased activity or energy are
less severe, of shorter duration, and produce less impairment in functioning than a manic episode. DSM5 also includes a specifier of “with mixed features,” which can be used when a current manic or
hypomanic episode includes subthreshold symptoms of depression or dysthymia or when an episode of
MDD includes subthreshold symptoms of mania or hypomania.
DIFFICULTY: Moderate
REFERENCES: Bipolar Disorder
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Bloom’s: Understand
74. What are some of the concerns or difficulties in diagnosing a child with bipolar disorder?
ANSWER:
At the center of the controversy is whether BP can be diagnosed in prepubertal children. Some clinicians
avoid the use of this label entirely, and instead label young children who display unstable moods with
the less stigmatizing categories of ADHD or depression. Others use the label of BP liberally in young
children, often based solely on the presence of mood swings, irritability, and aggression, leading to
concerns about overdiagnosis. Thus, clinicians presented with identical diagnostic information vary
widely in their assessment of BP in children, from 0% risk to 100% risk (Jenkins et al., 2010). A focal
point of this debate is whether BP looks the same in young children as in adults.
DIFFICULTY: Moderate
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Analyze
75. What are some of the concerns with medications such as lithium in treating a child who has been diagnosed with
bipolar disorder?
ANSWER:
Lithium is a common salt that is widely present in the natural environment—for example, in drinking
water—usually in amounts too small to have any effects. However, the side effects of therapeutic doses
of lithium can be serious, especially when used in combination with other medications; side effects may
include toxicity (poisoning), renal and thyroid problems, and substantial weight gain (Gracious et al.,
2004). It can be given to young people when used with the same safety precautions and similar careful
monitoring used for adults. However, lithium cannot be given to children in chaotic families or to
children who are unable to keep the multiple appointments needed for monitoring potentially dangerous
side effects (Carlson, 1994; Geller & Luby, 1997).
DIFFICULTY: Moderate
REFERENCES: Bipolar Disorder
KEYWORDS: Bloom’s: Analyze
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