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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?