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Flashcards in Childhood Depression Deck (16):
1

The Diagnosis of Childhood Depression

 Diagnostic criteria are essentially the same as for adult major depression

 Need for different intervention strategies

2

Developmental Variations to Childhood Depression

CHILDREN:
 More symptoms of anxiety (e.g., exaggerated fears)

 Somatic complaints (e.g., headaches)

 Irritability & behavior problems (e.g., school refusal)

 Fewer suicide attempts


ADOLESCENTS:
 More sleep and appetite disturbances

 More suicidal ideation & acts

 Increased impairment of functioning

 Compared to adults, more behavioral problems

3

Assessment of Childhood Depression (e.g., K-SADS-PL)

 Importance of multiple methods due to limited cross-informant agreement

 Self-report measures and individual interviews are essential

4

Psychological theories to childhood depression

 In general, the theoretical approaches used to explain adult depression have also been applied to this disorder in childhood and adolescence

 For e.g., behavioural, cognitive, social skills etc

 However, the developmental application of such theories currently lacks a sound empirical basis (Lakadawalla et al., 2007)

5

Developmental Research on Childhood Depression

• Emerging research studying how cognitive theories might be applied to children and adolescents (e.g., Beck’s Theory, 1967, 1987; Hopelessness Theory, Abramson et al., 1978)

• As cognitive development proceeds, the child develops a pessimistic inferential style which interacts with negative life events and maintains depressive symptomatology

6

However...

• Cognitive theory is most valid for adolescents (Lakdawalla et al., 2007)

• For young children, depressive symptoms are more likely to be a direct response to current life events

• Prior to formal operational functioning (approx age 12) children may lack the single, stable negative cognitive style that adults display

7

Treatment of Childhood Depression

 Treatment research is relatively sparse for depression in children and adolescents

 Initial choice for treatment depends upon a wide variety of factors (e.g., severity of symptoms, motivation etc)

 Stepped care approach through Child and Adolescent Mental Health Service (CAMHS)

8

Pharmacological Treatments of Childhood Depression

 Provision of antidepressants for: bipolar disorder, psychotic depression and severe depression (7-10 symptoms) that prevents effective psychotherapy or that fails to respond to adequate psychotherapy

 Consider that due to environmental factors, pharmacotherapy alone may not be effective

 Also, few treatment studies with children and adolescents, particularly longitudinal

9

Efficacy of Treatment with SSRI’s


 Limited research suggests that SSRI’s are most helpful at relieving depressive symptoms (particularly in adolescence)

 However, efficacy is modest:(e.g., fluoextine Prozac )
Emslie et al (1997): fluoxetine 58%, placebo 32%

Emslie et al (2002): fluoxetine 41%, placebo
20% (& not all outcome measures were
significantly different than placebo)

10

Concerns over SSRI’s

 Long term effects are relatively unknown

 Side effects, interaction with other medication and withdrawal effects

 Small number of case reports (King et al, 1991; Teicher et al., 1990) described association between SSRI’s treatment and increased suicidal tendencies

11

Depression in Children and Young People: NICE (2005) Guidelines

 Antidepressant medication should only be prescribed following assessment by a psychiatrist

 Should only be offered in combination with psychological treatments

 First-line treatment is fluoxetine

 Monitor for agitation, hostility, suicidal ideation and self-harm and advise urgent contact with prescribing doctor if detected

12

Psychological Therapies


 Therapeutic approaches for older children and adolescents similar to adults.

For example:
- Social skills training (e.g., Clarke, BeBar, & Lewinsohn, 2003)

- Interpersonal (e.g., Mufston & Dorta, 2003)

- Cognitive, behavioural or cognitive behavioural

13

Treatment of Pre-school depression

 Limited research into treatment of preschool depression

 Given the importance of parent-child interaction for socio-emotional development, dyadic psychotherapy is an important first line of treatment (Luby, 2009)

14

Parent Child Interaction Therapy – Emotional Development (PCIT-ED)

 Focus upon emotional recognition and regulation, and strengthening of the parent-child relationship

 Methods include observation, play, direct coaching and homework tasks

 Initial research suggests significant improvements in child’s mood, behaviour and executive functioning as well as in maternal stress and depression (Luby, Lenze & Tillman, 2012)

15

Combined Treatment

 NIMH Research on Treatment for Adolescents with Depression Study (TADS): (March et al., 2004)

 A clinical trial of 439 adolescents with major depression found a combination of medication and psychotherapy to be the most effective treatment

 Response rate of 60.6% for Fluoxetine compared to 70% for Fluoxetine and CBT combined

16

Evaluation of Treatment

 While medications can be of value, they do not negate the need for psychotherapy

 Combined treatment seems best

 Requires multidisciplinary review and a change of approach if symptoms deteriorate

 More child-specific research is needed


 Often need for continuous treatment due to the risk of relapse and reoccurrence

 Risk factors for relapse and reoccurrence:
- Earlier age of onset
- Comorbidity
- Negative life events / psychosocial stressors
- Level of engagement with therapy