Depression in Children
What Is Childhood Depression?
The research applies the term “depression” to unipolar mood disorders, or major depressive disorder (Rao & Chen, 2009). Before 1975, depression in children was not recognized as a separate phenomenon due to young individuals’ immaturity for such a disorder. However, the researchers had to accept the evidence showing the incidence of depressive symptoms in children as early as three and even two years old (Rao & Chen, 2009; Luby, 2008). During the past three decades, the disorder under discussion has not been considered “an adult disease,” and it has received proper theoretical and empirical investigation, predominantly in the area of developmental psychopathology (Rao & Chen, 2009, p. 46). A developmental perspective on depression views the disorder in the context of the emotional functioning of children that undergoes different stages and transitional periods. However, normally performing psychological processes should be distinguished from pathological emotions, reactions, and dysfunctional expressions (Cole et al., 2008). Although many affective problems characterize normal critical stages, especially in adolescents’ behavior, certain individuals experience abnormal emotional distress. Emotion developmental findings constitute an appropriate theoretical framework for early childhood depression. The studies implemented within this context claim that even preschoolers suffer from complex affects characteristic of the depressive disorder, for instance, guilt and shame (Luby, 2009). All in all, it is vital to differentiate such problems as sadness, irritation, self-doubt, or social withdrawal as normative expressions of adolescents’ crisis from the symptoms of a serious psychiatric disorder (Rao & Chen, 2009).
From the developmental viewpoint, depression can set in under unfavorable conditions of a child’s emotional development. Here, attention should be paid to the fact that both negative and positive emotions are adaptive and can be present in healthy individuals. Cole et al. (2009) emphasize that different kinds of these psychological processes are vital for the human survival and well-being. Indeed, negatively colored emotions are linked to the presence of risk for psychological problems, but they are also crucial in reacting to challenges and hardships. All in all, many researchers stress the importance of observing the way how normally functioning emotional sphere becomes dysfunctional and stops being regulated effectively. In brief, depressive psychopathology can start when children fail to regulate their emotional reactions and moods (Cole et al., 2009). Cole et al. (2009) also admit the role of biological and environmental factors in determining the cases when a child’s emotional strategies turn out to be ineffective and deviant from the norm. For instance, sadness becomes maladaptive only as long as it gets pervasive and dominates other domains of personality (Cole et al., 2009). Additionally, researchers single out the following causes and risk factors: problematic interpersonal relationships and school performance, delays in social, emotional, and cognitive development, comorbid psychiatric disorders, and stressful experiences. Moreover, low income and socioeconomic status, chronic stress, adverse environmental conditions, and poor family functioning add to adverse factors (Rao & Chin, 2009).
The most typical symptom that makes caregivers consider the possibility of mental concerns in a child is intense irritability. However, it should be kept in mind that this symptom can characterize many disorders of an early age as well as a normative behavior of a developmental stage (Luby, 2008; Cole et al., 2009). Therefore, irritability prompts the onset of depression in case it is combined with social withdrawal, anhedonia (loss of pleasure and interest), and guilt (Luby, 2008, p. 974; Cole et al., 2009). Cole et al. (2009) highlight that the prolonged nature of sadness, irritability, and anhedonia is the crucial factor determining the diagnosis of depression in a child. Furthermore, such affective conditions are accompanied by observable alterations in eating, sleeping, motor activity that can express in two extremes – either restlessness or lethargy. Next, children can experience difficulty concentrating, feelings of worthlessness and guilt, and finally, suicidal thoughts (Cole et al., 2009, p. 142). Except for stable constellation of symptoms, early-onset depression has biological alterations in the hypothalamic-pituitary adrenal axis that resemble the psychopathology of adults (Luby, 2009). Due to clinical evidence, researchers had to recognize that the symptoms of depression can settle early, with recurrence and continuity further in life, frequently demonstrating a chronic and relapsing course of symptoms. In such a way, young children have often shown a clinical picture characteristic of depressive disorder that forced the specialists to diagnose it correspondingly. Moreover, their symptoms turn out to be stable, specific and appear to be similar to those in older individuals. Besides, they are easily distinguished from other mental and behavioral disorders (Cole et al., 2009).
Luby (2009) admits the scarcity of empirical research guiding the treatment of early childhood depressive disorder. There is a probability that the lack of systematic treatment studies can be explained by comparatively recent acknowledgment of preschool depression. One of the methods makes use of traditionally widespread and rather popular cognitive-behavioral therapies (CBT) and interpersonal therapy; particularly, their variants designed for young children. However, Luby (2009) highlights that their long-term efficacy has not been established through scientific evidence. The investigations of CBT, in combination with medications, were conducted concerning adolescent depression, but the outcomes turned out to be short-term with numerous relapses (Luby, 2009). Overall, the scholar reports that the challenges in regard to the treatment of childhood depression still remain and need a clear and effective model. Besides, it is advisable to apply prevention strategies to address the onset of an early psychiatric syndrome. As for medication treatment, Luby (2009) warns of both the inefficacy and risk of using antidepressants for preschoolers as they may be at greater risk for activation from selective serotonin reuptake inhibitors (p. 144). Therefore, the first line of treatment for preschoolers should not contain tricyclic antidepressants. Instead, the theorist suggests parent-child dyadic psychotherapeutic interventions that focus on child and caregiver simultaneously. This novel psychotherapy, called Parent Child Interaction Therapy – Emotion Development (PCIT-ED) enhances a child’s emotion development along with its capacity to regulate the own affective states.
Rao, U., & Chen, L. A. (2009). Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders. Dialogues in Clinical Neuroscience, 11, 45-62.
The article presents a profound analysis of numerous aspects associated with pediatric depression, as well as the comparison of its symptoms in children, adolescents, and adults. The authors stem from the developmental framework in understanding childhood and adolescent depression and take into account the concrete stages of development through childhood and adolescence. Furthermore, they emphasize the importance of early identification and treatment of the discussed disorder for the purpose of the prevention of grave consequences later in life. Therefore, the article contributes to understanding the nature of depressive syndrome, including its etiology, phenomenology, clinical course, correlates – all taken as the foundation for early intervention. In considering the epidemiology of depression in children and adolescents, Rao and Chin (2009) analyze various aspects of the problem, including secular trends, gender differences, the effect of social status, ethnic and cultural differences, functional consequences, and socioeconomic burden. Additionally, the scholars examine the clinical presentation of the disorder, its course, and outcomes in adult life. Thus, they present evidence supplied by longitudinal studies to the high probability of recurrence and continuity of the psychopathologic episodes into adulthood, especially in the cases of adolescent-onset depression. Importantly, Rao and Chin (2009) discuss the risk factors for childhood depression as well as predictors of its recurrence in adult life. For instance, such negative factors include developmental influences on vulnerability to depression, family-genetic aspects, negative temperamental, personality, and cognitive factors, family interactions, and experienced stress. In the context of neurobiology belying the discussed affective problems, the article analyzes all the existing frameworks in the field, such as electrophysiological, neuroendocrine, and neuroimaging studies.
Cole, P. M., Luby, J., & Sullivan, M. W. (2008). Emotions and the development of childhood depression: Bridging the gap. Child Development Perspectives, 2(3), 141–148. doi:10.1111/j.1750-8606.2008.00056.x.
The authors aim to address the problem of the existing gap between the knowledge about children’s emotional development and clinical treatment of early childhood mental disorders. First of all, Cole et al. (2008) emphasize the danger of inattention and the absence of recognition of early-onset syndrome while there is evidence to young children’s severe mental problems, behavioral and emotional difficulties. Such disorders can hamper the normal development of the child’s emotional sphere and lead to psychopathology. In contrast, early identification and treatment allow clinicians to make use of behavioral and neural plasticity of young children to prevent a further development of disorders. In such a way, the authors suggest new directions in research, whose essence is the integration of scientific knowledge and methods with the clinical investigation of individual risk, impairment, and symptoms of affective disorders in children. In other words, Cole et al. (2008) compare the typical emotional development with that comprising risk for depression and stress the different nature of normal transitory problems if contrasted to emerging psychopathology. Thus, every healthy child can demonstrate irritability as a sign of typical developmental stage, but the clinical disorder is characterized by a vivid predisposition for negative reactions and problems in self-regulation. Importantly, the article presents the summary of the existing knowledge about the emotional development of young children and the trends in research on early depression from the perspective of the risks for normal emotional functioning. Finally, the authors analyzed an example of a troubled preschooler’s emotional profile characterized by the prevalence of the emotions of anger, anxiety, guilt, and shame with the simultaneous inhibition of positive emotions, including joy, interest, and pride.
Luby, J. L. (2009). Early childhood depression. The American Journal of Psychiatry, 166(9), 974–979. doi:10.1176/appi.ajp.2009.08111709
The author of the article discusses the problem of diagnosing childhood depression, whose symptoms may be confused with other disorders. In particular, Luby (2009) focuses on early childhood depression stating that, like older children, preschoolers demonstrate more age-adjusted manifestations of the symptoms in contrast to “masked” ones, to which belong somatic disorders or aggression. The scholar grounded on developmental studies as a framework for the clinical investigations. Thus, Luby (2009) summarized that research on the early-onset disorder established specific markers and symptoms of preschool depression, as well as biological foundations of the syndrome. In addition, the theorist defined a leading question in the empirical investigation of the early childhood depression that is associated with its longitudinal continuity with later school-age depression. Based on the prior research and theoretical background, the author proposed a parent-child psychotherapy as a first line of treatment for whereas emphasizing that it is vital to address the early-onset symptoms by specially organized intervention. Otherwise, watchful waiting, which is a frequent practice in dealing with the early depression, may lead to more severe clinical picture of a later disorder. Besides, she warned of the cautious use of antidepressant medications at this age and suggested applying Parent Child Interaction Therapy–Emotion Development, which requires testing at the present stage. Luby (2009) stresses that this novel dyadic psychotherapeutic model concentrates on the emotional development of a child and allows a clinician to ameliorate the sufferings of both family and child without inflicting harm of medications. However, since the treatment based on developmental psychotherapies is currently experimental, the corresponding warning of parents should be introduced before its application.