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October 6, 2004. Questions Substance Use and Abuse Case Mood Disorders Definitions Classification/ Diagnosis Prevalence Theories, Models, Causes Intervention/Prevention Cases. Mood Disorders in Children. History Depression in Children Controversial for Decades: Doesn’t exist
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October 6, 2004 Questions Substance Use and Abuse Case Mood Disorders Definitions Classification/ Diagnosis Prevalence Theories, Models, Causes Intervention/Prevention Cases
Mood Disorders in Children • History Depression in Children Controversial for Decades: Doesn’t exist Part of normal development Is masked 1980’s –assumption that depression in childhood is similar to that in adults (use of DSM-IV), some allowances for children • Definitions Mood, Syndrome, Set of Indicators Mood disorders-disturbances in mood Depression-pervasive unhappy mood Major Depressive Episode-5 or more symptoms during same 2 week period Dysthymic-depressed mood for most of the day for at least 2 years (children=1 year) Bi-polor I disorder-cycles of depression and mania (at least 1 week) Bi-polar II disorder-major depression and hypomania Cyclothymia-chronic mild fluctuations of mood, does not meet criteria for major depression
Mood Disorders in Children • Classification/Diagnosis DSM-IV Criteria DSM-PC ISD-10 Problems
Mood Disorders in Children • Prevalence (Dependent upon criteria- 30days, 12 months, lifetime) 9-17 year olds, 6% (U.S. DHHS, 1999) Only 1/3 of U.S. teenagers with mood disorders receive treatment (King, 1991) 70% of children with a single major depressive episode will experience a recurrence within 5 years ( Birmaher et.al, 1996) 20% with bi-polar experienced 1st manic episode in adolescence (Geller & Luby, 1997) Chapter 5, M & B, “Great Smoky Mountain Study” (1996) 3 month rate=.03% for major depressive episode & .13% for dysthymia, & 1.45% for depression, NOS (ages 9, 11, & 13)
Mood Disorders in Children M & B-rates of diagnosed depression among adolescents comparable to adult rates. National Comorbidity Study-15-18 year olds, MD=14% lifetime & 11% reporting minor depression Increased and growing rates of depression in those born since 1960 • Suicide-where does it belong? Suicidal thoughts and attempts among the criteria for major Depressive Episode Big increase in rate per 100,000 in last 20 years (CDC) 3rd leading cause of death in 15-24 year olds
Mood Disorders in Children • Demographic Correlates Gender (higher rates for adolescent girls, preadolescent boys and girls not clear) Why do the differences occur and when do they occur? SES (lower income=more depression) What are the reasons for these differences? Ethnicity (few studies) M & B report on 1 large study, higher rates for Latinos. What are the possible reasons for these differences?
Mood Disorders in Children • Developmental Course and Prognosis • Irritability mood versus depressed mood • Depressed adolescents may have significantly higher rater of hypersomnia than pre-adolescents • Some symptoms increase with age, others decrease with age • Comorbidity may vary with age • Early Onset <5 rare • Mean Onset- major depression=14. dysthymia=11 • Early adolescence most common age of onset for girls • Earlier onset=more severe course of disorder • Duration-mean recovery time=7-9 months, median recovery time=8 weeks in a 5-year study (M & B) • High rates of recurrence-40% over 3-5 years (M & B)
Mood Disorders in Children Theoretical Models of Childhood Depression • Biological Models • Genetic influences • Brain & Neurochemistry • Sleep-Wake Cycle • Cognitive Models • Information Processing/Schemas • Attributional Style/Control-Related Beliefs • Behavioral/Interpersonal Models • Interpersonal Relationships • Social Problem Solving/Coping/Emotion Regulation • Achievement and School Functioning • Multidimensional Competence-based Models
Mood Disorders in Children • Family Models • Psychodynamic Theories • Attachment Theories • Parent-Child Relationships (High-Risk Studies) • Parent-Child Relationships (Parents of Depressed Children) • Contextual Family Variables • Life Strress Models • Stress Exposure • Diathesis-Stress Models • Mediation Models • Stress Generation Models • Other Environmental Influences
Mood Disorders in Children • Integrative Developmental Theory of Youth Depression • Comorbidity • Bipolar Disorders in Children and Adolescents
Mood Disorders in Children • Interventions • Prevention • The Future
Sources Used • Barrett & Ollendick (2004) • Mash & Barkley (2003) • Kaufmann, J. A. (2005). Characteristics of emotional and behavioral disorders of children and youth, 8th edition. Upper Saddle River, New Jersey: Pearson, Merrill, Prentice-Hall. • Wicks-Nelson, R. & Israel, A. C. (2003). Behavior disorders of childhood, 5th edition. Upper Saddle River, New Jersey: Prentice-Hall • American Academy of Pediatrics website: http://www.aap.org