Child Abnormal: Depression

Question 1

Developmental Psychopathology

Answer 1

• To understand maladaptive behavior:
  o What is normative?
• Study abnormal child psychology around milestones and sequences in development

Question 2

Most Common Diagnoses

Answer 2

• ‘Internalising’ Disorders
  o Anxiety disorders, mood disorders
• Externalising Disorders
  o Oppositional Definat Disorder (ODD), Conduct Disorder (CD), Attention Deficit Hyperactivity Disorder (ADHD)
• Developmental Disorders
  o Autism, Mental Retardation, Learning Disorders

Question 3

Major Depression - Epidemiology

Answer 3

• Less than 1% in preschoolers
• 2-3% in school-age children
  o Similar rates in both genders
• 15-30% in adolescence (age 14-18)
• Risk of depression rises greatly in adolescence
• Gender ratio 2:1
  o Dramatic gender differences emerge during early-to-middle adolescence

Question 4

Depression in adolescents

Answer 4

• Cognitive diathesis-stress models
  o Beck: negative schema
  o Seligman: helplessness, negative attributions
  o Cognitive style + Negative events → Depression
  • Predict depression from 12-14 years (Abela, 2001)
• Mid adolescence: critical time for MD
  o Negative cognitive styles consolidated
  o Increased stress during adolescence

Question 5

Why MD increases especially in females?

Answer 5

o Reporting differences?
o Self-medication in males?
o Hormonal differences?
- Higher stress exposure in females
o Sexual victimisation (16-19 peak age for rape)
o Body image concerns (80% girls)
o Interpersonal negative events
o ‘Vicarious stress’ in social network
- Higher negative cognitive style in females
- Different coping responses to stress
o Rumination vs. distraction/problem solving

Question 6

Causes of MD in adolescents

Answer 6

o Do children possess negative cognitive styles?
o Negative events → cognitive style → depression
o Role of depressed parent (Shih et al., 2009)
o Emotional abuse, neglect (Gibb & Abela, 2008)

Question 7

Treatment - Medication

Answer 7

• SSRIs: Zoloft, Prozac, Paxil, Luvox etc. SNRIs (Effexor)
• None of the SSRIs, and indeed no antidepressant, is currently approved in Australia for the treatment of MDD in children and adolescents (persons aged less than 18 years).
  Fluoxetine, but none of the other SSRIs, is approved in the US for MDD in young people without a specified lower age limit.
  Two of the SSRIs, fluvoxamine and sertraline, are approved in Australia for children and adolescents with obsessive compulsive disorder (OCD).

Question 8

Treatment - CBT

Answer 8

• CBT derived from adult approaches
• Prevention (e.g., Gillham, Reivich, Jaycox,� & Seligman, 1995)
• Uses CBT techniques
• Universal prevention: given to all students
• Indicated prevention: aimed at children or adolescents with high scores on symptom scales
• Selective prevention: target ‘high risk’ groups
• Young children/toddlers: aimed at parents
  o Depressed or overprotective parents are treated