Developmental considerations in the study of childhood depression

From children's expressive control to emotion regulation: Looking back, looking ahead

In 1984, Carolyn Saarni published an important cross-sectional study on the development of children's expressive control. That paper, as with much of her early work, presaged interest in the development of emotion regulation and of the efforts to understand emotion regulation both in typical and at risk children. In this paper, we look back on Dr. Saarni's work on expressive control and studies that used her creative disappointment task. We discuss conclusions from that work and how this germinal work on expressive control contributed to the study of the broader concept of emotion regulation. We look ahead to the next steps that carry this line of research forward contributing to the development of emotional competence and mental health.

Depressive Experiences of Nonreferred Adolescents and Young Adults

The cognitive theory of depression proposed by Beck and the cognitive developmental theory proposed by Piaget provided the theoreticalframeworks for an exploratory and developmentally based investigation of the depressive experiences of nonreferred adolescents and young adults. Specifically, the students'experiences of depressive symptomatology and expressions of hopelessness were examined as a function of their stage of cognitive development (i.e., concrete operations vs. formal operational thought). Participating in the present study were 107 high school, community college, and university students. The students completed several self-report measures designed to assess their levels of depressive symptomatology, hopelessness, and cognitive development. Contrary to theoretical expectations, students classified as functioning within the concrete operational stage were found to report a greater frequency and severity of depressive symptomatology, as well as higher levels of hopelessness, than were those classified within the formal operational stage. The implications and limitations of the study are discussed.

Psychological factors linked to self-reported depression symptoms in late adolescence

BACKGROUND

The likelihood of developing depression increases throughout adolescence.

AIMS

Understanding the relative contribution of psychosocial and cognitive variables to depressive symptoms during the transitional stage of late adolescence should increase the scope for effective prevention and intervention.

METHOD

The Inventory of Parent and Peer Attachment (IPPA), Adolescents' Cognitive Style (ACSQ), Relationship Rating Scales (RRS), The Life Events Checklist, and the Children's Depression Inventory (CDI) were completed by 140 adolescents aged 16-18 years.

RESULTS

Alienation from parents and peers, helpless attributional style, gender, and perceived criticism from teachers contributed significantly to variance in scores for depressive symptoms. Negative self-inference and helpless attributions moderated the relationship between perceived criticism and depression in male participants.

CONCLUSIONS

Different approaches to intervention may be more successful for males and females.

Gender differences in emotional reactivity of depressed and at-risk preschoolers: implications for gender specific manifestations of preschool depression

We investigated whether differences in positive and negative emotional reactivity could be found in depressed preschoolers and preschoolers at risk for later internalizing symptoms relative to nondepressed/low risk comparison groups. Observational measures of emotional reactivity, used to derive a score of the balance between anger and sadness, were obtained and analyzed in independent samples. One study utilized cross-sectional data from preschoolers (M age = 4.6 years) with a current depressive syndrome and two nondepressed comparison groups. The other study utilized longitudinal data that assessed emotional reactivity at preschool age (M age = 4.5 years) and later mental health symptoms during the transition to primary school, allowing a retrospective determination of risk. Depressed and at-risk boys displayed more anger than sadness in contrast to girls in the same groups and in contrast to no disorder/low-risk controls. This finding was detected in depressed and "at risk for internalizing" boys who were not comorbid for externalizing problems.

Are self-reported depressive symptoms in first-grade children developmentally transient phenomena? A further look

In light of putative developmental constraints, some have argued that prior to the middle to late elementary school years children's reports of depressive symptoms represent nothing more than transient developmental phenomena. In an earlier study of an epidemiologically defined sample of first-grade children, self-reported depressive symptoms proved relatively stable and significantly related to adaptive functioning. In the present study, we follow that cohort of first graders longitudinally and assess the prognostic value of self-reports of depressive symptoms in first grade with respect to depressive symptoms and adaptive functioning in the late elementary school years. We also assess whether or not children's reports of depressive symptoms demonstrate greater stability and are more highly associated with adaptive functioning in the middle to late elementary school years. First-grade depressive symptoms were found to have significant prognostic value in terms of levels of depressive symptoms and adaptive functioning in fifth grade, with the strength of prediction varying by gender in the former. Although there was a moderate increase in short-term stability from first to fifth grade, it remained consistently strong across first, fourth, and fifth grades. The magnitude of the relationship between depressive symptoms and adaptive functioning also remained consistent over time. These findings on stability, caseness, and prognostic power attest to the significance of children's self-reports of depressive symptoms in the early as well as the middle to late elementary school years.

Conduct and affective disorders in developmental perspective: A systematic study of adolescent psychopathology

This study examined the relationship of psychiatric diagnoses to gender, IQ, and ego development level in an inpatient sample of 269 adolescents. It was found that adolescents with an affective disorder diagnosis, in contrast to those with a diagnosis of conduct or mixed affective-conduct disorder, were more likely to (a) be female, (b) have higher IQ scores, and (c) have higher ego development levels. No significant age differences were found between groups. Comparisons between the single diagnosis and mixed disorder groups indicated that the mixed disorder group is characterized by the most severe symptoms found in each of the pure affective and conduct disordered groups. A relationship between type of DSM-III diagnosis and ego development level in adolescence was demonstrated after controlling for the effects of age, gender, and IQ. These results are offered as an explication of the developmental dimensions inherent in DSM-III psychiatric diagnoses.

Depressive symptoms over first grade and their response to a developmental epidemiologically based preventive trial aimed at improving achievement

This article is about the course of depressive symptoms during a classroom-based randomized preventive field trial aimed at improving reading achievement among first-grade children in an urban population of mixed ethnicity and lower middle to low socioeconomic status. In the fall, children reported high levels of depressive symptoms, a risk factor for major depressive disorder. There was a linear relationship in the fall between depressive symptoms and achievement test scores. Among male children in intervention classrooms whose gain in achievement was at least the national average, depression from fall to spring was decreased, compared to those whose achievement gain was lower. Among female children both in the control and in the intervention classrooms, there was also a significant relationship between gain in achievement and the course of depression.

Dysfunctional attitudes, self-esteem, and hassles: cognitive vulnerability to depression in children of affectively ill parents

The current study tested the diathesis-stress component of Beck's [(1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row, (1983). Cognitive therapy of depression: New perspectives. In P.J. Clayton, J.E. Barnett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265-290). New York: Raven Press] cognitive theory of depression in a sample of children between the ages of 6 and 14. We also examined whether high self-esteem buffers cognitively vulnerable youth against experiencing increases in depressive symptoms following increases in hassles. To provide a effective test of hypotheses, an at-risk sample (children of parents with a history of major depressive episodes) and a multi-wave longitudinal design were used. At Time 1, children (n=140) completed measures assessing dysfunctional attitudes, self-esteem, and depressive symptoms. Every 6 weeks for the next year, children completed measures assessing depressive symptoms and hassles. Hierarchical linear modeling analyses indicated that children possessing high levels of dysfunctional attitudes and low levels of self-esteem reported greater elevations in depressive symptoms following elevations in hassles than other children.

Depression in children and adolescents with epilepsy

Depression in children and adolescents with epilepsy is a common but often unrecognized disorder. Both epilepsy and depression are characterized by a chronic course and poor long-term psychosocial outcome. The risk of suicide is even greater in depressed youth with epilepsy than in the general youth population. Educating parents about mood disorders may allow them to be more receptive to psychiatric treatment for their child or themselves. Epidemiological and clinical data on depression in children/adolescents with epilepsy are presented. Seizure-related and general risk factors for the development of depression in youth with epilepsy are reviewed. General guidelines for diagnosis and treatment of depression in children and adolescents are discussed. The early identification and treatment of childhood-onset depression is an important clinical task for all pediatric specialists. Safe and effective multimodal treatment approaches are available.

The clinical picture of depression in preschool children

OBJECTIVE

To investigate the clinical characteristics of depression in preschool children.

METHOD

One hundred seventy-four subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview for parents. Modifications were made to the assessment of major depressive disorder (MDD) criteria so that age-appropriate manifestations of symptom states could be captured. Typical and "masked" symptoms of depression were investigated in three groups: depressed (who met all MDD criteria except duration criterion), those with nonaffective psychiatric disorders (who met criteria for attention-deficit/hyperactivity disorder and/or oppositional defiant disorder), and those who did not meet criteria for any psychiatric disorder.

RESULTS

Depressed preschool children displayed "typical" symptoms and vegetative signs of depression more frequently than other nonaffective or "masked" symptoms. Anhedonia appeared to be a specific symptom and sadness/irritability appeared to be a sensitive symptom of preschool MDD.

CONCLUSIONS

Clinicians should be alert to age-appropriate manifestations of typical MDD symptoms and vegetative signs when assessing preschool children for depression. "Masked" symptoms of depression occur in preschool children but do not predominate the clinical picture. Future studies specifically designed to investigate the specificity and sensitivity of the symptoms of preschool depression are now warranted.

The separateness of social and emotional loneliness in childhood

BACKGROUND

Much of the childhood loneliness research is misleading because it confounds objective and subjective measures of loneliness. The overall aim of this research was to examine the relationship between social isolation and emotional loneliness.

METHOD

Three extreme groups were identified in a sample of 640 4-9-year-old children. There were two ('rejected' [N=60] and 'lonely' [N=146]) in which social and emotional loneliness were unrelated. The first were socially isolated (rejected) but they did not feel lonely. The second group felt lonely but they were not socially isolated. The third group ('rejected/ lonely') consisted of 61 children who were rejected and also felt lonely.

RESULTS

Felt loneliness and social rejection were experienced together by 61 children, but 206 children experienced either one or the other, but not both. The fourth and largest group [N=374] were neither rejected nor lonely. Differences between the groups were found on direct observation measures of solitariness, sociability, and aggression; peer reports of shyness, aggression, prosocial behaviour, disruptive behaviour and inability to take teasing; self-reports of self-worth and competence, self-reports of supportive relationships; and measures of language use.

CONCLUSIONS

The results indicate that it is loneliness and not rejection that co-occurs with emotional problems.

Mood Induction in Children: Methodological Issues and Clinical Implications

The author reviews 7 different types of mood induction procedures for use with children and discusses these procedures in light of a number of critical methodological issues. The issues considered are administration, participant characteristics, measurement, mood quality, and demand characteristics. The author proposes a broad framework for the future investigation of mood induction procedures for children that includes comparative outcome studies, parametric studies, and more comprehensive mood measurement. Several issues are outlined that investigators might consider when designing experiments to test the generality of negative mood induction studies to clinical depression, including specificity or comorbidity, intensity or severity, age, and sex.

An epidemiological study of disorders in late childhood and adolescence--I. Age- and gender-specific prevalence

Developmental aspects of psychiatric disorders may be inferred from patterns of age differences in prevalence. Age-specific prevalences are provided for nine disorders in a general population sample of ages 10-20. Age and gender patterns for several disorders suggest developmental stage-associated risks. These include oppositional disorder in both genders and conduct disorder and major depression in girls. Major depression shows a pattern suggestive of a role for the onset of puberty. The prevalence of one or more disorders did not differ by age or gender. However, the pattern of specific diagnoses varied greatly by both age and gender.

Self-reported depressive symptoms in first-grade children: developmentally transient phenomena?

The question of whether self-reported depressive symptoms in young children represent more than transient developmental phenomena was examined in an epidemiologically defined sample of 1,313 first graders. Children's reports of depressive symptoms were relatively stable over a 4-month interval. The level of stability was particularly impressive for children initially in the highest quartile of depression, of all whom remained in the highest quartile at retest, 4 months later. In addition, depressive symptoms were significantly related to the negotiation of a number of salient developmental tasks at entrance to first grade, including academic achievement, peer relations, and attention/concentration in the classroom. Moreover, the relationships between depressive symptoms and the various indices of social and academic functioning remained stable over the 4-month test-retest interval.

The social behavior of depressed children: an observational study

Few investigations have examined directly the psychosocial functioning of depressed children. In the present study, 20 depressed and 20 nondepressed fourth- and fifth-grade children were observed in free play during their recess period at school, and their self-perceptions were assessed in subsequent individual sessions. The 10 boys and 10 girls in each group were selected according to their scores on both the Child Depression Inventory and the Peer Nomination Inventory of Depression. Analyses conducted on the eight categories of behavioral observations revealed significant differences between the social behavior of the depressed and the nondepressed children. Although the depressed children made more overtures for social contact than did the nondepressed children and were approached by other children more frequently, they spent more time alone and engaged in a higher frequency of negative interactions with their peers. Consistent with these results, the depressed children's responses to the Self-Perception Profile for Children indicated that they experienced themselves as less socially competent in general, as well as less competent across several specific domains of functioning. These findings are discussed as they relate to developmental processes, theories of adult depression, and recent studies on socially isolated children, and directions for future research in this area are offered.