Mother-child dynamics in early-onset depression and childhood schizophrenia spectrum disorders

Cognitive–Behavioural Treatment of Internalising Disorders in Youth

Cognitive-behavioural (CB) therapy for internalising disorders in youth is discussed from both a procedural and empirical standpoint. A theoretical overview of CB treatment is provided, and the unique difficulties faced in the identification and treatment of internalising disorders are considered. With reference to specific internalising disorders (i.e., anxiety and depression), the present paper considers the differential application of CB strategies and the efficacy of treatment procedures. Issues relevant to CB treatment, including (a) flexibility in application, (b) developmental considerations, (c) treatment methodology, and (d) transportability, are discussed.

Interaction patterns of adolescents with depression and the important adults in their lives

The purpose of this study is to describe common interaction patterns between adolescents who are depressed and the important adults in their lives, with special attention given to interactions that influence the course of the teens' depression. Data are drawn from an ongoing grounded theory study of the management strategies and service usage patterns of adolescents who are depressed. The sample includes 52 young adults between the ages of 18 and 21 who experienced depressive symptoms as adolescents, 4 of their parents, and 8 professionals who work with youths. All participants discussed how both adolescents and adults ignore, hide, or minimize the adolescents'distress by putting up a façade. The three common interaction patterns that were identified (maintaining the façade, poking holes in the façade, breaking down the façade) are responses to the façade. The author discusses interaction patterns and their influence on the course of the adolescents' depression.

Laboratory and performance-based measures of depression in children and adolescents

Reviews laboratory and performance-based measures for the assessment of symptoms and correlates of depression in children and adolescents. First, we briefly review limitations of self-report and other report measures of depression. Next, we describe four laboratory methods, including social interaction tasks, information-processing tasks, measures of psychological deficits and laboratory analogue designs, and sleep studies. We then summarize the specific depressive symptoms measured by each of these methods. Finally, we discuss issues of the validity and utility of these methods.

Family interaction styles of children with depressive disorders, schizophrenia-spectrum disorders, and normal controls

Family interaction processes during a problem-solving task were examined in children with depressive disorders, children with schizophrenia-spectrum disorders, and a normal control group of community children screened for the absence of psychiatric disorder. Major findings were: a) children with depressive disorders were more likely than children with schizophrenia-spectrum disorders and children with no psychiatric disorder to direct guilt-inducing comments toward their parents; and b) parents of children with schizophrenia-spectrum disorders were more likely to direct harsh critical comments toward the child than were parents of depressed children or parents of normal controls. In addition, children's and mothers' use of benign criticism was linked, while children's harsh criticism was associated with intrusion from the father, and children's self-denigrating comments were related to specific paternal criticism. Implications of these results for understanding transactional processes associated with childhood-onset depressive and schizophrenia-spectrum disorders are discussed.

Interactional processes in families with depressed and non-depressed adolescents: reinforcement of depressive behavior

Problem-solving interactions were observed in 86 families of depressed adolescents and 408 families of non-depressed adolescents. Sequential analyses indicated that mothers of depressed adolescents were more likely than mothers of non-depressed adolescents to increase facilitative behavior in response to adolescent depressive behavior. Additionally, fathers of depressed adolescents were more likely than their counterparts in families of non-depressed adolescents to decrease aggressive behavior subsequent to adolescent depressive behavior. These analyses suggest that parents of depressed adolescents may be inadvertently reinforcing depressive behavior. Decreases in adolescent depressive symptomatology from year 1 to year 2 were not accompanied by changes in family interaction patterns.

Childhood and adolescent depression: a review of the past 10 years. Part I

OBJECTIVE

To qualitatively review the literature of the past decade covering the epidemiology, clinical characteristics, natural course, biology, and other correlates of early-onset major depressive disorder (MDD) and dysthymic disorder (DD).

METHOD

A computerized search for articles published during the past 10 years was made and selected studies are presented.

RESULTS

Early-onset MDD and DD are frequent, recurrent, and familial disorders that tend to continue into adulthood, and they are frequently accompanied by other psychiatric disorders. These disorders are usually associated with poor psychosocial and academic outcome and increased risk for substance abuse, bipolar disorder, and suicide. In addition, DD increases the risk for MDD. There is a secular increase in the prevalence of MDD, and it appears that MDD is occurring at an earlier age in successive cohorts. Several genetic, familial, demographic, psychosocial, cognitive, and biological correlates of onset and course of early-onset depression have been identified. Few studies, however, have examined the combined effects of these correlates.

CONCLUSIONS

Considerable advances have been made in our knowledge of early-onset depression. Nevertheless, further research is needed in understanding the pathogenesis of childhood mood disorders. Toward this end, studies aimed at elucidating mechanisms and interrelationships among the different domains of risk factors are needed.

Family-expressed emotion, childhood-onset depression, and childhood-onset schizophrenia spectrum disorders: is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.

The psychosocial functioning and family environment of depressed adolescents

OBJECTIVE

This study examined measures of functional impairment and family relations in a sample of 62 adolescents with major depressive disorder (MDD) and 38 normal controls with no history of psychiatric illness.

METHOD

Ratings of the following domains were obtained: mother-child relations, father-child relations, spousal relations, sibling relations, peer relations, and school performance. Ratings of each domain for the 3-month period preceding the assessment were derived from information obtained using a semistructured interview administered independently to the adolescents and one of their parents.

RESULTS

Adolescents with MDD were found to have severe difficulties in all areas. Ninety percent of the depressed adolescents had scores greater than 2 SD above the mean of the normal controls on one or more of the domain ratings. In addition, adolescents with difficulties in parent-child relations were more likely than those adolescents without problems in family relations to have difficulties in peer relations and school performance.

CONCLUSIONS

The authors discuss the importance of systematically examining psychosocial variables in future studies of the etiology, course, and treatment of MDD in adolescents.

One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion

The association between 1-year post-hospitalization outcome and the brief Five Minute Speech Sample (FMSS) measure of expressed emotion (EE) was examined among children with depressive disorders. Results indicated a strong association between 1-year outcome and the FMSS-EE measure. Whereas children returning to high EE homes were likely to show persistent mood disorder, recovery was more common among children returning to low EE homes. This predictive relationship was independent of possible mediating variables such as treatment regimen and clinical characteristics. Results provide the first reported demonstration that (1) the brief FMSS-EE measure predicts clinical outcome, and (2) EE measures predict 1-year outcome for children with depressive disorders.

Communication styles of children of mothers with affective disorders, chronic medical illness, and normal controls: a contextual perspective

Research has demonstrated impaired parent-child relationships in families with affective disorders. The present study examines the association of children's interactional style during a direct conflict-solving task to both the mother's interactional style and the child's diagnostic status. The sample includes 63 children, ages 8 to 16, of mothers with affective disorders, chronic medical illness, and normal controls. Children's dominant coping style profile (CS) (autonomous, neutral, or critical) was related to their mother's affective style (AS) (benign or negative). Affective disorder in the child at 6-month followup was associated with a critical CS profile at intake, while the child's nonaffective symptomatology was unrelated to CS. Findings indicate that children's affective disturbance is linked to interpersonal deficits in affectively charged situations. Results suggest that the child's CS is more strongly predicted by maternal AS than by either the child's or the mother's diagnostic status.