Cognition, competence, and coping in child and adolescent depression: Research findings, developmental concerns, therapeutic implications

The initial development and validation of the Racial Socialization Competency Scale: Quality and quantity

OBJECTIVES

The present study investigated the reliability and validity of the Racial Socialization Competency Scale (RaSCS). As posited by the Racial Encounter Coping Appraisal and Socialization Theory (RECAST), the RaSCS consists of 3 factors representing 3 novel dimensions of racial socialization competency present in families (e.g., stress, skills, and confidence).

METHOD

Responses to the RaSCS were collected from 361 self-identified Black and African American parents and primary caretakers across the United States.

RESULTS

After factor analysis, three scales and 27 items were maintained. Evidence was consistently found for 2 subscales within the stress dimension, namely "Call to Action" and "General" racial socialization stressors. Dimensions were also related to their respectively hypothesized constructs, including overall stress, racial socialization frequency, and self-efficacy.

CONCLUSIONS

Future directions and recommendations on the measure's use, particularly in the context of interventions, are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Personality of parents with bipolar disorder and interpersonal functioning among their offspring: a prospective 10-year study

A comparison of offspring of parents with bipolar disorder (OBD) and offspring of parents with no mental disorder (ONMD) showed that parents' neuroticism was associated with internalizing and externalizing problems among their children. The present study examined whether parents' neuroticism predicted poor interpersonal functioning among offspring 10 years later and whether the problems observed in middle childhood mediated the association between parents' neuroticism and offspring functioning. When offspring were in middle childhood, parents completed the revised NEO Personality Inventory and rated the child's behavior on the Child Behavior Checklist. Ten years later, 65 OBD and 59 ONMD completed interviews assessing mental disorders and interpersonal and noninterpersonal functioning. High neuroticism and low agreeableness in parents predicted poor interpersonal functioning in their offspring in late adolescence-early adulthood. The offspring's externalizing and internalizing problems in middle childhood partially mediated the association between parents' personality and offspring interpersonal functioning. Moreover, the association between parents' neuroticism and offspring internalizing problems was stronger among the OBD than the ONMD. Overall, the results suggested an intergenerational transmission of risk whereby high neuroticism and low agreeableness in parents were associated with behavioral problems among offspring in middle childhood that, in turn, predicted poor interpersonal functioning 10 years later.

A Longitudinal Study of Cognitive Risks for Depressive Symptoms in Children and Young Adolescents

Youths with high (N = 52) or low cognitive vulnerability (N = 48) for depression were selected from a larger sample (N = 515) of students (7-10 years old), based on their attributional style (AS), negative cognitions (NC), and/or self-competence (SC). Long-term effects of cognitive vulnerabilities on depressive symptoms were examined in a 3-year, three-wave, multiinformant, longitudinal design. Three findings emerged. First, some empirical overlap exists among these three types of cognitive diatheses, especially between NC and SC. Second, the combination of AS, NC, and SC had a significant (but diminishing) relationship to depressive symptoms at 6, 18, and 30 months, primarily due to NC and SC, not AS. Third, interactions between cognitive risk and life events were not significant, suggesting an additive type of diathesis-stress model for depression in young adolescents.

Factors associated with reported childhood depressive symptoms at age 8 and later self-reported depressive symptoms among boys at age 18

AIMS

This study aimed to study conditions associated with depressive symptoms at ages 8 and 18 in a representative birth cohort of Finnish males.

METHODS

The participants in this community-based 10-year follow-up study consisted of 2,348 boys born in 1981. At age 8, three informant sources were used: parents, teachers, and the children themselves. Depressive symptoms were established using the Children's Depression Inventory (CDI). At age 18, self-report questionnaires were used to study the boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI).

RESULTS

Poor adaptive functioning at age 18 was independently associated with both child and late adolescent depressive symptoms. Use of illicit drugs and somatic health problems were independently associated with later depressive symptoms. Parental divorce in early childhood independently predicted depressive symptoms both in childhood and in late adolescence. Teacher reports of child's total problems at age 8 independently predicted depressive symptoms at age 18.

CONCLUSIONS

Depression in males at ages 8 and 18 is particularly associated with stressful life events in childhood, whereas late depression is associated with somatic health problems and substance use. Further population-based studies comparing conditions associated with childhood and adolescent depression are needed.

Clinical and cognitive correlates of depressive symptoms among youth with obsessive compulsive disorder

Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, M age = 12.7 years) with primary OCD. Youths presented with a range of depressive symptoms, with 21% scoring at or above the clinical cutoff on the self-report measure of depression. Higher levels of depressive symptoms were associated with higher levels of cognitive distortions assessed on measures of insight, perceived control, competence, and contingencies. Depressive symptoms were also linked to older age and more severe OCD. Low perceived control and self-competence and high OCD severity independently predicted depression scores.

Depression as a longitudinal outcome and antecedent of preadolescents' peer relationships and peer-relevant cognition

Using longitudinal data and structural modeling, we investigated bidirectional associations among preadolescents' peer relationships, peer-relevant cognition, and depressive symptoms. Depression was expected to be an outcome and precursor of peer-relevant cognition, and cognition was expected to be an outcome and precursor of being more or less liked by classmates (peer likeability). We also examined whether cognition mediated the association between peer likeability and depression. Participants were 308 students (mean age = 11.0, SD = 0.9) who participated twice during a school year. A third assessment was completed with Grade 5 to 6 students 1 year after the second assessment. The model with bidirectional paths had a good fit to the data, but the most parsimonious model was an "effects" model showing that preadolescents with more depressive symptoms had less positive peer-relevant cognition at later assessments, and that those with more positive peer-relevant cognition were more liked by their peers over time. There were no age differences, some gender differences, and no support for cognition as a moderator of the association between depression and peer likeability.

Affect regulation in depressed and nondepressed children and young adolescents

The present study examined children's reported frequency and efficacy of strategies for regulating their negative affect in response to a description of a particular affiliative (fight with a friend) or achievement (loss at a game) situation. The 275 children were in kindergarten through eighth grade; they completed the Children's Depression Inventory and either the “Fight” or “Game” version of the Child Affect Questionnaire (CAQ-F or CAQ-G). Children who endorsed higher levels of depressive symptoms generally reported using affect regulation strategies significantly less often than did nondepressed children, and they rated these responses as significantly less effective in altering their negative mood. Depressed girls rated mother-initiated affect regulation strategies as less effective than did nondepressed girls. Younger children rated both self- and mother-initiated strategies as more effective than did older children. Several directions for future research are suggested.

Eine Untersuchung zur Spezifität kognitiver Leistungen depressiver Kinder und Jugendlicher im HAWIK-III

Zusammenfassung. Theoretischer Hintergrund: Auffälligkeiten im Leistungsverhalten gehören zu den zentralen Symptomen depressiver Kinder und Jugendlicher. Im HAWIK-III konnte eine spezifische, differentialdiagnostisch nutzbare Abbildung solcher Defizite noch nicht durchgängig nachgewiesen werden. Fragestellung: Lassen sich spezifische kognitive Defizite bei depressiven Kindern nachweisen? Methode: Das Leistungsprofil von 33 monopolar depressiven Kindern und Jugendlichen ohne Komorbidität (9-16 J., 22 w) wird mit einer Kontrollgruppe hyperkinetischer Patienten (n = 33; 7-15 J., 10 w) hinsichtlich störungsspezifischer Abweichungen von der Normstichprobe untersucht. Ergebnisse: Die depressiven Patienten weisen weder im Vergleich zur Normstichprobe noch zur Kontrollgruppe die erwarteten Defizite auf. Einzig im Allgemeinwissen (t(33) = -2.43, p = .021; d = -0.41) und Rechnerischen Denken (t(33) = -1.51, p = .141; d = -0.25) treten begrenzt Einbußen zu Tage. Schlussfolgerung: Die Leistungsdefizite der depressiven Patienten in schulähnlichen Aufgaben werden in Zusammenhang mit misserfolgsorientiertem und gehemmtem Verhalten verstanden. Der Stellenwert psychometrischer Leistungsdiagnostik in der klinischen Diagnostik von Depressionen wird diskutiert.

Depression in children and adolescents: linking risk research and prevention

The National Institute of Mental Health has called for translational research linking basic knowledge about vulnerabilities that underlie mood disorders to the development of effective preventive interventions. This paper highlights research about risk factors for depression in children and adolescents and links it to current knowledge about interventions aimed at preventing depression in youth. Basic epidemiologic and clinical research indicates that increased risk for depression is associated with being female; a family history of depression, particularly in a parent; subclinical depressive symptoms; anxiety; stressful life events; neurobiological dysregulation; temperament/personality (e.g., neuroticism); negative cognitions; problems in self-regulation and coping; and interpersonal dysfunction. These vulnerabilities both increase individuals' chances of encountering stress and decrease their ability to deal with the stress once it occurs. Although several existing depression-prevention studies have targeted one or more of these risk factors, the efficacy of these various prevention programs for youth with different combinations of these risk factors needs to be investigated further. Most existing depression-prevention programs in youth have used cognitive-behavioral techniques, with some success. Other depression-prevention strategies have included training in coping, social problem solving, social skills, communication skills, and parenting. A comprehensive prevention program is recommended that includes multiple intervention components, each of which addresses risk and protective factors across different domains and levels of analysis.

Contextual emotion-regulation therapy for childhood depression: description and pilot testing of a new intervention

OBJECTIVE

To pilot test the acceptability and efficacy of contextual emotion-regulation therapy (CERT), a new, developmentally appropriate intervention for childhood depression, which focuses on the self-regulation of dysphoria.

METHOD

Two samples of convenience (n = 29, n = 2) served to verify some CERT constructs; it was then operationalized in a treatment manual. To pilot test CERT, 20 children (ages 7-12; 35% girls) with DSM dysthymic disorder (mean duration 24.4 months) entered an open, 30-session, 10-month, 4-phase trial, with 6- and 12-month follow-up. Assessments included independent clinical evaluations and self-rated questionnaires.

RESULTS

Fifteen children completed theraphy, four were administratively terminated and one dropped out. Completers did not clinically differ from the rest, but they were more likely to have better educated and less depressed mothers and intact families. At the end of treatment, 53% of the completers had full and 13% partial remission of dysthymia (remission from superimposed major depression was 80%). By 6- and 12-month follow-up, 79% and 92% had full remission of dysthymia (p < 0.0001). Self-reported depressive and anxiety symptoms significantly declined by the end of treatment (p < .001) and remained so throughout follow-up.

CONCLUSIONS

CERT enables clinicians to "match" the intervention to children's emotion regulatory needs and symptoms and was readily accepted by families. The promising results suggest the need for a randomized trial.

Bias and Accuracy of Children's Perceptions of Peer Acceptance: Prospective Associations with Depressive Symptoms

Are depressive symptoms in middle childhood associated with more or less realistic social self-perceptions? At the beginning and end of the school year, children in grades 3 through 5 (n=667) rated how much they liked their classmates, predicted the acceptance ratings they would receive from each of their classmates, and completed self-report measures of perceived acceptance and depressive symptoms. Accuracy of perceived acceptance was indexed by the mean difference between pairs of predicted and received ratings (absolute values). Standardized residual scores created by regressing self-reported perceived acceptance (either predicted ratings or children's responses to a questionnaire measure of perceived peer acceptance) onto peer acceptance ratings formed two measures of bias. Bi-directional associations were found for accuracy of perceived acceptance and depressive symptoms; inaccurate perceptions predicted increases in depressive symptoms and depressive symptoms predicted decreased accuracy. Neither measure of bias predicted changes in depressive symptoms. Depressive symptoms predicted increases in negatively biased perceptions as assessed via questionnaire.

Girls' and mothers' social anxiety, social skills, and loneliness: associations after accounting for depressive symptoms

This study examined, in 102 mother-daughter dyads, whether (a) girls' social skills and loneliness are related to girls' social anxiety, after adjusting for girls' depressive symptoms, and (b) mothers' social functioning (social anxiety, social skills, and loneliness) is related to girls' social anxiety, after accounting for girls' social functioning (social skills and loneliness) and mothers' and girls' depressive symptoms. After accounting for girls' depression, girls' loneliness (and not social skills) was related to girls' self-reported social anxiety and girls' social skills (and not loneliness) were related to mothers' reports of girls' social anxiety. Mothers' social functioning accounted for significant variance in girls' social anxiety, beyond that accounted for by girls' social functioning and mothers' and girls' depression. Mothers' loneliness and fear of negative evaluation showed significant relations to girls' social anxiety when variance attributable to other variables was partialed out, whereas mothers' social skills and social avoidance and distress did not. Directions for future research on social anxiety are highlighted.

Ethnic and sex differences in children's depressive symptoms: mediating effects of perceived and actual competence

Examined ethnic and sex differences in depressive symptoms, along with hypothesized mediators of those differences (academic achievement, peer acceptance), for a sample of African American (n = 272) and Euro-American (n = 630) children in Grades 3 to 5. Group comparisons revealed a significant Ethnicity x Sex interaction in depressive symptoms. African American boys reported more depressive symptoms than Euro-American boys, whereas African American and Euro-American girls reported comparable levels of depressive symptoms. Sex differences in depressive symptoms differed by ethnicity: Boys were more depressed than girls in the African American group whereas girls were more depressed than boys in the Euro-American group. The Ethnicity x Sex interaction was mediated by academic achievement, but not peer acceptance. These findings have implications for understanding the mechanisms underlying depressive symptoms in preadolescence and for developing interventions to prevent depression.

Posttraumatic stress disorder in children. The influence of developmental factors

Despite the prevalence of childhood trauma, there are currently no developmentally oriented cognitive theories of posttraumatic stress disorder (PTSD). This paper outlines the definitional issues of PTSD in children, reviews the incidence of PTSD in children, and compares PTSD profiles in children and adults. We propose that a cognitive theory of childhood PTSD needs to accommodate developmental factors, including knowledge, language development, memory, emotion regulation, and social cognition, in addition to contextual factors such as family interactions. Implications of these developmental factors for assessment and treatment of traumatized children are discussed.

Child and Adolescent Empirical Psychotherapy Research

This paper reviews child and adolescent psychotherapy research, with a focus on two major theoretical classes of psychotherapies: cognitive-behavior and psychoanalytic psychotherapies. Our interest is particularly drawn to different issues: definition of psychotherapy and research on outcome and process. Specific attention is given developmental issues. We identify the major results and problems and propose methodological strategies for improving psychotherapeutic treatment research for child and adolescent disorders. Some areas that need to be addressed in the future are also discussed, such as the effects of specific techniques, the intensity and duration of treatment outcome and process, the effect of comorbidity, and the relationship between research and clinical practice.

Control-related beliefs and depressive symptoms in clinic-referred children and adolescents: developmental differences and model specificity

The contingency-competence-control (CCC) model links contingency and competence beliefs to perceived control and, in turn, to depression. However, a developmental perspective suggests that noncontingency may be too abstract a concept to be directly tied to depression before adolescence. We tested the CCC model and this developmental notion, using structural equation modeling, with 360 clinic-referred 8- to 17-year-olds. The CCC model fit the data well for the full sample accounting for 46% of the variance in depression. Separate analyses by age group placed perceived contingency in the best-fit model for adolescents (ages 12-17 years) but not for children (8-11 years). This suggests that abstract cause-effect concepts may have more direct affective impact after the cognitive changes of adolescence (e.g., formal operations) than before. Finally, the CCC model accounted for much more variance in depression than conduct problems, suggesting diagnostic specificity.

Predicting dysphoria in adolescence from actual and perceived peer acceptance in childhood

Predicted dysphoria in midadolescence using actual and perceived peer acceptance of 68 4th and 5th graders (48% male, 30% minority). Main effect, additive, and interactive models for predicting dysphoria were examined. Perceived acceptance predicted later dysphoria, after controlling for initial levels of dysphoria, supporting the main effect model. Actual acceptance did not uniquely contribute to prediction of later dysphoria, and actual acceptance did not moderate the prediction of dysphoria from perceived acceptance. Sex differences in dysphoria were significant, but sex did not moderate the predictive links between perceived acceptance and dysphoria.

The context of depression in clinic-referred youth: neglected areas in treatment

OBJECTIVE

To review the empirical, methodological, and conceptual limitations of psychotherapy and pharmacotherapy for childhood and adolescent depression and to present descriptive data on key characteristics of a depressed sample to illustrate gaps in treatment.

METHOD

Interview-based assessment of psychiatric features and psychosocial functioning, family psychopathology and marital adjustment, and child and parent stressful life events was performed in a sample of 43 depressed youngsters seeking outpatient treatment.

RESULTS

The empirical and conceptual review indicated that treatments based on downward extensions of adult procedures are limited in number and success. Also, the treatments generally neglect the following characteristics revealed in the descriptive data: depressed youngsters have high rates of recurrent depression and comorbid conditions, impaired academic and social functioning, exposure to high rates of parental psychopathology, parental assortative mating, severe marital dysfunction, and high rates of severe stressors.

CONCLUSIONS

Treatments need to be informed by and address the actual characteristics of depressed youngsters and their environments, which are highly dysfunctional.

Mother- and father-rated competence, child-perceived competence, and cognitive distortions: unique relations with children's depressive symptoms

Examined the unique relations of mother- and father-rated social and academic competence, children's perceived competence, and cognitive distortions to children's depressive symptoms. Participants were 389 8- to 12-year-old children and their mothers and fathers. Mother- and father-rated competence did not explain variability in child-reported depressive symptoms beyond that explained by child-perceived competence. Children's perceived competence was not related to mothers' ratings of children's depressive symptoms after statistically adjusting for mother-rated competence. Although child-perceived academic competence was not related to fathers' ratings of children's depressive symptoms after adjusting for father-rated academic competence, child-perceived social competence explained significant variability in fathers' reports of depressive symptoms, beyond that explained by father-rated social competence. Children's cognitive distortions were significantly related to both child- and mother-reported depressive symptoms after adjusting for the relations of both parent-rated competence and children's perceived competence. The results are discussed in light of competency-based and cognitive models of depression and highlight the need to consider the interplay of parent-rated competence, child-perceived competence, and cognitive distortions in examining childhood depression.

Practitioner review: the pharmacotherapy of adolescent depression

This paper is a review of the pharmacotherapy of adolescent depression. It begins with a brief discussion regarding the nature of adolescent depression and then critically evaluates the available evidence regarding the efficacy and tolerability of psychotropic intervention as it has, to date, been reported. As the available evidence suggests that tricyclic antidepressants have failed to show efficacy, yet demonstrate significant problems with tolerability and safety, the remainder of the article describes how clinicians should prescribe antidepressants using the serotonin reuptake inhibitors. Areas covered include assessment, treatment initiation, dosing, outcome evaluation, adverse events, and combinations. The review concludes with a discussion of long-term therapy with antidepressant medications.

The Emanuel Miller Memorial Lecture 1994. Depressive disorders in childhood: an impressionistic landscape

To convey an impressionistic landscape of depressive disorders in childhood, studies of clinically referred and diagnosed patients as well as community samples, and data from experimental investigations are used to consider five questions: Are depressive syndromes morbid states in childhood? Should we be concerned about depression in childhood? How do very early-onset depressions arise? What happens to depressed children as they grow up? And how can we help youngsters who suffer from depression? The information is discussed with respect to its implications for the management of clinically depressed children, as well as the prevention of very early-onset depressive disorders.

Coping with life span crises in a group at risk of mental and behavioral disorders: from the Lundby study

The subjects belong to a prospective, longitudinal population study on mental health, the Lundby study, performed in 1947, 1957 and 1972. In 1988-1989, 148 individuals, then 42-56 years of age, raised in families with at least 3 risk factors for mental or behavioral disorders, were interviewed about their life span coping style. Twenty-two coping mechanisms were rated; optimism, substitution, wishful thinking, problem-solving, planning, self-reliance, humor, acceptance, resignation, social support, comparison with others, religion, catharsis, self-criticism, value reinforcement, alcohol and drug consumption, professional help, endurance, information-seeking, isolating activity, magic and minimizing. Together they contributed statistically significantly to mental health (explained variance 24%) and quality of life (explained variance 28%). Problem-solving, social support and optimism were frequently used and were statistically associated with positive mental health and lower frequencies of some mental disorders. Sense of coherence, a personal disposition factor, was also statistically associated (explained variance 22%) with the combined coping mechanisms.

Developmental and symptom specificity of hopelessness, cognitive errors, and attributional bias among clinic-referred youth

The present study examined the unique and interactive relationships between age and indices of psychopathology (i.e., anxiety, aggression, and depression), with three types of maladaptive cognitions: hopelessness, negative cognitive errors, and attributional bias. Some negative cognitions were not unique to depression and were associated with broader psychopathology. Developmental considerations also influenced some negative cognitions or qualified the association between negative cognitions and depression.

The efficacy of psychoanalysis for children: prediction of outcome in a developmental context

OBJECTIVE

This is the third report from a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre. This paper examines the way in which the age of a child or adolescent at the time of treatment in psychoanalytic psychotherapy relates to the outcome of that treatment.

METHOD

One hundred twenty-seven children were selected from each of three age bands (younger than 6 years, 6 to 12 years, and adolescents); they were matched on broad diagnostic grouping, gender, socioeconomic status, global adaptation (Children's Global Assessment Scale), and frequency of sessions. Outcome was indicated by diagnostic change and clinically significant change in adaptation.

RESULTS

Younger children were more likely to show significant improvement. Children younger than 12 benefited from intensive (four or five times weekly) treatment more than from nonintensive (one or two times weekly) treatment; this was not true of adolescents. There were interactions between certain diagnostic categories, age, and outcome. Predictors of good and poor outcome were different for the three age groups, further highlighting the importance of a developmental perspective.

CONCLUSIONS

Within the limitations of a retrospective design, this study suggests that in psychodynamic treatment, younger age is an advantage and developmental factors considerably affect the outcome of this form of therapy.

Interpersonal functioning and depressive symptoms in childhood: addressing the issues of specificity and comorbidity

Research has supported linkages between depression and social impairment in youngsters, but has often focused on depressive symptoms in isolation. We collected data on depressive, anxiety, and externalizing symptoms in 161 school children. Information about interpersonal competence was gathered from several sources, including children, teachers, and behavioral observations. Depressive symptoms were found to be related to difficulties in multiple areas of competence, including maladaptive social problem-solving styles, conflict-negotiation and affect-regulation deficits, and peer rejection. Comparisons of the relative contributions made by depressive and anxiety symptoms to the prediction of functioning yielded some evidence for a specific relation between depressive symptoms and impairment. Children with cooccurring internalizing and externalizing symptoms generally suffered from the most social dysfunction. If replicated in clinical samples, findings such as these may help to guide intervention efforts with depressed children.

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.