A follow-up investigation of offspring of parents with bipolar disorder.

Seven male children who each had a manic-depressive parent (five alos had a parent with unipolar depression) and 12 control children were studied. The proband children had shown a range of adjustment problems as infants and toddlers. Four years later, they continued to have substantial behavior problems, including ones that could be classified as DSM-III psychiatric diagnoses. On the basis of psychiatric interviews and psychological assessments, the proband children received more DSM-III diagnoses than the control children. Proband children reported internalizing symptoms; this pattern was corroborated by their mothers, who also characterized these children as showing antisocial behavior patterns.

Personal and social resources in children of patients with bipolar affective disorder and children of normal control subjects.

The authors examined the personal resources (social problem-solving ability, internal locus of control, self-esteem, and self-perceived competence) and social resources (social network structure and support) in 23 children of patients with bipolar affective disorder (probands) and 33 children of normal control parents. Positive resource profiles were related to psychiatric well-being in the offspring. Nondisordered probands, in particular, demonstrated a strikingly positive profile of personal resources as well as a wide range of peer, sibling, and other kin supporters. Disordered probands had a strikingly negative set of personal resources and a relatively greater reliance on nonkin adult supporters. The absence of a supportive best friend was associated with affective disorder across offspring groups.

Social and affective development in infants with a manic-depressive parent.

The authors observed seven infants who had a manic-depressive parent longitudinally in a structured laboratory setting with their mothers at ages 12, 15, and 18 months. The infants' attachment and affiliative behaviors and the patterning of their affective responses were assessed according to systematic measures and compared with those of a matched control group. The proband infants appeared to show a disturbance in the quality of their attachments to their mothers as well as a generalized disturbance in their capacities to regulate their emotions adaptively. There appeared to be an increasing severity of disturbance with increasing age. The authors discuss the implications of these findings.

Altruism, aggression, and social interactions in young children with a manic-depressive parent.

This is an exploratory study of the emotional and social functioning of young children with a manic-depressive parent. Seminaturalistic observations and experimental manipulations of the affective environment were used to assess 2-year-old children's regulation of emotion, as well as their aggression, altruism, and affiliative interactions. Children with a bipolar parent sometimes showed heightened distress and preoccupation with the conflicts and suffering of others, especially disturbances in adults. These children had difficulty in maintaining friendly social interactions, in sharing, and in helping their playmates. They also had difficulty modulating hostile impulses; they showed more maladaptive patterns of aggression toward peers and adults. These interpersonal and emotional problems of offspring of manic-depressives were often similar to those problems of manic-depressives that have been implicated in the clinical literature as possibly associated with the transmission of the disorder. This apparent congruence of findings obtained from different disciplines employing very different research strategies and studying people of different ages, attests to the utility of an explicit interdisciplinary approach in the area of developmental psychopathology.

Problem behaviors and peer interactions of young children with a manic-depressive parent.

By the age of 2 years, children with a manic-depressive parent were already found to be experiencing substantial psychiatric problems. The authors examined the ways in which these early problems then become embedded in social relationships. Naturalistic observations and experimental manipulations of the emotional environment were used to measure 2-year-old children's regulation of emotion, aggression, and altruism during peer interactions. Children with a manic-depressive parent had difficulty in sharing with their friends and in handling hostility, showing maladaptive patterns of aggression. The social and emotional problems of these children were similar to the interpersonal problems of their manic-depressive parents.

A developmental view of affective disturbances in the children of affectively ill parents.

The authors review the various clinical and experimental studies of children of parents with affective illness, spanning infancy, childhood, and early adolescence and including their own and the studies reported in this Special Section of the Journal. They find a clear tendency to early disturbances in these children that seems related to adult affective illness in the areas of affect regulation and social interaction. Although these findings suggest a developmental line of affective illness linking child and adult forms, many issues need further clarification.

Depression in a sample of 9-year-old children, Prevalence and associated characteristics.

We investigated the prevalence of depression in a sample of 9-year-old children from the general population being studied longitudinally. Current point prevalences of major and minor depressive disorder were estimated at 1.8% and 2.5%, respectively. A comparison of children with depression and a nondepressed group disclosed no significant differences by sex, nor any significant association between depression and socioeconomic status, teacher reports of behavior problems, and cognitive or motor development. The children with current depression were reported by a parent to have had a history of more behavioral problems, had been referred more often for assessment or treatment of behavioral or emotional problems, and had more negative self-perceptions of their academic ability. The results suggested that parents may be more sensitive than teachers to the behavior problems exhibited by depressed children.

Lithium in children of lithium-responding parents.

Six offspring of manic-depressive patients, whose parents were lithium responders, were selected on the basis of their incapacitating psychopathology for treatment with lithium. The children ranged in age from 6 to 12. A double-blind, crossover design was used over 16-18 weeks. Weekly ratings were done, and average evoked potentials (EPs) were measured at each crossover. Two children diagnosed as having a bipolar affective disorder had a clear-cut response to lithium and were strong augmenters on the EP. This, taken together with the similarity of the EP changes on lithium to those occurring in adult patients treated with lithium, supports a physiological parallel between bipolar affective illness in adults and children.

Current perspectives on childhood depression: an overview.

The rapidly increasing research interest in childhood depression indicates that it has become a recognized disorder. The authors review the literature on depression in children, focusing on epidemiology, various diagnostic criteria, classification schemes, assessment instruments, and intervention studies that have been applied to childhood depression. Given that there are many etiological factors, it will be important to study the disorder from various conceptual frameworks, including biochemical, genetic learned helplessness, life stresses, cognitive distortion, behavioral reinforcement, and sociological models.

Depression among incarcerated delinquents.

The authors examined the prevalence of depression among incarcerated delinquents and nonincarcerated, nondelinquent adolescents and reported a prevalence of 18% and 4%, respectively. The possible effect of incarceration on the development of depression was also studied. DSM-III diagnostic criteria for major depressive disorders were used. Of the 100 delinquents admitted consecutively to a detention center, 11 showed evidence of depression both during and before incarceration, while seven developed a depressive disorder in the center. With regard to specific symptoms, 100% of the depressed incarcerated adolescents were found to suffer from sleep difficulties, and 94% experienced disturbances of appetite. Psychomotor retardation or agitation were the symptoms least commonly observed.

Diagnosis of depression in children: a reassessment.

The recent interest in childhood depression has exacerbated the confusion about nosology of this disorder. The authors have attempted to synthesize the latest thinking of several groups working in this area. They present a point-by-point comparison between the diagnostic criteria of Cytryn and McKnew, Weinberg, Kovac's CDI, and DSM-III. There is a striking overlap between these criteria with minor exceptions. This comparison led the authors to conclude that childhood and adult diagnostic criteria for affective disorders are very similar, and DSM-III is a valid instrument for diagnosing childhood affective disorder.

Offspring of patients with affective disorders.

All the children (ages 5-15) of 14 consecutive patients admitted to hospital at the National Institute of Mental Health with a diagnosis of bipolar or unipolar affective disorder were studied. The children were seen twice, four months apart, and assessed by an interview and rating scales. The parents were also assessed. Of 14 boys, five were depressed on both interviews and three were depressed on one interview. Four of the 16 girls were depressed on both interviews and 11 were depressed on one interview. The clinical picture and the ratings showed the boys, but not the girls, to have a significant correlation for depression on both interviews. The children diagnosed as suffering from depression showed the symptoms of a primary unipolar affective disorder without other significant pathology.