Does theory have value in clinical child psychology?

Examines the value and importance of theory in child psychology, particularly with respect to clinical practice. Although it is readily apparent that theory is not an essential element of treatment, the role of theory is to provide a coherent framework for clinical intervention. Theory provides a foundation for understanding the presenting pathology, the factors that affect it, the patient's and therapist's roles within the context of treatment, and the specific intervention strategies to be utilized. Therapeutic commonalities are considered as they may affect treatment outcome, but they are not viewed as the essential factors in efficacy. The value and meaning of eclecticism are also discussed.

Depression, self-esteem, sex, and age in a child and adolescent clinical sample.

Examines the relation between depression, self-esteem, sex, and age to determine if the previously reported associations between these variables in nonreferred samples remain consistent in a sample of clinically referred patients. Two hundred thirty-six participants between the ages of 6 and 17 years were included. All were consecutive referrals to an outpatient child and adolescent mood disorders program. Eighty-four percent met the criteria for at least 1 depressive disorder from the third and revised edition of the Diagnostic and Statistical Manual of Mental Disorders (major depressive disorder, dysthymia, both, depression NOS, or adjustment disorder with depressive mood). In keeping with previous reports, the data indicate an inverse relation between age and self-esteem and an even stronger inverse relation between depression and self-esteem. However, there was no evidence for a sex difference for self-esteem, alone or interactively with age. The implications of these findings in relation to the importance of self-esteem in depressed youth are discussed.

The failure of 'adult' interventions with adolescent depression: what does it mean for theory, research and practice?

The literature on the biological and phenomenologic presentation of major depressive disorder (MDD) in adolescents is reviewed and compared with that of depressed adults. Biological and psychosocial treatment approaches with adults and adolescents are then contrasted and the applicability of adult interventions to adolescents is examined. Some biological, cognitive, and experiential differences between adult and adolescent MDD may have treatment implications which have not yet been adequately addressed in the field. No effective treatments for adolescent MDD have, as yet, been developed or empirically tested. Based upon the results of this review, suggestions are made for the direction of future research.

Children's understanding of death in relation to child suicidality and homicidality.

This review examines children's understanding of death and how such understanding may be related to the increasing incidence of child suicidality and homicidality. Several factors have been reported to influence children's acquisition of the concepts of death. Those most often reported involved include children's age, cognitive development, and exposure to death; religion and culture appear to play a more minimal role. Most of what we know about how and when children begin to understand death is derived from research with healthy children. Although less robust, the data available from chronically physically ill children and suicidal children indicate some distortions in and less mature concepts of death. These distortions may indeed make death appear more attractive and less permanent to some suicidal children. Despite these provocative findings, no similar investigations have been conducted with homicidal children. Implications of these data for future research and potential intervention are discussed.

Continuity of psychopathology in a community sample of adolescents.

OBJECTIVE: To examine the continuity between the primary (first) diagnosis and secondary (second) diagnosis of those adolescents who have more than one episode of psychiatric disorder. Data were examined to determine whether the second episode "breeds true" (i.e., remains within the same diagnostic category as the first) or involves a different disorder. METHOD: The sample consisted of 236 youngsters selected from the larger (n = 1,507) population of adolescents (aged 14 through 18 years) from the Oregon Adolescent Depression Project who had been assessed on two occasions, approximately 1 year apart. RESULTS: Results support the continuity hypothesis for the categories of disorder studied (major depression, anxiety, disruptive, substance use), with the exception of dysthymia. Primary dysthymia did not result in the diagnosis of secondary dysthymia, because most adolescents who had dysthymia had not recovered within the time frame of the study and were chronic cases, often with secondary anxiety. Also presented are data on age of onset of disorder (lowest for anxiety and highest for substance use) and information on remission intervals between episodes (well time) (lowest for substance use and highest for anxiety). CONCLUSIONS: The findings are interpreted as providing support for the "breed true" hypothesis, although clearly not all second episodes are identical with the first. While the psychosocial factors examined did not predict the nature of the second disorder, this clearly needs further study.

Group psychotherapy for depressed adolescents: a critical review.

The usefulness and efficacy of group psychotherapy with a variety of adolescent problems has been well documented. Far less has been reported with respect to group treatment approaches for youthful depressives, however. Currently available treatments lack specificity, making replication difficult. Additionally, they often focus on a narrow range of deficit areas rather than addressing the multifaceted range of dysfunction characteristic of depression in adolescents. This paper critically reviews the available literature on group treatments with depressed adolescents, explores some of the shortcomings inherent in these reports, and suggests alternatives for future group protocols. It is proposed that subsequent interventions be manualized and that they target affective, behavioral, and cognitive aspects of adolescent depression. Such an approach would be more amenable to scientific investigation, replication, and comparison with alternative approaches.

Sexually abused children at high risk for post-traumatic stress disorder.

Ninety-two sexually abused children were studied using structured interviews and standardized instruments to determine the frequency of post-traumatic stress disorder (PTSD) and associated symptoms. Of these sexually abused children, 43.9% met DSM-III-R PTSD criteria; 53.8% of children abused by fathers, 42.4% abused by trusted adults, and 10% of those abused by strangers met criteria as opposed to none of the children abused by an older child. No relationship was observed between the time lapsed since last abusive episode and the presence of PTSD. Many children not meeting full criteria exhibited partial PTSD symptoms. Only one standardized instrument (Child Behavior Checklist) detected group differences with PTSD children exhibiting more symptoms. This study replicates an earlier pilot study and underscores the need for further PTSD research.

A secular increase in child and adolescent onset affective disorder.

Both longitudinal and cross-sectional studies utilizing population and family study samples have found evidence for a secular increase in major affective disorders in adults. Applying techniques used in cross-sectional studies in adults to family study data of children and adolescents, the authors demonstrate evidence of a parallel secular increase for child and adolescent onset affective disorders. Normal and depressed prepubertal probands were identified. All full siblings were directly interviewed for lifetime episodes of affective disorder. Analysis of the siblings (probands not further analyzed in this article) by the Cox proportional hazards model demonstrates that the risk for affective disorder is higher in siblings born more recently.

Current perspectives on anxiety disorders in children and adolescents: an overview.

This report provides an overview of the status of child and adolescent anxiety disorders. General biological and theoretical concepts of anxiety are reviewed, as are current diagnostic systems. We then examine developmental, epidemiologic, and clinical data, as they add to our understanding of child and adolescent anxiety disorders. A brief discussion of the assessment and treatment of childhood anxiety is also included. Some areas of future research are identified.

Anxiety disorders in children and their families.

The first- and second-degree relatives of children with anxiety disorders were compared with relatives of children with attention deficit-hyperactivity disorder and children who had never been psychiatrically ill for lifetime rates of psychopathological conditions, particularly anxiety disorders. Results from blind, diagnostic interviews indicated an increased prevalence of anxiety disorders in the first-degree relatives of children with anxiety disorder compared with relatives of both children with attention deficit-hyperactivity disorder and never psychiatrically ill children. Relationships between specific anxiety disorders in children and their relatives revealed an increased rate of panic disorder among the first-degree relatives of children with over-anxious disorder, compared with the relatives of children with separation anxiety disorder and children with other types of anxiety disorders. There also was a trend for panic disorder to be more prevalent among relatives of children with panic disorder than among relatives of children with anxiety disorder without panic. Obsessive-compulsive disorder was the only other anxiety disorder that appeared to show a similar specific relationship between children and their relatives. In general, the findings from this study suggest that there is a familial component involved in the pathogenesis of childhood anxiety disorders. The specificity of this relationship varies among individual anxiety disorders.

Paranoid schizophrenia in adolescence.

BACKGROUND: Paranoid schizophrenia is considered to be a rare condition in adolescence. Since this is contrary to the authors' clinical experience, they hypothesized that a controlled study would show that a significant number of adolescents would be diagnosed with paranoid schizophrenia and that scores from the childhood version of the Schedule for Affective Disorders and Schizophrenia (K-SADS) would differentiate between the paranoid schizophrenic adolescents and adolescents with other types of schizophrenia or with affective disorder. METHOD: The authors conducted a prospective study of 120 adolescents admitted consecutively to an adolescent psychiatric inpatient department. Patients were diagnosed on the basis of DSM-III after an 8-week period during which they were evaluated with a structured psychiatric history and psychiatric examination, the K-SADS, repeated nonstructured interviews, and extensive ward observations. RESULTS: Thirty-eight percent of the schizophrenic adolescents and 14% of the total hospitalized population met the DSM-III criteria for paranoid schizophrenia. The symptom profile of the paranoid schizophrenic adolescents clearly distinguished them from adolescents with other psychiatric disorders. CONCLUSIONS: Given the incidence of paranoid schizophrenia in an adolescent population, adolescent psychiatrists are likely to encounter this disorder. DSM-III-R should be used in future studies to further clarify the issue of the prevalence of paranoid schizophrenia in adolescents.

A community study of anxiety in children and adolescents.

The authors used an epidemiologic approach to investigate rates, symptoms, and behavioral concomitants of anxiety across the child and adolescent age span. They drew 210 children aged 8, 12, and 17 in equal numbers from a community sample and evaluated them with structured diagnostic assessments. They found anxiety to be the most frequently reported type of psychopathology across all three age groups. Although the prevalence of any anxiety symptom remained constant, specific types of anxiety varied with age. Age differences in nonanxiety behavior were found between subjects with and without anxiety, particularly with regard to interpersonal dysfunction.

Early onset psychiatric disorder in high risk children and increased familial morbidity.

The relationship between child psychopathology and familial morbidity in second degree relatives was examined for children considered at risk on the basis of parental affective illness. Second degree relatives in high-risk families with no child psychopathology were no different from low-risk families in their rates of depression and anxiety. Second degree relatives in high-risk families positive for child psychopathology had significantly higher rates of depression and anxiety than relatives of low-risk children and relatives of high-risk children with no disorder. The implications of these findings are discussed with respect to risk status, prepubertal onset of psychopathology, and familial morbidity for specific psychiatric disorders.

Psychopathology in a community sample of children and adolescents: a developmental perspective.

Psychiatric disorders, symptom clusters and adjustment problems in a community based sample comprised three age cohorts: 8, 12, and 17 years. The data indicated that anxiety symptoms decreased with age. Conduct problems increased with age for males, affective problems increased with age for females, and substance use and social anxiety increased with age for both sexes. Concerns about inadequacy also increases with age, but only for females. These gender-based developmental differences in psychopathology and other findings are discussed.

Psychometric properties of the K-SADS-P in an Israeli adolescent inpatient population.

Seventy adolescent admissions to a psychiatric unit were evaluated with a Hebrew translation of the Schedule for Affective-Disorders and Schizophrenia for School-Aged Children (K-SADS-P). Interrater and test-retest reliability and mother-child agreement were evaluated for diagnoses, symptom clusters, and 20 affective symptoms. K-SADS diagnoses were also compared with 3-month unit evaluation diagnoses as a measure of consensual validity. The reliability of assessing psychosocial functioning was additionally examined. Reliability and validity of diagnoses were high and reliability of symptoms and syndromes was good to excellent. Mother-child agreement faired less well on all measures. The use of semistructured interviews and DSM-III criteria in an Israeli adolescent psychiatric setting are discussed.

Anxiety disorders in mid-adolescence: a community sample.

The authors report the 6-month period prevalence of anxiety disorders in a community sample of 150 adolescents 14 to 16 years old. Diagnoses were based on structured psychiatric interviews, DSM-III criteria, and a psychiatrist's review of the data. Additional measures of affect, self-concept, and coping were also obtained for all subjects. Seventeen percent of the adolescents met criteria for one or more anxiety diagnoses and 8.7% were identified as "cases" of anxiety disorder. A significant relationship was found between anxiety and depression. The authors discuss the distribution and expression of anxiety disorders among adolescents in the community.

Psychopathology in children of parents with recurrent depression.

We examined the prevalence of psychopathology in children of parents with recurrent major depression (n = 61) and children of normal control parents (n = 46). Rates of psychopathology in the children of depressed parents were consistently higher when compared either with the control children or with rates of disorder reported for nonclinically referred children from other studies. Forty-one percent of high-risk children met criteria for at least one psychiatric disorder compared with 15% of low-risk children. Significant differences between groups were found for affective disorders and attention deficit disorder, and a nonsignificant trend was noted for anxiety disorder, all of which were more prevalent in the children of depressed parents.

Depression and depressive symptoms in preschool children from the general population.

This multiphasic study used four independent sources of information to investigate depression and depressive symptoms in a sample of preschool-age children from a general population. The study provides evidence that major depressive disorder exists in preschoolers and that stressful life events are associated with depressive symptoms; it underscores the importance of the teacher's report for identifying the presence of depression in this age group. Details of the findings, including a new scale for rating depression in young children, are discussed.

Psychiatric disorders (DSM-III) and cognitive impairment among the elderly in a U.S. urban community.

Results are presented on the current prevalence rates of psychiatric disorder in 2,588 non-institutionalized persons aged 65 and older who were drawn from a probability sample of New Haven, Connecticut, and 12 surrounding towns in South Central Connecticut. Based on the Diagnostic Interview Schedule (DIS), 6.7% of the respondents had a psychiatric diagnosis (DSM-III), and based on the Mini-Mental Status Exam (MMS), 3.4% had severe cognitive impairments during the past 6-month period. Therefore, more than 10% currently had either a psychiatric or a severe cognitive problem. Overall, these rates of psychiatric disorders are lower than those found in adult populations under age 65. As with younger samples, anxiety and affective disorders were among the most common psychiatric problems. The majority of elderly reported themselves in good emotional and physical health and felt they had sufficient finances to meet their needs. The rate of severe cognitive impairment did not increase until after age 79. Among those 80 years and older, cognitive impairments were more common in women than men, probably due to differential survival rates. Since less than 6% of the elderly sample are living in institutions these results among non-institutionalized elderly point to the relative psychiatric well-being of the majority of the elderly. However, in view of the longer life expectancy, the next decade will see an increase in the absolute number of persons with cognitive impairments.