Abstract
Empirical evidence shows that that depression disorder in children is a common condition that affects emotional, physical, and social development. Risk factors include parental conflict, a family history of depression, poor peer relationship, negative thinking, and deficit in coping skills. Treatment criteria of children and adults are the same, with the exception that children may display irritability rather than depressed or sad mood, and loss of weight may be seen as a failure gain appropriate weight milestones. Diagnosis and treatment should take into account developmental stage, suicidality, severity of depression, and social and environmental factors. The recommended therapies for mild depression include interpersonal therapy and cognitive behavior therapy and serve as appropriate adjuvant to medical treatments for those with moderate and severe depression. This paper explore depression among children, outlines different types of diagnosis, as well as the parameters for rare situations in which practitioners can try antidepressants when psychotherapeutic options fail and the depression is in severe stage.
Introduction
About 2.8 percent of children younger than 13 years suffer from depression at any given point in time (Clark, Jansen, & Cloy, 2012). The incidence of depression among children is a major concern because of the damaging and acute consequences associated with the disorder. Research shows that 60 percent of adolescents with depression experience recurrences throughout adulthood (Clark, Jansen, & Cloy, 2012). Moreover, adults with history of depression have high chances of committing suicide compared to those without history of the disorder (Clark, Jansen, & Cloy, 2012). The symptoms of depression in children vary, and often pass undiagnosed and untreated they are ignored as normal psychological and emotional changes that occur during growth. Depression in children is often associated with anger or irritability or anger, social withdrawal, continuous feelings of hopelessness and sadness, changes in appetite, poor concentration, and thought of suicide or death. Despite the high prevalence of children depression, many cases go under diagnosed and under-treated (Clark, Jansen, & Cloy, 2012). The inadequacy of mental health care professionals has rendered family physicians responsible for diagnosing and treating childhood depression.
Diagnosis
When considering suitable diagnosis of depression, physicians must take into account medical causes of presenting such as anemia, hypo- or hyperthyroidism, or uses of certain medications, including isotretinoin (Burgić-Radmanović, 2011). If the mood of the client is better explained by medical reasons, the diagnosis of major depressive disorder is not suitable. Some psychological illnesses present in children that share similarity with depression, especially dysthymic, adjustment, and bipolar disorders. These disorders have symptoms similar to those found in children with depression.
Differential Diagnosis
Identification of depression among children in the clinical setting remains a challenge. Common symptoms such as sadness or irritability, when persistent in the absence of other depressive symptoms, are rather nonspecific indicators and cannot help to differentiate childhood depression from other disorders. A research conducted to investigate the likelihood of specific depressive symptoms associated with major depression compared to a variety of childhood disorders suggested that excessive guilt, anhedonia, poor concentration, and extreme fatigue are the most instrumental signs of childhood depression as distinguished from other early psychiatric disorders (Luby, 2010). Findings from this research provide useful framework for differential diagnosis of childhood depression.
Risk Factors
Even though risk factors for childhood depression are categorized as psychological, biological, or environmental (Table 1), these factors often correlate (Clark, Jansen, & Cloy, 2012). For example, history of parental depression is strongly associated with childhood depression, while children of parents with depression are three times at risk of depression than those whose parents do not have such history (Maughan, Collishaw, & Stringaris, 2013). Additionally, the age when the risk factors occur may predict depression in the future. For example, children diagnosed with health problems such as asthma and diabetes mellitus between the age of three and five are more prone to depression (Clark, Jansen, & Cloy, 2012)
Continuities and discontinuities across development
Empirical research of depression among children confirms that it is a chronic and recurrent condition (Burgić-Radmanović, 2011). Evidence of persistence of the same disorder over time (homotypic continuities) may suggest the recurrence of a single disease at different developmental stages. On the other hand, homotypic continuities may imply that either that some disease process manifest differently across developmental stages, or that one disorder acts as a risk factor for the other. There is research evidence for both processes in childhood depression. Starting with homotypic continuities, follow-ups on younger children samples provides evidence of continued risk for depression in late childhood (Luby, 2010).
Treatment
There exists little empirical literature to guide the treatment of childhood depression once the diagnosis has established the risk factors. Owing to the relatively limited recent scientific validation and acceptance of childhood depression, no methodical treatment studies have become available. This has posed a major challenge to effective treatment of childhood depression. Psychotherapies applied to adolescent and adult depression, specifically interpersonal psychotherapy and cognitive-behavioral therapy (CBT), have been adopted for use in children with depression. While many empirical researches have reported positive results with CBT for treating children, data showing the efficacy of interpersonal psychotherapy are only available for adolescents.
Early treatment of depression helps for faster recovery for children with the disorder. Both counseling and medicine can help treat depression in children. The play environment of the child and the role of the family in the treatment are different from that of adolescents and adults. In most case, the child’s health care provider may recommend psychotherapy first, and consider antidepressant medication as an additional option in case there is no significant improvement. However, there no good empirical research documenting the effectiveness of medicine therapy over psychotherapy for children. However, empirical research shows that antidepressant Prozac is effective in treating childhood depression (Burgić-Radmanović, 2011). Even though a study has demonstrated the efficacy of fluoxetine in treating childhood depression (Luby, 2010), further complicating the treatment of childhood depression is the fact that children with depression are characterized by alterations in neurotransmitter system. These differences in development stages have been proposed as factors contributing to the lack of efficacy of tricyclic antidepressants.
In line with these findings and balancing the need for efficiency and safety, parent-child dyadic psychotherapeutic interventions are the recommended treatment for childhood depression. Dyadic approaches defined by the relationship between the parent and the child are the main psychotherapies suitable for children, given primary reliance of the child on parents or caregiver for adaptive and socio-emotional functioning. Early behavioral and psychotherapeutic approaches showed positive results in treatment of early disruptive disorders in early childhood (Burgić-Radmanović, 2011). Given these promising findings, health professionals have developed a parent-child psychotherapy treatment for childhood depression and is currently undergoing validity test. Parent Child Interaction Therapy–Emotion Development (PCIT-ED) is a annualized 14-session psychotherapeutic treatment. Borrowing much from a well-validated manualized treatment (PCIT) developed by Eyberg, PCIT-ED defines the key role of caregiver in implementing this treatment and helping the therapist (Teixeira, & Lima, 2013).
Conclusion
Childhood depression is a major problem that still lacks adequate research to develop and effective diagnosis and treatment method. As this research paper suggests, developmental studies have resulted into constructive contribution to the understanding of childhood depression, and the complex interaction between psychological, inherited, and psychological factors that influence short- and long-term risk factors. Taking a developmental perspective provides a crucial means of understanding how proximal and distal risks interact with normal developmental processes to affect the vulnerability of childhood depression. The recommended treatment for childhood depression is multimodal treatment that includes parent and family education, while other methods such as antidepressant medication can help in some conditions. Depression among children should be identified early, and treated because the potential of adversely affecting on emotional, social, and cognitive development.
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