Chapter 10, p. 311-355 (zonder 322-323, 335-337 maar section summary wel)
Mood disorder = in which a disturbance in mood is the central feature.
→ Children with mood disorders suffer from extreme, persistent, or poorly
regulated emotional states, such as excessive unhappiness, ongoing irritability or
anger, or swings in mood from deep sadness to high elation.
Dysphoria = a state of prolonged bouts of sadness. Children who have severe depression
suffer from this.
Anhedonia = a state in which they feel little joy in anything they do and lose interest in nearly
all activities
Irritability = refers to easy annoyance and touchiness, characterized by an angry mood and
temper outbursts.
→ Irritability is one of the most common co-occurring symptoms of depression.
Mania = an exaggerated sense of well-being.
→ They suffer from an ongoing combination of extreme highs and extreme lows,
a condition known as bipolar disorder (BP) or manic–depressive illness.
Section summary:
● Children with mood disorders suffer from extreme, persistent, or poorly regulated
emotional states, for example, excessive unhappiness, irritability, or swings in mood
from deep sadness to high elation.
● Mood disorders are common and are among the most persistent and disabling
illnesses in young people.
● There are two major types of mood disorders: depressive disorders and bipolar
disorders (BP).
Even when children experience disappointment, disapproval, or other inevitable negative
events in their lives, their sadness, frustration, and anger are expected to be short-lived.
Unlike most children, who bounce back quickly when they are sad, children who are
depressed cannot seem to shake their sadness, and it begins to interfere with their daily
routines, social relationships, school performance, and overall functioning.
Unfortunately, depression often goes unrecognized and untreated because parents and, in
some cases, teachers may not recognize the child’s underlying subjective negative mood.
As depression in children was acknowledged, a popular view emerged that children express
depression in a much different way than adults, ways that are often indirect and hidden =
masked depression.
The long-lasting emotional suffering, problems in everyday living, and heightened risk of
these youths for suicide, substance use, other mental health problems, poorer health
outcomes, and higher health-care costs make depression in young people a significant
concern.
,Children express and experience depression differently at different ages.
- An infant may show sadness by being passive and unresponsive;
- a preschooler may appear withdrawn and inhibited;
- a school-age child may be argumentative and combative or complain of feeling sick;
- a teenager may express feelings of guilt and hopelessness, sulk, or feel
misunderstood.
No one pattern fits all children within a particular age group or developmental period, and
depression is not clearly recognizable as a clinical disorder using DSM criteria until children
are older.
It is important to recognize depressive symptoms in preschool children, since their
symptoms can persist or reoccur and develop into depressive disorders during late
childhood or early adolescence.
It also became clear that similar symptoms could occur even in noninstitutionalized infants
raised in severely disturbed families in which the mother was depressed, psychologically
unavailable, or physically abusive.
Therefore, the presence of a sad mood, diminished interest or pleasure, or irritability is
essential for diagnosing depression. In addition, regardless of the child’s age, the symptoms
must reflect a change in behavior, persist over time, and cause significant impairment in
functioning.
Depression as a
● Symptom = depression refers to feeling sad or miserable.
→ Depressive symptoms often occur without the existence of a serious
problem, and they are relatively common at all ages.
● Syndrome = depression is more than a sad mood.
→ A syndrome refers to a group of symptoms that occur together more
often than by chance.
● Disorder = depression comes in several forms.
○ major depressive disorder (MDD)
○ persistent depressive disorder (P-DD)
○ disruptive mood dysregulation disorder (DMDD)
■ frequent and severe temper outbursts that are extreme overreactions
to the situation or provocation;
■ chronic, persistently irritable or angry mood that is present between
the severe temper outbursts.
Section summary:
● Depression in young people involves numerous and persistent symptoms, including
impairments in mood, behavior, attitudes, thinking, and physical functioning.
● For a long time, it was mistakenly believed that depression did not exist in children in
a form comparable to depression in adults.
● It is now known that depression in young people is prevalent, disabling, and often
under-referred.
● The way in which children express and experience depression changes with age.
, ● It is important to distinguish between depression as a symptom, a syndrome, and a
disorder.
● Three types of DSM-5 depressive disorders are major depressive disorder (MDD),
persistent depressive disorder (P-DD), or dysthymia, and disruptive mood
dysregulation disorder (DMDD).
Key features of major depressive disorder (MDD):
- sadness
- loss of interest or pleasure in nearly all activities
- irritability
- a number of additional specific symptoms that are present during the same two-week
period
→ must represent a change from previous functioning
A diagnosis of MDD depends on the presence of a major depressive episode plus the
exclusion of other conditions, such as the prior occurrence of a manic episode.
It also requires ruling out physical factors.
Finally, the symptoms must cause clinically significant distress or impairment in important
areas of life functioning.
If full criteria are currently met for MDD, DSM-5 also provides for severity ratings of “mild,”
“moderate,” or “severe” based on the number of symptoms in excess of those required to
make the diagnosis, the amount of symptom distress and its manageability, and the extent of
impairment in life functioning caused by the symptoms.
3 important points about the diagnosis of MDD in children and adolescents:
1. The same DSM-5 criteria for diagnosing adults can be used to diagnose school-age
children and adolescents.
2. Because children’s disruptive behaviors attract more attention, or are more easily
observed as compared with internal, subjective suffering, depression in children can
be easily overlooked.
3. Some features of depression are likely more common in children and adolescents
than in adults—notably, irritable mood. In light of this, DSM-5 specifies that irritable
mood can substitute for depressed mood in diagnosing depression in children.
Children who develop MDD suffer from their disorder for many years longer than adults,
making early-onset of this disorder a particularly severe form of affective illness.
Since depression comes and goes, prevalence estimates vary with the time frame during
which symptoms are assessed.
The modest increase in depression from preschool to elementary school is likely not
biologically based, but rather is a reflection of the school-age child’s growing self-awareness
and cognitive capacity, verbal ability to report symptoms, and increased performance and
social pressures.
In contrast, the sharp increase in depression in adolescence appears to be the result of
biological maturation at puberty interacting with important developmental changes that occur
during this tumultuous period.
, The most frequent co-occurring disorders in youths with MDD are anxiety disorders,
particularly generalized anxiety disorders, specific phobias, and separation anxiety
disorders.
Many co-occurring disorders are present before MDD manifests, and they are likely to
persist after the child is no longer depressed.
The presence of a co-occurring disorder is significant because it can increase the risk for
recurrent depression, increase the duration and severity of depressive episodes, and
increase the risk for suicide attempts. The presence of another disorder also decreases a
depressed youth’s response to treatment and is related to less effective treatment outcomes.
Youth typically has a history of milder episodes of depression that do not meet DSM-5
diagnostic criteria.
A significant number of youths develop a chronic, relapsing disorder that persists into young
adulthood and beyond.
Depression is a condition that endures over the course of development, creating a long-term
social, emotional, and economic burden for the youth and the family.
As they become adults, youths with a history of MDD continue to experience many negative
long-term outcomes that include a high rate of suicidal behavior, adult depression and other
psychiatric disturbances, high rates of psychiatric and medical hospitalizations, alcohol
abuse/dependence, psychosocial impairments, lower educational achievement, and
employment problems.
Females are twice as likely as males to suffer from depression, are more susceptible to
milder mood disorders, and are more likely to experience recurrent episodes.
Many physical, psychological, and social changes during adolescence may heighten the risk
for depression in girls:
- hormonal changes in estrogen and testosterone may affect brain function,
- increasing sexual maturity may affect social roles,
- interpersonal changes and expectations may result in heightened exposure to
stressful life events,
- non-normative changes such as early maturation may lead to isolation from one’s
peer group
Findings suggest that sex differences in depression may be partly rooted in biological
differences in the brain processes that regulate emotions.
Race and ethnicity are known sources of varying levels of exposure to stress and availability
of resources.
