Depression Assessment: Children and Adolescents

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For some people, it is surprising to learn that depression can strike early in life. However, the numbers don’t lie—children and adolescents experience depression at about the same rate as adults. For example, about 15% of children and adolescent will experience depression in their lifetime and that number is 16% for adults (CDC). Although the prevalence is similar, mental health problems in young people can look very different from mental health problems in adults. One common difference between pediatric and adult depression is that children and adolescents may be more likely to show irritability as the primary mood symptom when compared to adults.  Unfortunately, irritability can cause a lot of tension with family members, friends, and teachers making it hard to get social support at a time when young people may need it most.  When people experience depression early in life, they are at increased risk for relationship problems, teen pregnancy, poorer performance in school and career, and alcohol and substance use problems. Fortunately, there are several effective treatments for young people with depression.
Theories About Pediatric Depression
Some of the most common theories about why young people experience depression include:
• Stress Diathesis Theory (Hilsman, 1995) states that stressful life events interact with a built-in vulnerability to cause depression.  For example, a child with a sensitive or perfectionistic personality may be more likely to experience depression in response to family problems or traumas compared with children who do not have sensitive or perfectionistic personalities.
• Stress Generation Theory (Hammen) states that people who are prone to depression may be more likely to contribute to stressful life events that, in turn, make depression more likely.  For example, people with a history of depression are more likely to have relationship problems and relationship problems are one of the most common triggers for depression.
• Parent and Child Socialization Theory (Pomerantz) states that when children show difficulties, parents respond with one of two types of attempts to control their children’s experience: psychological control and behavioral control.  Psychological control involves using words to restrict or invalidate a child’s internal experience.  Behavioral control involves setting limits and using positive reinforcement to influence a child’s behavior.  Psychological control is associated with higher chances of developing depression.
Considerations for Treatment of Children and Adolescents
The general treatment guidelines  for pediatric depression are very similar to the general treatment guidelines for adults with depression.  Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are two psychotherapies that have strong evidence for the treatment of depression in young people.  Compared to CBT  for adults, CBT for young people pays extra attention to coping skills for irritability.  IPT  is most effective when a young person’s depression appears to be triggered by a change in their social life and they are willing to talk about it in psychotherapy. 
Prozac is the only antidepressant approved by the FDA for pediatric depression. Although other SSRI and SNRI antidepressants are not approved by the FDA for the treatment of pediatric depression, they are commonly used “off-label” for this purpose.  When it comes to medications for pediatric depression, it is important to be familiar with the Food and Drug Administration’s (FDA) warning on the safety and efficacy of antidepressants for children and adolescents.  In 2004, the FDA started a process that requires makers of antidepressants to state the potential for an increased risk of suicidal thinking and behavior in children and adolescents. These warnings are commonly called “black box” warnings. Thus, it is especially important that a young person is carefully monitored by a health care provider for changes in suicidal thoughts or behaviors when first beginning an antidepressant medication.

• Hilsman, R., & Garber, J. (1995). A test of the cognitive diathesis-stress model of depression in children: academic stressors, attributional style, perceived competence, and control. Journal of Personality and Social Psychology, 69(2), 370.
• Pomerantz, E. (2001). Parent x child socialization: Implications for development of depressive syndromes. Journal of Family Psychology, 15, 510-525.
• Hammen, C. (1991). The generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 555-561.