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Major depressive disorder, or MDD, may affect up to twenty percent of the adult population. The recognition of depression as a serious and common mental disorder has been vital in the identification and treatment of depression in adults. Leaps and bounds have been made in the field of depression research. The widespread recognition of the many possible causes of depression, including chemical imbalances with genetic or medical origins as well as traumatic life events, has made it possible for those suffering from depression to openly seek treatment options and discuss their depression without necessarily feeling the same overwhelming shame and isolation that were inevitable in generations past. Depression is more likely to be identified in an affected individual by family members, physicians, or others because of the public information that is available for professionals and the common people. Research is constantly revealing new treatment options, identifying causal factors, and overall quickly improving the outlook for depressed adult individuals.
Unfortunately, there exist a significant number of individuals suffering from depression that are not benefiting from the research developments, educational campaigns, and treatment options that have changed the outlook for so many others. Childhood depression has been an under-recognized disorder. However, ignoring childhood depression does not make this problem disappear. For many years, it was believed that young children simply do not have the mental or emotional capacity to become affected by depression. Symptoms which would have been telltale of this disorder in an adult have been dismissed as shy or rebellious behavior, or completely misdiagnosed as another disorder, such as a learning disability. Parents, teachers, and others involved with children remain uneducated about childhood depression. Researchers may be reluctant to focus on the difficult topic of childhood depression. Children continue to suffer with major depressive disorder, even while revolutionary findings are eliminating the need for suffering among adults with major depressive disorder.
The need for further research in the area of childhood depression is therefore blatantly obvious. The well-being of children relies on the dedication of adults to researching and developing solutions to problems. Major depressive disorder is indeed a childhood problem. The purpose of the proposed research at hand is to study some of the important primary issues which must be addressed when studying depressive disorders in children.
The primary focus of the proposed study are the factors which may directly cause childhood major depressive disorder, or which may cause children to be predisposed to depression. In order to understand depression in children, it is necessary to know the origins of this disorder. Treatment options can be opened up to include specifically formulated counseling and/or medication -- or even prevention -- if the exact causes of depression can be properly identified. "Education is key in the management of childhood depression. Both the patient and the family should understand the difference between clinical depression and the typical growing pains of development: although most children experience periods of loneliness, rebellion, and confusion, depressed children feel this way all or most of the time....Education may also diminish the feelings of blame and guilt often felt by the child or parents...depression does not simply result from the influence of a particular environment and is not preventable." (Louder 2004)
An important aspect of the present study is to review literature that is currently available from research conducted on childhood depression. Unfortunately, while a great deal of the MDD research conducted which has focused on adults is invaluable to this subject, it is necessary to filter out a lot of information that is not transferable from depressed adults to depressed children. Information taken from studies on adult MDD may actually be detrimental if not properly filtered because it will give researchers inaccurate expectations of how children may respond to causal factors and treatments alike. Therefore information will be collected from studies which have specifically focused on childhood depression. This literature will help to identify a wide spectrum of causal factors, as well as some correlating factors, and a quick survey of treatment options. However, the focus of the review of literature will be on the direct causal factors and factors which will predisposition children to major depressive disorder.
In order for childhood depression to be properly diagnosed and treated, the predispositioning and causal factors must be understood. The literature review will show that these factors are an integral part of how and why depression manifests in children. Further original research will be conducted to identify how widespread the lack of knowledge regarding the causes and symptoms of childhood depression may be. Additionally, the proposed research will identify further causal factors and symptoms that may be correlated to childhood depression which may not have been thoroughly covered by the material in the review of literature. From this research, further clarity may be drawn on the causal and predispositioning factors of childhood depression, as well as the ways in which depression may manifest itself in children and the lasting effects this may have on the affected child.
This study is intended to help provide guidelines for future research and development in the field of child depression and MDD. The literature review and findings from the original survey research that will be conducted are delimited by the fact that they are not being performed for the purpose of gathering conclusive evidence. The proposed research and survey will give an overview of the current state of academic knowledge on this subject, as well as an overview of the experiences of individuals who have experienced childhood depression first- or second-hand. Further clinical research will be necessary in order to provide more definitive results.
For this study, the definition of major depressive disorder will be based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which outlines the criteria for a diagnosis of MDD. (Louters 2004) Major depressive disorder cannot be diagnosed without five or more of the listed symptoms being present during a two-week period. These symptoms must occur every day or nearly every day, and they include the following:
1. Decreased concentration, indecisiveness
2. Depressed or irritable mood
3. Diminished pleasure or interest in activities
4. Failure to make expected weight gains
6. Feelings of guilt or worthlessness
7. Insomnia or hypersomnia
8. Morbid thoughts, suicidal ideation or attempt
9. Psychomotor retardation or agitation.
However, the term childhood depression may be used herein without there being an official, clinical diagnosis for the individual or individuals in question.
An introduction to childhood depression including causal risk factors, symptoms, and research was presented by Lauren Louters in the Journal of the American Academy of Physicians Assistants article, "Don't overlook childhood depression: an effective approach to childhood depression requires that you maintain a high index of suspicion and understand the disorder's full spectrum of manifestations." (2004) Louters acknowledges that in the past, the possibility of diagnosis for mood disorders such as MDD in children was not considered. "Although children once were thought to lack the emotional and cognitive ability to experience depressive symptoms, we now know that a range of mood disorders, including major depressive disorder (MDD), can affect children and adolescents." (Louders 2004) Despite the recognition of psychologists that this mood disorder does affect children, it is still not as widely recognized as adult depression.
Mood disorders such as depression can be very difficult to recognize and diagnose in children, presenting some difficulties that are not factors for adults. One difficulty is that there are issues such as the child's stage of development; the presentation of depression may be very different depending on the stage of development and other factors. Often times, depression is mistaken for other conditions in children, or comorbid conditions may further complicate diagnosis by masking or altering the symptoms of depression. Children also generally do not have the same amount of integration into the norms of social behavior as adults. "The spectrum of normalcy among children may also be a factor: a socially withdrawn 6-year-old may be depressed or may be just shy, while an adolescent's troublesome behavior may be related to clinical depression or to the challenges of growing up." (Louders 2004) There is still no objective test for mood disorders, including depression.
A number of possible symptoms, including an irritable mood, a loss of interest in activities that once brought pleasure, fatigue, disinterest in food, abnormal sleeping patterns, thoughts about suicide or attempts to commit suicide, and a number of other possible symptoms, must be taken into consideration when recognizing depression in children. "Psychiatric disorders other than MDD -- such as bereavement, adjustment disorder with depressed mood, bipolar disorder, and substance-induced mood disorder -- should also be considered. Alcohol and marijuana use can cause depressive symptoms, as can drugs such as systemic corticosteroids, oral contraceptives, benzodiazepines, barbiturates, stimulants, and anticonvulsants." (Louders 2004) However, the detection of just one symptom does not give cause to diagnose depression, nor does the detection of several symptoms guarantee the presence of depression. Children may also be exhibiting symptoms, however…[continue]
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