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Children and Adolescents with Depression
Statistics show that up to 2.5% of children and 8.3% of adolescents suffer from depression in the United States. Depression is thought to affect school performance, social interactions and family relationships. However, diagnosis and treatment of depression in children and adolescents have been hampered by the confusion of the symptoms of depression with normal adolescent behaviors. In order to reduce the incidence of depression and its effects on young people, the researcher aims to provide information that will help to clear up some of the controversy. Most of the research on depression has been done with adults but depressed children and adolescents show some different symptoms. There is not enough research on the topic of depression in children and adolescents in general, and on how depression affects their lives.
The study will address the following research questions:
How does depression affect the academic performance, social interactions and peer relationships and family life of children and adolescents?
What difficulties do children and adolescents with depression face in managing and treating the illness?
The literature was reviewed to gain insights in the research that has been done on the effects of depression on various aspects of the behavior of children and adolescents. Research methods, particularly instruments used, were also noted.
Messman (2000) in her examination of parent- and teacher- reported behaviors in relation to child-reported depression and anxiety in preadolescents concluded that parents needed to be more acutely aware of the internalizing behavior of their children. This study was a continuation of a longitudinal study of 420 preschool children drawn randomly from the general population of a Dutch province. The sample eventually consisted of 293 children of average age 10.9 years. The main aim of the study was to investigate which parent- and teacher- reported behavioral syndromes signal the presence of child-perceived depression and anxiety in children. A packet of questionnaires was mailed to all participants- children, parents and teachers. The instruments used were:
The Dimensions of Depression Profile for Children (DDPC) to assess specific aspects of depression in children, The Child Behavior Checklist / 4-18 (CBCL/4-18) for the parents, and The Teacher's Report Form (TRF) for the teachers.
The results of the study showed that the correlation between child-reported depression and anxiety and the parent- and teacher- reported behavior signs were generally small or medium. The teacher- reported syndromes were generally higher and more significant that the parent-reported syndromes. The results indicate an apparent lack of parental awareness of child-perceived internalizing problems.
It would be useful to extend this study to determine if this is true of parents and children in my culture. Obtaining data on the parents' and teachers' perception of childhood and adolescent depression and their ability to recognize the symptoms will lead to earlier diagnosis and intervention and better support for the child or adolescent.
In younger children it is harder to diagnose depression. Play is a useful activity to use in the study of depression of children since most of their behavior is expressed in play, e.g. loss of interest and pleasure, hypo activity, psychomotor agitation and aggression. Mol Lous and others (2000) compared the behavior of depressed and non-depressed 3- to 6-year-olds in three play situations- solitary free play, interactive free play and play narratives. They used seven depressed children (3 girls and 4 boys) and matched them with seven non-depressed children, ages from 3 yrs - 5 yrs 11 months. The children were observed in rooms at their school. The experimenter chatted first with the child and then played with him/her. For solitary free play the experimenter played two games with the child- a puzzle and a bowling game. The child was then left for four minutes to engage in solitary play while being videotaped. For interactive play, the child was invited to play for twenty minutes with the experimenter in the room equipped with play materials and toys- Lego, blocks, clay, dolls, etc. This was also videotaped. The child and experimenter then sat at a table for play narrative. The child was given dolls and props at the start of a story and asked to choose a doll to represent the child and family and to act out how he thought history would end. In each of these three situations nine behaviors were observed, three play behaviors and six non-play behaviors.
The researchers found that the depressed children played significantly less than the non-depressed children; more so in symbolic play than in manipulative play. The depressed children also displayed more non-play behavior and more behavior changes. The researchers concluded that depressed children are not necessarily less active than non-depressed children. Their behavior patterns are only different.
This study provides a useful way to study depression in young children particularly since it is difficult for young children to fill out questionnaires or to be interviewed.
Family interaction is an important aspect of the effect of depression on adolescents especially since the relationship with parents is important to help adolescents develop their autonomy. Pavlidis and McCauley (2001) investigated the relationship between depressed adolescents and their mothers. The sample consisted of twenty dyads of clinically depressed adolescents (ten females and 10 males) and their mothers, and twenty externalizing youths and their mothers and twenty non-clinical youths and their mothers were used as controls.
Each dyad underwent a three- hour visit and the mother had an additional one- hour visit. The assessment tool used was the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS) and the Issues checklist (a 44-item self-reporting scale of everyday conflicts between parents and adolescents) Each dyad chose one of the topics of discussion from the checklist for a 15 minute videotaped problem-solving discussion. The adolescents also completed the Inventory of Parent and Peer Attachment (IPPA), a self- report instrument with 28 parent and 25 peer items.
The depressed adolescents and their mothers did not differ in their behavior compared with the non-clinical adolescents. The externalizing adolescents showed the highest impairment in autonomy and relatedness. The depressed and externalizing adolescents perceived their relationship with their mother to be impaired compared to the non-clinical adolescents. However this level of impairment reported by the depressed adolescents was not observed in the study.
Further study is needed to deeper examine this discrepancy between the perception of the depressed adolescents and the observation. There may be some effect on the emotions or the cognitive processes of the depressed adolescents that are not accurately manifesting themselves.
Another important challenge for depressed children and adolescents is their peer relationships. Hecht, Inderbitzen and Bukowski (1998) conducted a study of 1,687 students (854 males and 833 females) in grades 4-11 from nine different schools in Midwest, U.S.. The study sought to correlate the peer status of the children with their level of depression. The instruments used were the Peer Socio-metric Nomination Task and the Children's Depression Inventory (CDI). The Nomination Task required them to nominate three same gender grade mates for seven behavioral descriptors e.g. like most, best leader, fights most, etc. This was analyzed to group students into socio-metric groups and subgroups. The main groups were popular, rejected, neglected, controversial and average.
There was no difference in the total CDI score but there were differences in specific depression subscales. The aggressive-rejected children reported more interpersonal problems; the neglected and submissive-rejected reported less pleasure and interest in activities. The study therefore found definite correlations between children's perception of their status with their peers (whether they were accepted or rejected) and reported symptoms of depression. This study could be expanded to include other areas, e.g. inner city, and more ethnically diverse students and also include reports from teachers and parents and observations.
One of the challenges of depression in this early age is the possibility of its continuation into adulthood. A…[continue]
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