Differential diagnosis of childhood depression: Using comorbidity and symptom overlap to generate multiple hypotheses

Abstract

Childhood depression is often found to share symptoms and coexist with several other childhood disorders and physiological conditions, leading to diagnostic errors and possibly inappropriate treatment. Literature relevant to the differential diagnosis of childhood depression is reviewed with particular attention given to the similarities and differences between depression and coexisting conditions such as anxiety disorders, conduct disorders, and attention deficit hyperactivity disorder. The characteristics of childhood depression are compared and contrasted with other possible coexisting disorders. Diagnostic reasoning, confirmatory bias, and the advantages of considering multiple hypotheses when diagnosing depression are discussed.

Depressed Adolescents and Comorbid Psychiatric Disorders: Are There Differences in the Presentation of Depression?

“…At the syndromal level, rates of comorbidity between internalizing and externalizing disorders appear quite high (Angold et al 1999, de Mesquita and Gilliam 1994, Woolston et al 1989. Comorbidity between conduct disorder and comorbid internalizing disorders are common in adults, with odds ratios (ORs) ranging from 1.6 (MDD, p<0.05) to 4.2 (post-traumatic stress disorder, p<0.05; Nock et al 2006), with only agoraphobia (OR=1.4) not reaching statistical significance in the study.…”

Overdiagnosis of mental disorders in children and adolescents (in developed countries)

“…For example, DSM-5 diagnostic criteria of major depression disorder state that children might not show sad, but irritable mood [45]. Depressed children might report unspecific somatic complaints [46] or depression might result in attention problems, leading to misdiagnosis of depressed children as having learning disorders [47]. Similarly, adolescents with substance abuse might show symptoms of learning disabilities [48].…”

Understanding locally, culturally, and contextually relevant mental health problems among Rwandan children and adolescents affected by HIV/AIDS

“…Numerous studies in Western populations have also found significant comorbidity of mental health problems (de Mesquita & Gilliam, 1994; Kessler, et al, 2009; Kessler, Merikangas, & Wang, 2007). For Western clinicians, symptom overlap between disorders and widespread “true” comorbidity among syndromes contributes to “clouding” of diagnostic differentiation (de Mesquita & Gilliam, 1994). Further research is needed to determine how much of this overlap is due to sharing of symptoms among two or more syndromes as opposed to comorbidity.…”