Issues in the treatment of depressed children

Abstract

Basic research into the cognitive, behavioral, familial, and physiological disturbances associated with depressive disorders during childhood is reviewed. hnplications for the development of a treatment program are discussed and a comprehensive treatment model is proposed. The proposed model includes intervention strategies for the child, parents, family, and school. The child component consists of intervention strategies for the affective, cognitive, behavioral, and physiological disturbances that are evident from the existing research. The parent training component is designed to address disturbances in parenting due to cognitive disturbances and skills deficits. The family therapy component emphasizes changing interaction patterns that communicate schema-consistent maladaptive interactions. A school consultation component is proposed in which school personnel support the skills training through prompting use of the skills and reinforcement of the use of the coping skills. Key words: Childhood depression, Treabnent of childhood depressionDepressive disorders during childhood appear to be more common and of longer duration than previously thought. Onsel of a depressive disorder during childhood is a risk factor for later episodes, impacts the youngster's psychosocial functioning, family system, and parent-child dyads, and has potentially life-threatening consequences. Perhaps because of a recognition of the seriousness of the disorder and the growing number of youths affected by it, research in the area has mushroomed over the past 15 years. As more is learned about the disorder, more issues become evident. Numerous advances have been made in many areas including: our understanding of the nature of the disorder, its impact on the youngster and his or her family. its course, common co-occurring disturbances, and how to assess it. However, issues surrounding the treatment of depressed children have been sorely neglecIed and few developmenlally sensitive treatment models have been proposed. Consequently, although a breadth of infonnation will be reviewed, the focus will be on integrating this information to highlight its treatment implications and on a proposed treatment model.When trying to develop an effective intervention for depressed youths, the most fundamental question that needs to be addressed is Ihe etiology of depressive disorders during childhood. If it is possible to identify etiologic variables and disturbances that are associated with the disorder, it may be 59possible to develop an intervention package that addresses each of the disturbances. This belief provides the structure around which this review was written. Infonnation was included to provide an understanding of the disturbances associated with depressive disorders during childhood and that bas implications for models of the etiology and treatment of depressive disorders. Both psychosocial and biological factors playa crucial role in the development and maintenance of depressive disorders. Research and theory regarding the major psy...

Understanding the psychology of bullying: Moving toward a social-ecological diathesis–stress model.

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