Depression is a relatively common mood disorder that often first
appears during childhood or adolescence. (Custom Medical Stock)
loss of interest in their usual activities plus other
symptoms such as sleep or appetite disturbance, loss
of energy, or trouble concentrating. These symptoms
must be present nearly every day for two weeks or
more. For dysthymia, the symptoms are typically of
a lower level of severity but persist for one year or
more. For both disorders, the symptoms must cause
impairment and must reflect a change from the
child’s usual level of functioning. Standardized ques-
tionnaires are also used to measure depression and
determine whether a child’s level of symptoms are in
the nondepressed range or indicate mild, moderate,
or severe levels of depression.
Studies of community samples have found that
from 2 percent to 5 percent of children have mood
disorders. Rates increase with age. Although rates are
about equal for boys and girls in childhood, begin-
ning at puberty girls are twice as likely as boys to re-
ceive a depression diagnosis. Depression is a
recurrent disorder, with each additional episode in-
creasing the likelihood of a recurrence.
Early stages in the emergence of depression are
often missed because children are not likely to recog-
nize or report their distress. Once a depression disor-
der emerges, it is typically persistent and progresses
from relatively mild symptoms to more severe symp-
toms.
Genetics contribute to the likelihood of a child-
hood depression occurring, as do neurobiological fac-
tors and stress. Children with particular patterns of
thinking, such as blaming themselves for negative
outcomes while not giving themselves credit for posi-
tive outcomes, may be more vulnerable to depression
than others.
Treatments that have been found to be successful
often involve intervention into the psychosocial com-
ponents of the disorder. For example, treatment may
involve helping the children identify and modify mal-
adaptive beliefs and perceptions, develop social skills
and problem-solving abilities, and broaden their re-
sources for coping with stress. A particularly effective
focus in treatment of adolescents with depression has
been on interpersonal relationships, addressing the
stage-salient concerns of adolescents. Although they
are often prescribed, evidence for the effectiveness of
antidepressant medication in children and adoles-
cents has been mixed, possibly because of the meth-
odological challenges of studying medications during
periods of still rapid development.Other Disorders
The disorders included in this last category in-
volve more extreme deviations from normal develop-
ment than the externalizing and internalizing
behavior disorders. Parents typically become ex-
tremely concerned when symptoms of these disorders
emerge. Two of these disorders, autism and child-
hood schizophrenia, are considered pervasive devel-
opmental disorders in the DSM-IV, a term suggesting
not only that the disorders emerge early but also that
they affect all of the developing systems, including so-
cial, language, and cognitive-intellectual.Autism
Autism is an extremely rare condition, occurring
in fewer than 5 out of 10,000 individuals, possibly
more common in males. Symptoms, which must
emerge before the age of three years to meet DSM-IV
diagnostic criteria, include impairment in social in-
teraction (e.g., avoidance of eye contact) and commu-
nication (e.g., delayed or inadequate speech), as well
as repetitive and stereotyped patterns of behavior, in-
terests, or activities. Thus autism develops early and
disrupts development in all key areas. The causes of
autism are not known, but research findings center on
genetic factors, including chromosome abnormali-
ties, and brain injuries or anomalies in brain develop-
ment. Research on treatment for autism has been
controversial because parents understandably pursue
a wide range of activities to help their children. Be-
havioral treatments of specific problematic behaviors
have been shown to be successful and often involve264 MENTAL DISORDERS