Depressive Disorders in Children and Adolescents: Identification and Treatment. Elizabeth McCauley, PHD, ABPP Professor University of Washington/Seattle Children ’ s Hospital. Agenda. What is Depression? Scope of the Problem Diagnostic Dilemmas
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Depressive Disorders in Children and Adolescents: Identification and Treatment
Elizabeth McCauley, PHD, ABPP
University of Washington/Seattle Children’s Hospital
When is depression depression….?
-- Dysthymia and anxiety – 30% to 80%
-- Disruptive Disorders – 10% to 80%
-- Substance Abuse – 20% to 30%
Stress Diathesis Model
Development of overall rates of clinical depression (1-year point prevalence combining new cases and recurrences by age and gender)
(Hankin, et al., 1998)
Why are Adolescents So Vulnerable?
Puberty stimulates changes in brain systems regulating arousal and appetite that influence intensity of emotion and motivation
adolescent emotional and behavioral problems 2nd to poor regulation skills--particularly when gap between pubertal arousal and consolidation of cognitive skills is extended
With age and experience comes maturation of frontal lobes which facilitates regulatory competence
0-2 scale. clinical cutoff 11
0-3 scale. Not at all to Nearly Every Day; 10-14 Moderate Dep
Kendall’s Coping Cat; March’s OCD Tx
Social Effective Tx-Beidel
Exposure/Transfer of Control-Silverman
Family, social skills, attentional skills training
Parent-child Interaction Therapy—Chamberlain
The Incredible Years—Webster Stratton
Parent/Child Treatment for Aggression—Barkley, Kazdin
Background and Rationale
Richardson, DiGiuseppe, Christakis, McCauley, Katon, 2004.
Psychotherapy for Depression: Evidence of Treatment Effects
Weisz, McCarty & Valeri
Inc. TADS N=439
IPT- 2 trials
ES = .34
Reinecke, Ryan & DuBois
6 CBT Trials
ES = 1.02
Lewinsohn & Clarke
ES = 1.27
Michael & Crowley
ES = .72
Weisz, McCarty, Valeri, 2006. Psych. Bull. 132:132-149
* Unweighted least squares
Adjusted mean Children's Depression Rating Scale-Revised (CDRS-R) total scores
The TADS Team, Arch Gen Psychiatry 2007;64:1132-1143.
CBT-the most widely investigated psychotherapy for depression
“You can change how you feel by changing how you think”
Aaron T. Beck
Require ability to reflect on, monitor, and evaluate own thinking process in midst of heightened emotional arousal—may not have skills on board
Moving on to Treatment—What Works Best?
Principles of CBT: Philosophy
Principles of CBT: Technology
Assessment, Feedback, & Treatment Plan
15-year-old girl (Kelly) presenting with depressed affect, loss of interest, sleep and concentration problems, and low self-esteem. Chief complaints are sadness, social isolation, and slipping grades. Maternal history of depression and substance use, absent father, limited family/social support. Endorses suicidal ideation; no plan.
Provide feedback and psychoeducation re: depression and appropriate treatment, discuss role of pharmacotherapy and psychotherapy, establish treatment plan including course of CBT.
‘Becoming Your Own Therapist’
“You can change how you feel by changing what you do”
Decrease in frequency or range of reinforcing stimuli or increase in frequency of punishment depression
Allows adolescent to practice with “coach” planning, monitoring and evaluation skills needed to coordinate affect arousal and cognitive skills w/o direct challenge to beliefs