Review of Handbook of depression in children and adolescents.

Reviews the book, Handbook of depression in children and adolescents by John R. Z. Abela and Benjamin L. Hankin (see record 2008-01178-000). The editors of this book embraced the ambitious objective of assembling a comprehensive review of the burgeoning literature on the etiology, prevention, and treatment of depression in children and adolescents. The book is divided into five parts. In an unusually brief introductory chapter, the editors emphasise the need for a critical analysis of the research on diverse theories of the etiology of depression in young people and coverage of interventions based on current theories. It is clear that this objective is met throughout the book. Abela and Hankin warn the reader that the reviews may generate more questions than answers. They hope the book will inspire the development of integrative and developmentally sensitive models. The book provides a comprehensive overview that clearly conveys the vibrancy of research in this area. The current format separates research on etiology from that on intervention. The authors of individual chapters do a good job of briefly highlighting the etiological factors on which the interventions are based. In a future edition, it would be very helpful for the editors to play a more explicit role in providing integrative syntheses to weave the themes together. In addition, to lay the foundation for the inclusion of positive psychotherapy and positive youth development programs, it would be useful to include a chapter addressing resilience and protective factors. In conclusion, this book will be appreciated by clinical scientists and scientist-practitioners alike. Abela and Hankin are to be congratulated for editing a book that convinces the reader that this is an exciting research area with great promise for further development of prevention and treatment of depression in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Countertransference in psychotherapy with children and adolescents.

Reviews the book, Countertransference in psychotherapy with children and adolescents edited by Jerrold R. Brandell (see record 1992-97833-000). Books on child analytic work are rare, and books on countertransference in child treatment are basically nonexistent, despite the proliferation of writing on countertransference in work with adults. Thus, Jerrold Brandell's edited volume is a welcome and long-overdue addition to the literature. Although the book is not strictly about analysis, it is analytically informed. Brandell's stated goal is to advance the principle that "countertransference is a ubiquitous factor in child and adolescent treatment, and that its recognition, understanding, and management are essential to effective psychotherapy." This is indeed a worthy if not essential undertaking, and the collection of articles in Brandell's book advances this goal. Brandell prefaced the chapters with his own thorough historical literature review of countertransference in both adult and child work. He then subdivided the book into two sections, with the first containing two classic articles an countertransference and the bulk of the book devoted to the following "scientific situations" in child psychotherapy: racial and cultural issues, depressed and suicidal children and adolescents, infant-family treatment, severely disturbed adolescents, eating disorders, abused children and adolescents, parent loss and divorce, borderline children and adolescents, life-threatening illness, and substance-abusing adolescents. This book is a very good resource for child analysts and therapists, especially those who espouse a more relational or intersubjective point of view. It is suitable both for inexperienced analysts and as a reminder to more seasoned ones of the importance and pervasiveness of countertransference issues in our work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treating Attachment Pathology.

Reviews the book, Treating Attachment Pathology by Jon Mills (see record 2005-04683-000). Many books written on attachment pathology focus on the assessment and treatment of children, and provide very little information on attachment difficulties found in adults and adolescents. This book addresses this neglected area by exploring attachment disorders and psychopathology in adults. As such, Mills' work is a welcome addition to the literature. It goes beyond simply linking adult psychopathology to early attachment difficulties. Mills' work provides a theoretical framework for understanding attachment from a psychodynamic/psychoanalytic perspective and then uses this theoretical framework to discuss the aetiology and treatment of adult disorders. Mills aims to make Treating Attachment Pathology accessible to the expert and novice alike. He does this by extensively reviewing the literature for the expert and by making the literature accessible to the novice by providing case examples. Mills himself, however, acknowledges that at times the literature and language is "dense and esoteric." To counteract this Mills makes extensive use of case examples and thereby makes complex and theoretically dense concepts accessible. This is one of the real strengths of Mills' book and it is done with great skill. Although Mills is working from a psychoanalytic/psychodynamic perspective, this book offers much to clinicians from all perspectives. Mills' frank discussion of his own mistakes, and his invitations to critique his therapeutic decisions and techniques, provide a fresh and welcome addition to the literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents

Child and adolescent major depressive disorders are common and recurrent disorders. The prevalence of major depressive disorders is estimated to be approximately 2% in children and 4 to 8% in adolescents. Major depressive disorders in children are frequently accompanied by other psychiatric disorders, poor psychosocial outcome and a high risk of suicide and substance abuse, indicating the need for effective treatment and prevention. The use of antidepressant medications as the first line of treatment for children and adolescents with mild to moderate major depressive disorders has been questioned. However, some subgroups of patients may benefit from initial treatment with antidepressants. These subgroups may include patients who are unwilling or unable to undergo psychotherapy, have not responded to at least 8 to 12 sessions of psychotherapy, have bipolar, atypical or severe depression or have recurrent depression. Currently, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the first medication choice because of their efficacy, benign adverse effect profile, ease of use and low risk of death following an overdose. Further research in continuation and maintenance treatments, treatment of comorbid conditions, subtypes of depression, e.g. bipolar, atypical, seasonal, and combinations of pharmacotherapy and psychotherapy are needed. In addition, studies of the pharmacokinetics, pharmacodynamics and long term adverse effects of antidepressant medications in children and adolescents are warranted.     

Psychiatric comorbidity among referred juveniles with major depression: fact or artifact?

OBJECTIVE: The high levels of psychiatric comorbidity reported in juveniles meeting operational definitions of depressive disorders raise both substantive and methodological concerns about whether depression with comorbid disorders should be classified as two disorders or as different manifestations of the same condition. Our purpose was to clarify issues of diagnostic heterogeneity and diagnostic overlap in juvenile depression. METHOD: The sample consisted of consecutively referred children and adolescents (N = 424) comprehensively evaluated with structured diagnostic interviews and psychosocial assessments. RESULTS: A clinical picture compatible with the diagnosis of major depression was identified in 40% of these referred youths. Children meeting criteria for major depression had prototypical symptoms of the disorder, a chronic course, and severe psychosocial dysfunction. In addition, they frequently met criteria for attention-deficit hyperactivity disorder, conduct disorder, and anxiety disorders. These comorbidity findings were not due to symptom overlap among major depression and the co-occurring disorders. For the most part, comorbid disorders preceded the onset of major depression by several years. CONCLUSIONS: Juvenile depression has a chronic course, severe dysfunction, and high levels of psychiatric comorbidity. Despite symptom overlap, our work suggests that major depression and other conditions may represent different disorders.     

Psychopharmacology of aggression in children and adolescents with primary neuropsychiatric disorders: A review of current and potentially promising treatment options.

Research examining the role of pharmacological therapy in the treatment of children and adolescents with clinical disorders is growing. Clinical disorders that present with comorbid aggression can add a challenge to treatment. Child and adolescent neuropsychiatric disorders associated with aggression include attention-deficit hyperactivity disorder, various mood disorders and in particular bipolar disorders/pediatric mania, schizophrenia, mental retardation, oppositional defiant disorder, conduct disorder, and autism spectrum disorders. This review describes the psychopharmacy to treat these disorders and the aggression that often appears comorbidly. Existing literature regarding the efficacy and safety of psychotropics for youth with neuropsychiatric disorders also is discussed. In addition, general guidelines for psychopharmacy of aggression in children and adolescents are presented. Studies reviewed in this article provide evidence for the use of psychostimulants, alpha-2 agonists, beta blockers, lithium, anticonvulsant mood-stabilizers, atypical antipsychotics, traditional antipsychotics, and selective serotonin reuptake inhibitors in treating pediatric aggression with the choice of medication dependent on symptomology. Despite increased support for pediatric psychotropic use, there is a need for more long-term safety and efficacy studies of existing medications and newer, safer, and more effective agents with fewer side effects for the pharmacological treatment of all childhood disorders in which aggression is prominent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Behavioral and emotional disorders in adolescents: Nature, assessment and treatments.

Reviews the book, Behavioral and emotional disorders in adolescents: Nature, assessment and treatment by David A. Wolfe and Eric J. Mash (see record 2005-16249-000). The primary goal of this edited volume is to capture the current state of knowledge about the important behavioural and emotional adjustment problems and disorders of adolescence. Through 20 chapters by foremost experts, the reader is apprised of the unique features of these disorders in adolescents in comparison with children and adults, and of the importance of developmental issues and a developmental perspective. Any thought that adolescent disorders are adequately addressed by upward extension of knowledge of child disorders and downward extension of knowledge of adult disorders is compellingly dispelled. The unique compilation of empirical findings specifically for adolescents is a boon to those pursuing research, teaching or evidence- based practice with this age group. This book will be mandatory reading for any mental health professional, including academics, graduate students, and clinicians working with or teaching about troubled adolescents. As a text, it is excellent for a graduate course on the subject, and an essential reference source for those teaching abnormal development at the undergraduate level or providing clinical service to adolescents and their families. The book will be a classic in the field and a mandatory starting point for any professional interested in a detailed overview of the state of the art in Western societies, including researchers interested in an overview of areas outside their own specific expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of stress autonomy versus stress sensitization in adolescents at varied risk for depression.

This longitudinal study investigated the stress autonomy, stress sensitization, and depression vulnerability hypotheses in adolescents across 6 years (i.e., Grades 6 through 12). Participants were 240 children (Time 1 mean age = 11.86, SD = 0.57) who varied in risk for depression on the basis of their mother's history of mood disorders. All analyses were conducted as multilevel models to account for nesting in the data. Results were consistent with the stress sensitization hypothesis. The within-subject relation of stress levels to depressive symptoms strengthened with increasing numbers of prior depressive episodes. In addition, evidence consistent with the vulnerability hypothesis was found. The relation of stress levels to depressive symptoms was stronger for adolescents who were at risk for depression on the basis of maternal depression history and for those who had experienced more depressive episodes through Grade 12. These findings suggest that onsets of depression in adolescents may be predicted by both relatively stable and dynamic transactions between stressful life events and vulnerabilities such as maternal depression and youths' own history of depressive episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of atypical neuroleptics in child and adolescent psychiatry

BACKGROUND: This article reviews the published clinical experience with atypical neuroleptics in children and adolescents. METHOD: A computerized literature search was conducted (MEDLINE, 1974-1998) to retrieve all reports on the use of atypical neuroleptics in children and adolescents. A hand search was performed as well. All relevant clinical data were collated by type of drug. RESULTS: We found 5 blind placebo-controlled clinical trials (105 patients), 24 open-label clinical trials (387 patients), and 33 case series (115 patients) describing the use of the atypical neuroleptics clozapine, risperidone, olanzapine, sulpiride, tiapride, amisulpride, remoxipride, and clothiapine in children and adolescents. Some of these agents, especially clozapine, risperidone, and olanzapine, were found to be efficacious in the treatment of schizophrenia, bipolar disorders, and pervasive developmental disorders. The role of atypical neuroleptics as augmenters of serotonin reuptake inhibitors in obsessive-compulsive disorder is unclear. Risperidone appears to possess anti-tic properties in patients with Tourette's disorder. CONCLUSION: The most convincing evidence of the efficacy of atypical neuroleptics in children and adolescents concerns clozapine in the treatment of schizophrenia. Data on other atypical neuroleptics in other disorders are still sparse, and further research is needed. Some of the atypical neuroleptics may become the first-line treatment for childhood schizophrenia and pervasive developmental disorders.     

Approaches to recognition and management of childhood psychiatric disorders in pediatric primary care

Psychiatric disorders occur in 14% to 20% of American children and adolescents and are a leading cause of disability among them, yet fewer than one in five of these children are recognized. The most common psychiatric disorders presenting to pediatricians include ADHD, anxiety disorders, depression, substance-use disorders, and conduct disorder, Approaches to recognition include screening for psychosocial concerns using specific questions in the clinical interview, and using brief, written questionnaires. Case vignettes illustrate comprehensive treatment planning for children with psychiatric disorders in the primary care context. As psychopharmacologic treatments and the new subspecialty of pediatric psychopharmacology take on growing importance, the traditional oversight role of the pediatrician and effective communication among referring and consulting physicians remain critical to quality care.     

Temporary vascular occlusion during cerebral aneurysm surgery

Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.     

Review of Pain in children and adolescents.

Reviews the book, Pain in children and adolescents by P. J. McGrath and A. M. Unruh (1987). This book is an extremely comprehensive work, dealing not only with specific clinical problems but also with such broader and complex issues as ethics and service delivery in pediatric pain. McGrath and Unruh go a long way to unravel the 'mystery' of pain in children by discussing clearly and concisely the literature on the assessment and measurement of pain in children. Clinical problems such as post-operative pain, abdominal pain, headache, muskuloskeletal pain, colic, injuries, psychogenic pain, and chronic intractable pain are all dealt with in individual chapters divided into clearly labelled sections, making it very easy for busy clinicians to locate their particular area of interest. One of the strengths of this book is the methodological expertise of the authors, which is evident in their evaluations of the research cited in the text. Novice researchers reading this book will be reminded of the many pitfalls to be avoided in research design, and postgraduate students seeking topics for research will find numerous suggestions in the 'future directions' sections of the book. The publishers are to be congratulated on their attractive presentation of the book. The type is large and very easy to read, the text is well spaced, and considering the amount of material in the book, it is remarkably compact in size and very reasonably priced. Providing as it does a comprehensive summary and analysis of the literature to date on pain in children, it is essential reading for all clinicians, paramedics, and researchers concerned with this important and long neglected area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive factors differentiating attention deficit–hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit–hyperactivity disorder (ADHD) co-occur in 20–30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n?=?14) or ADHD and a comorbid mood disorder (n?=?27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of self-reported depression: Clinic-referred children versus adolescents.

The literature on childhood depression has often treated children and adolescents as a homogeneous group. However, research on cognitive and affective development suggests that the nature of depression may be different for these two age groups. We explored this possibility, separately factor analyzing Children's Depression Inventory responses for 110 clinic-referred children (aged 8–11 years) and 139 adolescents (aged 12–26 years). Although both groups produced three-factor solutions, a number of developmental differences were noted. All of the adolescent factors were correlated with parent prceptions of externalizing behavior, but none of the child factors were. Furthermore, gender differences on the factors were found for the adolescents only. An inspection of communality estimates indicated that whereas all of the CDI items were relatively involved in depression for the adolescents, only 20 of 26 items were involved for the children. Theoretical interpretation of the results was deferred pending replication of the factor structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Language impairment and psychopathology in infants, children, and adolescents.

Reviews the book, Language impairment and psychopathology in infants, children, and adolescents by Nancy J. Cohen (see record 2001-05782-000). Approximately half of the children referred to mental health clinics for social-emotional problems have, on testing, been shown to have co-occurring language impairment. Conversely, about the same percentage of children originally seen for difficulties with language are later diagnosed with social-emotional problems. It is this overlap that Nancy Cohen explores in this concise and immensely readable book. We view this book as a broad and integrative first step that ought to be followed with more depth in specific areas. Thus, although much remains to be done, this book provides an excellent overview of a complex literature and will encourage interesting new clinical and research endeavours. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis, assessment, and treatment of internalizing problems in children: The role of longitudinal data.

Examines the role of longitudinal data in the diagnosis, assessment, and treatment of internalizing disorders in children and adolescents. On the basis of the limited longitudinal data available, it is suggested that internalizing disorders in children and adolescents are highly prevalent, frequently comorbid with other childhood disorders, and, arguably so, persistent over time. However, it is also noted that a considerable amount of instability characterizes these disorders and that the developmental course is not fully understood at this time. In addition, these disorders are responsive to treatment, at least on a short-term basis. Finally, a plea is made for longitudinal studies that use a developmental perspective in examining internalizing disorders in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)