Pediatric Annals

BOOK REVIEWS 

CHILDHOOD DEPRESSION: New Directions for Child Development

William R Beardslee, MD

Abstract

Dante Cicchetti and Karen Schneider-Rosen (eds) CHILDHOOD DEPRESSION New Directions for Child Development, No. 26 San Francisco: Jossey-Bass, 1984

This volume represents a major effort to apply the principles of developmental psychology to the study of childhood depression. It is broad in scope and provides a masterful introduction to the application of theoretically and empirically derived developmental theories to the specific psychopathology of childhood depression, as well as reports of three separate research investigations. Much of the research reported is original. In the introduction, Cicchetti states that it is essential to understand normal development in order to understand deviations from it, such as childhood depression, and that knowledge of the child's age, cognitive stage and physical stages of development, as well as other developmental phenomena are essential for full understanding. He argues convincingly that the best model for childhood depression is a transactional one which integrates domains from the biological, social and psychological realms, and he offers examples of how such a model can be applied to the phenomenon of childhood depression.

Garber presents data from a study of youngsters seen for treatment for various disorders at guidance centers across a span of ages. She examined the presence of depressive symptomatology and the syndrome of depression in these youngsters of differing ages. She reports that the nature of symptoms, and the prevalence of the disorder, increased in older children compared to younger ones and also that the pattern of symptoms is different. Verbalized depressed feelings, low self-esteem, and guilt were found to be more common in older youngsters. She concludes that the application of adult diagnostic criteria to children, as for example occurs in the current Diagnostic and Statis' tical Manual of the American Psychiatric Association (DSM-/!/), perhaps should be supplemented by awareness of the usual symptoms of children at various developmental ages.

Kovacs and iRaulauskas present empirical data on the effects of cognitive developmental state on the expression of childhood depression using a large sample of youngsters identified with this disorder. They demonstrate that the earlier the onset of depression, the less developed cognitively, and the younger the child, the more severe the effects of depression. This contrasts sharply with psychoanalytic theorists who have hypothesized that depression is a "higher order" disorder, only able to occur in older and more developmentally advanced youngsters. Their work emphasizes the importance of empirical data in studying these matters.

Finally, Zahn- Waxier and associates present data on a very detailed and intensive study of young mothers with either serious bipolar disorder or serious unipolar disorder and their offspring, ages O to 2. Youngsters of parents with bipolar disorder differed markedly from controls in their study, and showed more aggression toward unfamiliar adults, preoccupation with simulations of pain and sadness, and less engagement in social interactions. Children from homes where mothers had unipolar depression were very sensitive to the issue of harm and were less likely to engage in activity that might bring injury to their playmates. They were also more preoccupied and upset when exposed to conflict. The work draws attention to its high risk to infants and young children of maternal affective disorder.

This is a truly outstanding volume, a tour de force in the emerging area of developmental psychopathology. It does not, however, deal at all with the clinical identification of depressed children, nor with the clinical management or treatment, either psychopharmacologically or psychotherapeutically, of depressed of suicidal children. What it does do is describe the specific application of developmental theory to the problem of childhood depression, and give the reader an introduction to how broader perspectives of development enhance our…

Dante Cicchetti and Karen Schneider-Rosen (eds) CHILDHOOD DEPRESSION New Directions for Child Development, No. 26 San Francisco: Jossey-Bass, 1984

This volume represents a major effort to apply the principles of developmental psychology to the study of childhood depression. It is broad in scope and provides a masterful introduction to the application of theoretically and empirically derived developmental theories to the specific psychopathology of childhood depression, as well as reports of three separate research investigations. Much of the research reported is original. In the introduction, Cicchetti states that it is essential to understand normal development in order to understand deviations from it, such as childhood depression, and that knowledge of the child's age, cognitive stage and physical stages of development, as well as other developmental phenomena are essential for full understanding. He argues convincingly that the best model for childhood depression is a transactional one which integrates domains from the biological, social and psychological realms, and he offers examples of how such a model can be applied to the phenomenon of childhood depression.

Garber presents data from a study of youngsters seen for treatment for various disorders at guidance centers across a span of ages. She examined the presence of depressive symptomatology and the syndrome of depression in these youngsters of differing ages. She reports that the nature of symptoms, and the prevalence of the disorder, increased in older children compared to younger ones and also that the pattern of symptoms is different. Verbalized depressed feelings, low self-esteem, and guilt were found to be more common in older youngsters. She concludes that the application of adult diagnostic criteria to children, as for example occurs in the current Diagnostic and Statis' tical Manual of the American Psychiatric Association (DSM-/!/), perhaps should be supplemented by awareness of the usual symptoms of children at various developmental ages.

Kovacs and iRaulauskas present empirical data on the effects of cognitive developmental state on the expression of childhood depression using a large sample of youngsters identified with this disorder. They demonstrate that the earlier the onset of depression, the less developed cognitively, and the younger the child, the more severe the effects of depression. This contrasts sharply with psychoanalytic theorists who have hypothesized that depression is a "higher order" disorder, only able to occur in older and more developmentally advanced youngsters. Their work emphasizes the importance of empirical data in studying these matters.

Finally, Zahn- Waxier and associates present data on a very detailed and intensive study of young mothers with either serious bipolar disorder or serious unipolar disorder and their offspring, ages O to 2. Youngsters of parents with bipolar disorder differed markedly from controls in their study, and showed more aggression toward unfamiliar adults, preoccupation with simulations of pain and sadness, and less engagement in social interactions. Children from homes where mothers had unipolar depression were very sensitive to the issue of harm and were less likely to engage in activity that might bring injury to their playmates. They were also more preoccupied and upset when exposed to conflict. The work draws attention to its high risk to infants and young children of maternal affective disorder.

This is a truly outstanding volume, a tour de force in the emerging area of developmental psychopathology. It does not, however, deal at all with the clinical identification of depressed children, nor with the clinical management or treatment, either psychopharmacologically or psychotherapeutically, of depressed of suicidal children. What it does do is describe the specific application of developmental theory to the problem of childhood depression, and give the reader an introduction to how broader perspectives of development enhance our understanding of psychopathology and of children in general.

10.3928/0090-4481-19851201-11

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