Childhood Mood Disorders
Karen D. Rudolph
In the first edition of this volume, we noted the emergence of a large body of research on child and adolescent depression, based on the relatively recent “discovery” that children sometimes suffered from the same depressive syndromes as defined for adults in standard diagnostic systems. In only the few years since the chapter was written, the field has grown enormously yet again. There have been significant new developments in our understanding of mood disorders in youngsters. In the present chapter, therefore, we update the state of the field, adding a section on bipolar disorders to reflect expanding interest despite diagnostic controversies. We note that unipolar depression is increasingly viewed as a disorder of childhood or adolescent onset with a chronic or recurrent course, and we include expanded coverage of genetic and neurobiological aspects of depressive disorders, as well as recent research reflecting increased interest in family and interpersonal aspects of juvenile depression. As in the first edition, we highlight methodological issues and empirical gaps, and present an integrative model of depressive disorders in children and adolescents.
Joey is a 10-year-old boy whose mother and teacher have shared their concerns about his irritability and temper tantrums displayed both at home and at school. With little provocation, he bursts into tears, yells, and throws objects. In class, he seems to have difficulty concentrating and seems easily distracted. Increasingly shunned by his peers, he plays by himself at recess—and, at home, spends most of his time in his room watching TV. His mother notes that he has been sleeping poorly and has gained 10 pounds over the past couple of months from constant snacking. A consultation with the school psychologist has ruled out learning disabilities or attentiondeficit/hyperactivity disorder (ADHD); instead, she says, Joey is a deeply unhappy child who expresses feelings of worthlessness and hopelessness—and even a wish that he would die. These experiences probably began about 6 months ago when his father (divorced from the mother for several years) remarried and moved to another town, where he spends far less time with Joey.
The case of Joey is intended to illustrate three keys issues about the diagnosis of depression in youngsters. First, the same criteria used for adults can be applied, and the essential features of the depression syndrome are as recognizable in children as in adults (Carlson & Cantwell, 1980; Mitchell, McCauley, Burke, & Moss, 1988). Second, because children's externalizing or disruptive behaviors attract more attention or are more readily expressed than their internal, subjective suffering is, depression is sometimes overlooked. It may not be recognized, or it may not be as-