Depression in Children & Adolescents


🔴 Depression in Children & Adolescents

✅ Prevalence

  • 1 % of preschoolers
  • 2-3 % of school-age children
  • 6 % of girls & 4 % of boys during adolescence

*Depression -> high negative affect & low positive affect

*Anxiety -> high negative affect but not low levels of positive affect

✅ Etiology of depression in children & adolescents
📍Genetic factors
📍Early adversity & -ve life events
📍Family & relationship factors (parental depression, parental rejection, …)
📍Cognitive distortion & -ve attributional style
📍Stable attributional style

✅ C\F :

📍Symptoms common to children, adolescents, & adults
*Depressed mood
*Inability to experience pleasure
*Fatigue
*Problems concentrating
*Suicidal ideation

📍Symptoms specific to children & adolescents
*Higher rate of suicide attempts g guilt
*Lower rate of :
-early morning awakening
-early morning depression
-loss of appetite
-weight loss

**So the child can suffer from depression just like adult but usually appear as somatic symptoms

✅ Rx of Depression in Children & Adolescents

📍Medications
*SSRI is better (fluoxetine & sartaline)
*More effective for anxiety than depression g OCD
*S\E : diarrhea, nausea, sleep problems, agitation, …
*May increase the risk of suicide attempts

📍Interpersonal psychotherapy (IPT) -> focus on peer relationship

📍CBT

🔴 Anxiety in Children & Adolescents

-prevalence = 3-5%

💡Etiology of anxiety disorders
1-Genetics
2-Parenting (plays a small role)
3-Emotion regulation & attachment problems
4-Perception of lack of acceptance by peers (factor in social phobia)

💡Types of anxiety in children :

📍Separation anxiety disorder
-worry about separation from parents
-typically first observed when child begins school
-there is strong role of genetics in this type

📍Social anxiety disorder
-extremely shy & quiet
-may exhibit selective mutism (in unfamiliar social settings)
-prevalence = 1% of children & adolescents
-etiology -> overestimation of threat, underestimation of coping ability or poor social skills

💡Rx of anxiety
1-Exposure to feared object (systemic desensitization & flooding)
2-CBT (cognitive reconstruction, psychoeducation, modeling & exposure, skills training, …)

🔴 PTSD
-Children may exhibit agitation instead of fear or hopelessness
-Risk factors of PTSD :
*Family stress & coping style
*Past experience with trauma
**wee need more than 1 month for diagnosis

🔴 OCD
-Prevalence = 1-4 %
-Mote common in boys than girls (while in adult, more common in female)
-C\F = like those of adults
-Most common obsessions :
*Contamination
*Aggression
*Thoughts about sex & religion more in adolescence

🔴 Attention-Deficit \ Hyperactivity Disorder (ADHD)

-More common in boys than girls
-Many pt have persistent symptoms after childhood

*As the pt get older -> the hyperactivity improve but the attention-deficit still

✅ Etiology of ADHD

📍Genetic factors
*by adoption & twins studies
*by 2 dopamine genes (play a role only with prenatal maternal nicotine or alcohol use)

📍Neurobiological factors
-smaller dopaminergic areas

📍Parental & prenatal factors
-low birth weight
-maternal nicotine & alcohol use

📍Environmental toxins

📍Parent-child relationship
-give more commands
-have more -ve interactions
-family factors (genetic & neurobiological factors -> contribute or maintain ADHD but not cause it)

✅ DSM-5 Criteria for ADHD
(See the picture 👇)

✅ Types of ADHD
1-Predominantly inattentive type
2-Predominantly hyperactive-impulsive type
3-Combined type (the majority of diagnoses)

💡Girls with ADHD are more likely to :
-be anxious g depressed
-exhibit neurobiological deficits (poor planning, problem-solving)
-have symptoms pf eating disorder & substance abuse by adolescence
-usually a\w anorexia nervosa

✅ Comorbidity
Depression & anxiety

✅ Ddx
-CD

✅ Rx of ADHD

📍Stimulant medications
*Like Ritalin, Adderall, Concerta, Strattera, Amphetamine, Methylphenidate, Atomoxitrin, …)
*To reduce disruptive behavior
*Improve interaction with others
*Improve concentration
*Reduce aggression
*Effective in 75% of children
*S\E : loos of appetite, loss of weight, sleep problems

📍Medications plus behavioral treatment
*Slightly better than meds alone
*Improved “social skills”

📍Psychological treatment
*Parental training
*Change in classroom management (need special classes, increase time of exam, …)
*Behavioral monitoring & reinforcement of appropriate behavior

📍Supportive classroom structure
*Brief assignments
*Immediate feedback
*Task-focused style
*Breaks for exercise.

Medical disorder cause psychotic symptoms:-

Psychotic & epilepsy:-

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