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The similarities and differences between traits of teenagers and toddlers

This article has been cited by other articles in PMC. Abstract Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding the disorder during this developmental stage is critical for determining its etiology and course, as well as for deveiopinq effective intervention straieqies.

This paper summarizes current knoviedqe reqardinq the etiology, phenomenoiogy, correlates, natural course, and consequences of unipolar depression in children and adolescents. Using adult depression as a framevork, the unique aspects of childhood and adolescence are considered in order to better understand depression within a developmental context.

The data suggest that the clinical presentation, correlates, and natural course of depression are remarkably similar across the lifespan. There are, however, important developmental differences. Specifically, the familial and psychological context in which depression develops in youngsters is associated with variability in the frequency and nature of depressive symptoms and comorbid conditions among children and adolescents. Maturational differences have also been identified in the neurobiological correlates of depression.

These developmental differences may be associated with the observed variability in clinical response to treatment and longitudinal course. Characterization of the developmental differences will be helpful in developing more specific and effective interventions for youngsters, thereby allowing them to reach their full potential as adults.

Developmental psychopathology has identified the defining clinical and contextual features of depression in youngsters. In particular, empirical studies have characterized the longitudinal course of depressive illness and common patterns of co-occurring psychiatric conditions. The functional consequences of early-onset illness have also been documented.

  1. Neurobiology In contrast to the wealth of information on the neurobiology of adult depression, there are relatively few studies in pediatric samples, although this is a burgeoning area of investigation.
  2. Statistical analysis The frequency of depressive symptoms, suicidal behaviors, psychotic symptoms and manic symptoms for the total sample, for the age and gender subgroups were analyzed descriptively.
  3. It is important to note, however, that the sample sizes in many of these studies are modest.
  4. The role of sex, gender and coping in adolescent depression.

A growing body of research is identifying the neurobiological and psychological correlates. In addition, studies are beginning to identify specific genetic and experiential risk factors. In general, the core patterns of depressive disorders across the lifespan are emerging. This paper details the phenomenology, correlates, clinical course, and consequences of pediatric depression, highlighting the similarities and differences in the characteristics of depression among children, adolescents, and adults.

A few caveats are warranted before proceeding to the following sections. Up to now, most of the research on pediatric depression was conducted in major depressive disorder, and therefore, the reported findings are primarily for this condition. Historical context of depression in children and adolescents Case reports of youngsters exhibiting symptoms resembling depressive disorders in adults were described as early as the 17th century. In particular, it was considered that children did not have a well-developed superego.

In 1975, the National Institute of Mental Health convened a meeting to discuss the incidence and diagnosis of depression in children. A developmental framework in understanding childhood and adolescent depression In the past three decades, depression research in children and adolescents has progressed from applying simple extensions of clinical descriptions and theories developed in adults to generating an increasingly sophisticated understanding of these disorders informed by the emerging field of developmental psychopathology.

Research adopting this framework has taken into account the normative developmental processes influencing differences in the etiology, phenomenology, correlates, and outcomes of depression in children, adolescents, and adults. Although some continuity is likely across childhood and adolescence in the experience and expression of depression, the underlying risk mechanisms and the consequences of depression, some differences are also plausible.

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When applying a developmental perspective to psychopathology, one important issue to consider is the conceptualization of different life stages. For example, the transition from childhood to adolescence involves changes in multiple domains, including physical, sexual, cognitive, and social development, with a considerable range of individual differences in the age at which each of these changes occur.

At present, there is no consensus on the clear boundaries in defining child and adolescent populations.

  1. One over three patients 29.
  2. The analysis of the effect of being an only-child on the outcomes of interest was based on a hierarchical model which helped in the interpretation of the associations see Figure 1. These findings illustrate the importance of the interaction between pubertal transition and psychosocial factors in adolescent vulnerability to the manifestation of MDD.
  3. In one study, neurotic-like symptoms predicted the first episode of depression in 31-to 41-year-old individuals, but this was not the case for 17-to 30-year-olds.

In some cases, however, studies are reviewed in which these ages overlap eg, some studies included 13-year-olds in the child samples, whereas others included 12-year-olds among adolescent samples, and still others reported findings according to grade level or physical pubertal status. Epidemiology of unipolar depression in children and adolescents Prevalence and incidence Prevalence estimates of unipolar depression vary with the time period of reference and method of assessment.

The reported point prevalence rates 30-day or 1-year of major depressive disorder in nonreferred samples range between 0.

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However, the recent replication results from the National Comorbidity Survey and some studies of pediatric clinical cohorts arc very compelling, because adjusted lifetime hazard rates of depression are based on the same interview methods with participants across different age groups ascertained at the same time. Prior to adolescence, the rate of depressive disorders is about equal in boys and girls, or even higher among boys.

For example, low socioeconomic status is associated with high levels of chronic stress due to economic difficulties, adverse environmental conditions, and family disruption.

For example, one study found that African-American girls did not manifest the puberty-related increase in depressive symptoms that is commonly observed in non-Hispanic white girls. For instance, African-American teens living within predominantly non-Hispanic white neighborhoods were at especially high risk for depressive symptoms.

For example, depression is frequently associated with problems in interpersonal relationships and school performance, as well as delays in social, emotional, and cognitive development.

Moreover, other factors frequently associated with depression, such as comorbid psychiatric disorders, poor family functioning, low socioeconomic status, and exposure to stressful life events, impact psychosocial functioning.

Although the reasons for the developmental variations in depressive symptoms arc not known, maturational effects on emotional and behavioral regulation and cognitive function might contribute to these differences. Gender differences Gender differences have also been documented with respect to the severity and symptom profiles of unipolar depression among children, adolescents, and adults although no compelling gender effects were found on the salient features.

One model suggests that females are more prone to exhibit a cognitive style characterized by negative self-evaluation and rumination.

Differences between children and adults

Although it is not clear whether these comorbid conditions represent a developmental sequence, shared genetic or environmental risk factors or a separate subtype of the disorder, it is likely that one or more of these factors contribute to comorbidity.

For example, in a large sample of highschool students, the duration of major depressive episode ranged from 2 weeks to 250 weeks, with a mean duration of 26 weeks. Longer durations were reported in clinical samples, with a mean length of 6 to 9 months. Age at onset of illness, greater severity, presence of comorbid disorders, and parental history of depression potentially influence the time to recovery.

Several studies of depressed adolescents documented increased risk for recurrent depressive episodes, but not other psychiatric disorders, when compared with their counterparts without depression. Although these maturational transitions offer tremendous opportunities for youth, because the developing brain and behavioral and cognitive systems mature at different rates, and because these systems are under the control of both common and independent biological processes, this developmental period also is marked by heightened vulnerability.

The normative developmental transitions associated with adolescence might serve as sensitive periods for the activation of specific processes involved in the onset, persistence, and recurrence of depressive episodes. Family, twin, and adoption studies indicated effects of both genetic and environmental factors for unipolar depression.

Shared environmental influences may be more important in younger children, and these influences may be replaced by new genetic and unique environmental influences as children grow older.

Characteristics of Children and Adolescents With Multiple Sclerosis

The implication was that the two were separate, and it was assumed that gene-environment interactions were usually of so little importance that they could be ignored. Theoretical considerations suggested that this was not likely to be true, and empirical findings are now accumulating on the interactions between identified common single genetic variants and environmentally-mediated risks.

Neurobiology In contrast to the wealth of information on the neurobiology of adult depression, there are relatively few studies in pediatric samples, although this is a burgeoning area of investigation.

Adolescence

Most studies of childhood and adolescent depression have followed up the observations and methods used in adult studies, and they focused primarily on electrophysiological, neuroendocrine, and neuroimaging techniques.

It is important to note, however, that the sample sizes in many of these studies are modest. Nevertheless, convergent patterns across studies are informative in determining developmental continuities and discontinuities with adult depression. Electrophysiological studies Baseline electroencephalographic EEG studies documented reduced left frontal electrical activity in infant and adolescent offspring of depressed mothers, 171 - 173 and in adolescents with major depressive disorder.

Participants who developed bipolar disorder had the most extreme patterns of frontal EEG asymmetry. In the same sample, eye-blink responses to affective stimuli also were associated with variations in clinical outcome in adult life.

EEG sleep measures have shown considerable variability with regard to group differences between depressed youngsters and matched controls. For example, sleep data in adults suggest distinct biological substrates in unipolar and bipolar mood disorders. Therapeutic sleep deprivation also appears to have different clinical effects in unipolar and bipolar patients.

Few differences in basal Cortisol secretion have been observed between depressed adolescents and controls, and when group differences were detected, they tend to be subtle alterations in normal diurnal patterns. These subtle changes, however, were relatively robust in predicting the longitudinal clinical course; higher Cortisol secretion in the evening or during sleep, a time when the HPA axis is relatively quiescent, was associated with a longer time to recovery from the depressive episode, 197 a propensity for recurrence, 185198 and suicide attempts.

Although the precise role of growth hormone secretion in depression is not known, it appears to be a marker of central noradrenergic and serotonergic 5-HT systems.

Reduced growth hormone secretion during sleep has been observed in adult depression, 202 but findings in children and adolescents have been variable, with some studies showing no differences whereas others showing reduced or increased secretion. Although the sample sizes were modest in these adolescent studies, pubertal changes and gender might account for some variability among child, adolescent, and adult samples.

Alterations in amygdala and hippocampal volumes also were found, although the effects appear to be moderated by anxiety and manic symptoms. Summary Neurobiological research in pediatric depression suggests that neurobiological factors change during the similarities and differences between traits of teenagers and toddlers course of development, and developmentally influenced neurobiological processes may become disrupted during depressive episodes.

Longitudinal studies that account for familial and clinical variability allude to this possibility, whereas cross-sectional studies that fail to account for developmental changes, gender differences, and family history produced inconsistent findings. These data also indicate that early-onset depressive disorders may not necessarily result from the same etiological processes, and the specific subtype with a recurrent unipolar course is associated with neurobiological changes typically observed in adult unipolar depression.

Negative affectivity is the propensity to experience negative emotions, and it reflects sensitivity to negative stimuli, increased wariness, vigilance, physiological arousal, and emotional distress. In contrast, positive affectivity is characterized by sensitivity to reward cues, sociability, and adventurousness.

Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders

In one study, neurotic-like symptoms predicted the first episode of depression in 31-to 41-year-old individuals, but this was not the case for 17-to 30-year-olds. Indeed, children of depressed mothers reported lower perceived self-worth and greater negative attributional style than children of nondepressed mothers. Vulnerability to depression presumably arises in early family environments in which the children's needs for security, comfort, and acceptance are not met. Stressful events may be normative eg, school transitions or pathological eg, abuseand may be independent of, or dependent on an individual's actions.

Stress plays a prominent role in most theories of depression, and a clear empirical link exists between stress and depression in children and adolescents.