Handbook of Depression in Children and Adolescents Issues in Clinical Child Psychology Series Editors: Michael C. Roberts, University of Kansas-Lawrence, Kansas Lizette Peterson, University of Missouri-Columbia, Missouri BEHAVIORAL ASPECTS OF PEDIATRIC BURNS Edited by Kenneth J. Tarnowski CHILDREN AND DISASTERS Edited by Conway F. Saylor HANDBOOK OF DEPRESSION IN CHILDREN AND ADOLESCENTS Edited by William M. Reynolds and Hugh F. Johnston INTERNATIONAL HANDBOOK OF PHOBIC AND ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS Edited by Thomas H. Ollendick, Neville J. King, and William Yule MENTAL HEALTH INTERVENTIONS WITH PRESCHOOL CHILDREN Robert D. Lyman and Toni L. Hembree-Kigin A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Handbook of Depression in Children and Adolescents Edited by William M. Reynolds University of British Columbia Vancouver, British Columbia, Canada and Hugh F. Johnston University of Wisconsin Madison, Wisconsin Springer Science+Business Media, LLC Library of Congress Cataloging in Publication Data On file ISBN 978-1-4899-1512-2 ISBN 978-1-4899-1510-8 (eBook) DOI 10.1007/978-1-4899-1510-8 ©1994 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1994 Softcover reprint of the hardcover 1st edition 1994 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors Jessie C. Anderson, Division of Child and Adolescent Psychiatry, Children'S Pavilion, Dunedin Hospital, Dunedin, New Zealand William R. Beardslee, Judge Baker Children's Center, Department of Psychiatry, Harvard University Medical School, Boston, Massachusetts 02115 Jules R. Bemporad, Department of Psychiatry, The New York Hospital-Cornell Medical Center, White Plains, New York 10605 Lori Breedlove, Burrell Center, Springfield, Missouri 65804 Ronald T. Brown, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322 Dennis P. Cantwell, Department of Psychiatry and Biobehavioral SCience, Neuro psychiatric Institute, University of California at Los Angeles, Los Angeles, California 90024 Gabrielle A. Carlson, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, Stony Brook, New York 11794-8790 Dante Cicchetti, Mt. Hope Family Center, University of Rochester, Rochester, New York 14608 Harvey F. C1arizio, Department of Counseling and Educational Psychology, Michigan State University, East Lansing, Michigan 48824-1034 Gregory N. Clarke, Division of Child Psychology, Oregon Health Sciences University, Portland, Oregon 97201 Bruce E. Compas, Department of Psychology, University of Vermont, Burlington, Ver mont 05405-0134 Geraldine Downey, Department of Psychology, Columbia University, New York, New York 10027 GrahamJ. Emslie, Department of Psychiatry, University of Texas Southwestern Medical Center, and Children's Medical Center at Dallas, Dallas, Texas 75235-9070 Sydney Ey, Medical College of South Carolina, Charleston, South Carolina 29425 Scott Feldman, Department of Psychology, Columbia University, New York, New York 10027 Sarah Friedman, Department of Psychology, Columbia University, New York, New York 10027 J.Jay Fruehling, Child Psychopharmacology Information Center, Department ofPsychia try, University of Wisconsin, Madison, WISCOnsin 53792 v vi Kathryn E. Grant, Cook County Medical Center, Chicago, Illinois 60626 Kay Hodges, Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan Contributors 48197 Hugh E]obnston, Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Wisconsin Medical School, Madison, WISCOnsin 53792 ]awd H. Kashani, Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri 65212 Nadine]. Kaslow, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322 Alan E. Kazdin, Department of Psychology, Yale University, New Haven, Connecticut 06520-8205 Betsy D. Kennard, Department of Psychiatry, University of Texas Southwestern Medical Center, and Children's Medical Center at Dallas, Dallas, Texas 75235-9070 ]ananne Khurl, Department of Psychology, Columbia University, New York, New York 10027 Robert A. Kowatch, Department of Psychiatry, University of Texas Southwestern Medical Center, and Children's Medical Center at Dallas, Dallas, Texas 75235-9070 Cynthia Kurowski, Department of Educational Psychology, University of Texas, Austin, Texas 78712 Peter M. Lewinsohn, Oregon Research Institute, Eugene, Oregon 97403-1983 ]ames]. Mazza, Department of Psychology, St. John's University, Jamaica, New York 11439 Rob McGee, Department of Preventive and Social Medicine, University of Otago Medical School, Dunedin, New Zealand Laura L. Mee, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322 Hartmut B. Mokros, Rutgers University, New Brunswick, New Jersey 08903 Barry Nurcombe, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, 1bmessee 37212 Elva O. Poznanski, Rush-Presbyterian-St. Luke's Medical Center, Chicago, lllinois 60612 Gary R. Racusin, Connecticut Mental Health Center, Yale University, New Haven, Con necticut 06516 Wlllbun M. Reynolds, P5ychoeducational Research and 1hiining Centre, University of British Columbia, Vancouver, British Columbia V6T lZ4, Canada Fred A. Rogosch, Mt. Hope Family Center, University of Rochester, Rochester, New York 14608 Paul Rohde, Oregon Research Institute, Eugene, Oregon 97403-1983 Lawrence W. Rouse, Department of Educational Psychology, University of Texas, Austin, Texas 78712 Patrick Schloss, Assistant Vice President, Graduate Studies and Research, Bloomsburg University, Bloomsburg, Pennsylvania 17815 Holly Sher, Department of Special Education, University ofMissoud, Columbia, Missouri 65211 Donald L. Sherak, Child and Adolescent Services, Taunton State Hospital, Thunton, Massachusetts 02780 Patricia L. Speier, Langley Porter Psychiatric Institute, University of California at San Francisco, San Francisco, California 94143-0984 Kevin D. Stark, Department of Educational Psychology, University of Texas, Austin, Texas 78712 Sheree L. 10th, Mt. Hope Family Center, University of Rochester, Rochester, New York 14608 Paul V. '&ad, Department of Psychiatry, The New York Hospital-Cornell Medical Center, White Plains, New York, 10605 Warren A. Weinberg, Department of Neurology, University of Texas Southwestern vii Medical Center, and Children's Medical Center at Dallas, Dallas, Texas 75235-9070 Contributors Ingrid Wheelock, Judge Baker Children's Center, Department of Psychiatry, Harvard University Medical School, Boston, Massachusetts 02115 Lech Wisniewski, Department of Special Education, Eastern Michigan University, Ypsi lanti, Michigan 48197 Preface Anyone who has ever been close to a seriously depressed child has undoubtedly been affected by the youngster's vulnerability, misery, and pain. Indeed, it is much like caring for a child who is in physical pain. For the child in the depths of depression, no activity is fun, nothing can be enjoyed, and no one can provide enough consolation or comfort. At times, the youngster may cry or whimper. There may be fits of defiance or rage and sometimes withdrawal into a numb, sullen silence. A child in this state tries the patience of parents and siblings. Remedies of every sort are tried, including gifts, punishments, bribes, lectures, pleading, and a host of others. Such efforts occasionally provide temporary relief, but more often they seem to make matters worse. Commonly, there is an emotional wall of anger and frustration between a depressed child and other fumily members that may inevitably lead to further isolation and withdrawal. If too much time passes without their being helped, many depressed children and adolescents come to believe that suicide offers the only real relief for their pain. Currently, there is a Depression Awareness Week that includes free screening at participating health and mental health settings around the United States and is designed to identify depression in adults, suggesting that society's awareness of depression and psychiatric disorders is focused to a large extent on adults. Although professionals acknowledge the existence of depression in children and adolescents, with epidemiologi· cal studies suggesting significant prevalence, the scope of the problem is still unrecognized by the general public. For children and adolescents, the school typically provides a natural setting for the identification of depression, with a number of schools already having adopted a screening model for this purpose. Sadly, too litrle is yet being done to identify and treat depressed children and adolescents. Depression in children and adolescents is manifested by many of the same symptoms we find in depressed adults. Depression in the young may last for years with little respite or even relief from treatment. As this handbook illustrates, depression in young people represents a complex interplay of developmental, environmental, dynamic, interpersonal, cognitive, behavioral, and biological factors. The multitude and magnitude of these factors are well represented and presented. The need for a comprehensive handbook on depression in children and adolescents became evident to one of the editors (WMR) several years ago when he was writing a chapter on depression for a book on internalizing disorders. After he had completed an initial 200-page draft of his chapter, it was clear that no chapter nor, realistically, no one single-authored book could do justice to the depth and breadth of understanding depres sion in children and adolescents. This handbook is the result of our perception that the scope of this disorder merits a broad and multidisciplinaty approach. Toward this end, the ix x book includes contributions by many of the leading experts on child and adolescent depression in the fields of psychology and psychiatry. Preface This book was written for professionals as well as graduate students with clinical and research interests in child and adolescent psychopathology in general, and in depression in young people in particular. We anticipate that the book will be particularly useful to psychologists, psychiatrists, social workers, pediatricians, counselors, nurses, and other mental health professionals. The chapters cover a range of disciplines and orientations to provide a balanced and comprehensive treatment of depression in children and adoles· cents. The 25 chapters are organized in six parts. Part I, an introduction to depression in children and adolescents, consists of a brief introduction to the field, chapters on the description and epidemiology of depression in youngsters, phenomenology and treatment of bipolar disorder, and a thoughtful chapter on the validity of depression as a clinical disorder in young people. Part II describes a wide range of theories and models of depreSSion, with specific attention to children and adolescents. This range is illustrated by chapters on dynamic theories, cognitive-behavioral models, developmental models, and neurobiological models. Part III focuses on classification, diagnosis, and assessment of depression in youngsters, with a chapter on systems of classification and diagnOSiS, and chapters on assessment by clinical interviews, self-report procedures, and assessment by Significant others. The last chapter in this part discussed the important issue of variability in reports of child depression across informants. Part IV provides a comprehensive examination of treatment approaches for depression in children and adolescents, with chapters on the psychological treatment of children, the treatment of adolescents, family therapy, and a chapter on psychopharmacotherapy for depression in children and adoles cents. Part V; which examines depression in special populations, includes chapters on depression in infants, children with medical illness, and youngsters in special education placements within school settings. Part VI provides coverage of a wide range of important topics, with chapters on children of parents with depressive disorders, maltreatment and depression in children, the effects ofp sychosocial stressors, suicide and suicidal behaviors in children and adolescents, and the nature of comorbidity of other disorders and depression in children and adolescents. Each chapter in this handbook provides a compre hensive examination of an important topic related to depression in young people. Readers will find a useful blend of theory, research, and clinical practice within the overall scope of the book. This handbook is dedicated foremost to the millions of children and adolescents who suffer from depression and whose plight is the book's focus. Although by design the book is a compilation of current research and knowledge on depression in children and adoles cents, we hope and anticipate that readers will go beyond the individual chapters and integrate this information into a comprehensive picture of our understanding of depres sion in young people. We are grateful to many individuals who by direct or indirect means assisted us, provided comments, support, example, or by their writings and research enhanced our knowledge of depression in children and adolescents. Each of the editors has gained from interactions with colleagues at the University of Wisconsin-Madison. Among those who have helped both of us on our journey to this pOint, we wish to thank Dr. John H. Greist of the University of Wisconsin Medical School and Dean of the Foundation for Health, Research, and Education. Bill also thanks his friends and colleagues, Drs. Gloria Miller,Joe Czajka, Maribeth Gettinger, Allan Cohen, Bob Smith, Richard Rankin, Kevin Stark, Kevin Coats, James Mazza, Thomas Evert, and Gail Anderson, for their support, encouragement, and friendship over the years. In particular, he wishes to thank Dr. Norman Sundberg, friend and mentor for the past twenty years, for his support, friendship, and example. Hugh wishes to thank Drs. Bill Swift,Jack Westman, and Richard Anderson for years of thoughtful