Abstract
BackgroundCurrent clinical knowledge suggests that children can have different types of depressive symptoms (irritability and aggression), but presents no theoretical basis for these differences. Using a developmental approach, the present study sought to test the relationship between developmental level (mental age) and expression of depressive symptoms. The primary hypothesis was that as children's mental age increased, so would the number of internalizing symptoms present.MethodsParticipants were 252 psychiatric inpatients aged 4 to 16 with a diagnosed depressive disorder. All children were diagnosed by trained clinicians using DSM criteria. Patients were predominantly male (61%) with varied ethnic backgrounds (Caucasian 54%; African American 22%; Hispanic 19%; Other 5%). Children were given an IQ test (KBIT or WISC) while within the hospital. Mental age was calculated by using the child's IQ score and chronological age. Four trained raters reviewed children's records for depressive symptoms as defined by the DSM-IV TR. Additionally, a ratio score was calculated to indicate the number of internalizing symptoms to total symptoms.ResultsMental age positively correlated (r = .51) with an internalizing total symptom ratio score and delineated between several individual symptoms. Mental age also predicted comorbidity with anxiety and conduct disorders. Children of a low mental age were more likely to be comorbid with conduct disorders, whereas children with a higher mental age presented more often with anxiety disorders. Gender was independently related to depressive symptoms, but minority status interacted with mental age.ConclusionThe results of this study indicate that a developmental approach is useful in understanding children's depressive symptoms and has implications for both diagnosis and treatment of depression. If children experience depression differently, it follows that treatment options may also differ from that which is effective in adults.
Highlights
Current clinical knowledge suggests that children can have different types of depressive symptoms, but presents no theoretical basis for these differences
The first hypothesis, that mental age would be positively correlated with internalizing depressive symptoms was tested with a more stringent alpha level of
The results indicate that mental age was a strong correlate of internalizing depressive symptoms, r = .51, p
Summary
Current clinical knowledge suggests that children can have different types of depressive symptoms (irritability and aggression), but presents no theoretical basis for these differences. The primary hypothesis was that as children's mental age increased, so would the number of internalizing symptoms present. Research indicates that children's experience of depression differs significantly from that evidenced in adults. The current perspective on depression, as indicated in the Diagnostic and Statistical Manual of Mental Disorders [1] and the National Institute for Clinical Excellence [3], suggests that, children and adults can have similar symptoms, their presentation may vary. Developmental research indicates that externalizing behaviors are present at low developmental levels (young children) and gradually change to internalizing behaviors over time
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