Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

Mood disorders in childhood and adolescence

“…5 It is recommended that family assessment takes into account various sociocultural factors that may influence the presentation, description, and interpretation of symptoms, focusing not only on problems, but also including positive aspects, which could be essential in planning therapeutic approaches. 13 Despite the advances achieved with the adoption of operational classification systems (DSM and ICD), the difficulties in diagnosing depression in children and adolescents are higher than those found in older individuals. This is because the current diagnostic criteria were developed for the adult population, neglecting many of the developmental differences between children/ adolescents and adults.…”

“…Among the most prevalent comorbid diagnoses are anxiety disorders, followed by disruptive disorders, attention deficit disorder/hyperactivity (ADHD), and in adolescents, substance use disorders. 13 One of the areas of greatest uncertainty in the evaluation of a first depressive episode in a child or adolescent is whether the episode is part of a unipolar or a BD. Some risk factors for BD may be useful in the diagnostic decision, although none of them has sufficient predictive power to differentiate both disorders: among them are a strong family history of BD or psychosis and a history of pharmacologically induced mania or hypomania.…”

“…The American Association of Child and Adolescent Psychiatry recommends key screening questions for depression (sad or irritable mood and anhedonia) in every psychiatric evaluation. 13 As with any assessment of children and adolescents, it is essential to establish a connection and a confidential relationship with the child or young person, and information gathering from the largest number of informants (child/adolescent, parents, school) is the best strategy to capture the underlying psychopathology. When there is need to prioritize one source of information, the literature seems to suggest that internalizing symptoms in generaland depressive symptoms particularly -tend to be more frequently reported by patients in comparison with caregivers or teachers.…”

“…Thus, special attention should be given to observable manifestations such as changes in sleep patterns, irritability, poor academic performance, and social withdrawal. 13 For the longitudinal assessment of mood symptoms, it may be useful to adopt a mood diary or timelines, and use special dates like birthdays, holidays or school holidays as anchors. Mood is recorded ranging from very happy to very sad/angry; in addition, stressful events and possible treatments should also be registered.…”

“…The use of timelines can be extremely valuable in identifying triggers, in assessing treatment response, and in the identification of possible manic or hypomanic episodes (especially in the differentiation of these in relation to return to euthymia). 13 The diagnostic assessment of depressive disorders can make use of formal procedures such as structured/ semi-structured interviews or rating scales. In addition to general interviews to assess mental disorders in childhood and adolescence (e.g., the Schedule for Affective Disorders and Schizophrenia for School-Age Children [K-SADS] and the Development and Well-Being Assessment [DAWBA]), specific instruments have been developed for the assessment of depressive symptoms in children and adolescents.…”