Study objectives were to develop a treatment manual for a family-focused
intervention for depressed school-aged children, evaluate its feasibility and
acceptability, and complete an initial open trial to examine treatment effects.
Nine young people meeting criteria for depression (major depressive disorder,
dysthymic disorder, or depression not otherwise specified), completed a 12-week
family intervention, and were assessed immediately and at 9 months following
treatment completion. The intervention presented an interpersonal model of how
depressive symptoms are maintained, and emphasized developing family strategies
for altering interpersonal processes, supporting recovery and enhancing
resilience. At posttreatment 66% of the young people had recovered from their
depressive episodes; by 9 months posttreatment 77% had recovered. Significant
improvements in global functioning were noted. There were no relapses in the
follow-up period and no instances of suicidal behavior during the intervention
or follow-up. Mothers' and fathers' Child Behavior Checklist reports and
children's self reports indicated significant symptom reductions. Exploratory
analyses suggest particular benefit for young people with parents high in
criticism. The family-focused intervention for childhood-onset depression
demonstrated gains similar to those seen with empirically supported treatments
for depressed adolescents and superior to those seen in naturalistic studies of
depression outcomes. This favorable risk/benefit profile supports the value of a
randomized controlled trial.
Achenbach, T.M.
(1991). Manual for the Child Behavior Checklist
4—18 and 1991 Profile.
Burlington, VT: University of Vermont,
Department of Psychiatry
.
2.
Angold, A.
, &
Costello, E.J.
(2001). The epidemiology of depression in children and
adolescents. In
I.M. Goodyer
(Ed.), The depressed child and adolescent: Developmental and clinical
perspectives (pp. 127—148).
Cambridge: Cambridge University Press
.
3.
Asarnow, J.R.
, &
Carlson, G.A.
(1985).
Depression self-rating scale: Utility with child psychiatric inpatients
. Journal of Consulting and Clinical Psychology, 53,
491—499
.
4.
Asarnow, J.R.
,
Goldstein, M.J.
,
Tompson, M.
, &
Guthrie, D.
(1993).
One-year outcomes of depressive disorders in child psychiatric in-patients:
Evaluation of the prognostic power of a brief measure of expressed emotion
. Journal of Child Psychology and Psychiatry , 34,
129—137
.
5.
Asarnow, J.R.
,
Jaycox, L.H.
,
Duan, N.
,
LaBorde, A.P.
,
Rea, M.M.
,
Tang, L.
,
Anderson, M.
, et al. (2005)
Depression and role impairment among adolescents in primary care clinics.
Journal of AdolescentHealth, 37(6),
477—483
.
Asarnow, J.R.
,
Scott, C.V.
, &
Mintz, J.
(2002).
A combined cognitive-behavioral family education intervention for
depression in children: I treatment development study. CognitiveTherapy & Research, 26,
221—229
.
8.
Barrett, P.M.
,
Dadds, M.R.
, &
Rapee, R.M.
(1996).
Family treatment of childhood anxiety: A controlled trial
. Journal of Consulting and Clinical Psychology, 64,
333—342
.
9.
Birmaher, B.
,
Ryan, N.D.
,
Williamson, D.E.
,
Brent, D.A.
,
Kaufman, J.
,
Dahl, R.E.
,
Perel, J.
, &
Nelson, B.
(1996).
Childhood and adolescent depression: A review of the past 10 years, Part I
. Journal of the American Academy of Child and Adolescent
Psychiatry, 35,
1427—1439
.
10.
Brent, D.A.
,
Holder, D.
,
Kolko, D.
,
Birmaher, B.
,
Baugher, M.
,
Roth, C.
,
Iyengar, S.
, &
Johnson, B.
(1997).
A clinical psychotherapy trial for adolescent depression comparing
cognitive, family and supportive therapy
. Archives of General Psychiatry, 54,
877—885
.
11.
Cheung, A.H.
,
Emslie, G.J.
, &
Mayes, T.L.
(2005).
Review of the efficacy and safety of antidepressants in youth depression
. Journal of Child Psychology and Psychiatry , 46,
735—754
.
12.
Clarke, G.N.
,
Rohde, P.
,
Lewinsohn, P.M.
,
Hops, H.
, &
Seeley, J.R.
(1999).
Cognitive-behavioral treatment of adolescent depression: Efficacy of acute
group treatment and booster sessions
. Journal of the American Academy of Child and Adolescent
Psychiatry, 38,
272—279
.
13.
Diamond, G.
, &
Siqueland, L.
(1995).
Family therapy for the treatment of depressed adolescents
. Psychotherapy, 32,
77—90
.
14.
Diamond, G.
, &
Siqueland, L.
(1998).
Emotions, attachment and the relational reframe: The first session
. Journal of Systemic Therapies, 17,
36—50
.
15.
Diamond, G.
,
Reis, B.F.
,
Diamond, G.M.
,
Siqueland, L.
, &
Isaacs, L.
(2002).
Attachment-based family therapy for depressed adolescents: A treatment
development study
. Journal of the American Academy of Child & Adolescent
Psychiatry, 41,
1190—1196
.
16.
Fleming, J.E.
, &
Offord, D.R.
(1990).
Epidemiology of childhood depressive disorders: A critical review
. Journal of the American Academy of Child and Adolescent
Psychiatry, 29,
571—580
.
17.
Flory, V.
(2004).
A novel clinical intervention for severe childhood depression and anxiety
. Clinical Child Psychology and Psychiatry , 9,
9—24
.
18.
Geller, B.
,
Zimmerman, B.
,
Williams, M.
,
Bolhofner, K.
, &
Craney, J.L.
(2001).
Adult psychosocial outcome of prepubertal major depressive disorder
. Journal of the American Academy of Child and Adolescent
Psychiatry, 40,
673—677
.
19.
Hamilton, E.B.
,
Asarnow, J.R.
, &
Tompson, M.C.
(1999).
Family interaction styles of children with depressive disorders,
schizophrenia-spectrum disorders, and normal controls
. Family Process, 38,
463—476
.
20.
Hammen, C.
(1991). Depression runs in families: The social context of
risk and resilience in children of depressed mothers.
New York: Springer-Verlag
.
21.
Hammen, C.
,
Burge, D.
, &
Adrian, C.
(1991).
Timing of mother and child depression in a longitudinal study of children
at risk
. Journal of Consulting and Clinical Psychology, 59,
341—345
.
22.
Harrington, R.
,
Fudge, H.
,
Rutter, M.
,
Pickles, A.
, et al. (1990).
Adult outcomes of childhood and adolescent depression: I. Psychiatric status
. Archives of General Psychiatry,47,
465—473
.
23.
Jacobson, N.S.
,
Dobson, K.
,
Fruzzetti, A.E.
, &
Schmaling, K.B.
(1991).
Marital therapy as a treatment for depression
. Journal of Consulting and Clinical Psychology ,
59,
547—557
.
24.
Jaycox, L.H.
,
Reivich, K.J.
,
Gillham, J.E.
, &
Seligman, M.E.P.
(1994).
Prevention of depressive symptoms in schoolchildren
. Behavioral Research and Therapy , 32,
801—816
.
25.
Kahn, J.S.
,
Kehle, T.J.
,
Jensen, W.R.
, &
Clark, E.
(1990).
Comparisons of cognitive-behavioral, relaxation, and self-modeling
interventions for depression among middle school students
. School Psychology Review, 19,
196—211
.
26.
Kaslow, N.J.
,
Baskin, M.L.
, &
Wyckoff, S.C.
(2002). A biopsychosocial treatment approach for depressed
children and adolescents In
N.J. Kaslow
(Ed.), Comprehensive handbook of psychotherapy:
Integrative/eclectic , Vol. 4 (pp. 31—57).
New York : Wiley
.
27.
Kaslow, N.J.
,
Deering, C.G.
, &
Ash, P.
(1996). Relational diagnosis of child and adolescent
depression . In
N.J. Kaslow
(Ed.), Handbook of relational diagnosis and dysfunctional family
patterns (pp. 171—185).
Oxford: Wiley
.
28.
Kaslow, N.J.
, &
Racusin, J.H.
(1988).
Assessment entry to that of depressed children and their families. Families TherapyToday, 3,
1—5
.
29.
Kaufman, J.
,
Birmaher, B.
,
Brent, D.
,
Rao, U.
,
Flynn, C.
,
Moreci, P.
,
Williamson, D.
, &
Ryan, N.
(1997).
Schedule for affective disorders and schizophrenia for school-aged children
— present and lifetime version (K-SADS-PL): Initial reliability
and validity data
. Journal of the American Academy of Child and Adolescent Psychiatry,36,
980—988
.
30.
Kessler R.C.
(2002). Epidemiology of depression. In
I. Gotlib
&
C. Hammen
(Eds.), Handbook of depression (pp.
23—42).
New York: Guilford
.
31.
King, C.A.
, &
Kirschenbaum, D.S.
(1990).
An experimental evaluation of a school-based program for children at-risk:
Wisconsin early intervention
. Journal of Community Psychology, 18,
167—177
.
32.
Koerner, K.
,
Prince, S.
, &
Jacobson, N.S.
(1994).
Enhancing the treatment and prevention of depression in women: The role of
integrative behavioral couple therapy
. Behavior Therapy, 25,
373—390
.
33.
Kovacs, M.
(1998). Presentation and course of major depressive disorder
during childhood and later years of the life span. In
M.E. Hertzig
&
E.A. Farber
(Eds.), Annual progress in child psychiatry and child development:
1997 (pp. 285—298).
Bristol, PA: Brunner
/
Mazel
.
34.
Kovacs, M.
,
Feinberg, T.L.
,
Crouse-Novak, M.A.
,
Paulauskas, S.L.
,
Pollock, M.
, &
Kinklestein, R.
(1984).
Depressive disorders in childhood
. Archives of General Psychiatry, 41,
643—649
.
35.
Kovacs, M.
,
Obrosky, S.
, &
Gatsonis, C.
(1997).
First-episode major depressive and dysthymic disorder in childhood:
Clinical and sociodemographic factors in recovery
. Journal of the American Academy of Child & Adolescent
Psychiatry, 36,
777—784
.
36.
Kutcher, S.
, &
Marton, P.
(1991).
Affective disorders in first-degree relatives of adolescent onset bipolars,
unipolars, and normal controls
. Journal of the American Academy of Child and Adolescent
Psychiatry, 30,
75—78
.
37.
Leitenberg, H.
,
Yost, L.W.
, &
Carroll-Wilson, M.
(1986).
Negative cognitive errors in children: Questionnaire development, normative
data, and comparisons between children with and without self-reported
symptoms of depression, low self-esteem and evaluation anxiety
. Journal of Consulting and Clinical Psychology, 51,
528—536
.
38.
Lewinsohn, P.M.
(2002). Depression in adolescents. In
C. Hammen
&
I. Gotlib
(Eds.), Handbook of depression (pp.
541—553).
New York: Guilford
.
39.
Lewinsohn, P.M.
,
Clarke, F.N.
,
Hops, H.
, &
Andrews, J.
(1990).
Cognitive-behavioral treatment for depressed adolescents
. Behavior Therapy, 21,
385—401
.
40.
Lewinsohn, P.M.
,
Hops, H.
,
Roberts, R.E.
,
Seeley, J.R.
, &
Andrews, J.A.
(1993).
Adolescent psychopathology: I. Prevalence and incidence of depression and
other DSM-III-R disorders in high school students
. Journal of Abnormal Psychology, 102,
133—144
.
41.
McCauley, E.
, &
Myers, K.
(1992).
The longitudinal clinical course of depression in children and adolescents
. Child and Adolescent Psychiatric Clinics of North America,
1,
183—196
.
42.
McCauley, E.
,
Myers, K.
,
Mitchell, J.
,
Calderon, P.
,
Schloredt, K.
, &
Treder, R.
(1993).
Depression in young people: Initial presentation and clinical course
. Journal of the American Academy of Child and Adolescent
Psychiatry, 32,
714—722
.
43.
McCracken, J.
(1992).
The epidemiology of child and adolescent mood disorders
. Child and Adolescent Psychiatric Clinics of North America,
1,
53—72
.
44.
Magana, A.B.
,
Goldstein, M.J.
,
Karno, M.
,
Miklowitz, D.J.
,
Jenkins, J.
, &
Falloon, I.R.H.
(1986).
A brief method for assessing expressed emotion in relatives of psychiatric patients
. Psychiatry Research, 17,
203—212
.
45.
March, J.
,
Silva, S.
,
Petrycki, S.
,
Curry, J.
,
Wells, K.
,
Fairbank, J.
,
Burns, B.
, et al. (2004).
Treatment for Adolescents with Depression Study (TADS) Team. Fluoxetine,
cognitive-behavioral therapy, and their combination for adolescents with
Depression: Treatment for Adolescents with Depression Study (TADS)
randomized controlled trial. Journal of theAmerican Medical Association, 292,
807—820
.
46.
Miklowitz, D.J.
, &
Goldstein, M.J.
(1997). Bipolar disorder: A family-focused treatment
approach.
New York: Guilford
.
47.
Moos, R.H.
, &
Moos, B.
(1981). Family Environment Scale Manual.
Palo Alto, CA: Consulting Psychologists Press
.
48.
Mufson, L.
,
Dorta, K.P.
,
Wickramaratne, P.
,
Nomura, Y.
,
Olfson, M.
, &
Weissman, M.M.
(2004).
A randomized effectiveness trial of interpersonal psychotherapy for
depressed adolescents
. Archives General Psychiatry, 61,
577—584
.
49.
Mufson, L.
,
Weissman, M.M.
,
Moreau, D.
, &
Garkinkel, R.
(1999).
Efficacy of interpersonal psychotherapy for depressed adolescents
. Archives of General Psychiatry, 56,
573—579
.
50.
National Institute of Mental Health. (NIMH).
( 1990). National plan for research on child and adolescent
mental disorders: A report requested by the US Congress.
Bethesda, MD: Author
.
51.
Puig-Antich, J.
,
Goetz, D.
,
Davies, M.
,
Kaplan, T.
, et al. (1989).
A controlled family history study of prepubertal major depressive disorder
. Archives of General Psychiatry,46,
406—418
.
52.
Puig-Antich, J.
,
Lukens, E.
,
Davies, M.
,
Goetz, D.
,
Brennan-Quattrock, J.
, &
Todak, G.
(1985a).
Psychosocial functioning in prepubertal major depressive disorders: I.
Interpersonal relationships during the depressive episode
. Archives of General Psychiatry, 42,
500—507
.
53.
Puig-Antich, J.
,
Lukens, E.
,
Davies, M.
,
Goetz, D.
,
Brennan-Quattrock, J.
, &
Todak, G.
(1985b).
Psychosocial functioning in prepubertal major depressive disorders: II.
Interpersonal relationships after sustained recovery from an affective episode
. Archives of General Psychiatry , 42,
511—517
.
54.
Rosselló, J.
, &
Bernal, G.
(1999).
The efficacy of cognitive-behavioral and interpersonal treatments for
depression in Puerto Rican adolescents
. Journal of Consulting and Clinical Psychology, 67,
734—745
.
55.
Rotheram-Borus, M.J.
,
Goldstein, A.M.
, &
Elkavich, A.S.
(2003). Treatment of suicidality: A family intervention for
adolescent suicide attempters. In
S.G. Hofmann
&
M.C. Tompson
(Eds.), Treating chronic and severe mental and disorders: A handbook of
empirically supported interventions (pp.
191—212).
New York: Guilford
.
56.
Schwartz, J.A.J.
,
Kaslow, N.J.
,
Racusin, G.R.
, &
Carton, E.R.
(1998). Interpersonal family therapy for childhood
depression . In
V.B. Van Hasselt
&
M. Hersen
(Eds.), Handbook of psychological treatment protocols for children and
adolescents (pp. 109—151).
Hillsdale, NJ: Lawrence Erlbaum Associates
.
57.
Seligman, M.E.
,
Peterson, C.
,
Kalsow, N.J.
,
Tanenbaum, R.L.
,
Alloy, L.B.
, &
Abramson, L.Y.
(1984).
Attributional style and depressive symptoms among children
. Journal of Abnormal Psychology , 93:
235—238
.
58.
Schaffer, D.
,
Gould, M.S.
,
Brasic, J.
,
Ambrosini, P.
,
Fisher, P.
,
Bird, H.
, &
Aluwahlia, S.
(1983).
A children's global assessment scale (CGAS)
. Archives of General Psychiatry, 40,
1228—1231
.
59.
Stark, K.D.
,
Reynolds, W.M.
, &
Kaslow, N.J.
(1987).
A comparison of the relative efficacy self-control therapy and a behavioral
problem-solving therapy for depression in children
. Journal of Abnormal Child Psychology, 15,
91—113
.
60.
Tompson, M.C.
,
McKowen, J.W.
, &
Asarnow, J.R.
(in press). Adolescents mood disorders and familial processes. In N
.B. Allen
&
L. Sheeber
(Eds.), Adolescent emotional development and the emergence of depressive
disorders.
Cambridge: Cambridge University Press
.
61.
Weisz, J.R.
,
Thurber, C.
,
Sweeney, L.
,
Proffitt, V.
, & Le
Gagnoux, G.
(1997).
Brief treatment of mild to moderate child depression using primary and
secondary controlled enhancement training
. Journal of Consulting and Clinical Psychology, 65,
703—707
.
62.
Weisz, J.R.
,
Weiss, B.
,
Alicke, M.D.
, &
Klotz, M.L.
(1987).
Psychotherapy with children and adolescents: A meta-analysis for clinicians
. Journal of Consulting and Clinical Psychology, 55,
542—549
.
63.
Weisz, J.R.
,
Weiss, B.
,
Han, S.S.
,
Granger, D.A.
, et al. (1995).
Effects of psychotherapy with children and adolescents revisited: A
meta-analysis of treatment outcome studies
. Psychological Bulletin,117,
450—468
.
