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Child Psychiatry and Human Development

, Volume 24, Issue 3, pp 157–172 | Cite as

Differential diagnosis of childhood depression: Using comorbidity and symptom overlap to generate multiple hypotheses

  • Paul B. de Mesquita
  • Walter S. Gilliam
Articles

Abstract

Childhood depression is often found to share symptoms and coexist with several other childhood disorders and physiological conditions, leading to diagnostic errors and possibly inappropriate treatment. Literature relevant to the differential diagnosis of childhood depression is reviewed with particular attention given to the similarities and differences between depression and coexisting conditions such as anxiety disorders, conduct disorders, and attention deficit hyperactivity disorder. The characteristics of childhood depression are compared and contrasted with other possible coexisting disorders. Diagnostic reasoning, confirmatory bias, and the advantages of considering multiple hypotheses when diagnosing depression are discussed.

Key Words

Childhood Depression differential diagnosis comorbidity symptom overlap Anxiety Disorder Conduct Disorder Attention Deficit Hyperactivity Disorder 

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References

  1. 1.
    Kovacs M, Beck AT: An empirical-clinical approach toward a definition of childhood depression. In:Depression in childhood: Diagnosis, treatment and conceptual models, eds. Schulterbrandt JG & Raskin A. New York: Raven Press, 1977.Google Scholar
  2. 2.
    Rutter M. The developmental psychopathology of depression: Issues and perspectives. InDepression in young people: Developmental and clinical perspectives, eds. Rutter M, Izard CE, & Read PB. New York: Guilford Press, 1986.Google Scholar
  3. 3.
    Allen-Meares P: Depression in childhood and adolescence.Soc Work 32:512–516, 1987.Google Scholar
  4. 4.
    Herzog DB, Rathbun JM: Childhood depression: Developmental considerations.Am J Dis Child 136 115–120, 1982.PubMedGoogle Scholar
  5. 5.
    Stark K:Childhood depression: School-based intervention. New York: Guilford Press, 1990.Google Scholar
  6. 6.
    Anderson JC, Williams S, McGhee R, Silva PA: The prevalence of DSM-III disorders in pre-adolescent children: Prevalence in a large sample of the general population.Arch Gen Psychiatry 44: 69–76, 1987.PubMedGoogle Scholar
  7. 7.
    Ben-Amos B: Depression and conduct disorders in children and adolescents: A review of the literature.Bull Menninger Clin 56: 188–208, 1992.PubMedGoogle Scholar
  8. 8.
    Fleming JE, Offord DR: Epidemiology of child depressive disorders: A critical review.J Am Acad Child Adolesc Psychiatry 29: 571–580, 1990.PubMedGoogle Scholar
  9. 9.
    Kazdin AE: Childhood depression.J. Child Psychol Psychiatry 31: 121–160, 1990.PubMedGoogle Scholar
  10. 10.
    Kovacs M: Affective disorders in children and adolescents.Am Psychol, 44: 209–215, 1989.CrossRefPubMedGoogle Scholar
  11. 11.
    Turk DC, Salovey P:Reasoning, inference, and judgment in clinical psychology. New York: Macmillan, 1988.Google Scholar
  12. 12.
    Dumont F: Inferential heuristics in clinical problem formation. Selective review of their strengths and weaknesses.Prof Psychol 24: 196–205, 1993.Google Scholar
  13. 13.
    Dowie J, Elstein AS:Professional judgment: A reader in clinical decision making. Cambridge, England: Cambridge University Press, 1988.Google Scholar
  14. 14.
    Costello EJ:Clinical decision making in child psychiatry. Paper presented at the 29th meeting of the American Academy of Child Psychiatry, Washington, DC, October, 1982.Google Scholar
  15. 15.
    Reynolds WM: Depression in children and adolescents: Nature, diagnosis, assessment, and treatment.Sch Psychol Rev, 19: 158–173, 1990.Google Scholar
  16. 16.
    Carlson GA, Garber J: Developmental issues in the classification of depression in children. In:Depression in young people: Development and clinical perspectives, eds. Rutter M, Izard CE, Read PB. New York: Guilford Press, 1986.Google Scholar
  17. 17.
    Lefkowitz MM Testiny EP: Depression in children: Prevalence and correlates.J Consult Clin Psychol, 53: 647–656, 1985.PubMedGoogle Scholar
  18. 18.
    Ryan N, Williamson DE, Iyengar S, Orvaschel H, Reich T, Dahl RE, Puig-Antich JA. A secular increase in child and adolescent onset affective disorder.J Am Acad Child and Adolesc Psychiatry 31: 600–605, 1992.Google Scholar
  19. 19.
    Puig-Antich J, Gittelman R: Depression in childhood and adolescence. InHandbook of affective disorders, ed. Paykel ES, New York: Guilford, 1982.Google Scholar
  20. 20.
    Kazdin AE: Childhood depression. InTreatment of childhood disorders, eds. Mash EJ, Barkley RA. New York: Guilford Press, 1989.Google Scholar
  21. 21.
    Achenbach TM:Assessment and taxonomy of child and adolescent psychopathology. Beverly Hills, CA: Sage Publications, 1985.Google Scholar
  22. 22.
    Kashani JH, Holcomb WR, Orvaschel H: Depression and depressive symptoms in preschool children from the general population,Am J Psychiatry 143: 1138–1143, 1986.PubMedGoogle Scholar
  23. 23.
    Nolen-Hoeksema S, Girgus JS, Seligman MEP: Predictors and consequences of childhood depressive symptoms: A 5-year longitudinal study.J Abnorm Psychol 101: 405–422, 1992.CrossRefPubMedGoogle Scholar
  24. 24.
    Bernstein GA: Comorbidity and severity of anxiety and depressive disorders in a clinic sample.J Am Acad Child Adolesc Psychiatry 30, 43–50, 1991.PubMedGoogle Scholar
  25. 25.
    Brady EU, Kendall PC: Comorbidity of anxiety and depression in children and adolescents.Psychol Bull 111: 244–255, 1992.CrossRefPubMedGoogle Scholar
  26. 26.
    Cole DA, Carpentieri S: Social status and the comorbidity of child depression and conduct disorder.J Consult Clin Psychol 58: 748–757, 1990.PubMedGoogle Scholar
  27. 27.
    Kelly GL, Childhood depression and suicide.Nurs Clin North Am 26: 545–558, 1991.PubMedGoogle Scholar
  28. 28.
    Kovacs M, Paulauskas S, Gatsonis C, Richards C: Depressive disorders in childhood; III. A longitudinal study of comorbidity with and risk for conduct disorders.J Affect Disord 15: 205–217, 1988.CrossRefPubMedGoogle Scholar
  29. 29.
    Rohde P, Lewinsohn PM, Seeley JR: Comorbidity of unipolar depression: 2. Comorbidity with other mental disorders in adolescents and adults.J Abnorm Psychol 100: 214–222, 1991.CrossRefPubMedGoogle Scholar
  30. 30.
    Fleming JE, Offord DR, Boyle MH: Prevalence of childhood and adolescent depression in the community: Ontario Child Health Study.Br J Psychiatry 155: 647–654, 1989.PubMedGoogle Scholar
  31. 31.
    Barkley RA:Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press, 1990.Google Scholar
  32. 32.
    Dobson KS: The relationship between anxiety and depression.Clin Psychol Rev 5: 307–324, 1985.CrossRefGoogle Scholar
  33. 33.
    Eason LJ, Finch AJ, Brasted W, Saylor CF: The assessment of depression and anxiety in hospitalized pediatric patients.Child Psychiatry Hum Dev 16: 57–64, 1985.CrossRefPubMedGoogle Scholar
  34. 34.
    Kovacs M. Comorbid anxiety disorders in childhood-onset depressions. InComorbidity of mood and anxiety disorders, eds. Maser JD, Cloniger CR. Washington, DC: American Psychiatric Press, 1990.Google Scholar
  35. 35.
    Laurent J, Landau S, Stark KD: Conditional probabilities in the diagnosis of depressive and anxiety disorders in children.Sch Psychol Rev 22: 98–114, 1993.Google Scholar
  36. 36.
    Tannenbaum LE, Forehand R, Thomas AM. Adolescent self-reported anxiety and depression: Separate constructs or a single entity.Child Stud J 22: 61–72, 1992.Google Scholar
  37. 37.
    Strauss CC, Last CG, Hersen M, Kazdin AE: Association between anxiety and depression in children and adolescents with anxiety disorders.J Abnorm Child Psychol 16: 57–68, 1988.PubMedGoogle Scholar
  38. 38.
    Mitchell J, McCauley E, Burke PM Moss SJ: Phenomenology of depression in children and adolescents.J Am Acad Child Adolesc Psychiatry 27: 12–20, 1988.PubMedGoogle Scholar
  39. 39.
    Barrios BA, O'Dell SL: Fears and anxieties. InTreatment of childhood disorders, eds. Mash EJ, Barkley RA, New York: Guilford Press, 1989.Google Scholar
  40. 40.
    American Psychiatric Association:Diagnostic and statistical manual of mental disorders (3rd ed., revised), Washington, DC: Author, 1987.Google Scholar
  41. 41.
    Soltys SM, Kashani JH, Dandoy AC, Vaidya AF, Reid JC: Comorbidity for disruptive behavior disorders in psychiatrically hospitalized children.Child Psychiatry and Hum Dev 23: 87–98, 1992.Google Scholar
  42. 42.
    Ney, P., Colbert, P., Newman, B, & Young, J.: Aggressive behavior and learning difficulties as symptoms of depression in children.Child Psychiatry and Hum Dev 17: 3–14, 1986.Google Scholar
  43. 43.
    Rapoport JL, Ismond DR:DSM-III-R training guide for diagnosis of childhood disorders. New York: Brunner/Mazel, 1990.Google Scholar
  44. 44.
    Apter A, Bleich A, Plutchik R, Mendelsohn S, Tyano S: Suicidal behavior, depression and conduct disorder in hospitalized adolescents.J Am Acad Child Adolesc Psychiatry 27: 696–699, 1988.PubMedGoogle Scholar
  45. 45.
    King RB, Brown R, Gibson S:Differentiating conduct disorder from depressive disorders in school age children. Paper presented at the Annual Meeting of the American Educational Research Association, San Francisco. (ERIC Document Reproduction Service No. ED 269 683), 1986.Google Scholar
  46. 46.
    Dadds MR, Sanders MR, Morrison M, Rebgetz M: Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home.J Abnorm Psychol 101: 505–513, 1992.CrossRefPubMedGoogle Scholar
  47. 47.
    Barrett ML, Berney TP, Bhate S, Famuyiwa OO, Fundudis T, Kolvin I, Tyrer S: Diagnosing childhood depression: Who should be interviewed—parent or child? The Newcastle Child Depression Project.Br J Psychiatry 159(Suppl. 11): 22–27, 1991.Google Scholar
  48. 48.
    Jensen JB, Burke N, Garfinkel BD: Depression and symptoms of Attention Deficit Disorder with Hyperactivity.J Am Acad Child Adolesc Psychiatry 27: 742–747, 1988.PubMedGoogle Scholar
  49. 49.
    McClellan JM, Rupert MP, Reichler RJ, Sylvester CE: Attention-deficit disorder in children at-risk for anxiety and depression.J Am Acad Child Adolesc Psychiatry 29: 534–539, 1990.PubMedGoogle Scholar
  50. 50.
    Weinberg WA, Emslie GJ Attention-deficit hyperactivity disorder: The differential diagnosis.J Child Neurol 6(Suppl.): 23–36, 1991.Google Scholar
  51. 51.
    Faigel HC, Doak E, Howard SD, Sigel ML: Emotional disorders in learning disabled adolescents.Child Psychiatry Hum Dev 23: 31–40, 1992.CrossRefPubMedGoogle Scholar
  52. 52.
    Wright-Strawderman C, Watson BL: The prevalence of depressive symptoms in children in learning disabilities.J Learn Disabil 25: 258–264, 1992.PubMedGoogle Scholar
  53. 53.
    Campbell M, Malone RP. Mental retardation and psychiatric disorders.Hosp Community Psychiatry 42: 374–379, 1991.PubMedGoogle Scholar
  54. 54.
    Stabler B, Siegel PT, Clopper RR: Growth hormone deficiency in children has psychological and educational co-morbidity.Clin Pediatr 30: 156–160, 1991.Google Scholar
  55. 55.
    Brent DA, Crumrine PK, Varma RR, Allan M, Allman C: Phenobarbitol treatment and major depressive disorder in children with epilepsy,Pediatrics, 80, 909–917, 1987.PubMedGoogle Scholar
  56. 56.
    Alnaes R, Torgersen S: Clinical differentiation between major depression only, major depression with panic disorder and panic disorder only: Childhood, personality and personality disorder.Acta Psychiatr Scand 79: 370–377, 1989.PubMedGoogle Scholar
  57. 57.
    Reeve EA, Bernstein GA, Christenson GA: Clinical characteristics and psychotic comorbidity in children with trichotillomania.J Am Acad Child Adolesc Psychiatry 31: 132–138, 1992.PubMedGoogle Scholar
  58. 58.
    heiligenstein E, Jacobsen PB: Differentiating depression in medically ill children and adolescents.J Am Acad Child Adolesc Psychiatry 27: 716–719, 1988.PubMedGoogle Scholar
  59. 59.
    Patten SB: The loss of a parent during childhood as a risk factor for depression.Can J Psychiatry 36: 706–711, 1991.PubMedGoogle Scholar
  60. 60.
    Davidson JR, Hughes D, Blazer DG, George LK: Post-traumatic stress disorder in the community: An epidemiological study.Psychol Med 21: 713–721, 1991.PubMedGoogle Scholar
  61. 61.
    Rutter M, Tuma AH: Diagnosis and classification: Some outstanding issues. In:Assessment and diagnosis in child psychopathology, eds. Rutter M, Tuma AH, Lann IS New York: Guilford Press, 1988.Google Scholar
  62. 62.
    Meehl PE: Seer over sign: The first good example.J Exper Res in Pers 1: 27–32, 1965.Google Scholar

Copyright information

© Human Sciences Press, Inc 1994

Authors and Affiliations

  • Paul B. de Mesquita
    • 1
  • Walter S. Gilliam
    • 1
  1. 1.University of KentuckyLexington

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