Description and Classification Of Depression

While there has always been a broad consensus that children can experience sad affect, there has been considerable variation of opinion as to whether or not youngsters experience the full range of affective, somatic, cognitive, and behavioral attributes characteristic of major depression in adults. How then is depression in children and adolescents to be described and classified for scientific purposes?
It has been suggested that it is important to make a distinction between the phenomenon (or symptom) of depression and the syndrome (or disorder) called depression (e.g., Rutter, 1936b). The symptom of depression refers to the experience of sadness, die loss of interest or pleasure, the lack of responsiveness, and the like, that are used to describe this negative mood state. The term "symptom" here is used in its colloquial sense (equivalent to terms such as "problem" or "experience of”) and does not imply any illness. In contrast, it has been suggested that the concept of a depressive disorder be reserved for the notion of depression as a syndrome.

As a syndrome, 'depression" refers to a group of attributes that reliably go together. "The syndrome consists of the symptom of negative mood state accompanied by certain somatic, cognitive, and behavioral problems. It is sometimes suggested that a further distinction should also be made between a syndrome and a disorder (e.g., kovacs, 1989). The latter has all the characteristics of a syndrome, but there is also a persistence of the syndrome, and social impairment is observed in the youngster. In addition, for a disorder it is presumed that more is known about, the problem (e.g., a characteristic family history). Hopefully, careful use of these distinctions in future work will help to clarify some of the confusion regarding childhood depression.

Recent history.
A brief look at the recent history of thinking on childhood depression may also help clarify differing viewpoints. The dominant view in child clinical work for many years was the orthodox psychoanalytic perspective. From this perspective depression was viewed as a phenomenon of the superego and of mature ego functioning (Kessler, 1988). It was argued, for example, that in depression the superego acts as a punisher of the ego. Since the child's superego is not sufficiently developed to play this role, it is impossible, within this perspective, for a depressive disorder to occur in children. It is not surprising, therefore, that depression in children received little attention.
A second major perspective on childhood depression added to the controversy regarding the existence of a distinct disorder. The concept of masked depression represented an interesting view. This view held that there is a disorder of childhood depression. However, it proposed that there are numerous instances when the dysphoric mood and other features usually considered essential to the diagnosis of depression are not present. It was held that an underlying depressive disorder does exist, but the youngster's depression is "masked" by other problems (depressive equivalents) such as hyperactivity or delinquency. The "underlying" depression itself is not directly displayed, but is inferred by the clinician. Some workers, indeed, suggested that masked depressions were quite common and may have resulted in childhood depression being under diagnosed (Cytryn and McKnew, 1974; Malmquist, 1977).
The notion of masked depression is clearly problematic. There is no operational way to decide whether a particular symptom is or is not a sign of depression. Indeed, the symptoms that have been suggested as masking depression have included virtually the full gamut of problem behaviors evident in youngsters. The concept of masked depression is, thus, quite controversial. Even some of its early advocates came to view it as less important than once thought (Cytryn, and McKnew, and Bunney, 1980).
The concept of masked depression was, however, important. It clearly recognized depression as an important and prevalent childhood problem. The central notions of masked depression that depression in children does exist and that youngsters may display depression in a variety of age related forms and in ways that may be different from adult depression are still widely held. The concept that depression is manifested differently in children and adults contributed, in part, to the evolution of a broader developmental perspective.

Reference: Behavior Disorders of Childhood by Rita Wicks-Nelosn & Allen C. Israel

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