National Academies Press: OpenBook

Mental Disorders and Disabilities Among Low-Income Children (2015)

Chapter: 11 Clinical Characteristics of Mood Disorders

« Previous: 10 Clinical Characteristics of Learning Disabilities
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

11

Clinical Characteristics of Mood Disorders

The Social Security Administration (SSA) Listing of Impairments for mood disorders includes within the same diagnostic category criteria for the following diagnoses: major depressive syndrome, manic syndrome, and bipolar or cyclothymic syndrome. However, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (APA, 2013), the mood disorders that may have a childhood onset are (1) major depression, (2) persistent depressive disorder (PDD), and (3) disruptive mood dysregulation disorder (DMDD). In a departure from DSM-IV, DSM-5 treats bipolar disorders as a separate category. Pediatric bipolar disorder (PBD) will be addressed separately following a discussion of depression.

DEPRESSION

Diagnosis and Assessment

Major depression is defined by DSM-5 as the presence of all five symptoms including feeling—or being observed to feel—sad, empty, or hopeless most of the day (depressed mood); having markedly diminished interest in most activities (anhedonia); or having severe, recurrent verbal or behavioral outbursts of temper three or more times per week. Irritability may be a substitute for symptoms of persistent depression for children, but irritability alone is not a sufficient criterion for major depression in children (Stringaris et al., 2013). Chronicity is the most easily observed feature of PDD, which may include children diagnosed with subthreshold depression (formerly

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

known as dysthymia) as well as those diagnosed with chronic major depression. There is no lower age limit for the diagnosis of either major depressive disorder or persistent depressive disorder, but the latter is specified as “early onset” if the first episode occurs before age 21. Disruptive mood dysregulation disorder is applicable only to children between the ages of 6 and 18 years. DMDD is a new diagnosis that was developed to reduce the risk of misclassifying children with nonepisodic and chronic irritable mood as having bipolar disorder (Roy et al., 2014). Given that PDD and DMDD are new diagnostic categories, estimates of prevalence, clinical characteristics, and course may change as these criteria are applied in future research.

The most important difference between DSM-IV and DSM-5 in the diagnosis of mood disorders is that “depressive disorders” have been separated from “bipolar and related disorders.” In general, the differences between depressive disorders in DSM-IV and DSM-5 are very small and unlikely to have a great effect on estimates of prevalence or incidence.

The diagnosis of a childhood-onset depression disorder requires a comprehensive psychiatric diagnostic evaluation, including interviews with the child, primary caregivers, and collateral informants such as teachers (Birmaher et al., 2007). Although screening tools to detect depressive symptoms are available, findings from these are not a substitute for a clinical diagnosis (Birmaher et al., 2007).

There are no well-established biologic markers for these diagnoses. Research on the biologic correlates of child depression include studies examining contributing factors such as genetics, sleep, neuroendocrine, inflammatory, metabolic, and neurotrophic factors. These factors as well as neural networks are in the exploratory phase of research development (Li et al., 2013a,b; Miller and O’Callaghan, 2013; Mills et al., 2013; Nivard et al., 2015; Palagini et al., 2013; Penninx et al., 2013; Rao, 2013; Schmidt et al., 2011; Schneider et al., 2011). Early findings using brain neuroimaging, for example, have suggested that alterations in the developmental trajectories of limbic and striatal regions may increase the risk of adolescent-onset depression (Whittle et al., 2014). Luking and colleagues found an attenuated relationship between the amygdala and cognitive control regions, consistent with the hypothesis of altered regulation of emotional processing in early childhood–onset major depression (Luking et al., 2011). Preliminary studies using neuroimaging also raise questions about whether changes in brain white and gray matter differentiate between early onset unipolar and bipolar depressive disorders (Serafina et al., 2014). None of these research advances are as yet employed diagnostically.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Demographic Factors and Duration of the Disorder

Age

The age of onset for depression among children and youth is variable because the expression of depressive symptoms may differ by development stage. Irritability, for example, may be more prominent among younger depressed children (Birmaher et al., 2009). Preschool children with depressive syndrome may manifest subthreshold diagnostic criteria for depression of shorter duration (Luby et al., 2014). These early depressive symptoms are significant because in clinical samples they are predictive of major depressive disorder in later childhood even after controlling for a maternal history of depression and other risk factors (Luby et al., 2014). Furthermore, this relationship may persist because subthreshold depressive symptoms have also been found to be predictive of major depressive disorder (MDD) onset in young adulthood (Klein et al., 2013). Some of the best established risk factors for MDD include childhood anxiety and parental depression (Thapar et al., 2012).

Sex

The risk for early-onset depression among children (i.e., 12 years or younger) does not vary by gender; however, during adolescence the risk among girls substantially increases. Findings from most studies on children suggest that there are no differences in the rates of depression between boys and girls or only a slight elevation in boys compared to girls (Brooks-Gunn and Petersen, 1991; Costello et al., 1996; Garrison et al., 1989; Lewinsohn et al., 1998b; Nolen-Hoeksema et al., 1991; Petersen et al., 1991; Rutter et al., 1986; Wesselhoeft et al., 2014). In contrast, during adolescence the rate of depression among girls almost always exceeds that of boys (Avenevoli et al., 2015; Costello et al., 2003; Ferrari et al., 2013; Lewinsohn et al., 1998b; Offord et al., 1989), and this trend persists into early adulthood (Costello et al., 2003; Ferrari et al., 2013; Rao et al., 1999; Rohde et al., 2013). There is evidence that hormonal, rather than psychological or sociological, reasons account for the appearance of this adolescent gender difference, which persists until menopause (Angold et al., 1998).

Race/Ethnicity

The findings regarding differences in rates of depression among youth by race or ethnicity are mixed, and the variation is likely due to differences in study design, target populations, and how depression was identified. Among a nationally representative sample of adolescents, major depression

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

based upon youth-reported symptoms did not vary by race or ethnicity (Avenevoli et al., 2015). Using data from the National Health and Nutrition Examination Survey (NHANES) for children ages 8 to 15 years, a study found no differences in the prevalence of mood disorders by race or ethnicity, possibly because of the small sample size (Merikangas et al., 2010). In contrast, an analysis of data from the National Comorbidity Study-Adolescent Supplement (NCS-A) found higher rates of mood disorders among Hispanic adolescents than among non-Hispanic whites (Merikangas et al., 2010). Furthermore, findings from the National Longitudinal Study of Adolescent Health indicated that youth from racial or ethnic minority backgrounds were more likely to report depressive symptoms than non-minority youth (Rushton et al., 2002). This finding is consistent with that of a study that examined the variation in prevalence rates of depression among children and youth enrolled in Medicaid (Richardson et al., 2003).

Socioeconomic Status

Although studies of adults suggest that depression is associated with lower social class (Kessler et al., 2003), results from studies of children and adolescents are inconsistent (Merikangas et al., 2009). Some studies report a lack of association between depressive and anxiety disorders and social class (Costello et al., 2003), whereas others report a significant association, at least for the most impoverished groups (Costello et al., 1996; Gilman et al., 2003; Reinherz et al., 2003). There are also data on lifetime risk of depression that indicate that a low socioeconomic status (SES) in childhood is related to a higher risk of depression later in life (Gilman et al., 2002). Consequently the precise nature of the relationship between mood disorders in children or adolescents and poverty is unknown.

Duration

Childhood-onset depression is a chronic disorder, with an estimated average duration of 6 months. Among a longitudinal cohort of 816 high school students (ages 14 to 18) with depression, the mean age of onset was 15 years, and the mean duration of a major depressive episode was 26 weeks, but the duration varied widely, from 2 to 520 weeks (Rohde et al., 2013). The risk factors related to longer depressive episodes were earlier onset (age 15 years and younger), suicidal ideation, and seeking mental health treatment (Rohde et al., 2013). These findings are consistent with the NCS-A, which found the mean duration of a major depressive episode to be 27 weeks among a nationally representative sample of U.S. youth (Avenevoli et al., 2015). The median duration of major depressive episodes among clinically referred samples has been found to be considerably longer,

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

most likely reflecting the greater clinical severity among children who access and receive continuous mental health care. In such samples, the median duration of depression ranged from 7 to 9 months, which was more than three times longer than that found in a community-based sample (Kovacs, 1996).

Adolescent depression also tends to recur. A recent review of outcomes of childhood depression reached the following conclusions (Costello and Maughan, 2015): (1) One in two children with a diagnosis of depression had one or more further episodes as an adult; (2) depression alone has a much better prognosis than depression accompanied by any of the following: anxiety disorders, oppositional defiant disorder, or substance use disorder; and (3) family conflict predicts continuity of depression into adulthood. Among adolescents in the community who recovered from a depressive episode, 5 percent experienced another major depression within 6 months, 12 percent within 1 year, and approximately 33 percent within 4 years (Rohde et al., 2013). Within clinically referred samples, an estimated 70 percent of depressed young patients had at least one recurrence within 5 or more years (Kovacs, 1996). These findings are consistent with international studies that suggest that children and adolescents with depression are more likely to suffer major depression and to manifest suicidal tendencies as adults (Fergusson et al., 2005; Harrington et al., 1990).

Comorbidities

Comorbid disorders are common among children and youth with depressive disorders, and childhood onset may increase the risk for comorbidity (Fernando et al., 2011). Children and youth with depression are more likely to suffer from anxiety disorders, conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder (ADHD) as well as alcohol and drug abuse (Costello et al., 2003; Fleming and Offord, 1990; Hipwell et al., 2011; Meinzer et al., 2013). Among a community-based cohort of adolescents with major depressive disorder, 43 percent also had a lifetime occurrence of another mental disorder. Of those teens with major depression, for example, 20 percent had an anxiety disorder, 13 percent abused alcohol, 18 percent abused drugs, 4 percent had conduct disorder, 3 percent had oppositional defiant disorder, 3 percent had ADHD, 8 percent had core symptoms of bipolar disorder, and 30 percent reported smoking cigarettes daily (Lewinsohn et al., 1998b). In a study following older teens into adulthood, the rates of comorbid major depression and of alcohol abuse or dependence were both only 2 percent during adolescence, but they increased in early adulthood to 11 and 7 percent, respectively (Briere et al., 2014). Compared to major depression only (i.e., without other diagnoses), the prognosis for youth with combined depression and substance use disorders is poorer. Youth with both disorders are at higher risk for

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

alcohol dependence, suicide attempt, impaired role functioning, academic problems, life dissatisfaction, and less treatment utilization (Briere et al., 2014; Lewinsohn et al., 1998b).

Functional Impairment

A large proportion of children and adolescents with mood disorders have significant levels of functional impairment, defined as a reduced capacity to meet normal expectations in their roles at home, at school, and with peers and adults. Based on the NCS-A, 63 percent of youth with past-year major depression reported significant disability in at least one domain of functioning (Avenevoli et al., 2015). These findings are consistent with the 2001–2004 NHANES, which found that about half of children with a depressive diagnosis also showed significant functional impairment (Merikangas et al., 2010). Further, among a large epidemiologic sample, The Great Smoky Mountains Study of youth aged 9 to 13 found that 73 percent of a community sample with depression had significant functional impairment (Costello et al., 1996).

In addition, children with depression run a high risk of impaired functioning that continues into adulthood (Costello and Maughan, 2015). In the Great Smoky Mountains Study, four areas of functioning were defined as contributing to functional impairment in adulthood: (1) health, (2) education and income (SES), (3) social relationships, and (4) criminality or self-injurious behavior (Copeland et al., 2015). In all four areas, participants with early depression were significantly worse off than those with no psychiatric history, and they were the most likely of any diagnostic group to perform poorly as adults. Results from international studies are also consistent with these findings. In a Swedish sample (Jonsson et al., 2011) depressed adolescent females grew into adults who were more likely than other adults to be divorced, to be single parents, to have miscarried, to have experienced intimate partner violence, or to have had a sexually transmitted disease. In the Brisbane birth cohort study (Keenan-Miller et al., 2007), even after controlling for adult depression, early adolescent depression continued to be associated with poorer interviewer-rated health, poorer self-perceived general health, higher health care utilization, and increased work impairment due to physical health.

Treatment and Outcomes

Treatments for mood disorders among children and adolescents include evidence-based psychotherapies and psychotropic medications that may be administered alone or in combination, depending on the clinical severity, the prior history of treatment response, and parent (or older youth)

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

preference. For mild or brief depression, education, supportive therapy for 4 to 6 weeks, and case management to address environmental factors may be sufficient (AACAP, 2007).

For moderate to severe depression, the possible evidence-based psychotherapies for adolescents include cognitive behavioral therapy (CBT) (Compton et al., 2004; Harrington et al., 1998) and interpersonal psychotherapy (IPT) (Mufson et al., 1999, 2004; Rossello and Bernal, 1999). These therapies are typically delivered in six to eight weekly sessions. CBT helps adolescents recognize negative thoughts and unwanted behavioral patterns and gives them strategies to change their thoughts and actions (AACAP, 1998, 2007). Interpersonal therapy focuses on strategies to cope with problems in relationships (i.e., family disputes) that may exacerbate depressed mood (AACAP, 1998, 2007).

For persistent depression that is not improved by psychotherapy alone or for more severe depression, antidepressant medication is recommended. The medication class commonly used is selective serotonin reuptake inhibitors (SSRIs), and within this class only a few medications are approved by the Food and Drug Administration (FDA) for use with children or adolescents. In 2004 the FDA issued a public warning (i.e., a “black box warning”) about an increased risk of suicidal thoughts or behavior in children and adolescents treated with SSRI antidepressant medications. In 2007 findings from a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders (Bridge et al., 2007).

The results of research on the effectiveness of treatment are mixed but promising. Younger adolescents respond better to acute treatment than older or multiply comorbid adolescents (Curry et al., 2006). Within community-based treatment settings, psychotherapy for acute treatment of depressed youth is only modestly effective (AACAP, 2007; Weisz et al., 2006). Findings from randomized clinical trials comparing the efficacy of combined CBT and antidepressant medication with medication or psychotherapy alone are mixed (Curry et al., 2006; Goodyer et al., 2007; Kratochil et al., 2006; March et al., 2004, 2006; Melvin et al., 2006).

Antidepressant medications from the SSRI class are commonly used. Fluoxetine (Prozac) is the only SSRI approved by the FDA for use in treating depression in children ages 8 and older. Escitalopram (Lexapro) is also FDA approved for early-onset depression, but approval is restricted to youth ages 12 and older. The other SSRI medications and the SSRI-related antidepressant venlafaxine have not been approved for treatment of depression in children or adolescents, but they may be prescribed on an “off-label” basis. Table 11-1 summarizes the commonly used antidepressant medications for adolescents with depression.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

TABLE 11-1 Commonly Prescribed Antidepressant Medications for Depressive Disorders Among Adolescents

  Generic Name Brand Name
SSRI Fluoxetine Prozac
  Sertraline Zoloft
  Citalopram Celexa
  Escitalopram Lexapro
  Fluvoxamine Luvox
SNRI Venlafaxine Effexor

NOTE: SNRI = selective serotonin and norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.
SOURCE: AACAP, 1997.

Overall, the phases of treatment for depressive disorders are conceptualized as acute, continuation, and maintenance and are defined by the goal to be achieved. The goal of the acute phase is to achieve response (i.e., the patient having no symptoms or a significant reduction in symptoms for at least 2 weeks) and, ideally, full symptomatic remission (i.e., a period of at least 2 weeks and less than 2 months with no or few depressive symptoms) (AACAP, 2007). Continuation treatment is required for all depressed youths in order for them to avoid relapses (AACAP, 2007). This phase typically lasts 6 to 12 months. The goal of the maintenance phase is to avoid recurrences, especially among youth with depression of greater clinical severity. This phase may last 1 year or longer, and little research is available to guide national recommendations for when treatment during the maintenance phase should end (AACAP, 2007).

PEDIATRIC BIPOLAR DISORDER

Diagnosis and Assessment

DSM-5 conceptualizes bipolar and related disorders as a distinct diagnostic group which includes (1) bipolar I disorder, (2) bipolar II disorder, (3) cyclothymic disorder, and (4) other specified. The hallmark characteristic of bipolar I disorder is meeting criteria for a manic episode. Bipolar II disorder is characterized by a history of at least one major depression and at least one hypomanic episode. Given the chronicity of depression and mood instability, teens with bipolar II disorder may also experience serious impairment in social, academic, and occupational functioning (APA, 2013). The diagnosis of cyclothymic disorder is given to persons who experience both hypomanic and depressive periods without ever fulfilling the criteria

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

for mania, hypomania, or major depression (APA, 2013). The latest guidelines for diagnosing bipolar disorder in children were issued in 2007 by the American Academy of Child and Adolescent Psychiatry, and they are currently being updated to reflect new DSM-5 criteria. The diagnosis of PBD requires a comprehensive psychiatric diagnostic evaluation, including a psychiatric interview with the child or youth, the primary caregiver, and collateral informants, such as teachers. There are no well-established biologic markers for PBD. Pediatric bipolar disorder is a rare condition in childhood but it can lead to significant impairments (Goldstein, 2012).

A thorough evaluation is needed to rule out organic conditions. A pediatric examination should include a thorough neurological evaluation, especially in the presence of either psychotic symptoms or catatonia. Medical conditions that mimic either mania or depression, such as metabolic, endocrine, or infectious disorders or acute intoxication or withdrawal, need to be evaluated as indicated.

Comorbidities

Comorbid disorders among teens with bipolar disorder are common and include ADHD, anxiety disorders, oppositional defiant disorder, and substance use disorders (Bernardi et al., 2010; Birmaher et al., 2009; Jolin et al., 2008; Masi et al., 2006; Pini et al., 2006; Sala et al., 2014; Stephens et al., 2014). In a national household sample, rates of ADHD and alcohol use were three times higher among adolescents with bipolar disorder who received treatment than among those who received no treatment; those who received treatment often had much more severe bipolar disorder (Khazanov et al., 2015). Among youth hospitalized for their first manic episode, the rate of comorbid substance abuse is high. In one study, almost one-half (48 percent) of youth hospitalized for bipolar disorder had a substance use disorder either at baseline or within the following year (Stephens et al., 2014). Furthermore, early onset of mania may increase a youth’s risk for substance abuse (Gao et al., 2010), and combined bipolar and substance use disorders is associated with legal and academic difficulties, pregnancy, and suicidality (Goldstein and Bukstein, 2010).

Functional Impairment

The extent of functional impairment among children with pediatric bipolar disease is influenced by the severity of the child’s illness and by the complexity of the disorder. Because PBD is a chronic and serious disorder, severe impairments in functioning are very common. Youth with PBD have documented impairments in academic functioning and achievement due to executive functioning deficits (Biederman et al., 2011; Perlman et al., 2013).

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Research also shows that children and adolescents with PBD have difficulties reading facial expressions (Schenkel et al., 2012; Whitney et al., 2013), which is key to effective social functioning. Current longitudinal studies underway (see Findling et al., 2010 will elucidate the extent of functional impairments associated with this diagnosis.

Treatment and Outcomes

Treatment for bipolar disorder includes psychotherapy and medication. Recommended evidence-based psychotherapies are family-focused therapy (FFT), CBT, and IPT. FFT has a strong evidence base and targets reduction of highly charged emotions and stressors while promoting family problem-solving and conflict resolution (AACAP, 2009). FFT in combination with mood-stabilizing medications has been found to improve symptoms of mania, depression, and behavior problems (Miklowitz et al., 2006). CBT helps adolescents avoid stressful situations that may trigger mania (AACAP, 2009) and develop strategies to change thoughts and actions. IPT focuses on strategies to improve the stability of daily routines, such as maintaining a regular sleep schedule; it may also reduce a teen’s vulnerability to new episodes of mania (AACAP, 2009).

Medications for bipolar disorder in older children and youth include mood stabilizers and atypical antipsychotic medication (see Table 11-2).

Although the short-term efficacy of recommended first-line mood stabilizers and antipsychotic medication treatment has been established, there are few, if any, studies examining the long-term efficacy of medication treatment. Among a cohort of 263 children and adolescents with bipolar spectrum disorders, approximately 70 percent recovered from their index episode, but 50 percent had at least one syndromal recurrence, particularly

TABLE 11-2 Commonly Prescribed Medications for Bipolar Disorder in Adolescents

  Generic Brand Name
Mood stabilizers Lithium Eskalith, Lithobid
  Valproate Depakote, Depakene
  Carbamazepine Tegretol
  Oxcarbazepine Trileptal
  Lamotrigine Lamictal
Atypical antipsychotics Risperidone Risperdal
  Aripiprazole Abilify
  Olanzapine Zyprexa
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

depressive episodes (Birmaher et al., 2006). Clinically, the extent of improvement is likely influenced by clinical severity and complexity (i.e., comorbid substance abuse), timely access to care, treatment adherence, and environmental factors such as social support, family functioning, and schooling.

The duration of treatment for this chronic disorder also varies from individual to individual. Common short-term goals for treatment usually include a reduction in target symptoms. Longer-term goals include improvement in social and academic functioning, which may include a reduction in high-risk behaviors such as substance abuse.

FINDINGS

  • Diagnosis requires a comprehensive psychiatric diagnostic evaluation. Screening tools are available to detect symptoms of depression, particularly in adolescents. There are no well-established laboratory tests for mood disorders.
  • Mood disorders of childhood may occur in children of all ages. However, the risk of mood disorders increases during adolescence, especially among girls. A younger age of onset is a risk factor for increased severity and duration.
  • While symptoms may wax and wane, mood disorders cause significant functional impairment that often persist or recur through childhood and into adulthood.
  • Mood disorders frequently co-occur with other mental disorders.
  • There is evidence for the effectiveness of medication treatment and psychotherapies for mood disorders. Improvements in functional impairments are enhanced with a combination of evidence-based psychotherapy and medication.
  • Bipolar disorder in children and youth is classified by the DSM-5 as a diagnosis distinct from depression. Severe impairments in functioning are very common and frequently persist, even with treatment.

REFERENCES

AACAP (American Academy of Child and Adolescent Psychiatry). 1997. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry 36(10, Suppl):157S–176S.

AACAP. 1998. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry 37(10, Suppl):63S–83S.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

AACAP. 2007. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry 46(11):1503–1526.

AACAP. 2009. Parents’ medication guide for bipolar disorder in children & adolescents. http://www.parentsmedguide.org/bipolarmedicationguide.pdf (accessed November 12, 2014).

Angold, A., E. J. Costello, and C. M. Worthman. 1998. Puberty and depression: The roles of age, pubertal status and pubertal timing. Psychological Medicine 28(1):51–61.

APA (American Psychiatric Association). 2013. Diagnostic and statistical manual of mental disorders, 5th edition. Washington, DC: APA.

Avenevoli, S., J. Swendsen, J. P. He, M. Burstein, and K. R. Merikangas. 2015. Major depression in the national comorbidity survey-adolescent supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry 54(1):37–44.e2.

Bernardi, S., S. Cortese, M. Solanto, E. Hollander, and S. Pallanti. 2010. Biploar disorder and comorbid attention deficit hyperactify disorder: A distinct clinical phenotype? Clinical characteristics and temperamental traits. World Journal of Biological Psychiatry 11(4):656–666.

Biederman, J., C. R. Petty, J. Wozniak, T. E. Wilens, R. Fried, A. Doyle, A. Henin, C. Bateman, M. Evans, and S. V. Faraone. 2011. Impact of executive function deficits in youth with bipolar I disorder: A controlled study. Psychiatry Research 186(1):58–64.

Birmaher, B., D. Axelson, M. Strober, M. K. Gill, S. Valen, L. Chiappetta, N. Ryan, H. Leonard, J. Hunt, S. Iyengar, and M. Keller. 2006. Clinical course of children and adolescent with bipolar spectrum disorders. Archives of General Psychiatry 63(2):175–183.

Birmaher, B., AACAP Work Group on Quality Issues, D. Brent, W. Bernet, O. Bukstein, H. Walter, R. S. Benson, A. Chrisman, T. Farchione, L. Greenhill, J. Hamilton, H. Keable, J. Kinlan, U. Schoettle, S. Stock, K. K. Ptakowski, and J. Medicus. 2007. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry 46(11): 1503–1526.

Birmaher, B., D. Axelson, M. Strober, M. K. Gill, M. Yang, N. Ryan, B. Goldstein, J. Hunt, C. Esposito-Smythers, S. Iyengar, T. Goldstein, L. Shiapetta, M. Keller, and H. Leonard. 2009. Comparison of manic and depressive symptoms between children and adolescents with bipolar spectrum disorders. Bipolar Disorder 11(1):52–62.

Bridge, J. A., S. Iyengar, C. B. Salary, R. P. Barbe, B. Birmaher, H. A. Pincus, L. Ren, and D. A. Brent. 2007. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. JAMA 297:1683–1696.

Briere, F. N., P. Rohde, J. R. Seeley, D. Klein, and P. M. Lewinsohn. 2014. Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Comprehensive Psychiatry 55(3):526–533.

Brooks-Gunn, J., and A. Petersen. 1991. Studying the emergence of depression and depressive symptoms during adolescent. Journal of Youth and Adolescence 20(2):115–119.

Compton, S. N., J. S. March, D. Brent, A. M. Albano, V. R. Weersing, and J. Curry. 2004. Cognitive behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence based medicine review. Journal of the American Academy of Child & Adolescent Psychiatry 43:930–959.

Copeland, W. E., D. Wolke, L. Shanahan, and E. J. Costello. 2015. Adult functional outcomes of common childhood psychiatric problems: A prospective, longitudinal study. JAMA Psychiatry 72(9):892–899.

Costello, E. J., and B. Maughan. 2015. Annual research review: Optimal outcomes of child and adolescent mental illness. Journal of Child Psychology and Psychiatry 56(3):324–341.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Costello, E. J., A. Angold, B. J. Burns, D. Stangl, D. L. Tweed, A. Erikanli, and C. M. Worthman. 1996. The Great Smoky Mountains Study of Youth. Archives of General Psychiatry 53:1129–1136.

Costello, E. J., S. Mustillo, A. Erkanli, G. Keeler, and A. Angold. 2003. Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry 60:837–844.

Curry, J., P. Rohde, and A. Simons. 2006. Predictors and moderators of acute outcomes in the Treatment for Adolescents with Depression Study (TADS). Journal of the American Academy of Child & Adolescent Psychiatry 45:1427–1439.

Fergusson, D. M., L. J. Horwood, E. M. Ridder, and A. L. Bearutrais. 2005. Subthreshold depression in adolescent and mental health outcomes in adulthood. Archives of General Psychiatry 62:66–72.

Fernando, K., J. D. Carter, and C. M. Frampton. 2011.Childhood, teenage, and adult-onset depression: Diagnostic and individual characteristics in a clinical sample. Comprehensive Psychiatry 52(6):623–629.

Ferrari, A. J., F. J. Charlson , R. E. Norman, S. B. Patten, G. Freedman, C. J. Murray, T. Vos, and H. A. Whiteford. 2013. PLoS Medicine 10(11):e1001547.

Findling, R. L., E. A. Youngstrom, M. A. Fristad, B. Birmaher, R. A. Kowatch, L. E. Arnold, and T. W. Frazier. 2010. Characteristics of children with elevated symptoms of mania: The Longitudinal Assessment of Manic Symptoms (LAMS) study. The Journal of Clinical Psychiatry 71(12):1664–1672.

Fleming, J. E., and D. R. Offord. 1990. Epidemiology of childhood depressive disorders: A critical review. Journal of the American Academy of Child & Adolescent Psychiatry 29(4):571–580.

Gao, K., P. K. Chan, M. L. Verduin, D. E. Kemp, B. K. Tolliver, S. J. Ganocy, S. Bilali, K. T. Brady, R. L. Findling, and J. R. Calabrese. 2010. Independent predictors for lifetime and recent substance use disorders in patients with rapid-cycling bipolar disorder: Focus on anxiety disorders. The American Journal on Addictions/American Academy of Psychiatrists in Alcoholism and Addictions 19(5):440–449.

Garrison, C. S., M. D. Schluchter, V. J. Schoesnbach, and B. K. Kaplan. 1989. Epidemiology of depressive symptoms in young adolescents. Journal of the American Academy of Child & Adolescent Psychiatry 28:343–351.

Gilman, S. E., I. Kawachi, G. M. Fitzmaurice, and S. L. Buka. 2002. Socioeconomic status in childhood and the lifetime risk of major depression. International Journal of Epidemiology 31(2):359–367.

Gilman, S. E., I. Kawachi, G. M. Fitzmaurice, and L. Buka. 2003. Socio-economic status, family disruption and residential stability in childhood: Relation to onset, recurrence and remission of major depression. Psychological Medicine 33(8):1341–1355.

Goldstein, B. I. 2012. Recent progress in understanding pediatric bipolar disorder. Archives of Pediatrics & Adolescent Medicine 166(4):362–371.

Goldstein, B. I., and O. G. Bukstein. 2010. Comorbid substance use disorders among youth with bipolar disorder: Opportunities for early identification and prevention. Journal of Clinical Psychiatry 71(3):348–358.

Goodyer, I. M., B. Dubicka, and P. Wilkinson. 2007. A randomized controlled trial of SSRIs and routine specialist care with and without cognitive behavior therapy in adolescent with major depression. British Medical Journal 335:142–146.

Harrington, R., M. Rutter, A. Pickles, and J. Hill. 1990. Adult outcomes of childhood and adolescent depression: I. Psychiatric status. Archives of General Psychiatry 47:465–473.

Harrington, R., F. Campbell, P. Shoebridge, and J. Whittaker. 1998. Meta-analysis of CBT for depression in adolescent. Journal of the American Academy of Child & Adolescent Psychiatry 37:1005–1007.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Hipwell, A. E., S. Stepp, and X. Feng. 2011. Impact of oppositional defiant disorder dimensions on the temporal ordering of conduct problems and depression across childhood and adolescence in girls. Journal of Child Psychology and Psychiatry 52(10):1099–1108.

Jolin, E. M., E. B. Weller, and R. A. Weller. 2008. Anxiety symptoms and syndromes in bipolar children and adolescents. Current Psychiatry Reports 10(2):1213–1219.

Jonsson, U., H. Bohman, L. von Knorring, G. Olsson, A. Paaren, and A. L. von Knorring. 2011. Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community sample. Journal of Affect Disorders 130(3):395–404.

Keenan-Miller, D., C. L. Hammen, and P. A. Brennan. 2007. Health outcomes related to early adolescent depression. Journal of Adolescent Health 41(3):256–262.

Kessler, R. C., P. Berglund, O. Demler, R. Jin, D. Koretz, K. R. Merikangas, A. J. Rush, E. E Walters, and P. S. Wang. 2003. The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA 289(23):3095–3105.

Khazanov, G. K., L. Cui, K. R. Merikangas, and J. Angst. 2015. Treatment patterns of youth with bipolar disorder: Results from the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of Abnormal Child Psychology 43(2):391–400.

Klein, D. N., C. R. Glenn, D. B. Kosty, J. R. Seeley, P. Rohde, and P. M. Lewinshohn. 2013. Predictors of first time lifetime onset of major depressive disorder in young adulthood. Journal of Abnormal Psychology (122):1–16.

Kovacs, M. 1996. Presentation and course of major depressive disorder during childhood and later years of the life span. Journal of the American Academy of Child & Adolescent Psychiatry 35(6):705–715.

Kratochil, C., G. Emslie, S. Silva, S. McNulty, J. Walkup, J. Curry, M. Reinecke, B. Vitiello, P. Rohde, N. Feeny, C. Casat, S. Pathak, E. Weller, D. May, T. Mayes, M. Robins, J. March, and TADS Team. 2006. Acute time to response in the Treatment for Adolescents with Depression Study (TADS). Journal of the American Academy of Child & Adolescent Psychiatry 45:1412–1418.

Lewinsohn, P. M., P. Rohde, and J. R. Seeley. 1998b. Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications. Clinical Psychology Review 18(7):765–794.

Li, B., L. Liu, K. J. Friston, H. Shen, L. Wang, L. L. Zeng, and D. Hu. 2013a. A treatment-resistant default mode subnetwork in major depression. Biological Psychiatry 74(1):48–54.

Li, J. J., M. S. Berk, and S. S. Lee. 2013b. Differential susceptibility in longitudinal models of gene–environment interaction for adolescent depression. Development and Psychopathology 25(4 Pt 1):991–1003.

Luby, J. L., M. S. Gaffrey, R. Tillman, L. M. Arpirl, and A. C. Belden. 2014. Trajectories of preschool disorders to full DSM depression at school age and early adolescent: Continuity of preschool depression. American Journal of Psychiatry 171:768–776.

Luking, K. R., G. Repovs, and A. C. Belden. 2011. Functional connectivity of the amygdala in early-childhood-onset depression. Journal of the American Academy of Child & Adolescent Psychiatry 50(10):451–459.

March, J., S. Silva, and S. Petrycki. 2004. Fluoxetine, cognitive behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. JAMA 292:807–820.

March, J. S., S. Silva, and B. Bitiello. 2006. The Treatment for Adolescents with Depression Study (TADS): Methods and message at 12 weeks. Journal of the American Academy of Child & Adolescent Psychiatry 45:1393–1403.

Masi, G., G. Perugi, S. Millepiedi, M. Mucci, C. Toni, N. Berini, C. Pfanner, S. Berloffa, and C. Pari. 2006. Developmental difference according to age at onset in juvenile bipolar disorder. Journal of Child and Adolescent Psychopharmacology 16(6):679–685.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Meinzer, M. C., P. M. Lewinsohn, J W. Pettit, J. R. Seeley, J. M. Gau, A. Chronis-Tuscano, and J. G. Waxmonsky. 2013. Attention-deficit/hyepractivy disorder in adolescent predicts onset of major depressive disorder through early adulthood. Depression and Anxiety 30(6):546–553.

Melvin, G. A., B. J. Tonge, N. J. King, D. Heyne, M. S. Gordon, and E. Klimkeit. 2006. A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression. Journal of the American Academy of Child & Adolescent Psychiatry 45(10):1151–1161.

Merikangas, K. R., E. F. Nakamura, and R. C. Kessler. 2009. Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience 11(1):7–20.

Merikangas, K. R., J. P He, D. Brody, P. W. Fisher, K. Bourdon, and D. S. Koretz. 2010. Prevalence and treatment of mental disorders among U.S. children in the 2001–2004 NHANES. Pediatrics 125(1):75–81.

Miklowitz, D. J., A. Biuckians, and J. A. Richards. 2006. Early-onset bipolar disorder: A family treatment perspective. Development and Psychopathology 18(4):1247–1265.

Miller, D. B., and J. P. O’Callaghan. 2013. Personalized medicine in major depressive disorder—Opportunities and pitfalls. Metabolism 62(Suppl 1):S34–S39.

Mills, N. T., J. G. Scott, N. R. Wray, S. Cohen–Woods, and B. T. Baune. 2013. The role of cytokines in depression in adolescents: A systematic review. Journal of Child Psychology and Psychiatry 54(8):816–835.

Mufson, L., M. M. Weissman, D. Moreau, and R. Garfinkel R. 1999. Efficacy of interpersonal psychotherapy for depressed adolescents. Archives and General Psychiatry 56(6):573–579.

Mufson, L., K. P. Dorta, P. Wickramaratne, Y. Nomura, M. Olfson, and M. M. Weissman. 2004. A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry 61(6):577–584.

Nivard, M. G., C. V. Dolan, K. S. Kendler, K. J. Kan, G. Willemsen, C. E. M. van Beijsterveldt, R. J. L. Lindauer, J. H. D. A. van Beek, L. M. Geels, and M. Bartels. 2015. Stability in symptoms of anxiety and depression as a function of genotype and environment: A longitudinal twin study from ages 3 to 63 years. Psychological Medicine–London 45(5):1039–1049.

Nolen-Hoeksema, S., J. S. Girgus, and M. E. P. Seligman. 1991. Sex differences in depression and explanatory style in children. Journal of Youth and Adolescence 20(2):233–245.

Offord, D. R., M. H. Boyle, and Y. Racine. 1989. Ontario Child Health Study: Correlates of disorder. Journal of the American Academy of Child & Adolescent Psychiatry 28(6): 856–860.

Palagini, L., C. Baglioini, and A. Ciapparelli. 2013. REM sleep dysregulation in depression: State of the art. Sleep Medicine Reviews 17(5):377–390.

Penninx, B. W., Y. Milaneschi, F. Lamers, and N. Bogelzangs. 2013. Understanding the somatic consequences of depression: Biological mechanisms and the role of depression symptoms profile. BMC Medicine 11:129.

Perlman, S. B., J. C. Fournier, G. Bebko, M. A. Bertocci, A. K. Hinze, L. Bonar, J. R. Almeida, A. Versace, C. Schirda, M. Travis, M. K. Gill, C. Demeter, V. A. Diwadkar, J. L. Sunshine, S. K. Holland, R. A. Kowatch, B. Birmaher, D. Axelson, S. M. Horwitz, L. E. Arnold, M. A. Fristad, E. A. Youngstrom, R. L. Findling, and M. L. Phillips. 2013. Emotional face processing in pediatric bipolar disorder: Evidence for functional impairments in the fusiform gyrus. Journal of the American Academy of Child & Adolescent Psychiatry 52(12):1314–1325.e3.

Petersen, A. C., P. A. Sarigiani, and R. E. Kennedy. 1991. Adolescent depression: Why more girls? Journal of Youth and Adolescence 20:247–271.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Pini, S., J. D. Maser, L. Dell’Osso, M. Abelli, M. Muti, C. Gesi, and G. B. Cassano. 2006. Social anxiety disorder comorbidity in patients with bipolar disorder: A clinical replication. Journal of Anxiety Disorders 20(8):1148–1157.

Rao, U. 2013. Biomarkers in pediatric depression. Depression and Anxiety 30:787–791.

Rao, U., C. Hammen, and S. Daley. 1999. Continuity of depression during the transition to adulthood: A 5-year longitudinal study of young women. Journal of the American Academy of Child & Adolescent Psychiatry 38(7):908–915.

Reinherz, H. Z., A. D. Paradis, R. M. Giaconia, C. K. Stashwick, and G. Fitzmaurice. 2003. Childhood and adolescent predictors of major depression in the transition to adulthood. American Journal of Psychiatry 160:2141–2147.

Richardson, L. P., D. DiGiuseppe, M. Garrison, and D. A. Christakis. 2003. Depression in Medicaid-covered youth: Differences by race and ethnicity. Archives of Pediatric and Adolescent Medicine 157(10):984–989.

Rohde, P., P. M. Lewinsohn, D. N. Klein, J. R. Seeley, and J. M. Gau. 2013. Key characteristics of major depressive disorder occurring in childhood, adolescence, emerging adulthood, adulthood. Clinical Psychological Science 1(1):41–53.

Rossello, J., and G. Bernal. 1999. The efficacy of cognitive–behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology 67:734–745.

Rushton, J. L., M. Forcier, and R. M. Schectman. 2002. Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. Journal of the American Academy of Child & Adolescent Psychiatry 41(2):199–205.

Rutter, M., C. E. Izard, and P. B. Read. 1986. Depression in young people: Developmental and clinical perspectives. New York: Guilford Press.

Sala, R., M. A. Strober, D. A. Axelson, M. K. Gill, J. Castro-Fornieles, T. R. Goldstein, B. I. Goldstein, W. Ha, F. Lio, S. Iyengar, S. Yes, H. Hower, J. Hunt, D. P. Dickstein, N. D. Ryan, M. B. Keller, and B. Birmaher. 2014. Effects of comorbid anxiety disorders on the longitudinal course of pediatric bipolar disorders. Journal of the American Academy of Child & Adolescent Psychiatry 53(1):72–81.

Schenkel, L. S., A. M. Passarotti, J. A. Sweeney, and M.N. Pavuluri. 2012. Negative emotion impairs working memory in pediatric patients with bipolar disorder type I. Psychological Medicine 42(12):2567–2577.

Schmidt, H. D., R. C. Shelton, and R. S. Duman. 2011. Functional biomarkers of depression: Diagnosis, treatment, and pathophysiology. Neuropsychopharmacology 36(12): 2375–2394.

Schneider, B., D. Prvulovic, and V. Oertel-Knochel. 2011. Biomarkers for major depression and its delineation form neurodegenerative disorders. Progress in Neurobiology 95(4):703–717.

Serafina, G., M. Pompili, S. Borgwardt, J. Houenou, P. A. Geoffroy, R. Jardri, P. Girardi, and M. Amore. 2014. Brain changes in early-onset bipolar and unipolar depressive disorders: A systematic review in children and adolescents. European Child & Adolescent Psychiatry 23(11):1023–1041.

Stephens, J. R., J. L. Heffner, C. M. Adler, T. J. Blom, R. M. Anthenelli, D. E. Fleck, J. A. Welge, S. M. Strakowski, and M. P. DelBello. 2014. Risk and protective factors associate with substance use disorders in adolescent with first-episode mania. Journal of the American Academy of Child & Adolescent Psychiatry 53(7):771–779.

Stringaris, A., B. Maughan, W. S. Copeland, E. J. Costello, and A. Angold. 2013. Irritable mood as a symptom of depression in youth: Prevalence, developmental, and clinical correlates in the Great Smoky Mountains Study. Journal of the American Academy of Child & Adolescent Psychiatry 52(8):831–840.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Thapar, A., S. Collishaw, D. S. Pine, and A. K. Thapar. 2012. Depression in adolescence. Lancet 379(9820):1056–1067.

Weisz, J. R., C. A. McCarty, and S. M. Valeri. 2006. Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin 132(1):132–149.

Wesselhoeft, R., C. B. Pedersen, P. B. Mortensen, O. Mors, and N. Bilenberg. 2014. Gender–age interaction in incidence rates of childhood emotional disorders. Psychological Medicine 11:1–11.

Whitney, J., M. Howe, V. Shoemaker, S. Li, E. M. Sanders, C. Dijamco, T. Acquaye, J. Phillips, M. Singh, and K. Chang. 2013. Socio-emotional processing and functioning of youth at high risk for bipolar disorder. Journal of Affect Disorders,148(1):112–117. doi: 10.1016/j.jad.2012.08.016.

Whittle, S., R. Lichter, M. Dennison, N. Vijayakumar, O. Schwartz, M. L. Byrne, J. G. Simmons, M. Yücel, C. Pantelis, P. McGorry, and N. B. Allen. 2014. Structural brain development and depression onset during adolescent: A prospective longitudinal study. American Journal of Psychiatry 171(5):564–571.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

This page intentionally left blank.

Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 189
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 190
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 191
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 192
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 193
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 194
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 195
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 196
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 197
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 198
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 199
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 200
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 201
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 202
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 203
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 204
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 205
Suggested Citation:"11 Clinical Characteristics of Mood Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 206
Next: Part III: Prevalence of Selected Mental Disorders »
Mental Disorders and Disabilities Among Low-Income Children Get This Book
×
Buy Paperback | $85.00 Buy Ebook | $69.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder.

At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!