Joel P. Zrull

Childhood depression. A longitudinal perspective.

Abstract Ten children described as affectively depressed in childhood were reevaluated on an average of 6 1/2 years later. At this time, 50 percent were clinically depressed and their behavior style more closely resembled the adult depressive than it had in childhood. Dependency appeared more prominent while aggressivity had decreased. Continuing parental deprivation and rejection appeared to correlate with the outcome while broken homes and parental loss in themselves were not predictive of depression continuing into adolescence and young adulthood.

AN EVALUATION OF METHODOLOGY USED IN THE STUDY OF PSYCHOACTIVE DRUGS FOR CHILDREN

How can one measure the effects of a drug that acts upon the mind and the emotions of a child? Unlike adult patients, children rarely ask for symptomatic relief; they are given psychoactive drugs because others complain about their behavior. The drugs are given to alter behavior rather than subjective feelings. The evaluation of drug effect, then, depends upon observed changes in behavior. In a residential treatment setting, members of the staff can observe the childs behavior; with outpatients the physician must rely on his own observations and information from parents and school personnel. This two-year study examines home, school, and clinic perspectives of children receiving psychoactive drugs. Because they influenced the design of our drug-evaluation program, we shall first call attention to some problems encountered in previous psychopharmacological clinical research with children (Fisher, lQ59; Forster, 1961; Freed, 1962). Many workers stress the importance of defining specific, observable symptoms, like hyperactivity, as the target of the drug rather than more abstract syndromes, such as anxiety. The rating method should be validated by using more than one observer in order to minimize the bias inherent in the viewpoint of one

Hyperkinetic syndrome: The role of depression

The hyperkinetic syndrome is one of many manifestations of minimal brain dysfunction and emotional distrubance. Both physical and psychologic factors can be seen in its etiology. Depression has often been found to be related to hyperkinesis. The children described in this study give ample support to the frequency of this relationship. Some preliminary hypotheses are also drawn about the dynamics of the relationship between depression and the hyperkinetic syndrome.

THE PSYCHOTHERAPY OF A PAIR OF PSYCHOTIC IDENTICAL TWINS IN A RESIDENTIAL SETTING

Twins present a unique opportunity to study many aspects of psychopathology and its genesis. A number of recent articles on this subject have emphasized the psychological development in twins. This paper will develop suggestions for the treatment of psychotic twins based on one element of the twinning reaction: fusion of identity. Leonard (1961) stresses the intertwin identification as a factor in the development of the psychopathology. The constant close association of the twins leads to a fusion of identities which eventually resembles the primary identification seen between mother and child. In the motherchild relationship, the constant association allows the child to imitate the mother and thereby begin maturation. With the relationship between the twins as primary, the imitative process represents a closed circuit and precludes maturation: the twins are thus arrested in their development. One possible positive contribution noted by Gardner and Rexford (I 952) of the identification between twins is the development of enough relationship to avoid the production of a purely autistic state. The therapeutic efforts, however, should be directed at interrupting this circuit and substituting a more appropriate relationship for each twin, leading to their further maturation and developmen t.