Kevin D. Stark

A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children.

Twenty-nine children 9 to 12 years old who were identified as moderately to severely depressed using the Childrens Depression Inventory were randomly assigned to either a self-control, behavioral problem-solving, or waiting list condition. The self-control treatment focused on teaching children self-management skills. The behavioral problem-solving therapy consisted of education, self-monitoring of pleasant events, and group problem solving directed toward improving social behavior. Subjects were assessed pre-and posttreatment and at 8-week follow-up with multiple assessment procedures and from multiple perspectives. At posttreatment, subjects in both active treatments reported significant improvement on self-report and interview measures of depression while subjects in the waiting list condition reported minimal change. Results were maintained at follow-up. The general success of the experimental treatments was discussed and recommendations for further treatment components were provided.

Perceived Family Environments of Depressed and Anxious Children: Child's and Maternal Figure's Perspectives

This study examined perceived environment among families with a depressed, depressed and anxious, anxious, or normal child from the 4th to 7th grades. Fifty-one such children were classified according to criteria from the K- SADS and a set of self-ratings of depression and anxiety. Results showed that children in all three diagnostic groups, and to a lesser extent their mothers, experienced their families as more distressed on a host of dimensions relative to controls. In addition, significant differences were found between families with a depressed and anxious child and those with an anxious child. Discriminant function analyses revealed that 68.63 % of the youngsters could be classified correctly into depressed and anxious groups on the basis of their family ratings alone.

Joint Factor Analysis of the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale

Used a joint factor analysis with the Childrens Depression Inventory (CDI; Kovacs, 1980/81, 1992) and Revised Childrens Manifest Anxiety Scale (RCMAS; C. R. Reynolds & Richmond, 1978, 1985) to identify items that uniquely measured depression and anxiety. Data from 750 youngsters in Grades 4 through 7 were analyzed using principal-axis factoring with an oblique rotation. Salient factors were identified using guidelines provide by Gorsuch (1997). Item overlap and the large negative affectivity component across instruments were evident. Items that overlapped or had nonsalient loadings were eliminated. The sample was randomly split into 2 groups of 375 and analyses were repeated. Results indicated that a unique 9-item depression factor composed largely of items representing a negative view of oneself existed. In addition, a unique 7-item anxiety factor emerged that consisted of items reflecting worry. The validity of these abbreviated scales was explored using a separate sample of 131 students in Grades 4 through 9. The abbreviated scales were correlated with scales of positive and negative affect consistent with predictions. Findings suggest exploring alternative scoring strategies for the CDI and RCMAS to eliminate problems associated with overlapping items.

Cognitive, Behavioral, and Family Factors in the Differentiation of Depressive and Anxiety Disorders During Childhood

Contribution of cognitive, behavioral, and family environment variables to the differentiation of depressive and anxiety disorders in children was explored. Fifty-nine children from Grades 4-7 (14 diagnosed with a depressive disorder, 16 diagnosed with depressive and anxiety disorders, 11 diagnosed with an anxiety disorder, and 18 nondisturbed controls) completed measures of the depressive cognitive triad, depressive cognitions, social skills, family environment, and maladaptive family messages. Results of a stepwise discriminant function analysis indicated that 2 discriminant functions composed of 7 variables from the cognitive, behavioral, and family environment domains accounted for 91% of the between-groups variance. Results suggest that depressive disorders can be distinguished from anxiety disorders on the basis of ratings of cognition, social skills, and family environment. Implications for existing research and a model of depression during childhood are discussed.

Comparing the Family Environments of Adolescents with Conduct Disorder or Depression

We attempted to differentiate the family environments of youth with Conduct Disorder (CD) compared to youth with a depressive disorder. Participants were 34 adolescents from a residential treatment facility. The K-SADS-P was used to determine the youths diagnosis, while their family environment was assessed by the Self Report Measure of Family Functioning Child Version. A MANOVA was used to compare the two diagnostic groups on seven family environment variables. Results indicate that adolescents with CD described their parents as having a permissive and ambiguous discipline style, while adolescents with a depressive disorder described their relationship with their parents as enmeshed. A discriminant function analysis, using the two family environment variables of enmeshment and laissez-faire family style as predictors, correctly classified 82% of the participants. Implications for treatment of youth with both types of diagnoses and their families are discussed.

A qualitative versus quantitative approach to evaluating the Draw-A-Person and Kinetic Family Drawing: A study of mood- and anxiety-disorder children.

This study compared 2 methods of scoring the Draw-A-Person (DAP) and the Kinetic Family Drawing (KFD): A quantitative scoring method based on traditional individual indicators was contrasted with a qualitative scoring method based on an integrative approach designed to assess overall psychological functioning. The participants were 52 children with a mean age of 1 V/* years. Using DSM-III-R, they were assigned to the following groups: mood disorder (n = 12), anxiety disorder (n = 11), mood/anxiety (« = 16), control (n = 13). Unlike scores from the quantitative approach, scores obtained from the qualitative approach on the DAP differentiated children with mood disorders and mood/anxiety disorders, but not children with only anxiety disorders, from control children. Similarly, and again unlike scores from the quantitative approach, scores from the qualitative approach on the KFD differentiated children with mood disorders (but not mood/anxiety disorders) from control children. In addition, scores from the qualitative DAP and KFD scoring methods were significantly correlated with self-reported self-concept and aspects of family functioning. It appears that an integrated, holistic approach to scoring projective drawings, reflective of overall psychological functioning of the individual and of the family, can be a useful adjunct in assessing children with internalizing disorders. The assessment of internalizing disorders in children (i.e., depression and anxiety) presents problems that are not apparent for disorders with more obvious overt behavioral characteristics. The emotional discomfort and subjective feelings of distress that are central aspects of internalizing disorders are more difficult for parents, teachers, and often psychologists to identify accurately and reliably. Even when interviewed, children may experience considerable difficulty in naming, describing, or verbally communicating their emotional discomfort and subjective state. However, systematic input from children themselves is critical in the assessment of internalizing disorders (Cytryn & McKnew, 1980). This input must be obtained in a manner that minimizes demands for verbal expression and is sensitive to the childs level of development (Quay & La

Structure and Measurement of Depression in Youths: Applying Item Response Theory to Clinical Data

Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.

Psychometric Properties of the Beck Depression Inventory for Youth in a Sample of Girls.

A new measure has been developed to assess depressive symptoms, the Beck Depression Inventory for Youth (BDI-Y; J. S. Beck, A. T. Beck, & J. B. Jolly, 2001). This research extends previous validation research of BDI-Y total scores by examining internal consistency and convergent and predictive validity within a school-based sample (n=859) of girls 9-13 years old by age level and for selected races or ethnic groups. Scores had high internal consistency, and there was support for using the BDI-Y to assess depressive symptoms. Reliability was slightly lower for 9-year-olds, but reliability and validity estimates did not differ by race or ethnic group. Finally, confirmatory factor analysis results provide some support for unidimensionality of scores but also point toward possible refinements.

The Assessment of Depression in Children Are We Assessing Depression or the Broad-Band Construct of Negative Affectivity?

Evaluation of the overlap in symptomatology of depressed, anxious, and depressed and anxious children is described. Fifty-nine children from grades 4 through 7, including 14 who received a DSM-III-R diagnosis of a depressive disorder, 11 with a diagnosis of an anxiety disorder, 16 with a comorbid depressive and anxiety disorder, and 18 nondisturbed controls, completed the Childrens Depression Inventory, Revised Childrens Manifest Anxiety Scale, Hopelessness Scale for Children, and Coopersmith Self-Esteem Inventory. Diagnoses were determined by the childrens responses to a well-respected semi-structured clinical interview. Results indicated that all three diagnostic groups differed significantly from the non-disturbed controls across all of the self-report paper-and-pencil measures. However, in general, the three diagnostic groups could not be differentiated based on their responses to these measures. Implications for the negative affectivity hypothesis and future research are discussed.

Issues in the treatment of depressed children.

Abstract Basic research into the cognitive, behavioral, familial, and physiological disturbances associated with depressive disorders during childhood is reviewed. Implications for the development of a treatment program are discussed and a comprehensive treatment model is proposed. The proposed model includes intervention strategies for the child, parents, family, and school. The child component consists of intervention strategies for the affective, cognitive, behavioral, and physiological disturbances that are evident from the existing research. The parent training component is designed to address disturbances in parenting due to cognitive disturbances and skills deficits. The family therapy component emphasizes changing interaction patterns that communicate schema-consistent maladaptive interactions. A school consultation component is proposed in which school personnel support the skills training through prompting use of the skills and reinforcement of the use of the coping skills.