Anxiety and Depression in Children and Adolescents: Assessment, Intervention, and Prevention

481 Pages·2012·2.11 MB·English

by  Thomas J. Huberty (auth.)

Anxiety and Depression

in Children and Adolescents

Thomas J. Huberty
Anxiety and Depression
in Children and Adolescents
Assessment, Intervention, and Prevention
Thomas J. Huberty
Department of Counseling and Educational Psychology
School Psychology Program
Indiana University
Bloomington, IN, USA
ISBN 978-1-4614-3108-4 e-ISBN 978-1-4614-3110-7
DOI 10.1007/978-1-4614-3110-7
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2012932615
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To Marsha, my life partner, soul mate,
and best friend for her love, patience,
support, and encouragement
To Christopher, who reaffi rms my faith
and hope in our children and youth
In memory of my mother

Preface
Anxiety and depression are two of the most prevalent mental health problems of
childhood and adolescence, affecting up to as many as one-third of children and
youth over their lifetimes, but also are among the most under-identifi ed or misdi-
agnosed syndromes and disorders. They are also highly comorbid with each other
and other disorders and are diffi cult to differentiate for clinical and research pur-
poses. They present challenges in assessment, intervention, and consultation in
clinical, community, and school settings. Because the conditions are so prevalent,
complex, and comorbid, this book was conceptualized as an attempt to address the
complexity from a combination of considering relevant research and applying that
information to practice.
The book is based on principles and research in developmental psychopathology
as the organizing theme, refl ected in Part I that focuses on foundations with consid-
erations for assessment and intervention. The fi rst chapter describes major principles,
concepts, and research in developmental psychopathology, with emphasis on protec-
tive and risk factors, vulnerability, and resilience. Historically, development has been
conceptualized in fi ve domains or contexts: (a) genetic factors, (b) biological factors,
(c) cultural factors, (d) social factors, and (e) family factors. In this book, a sixth
contextual factor has been added: schools, because children spend approximately
one-fourth of their waking hours in school. Moreover, many of the emotional and
behavioral problems of children and youth are related to school functioning and as
many as half of mental health referrals originate from academic-related issues.
Schools not only teach literacy skills, but are also major contributors to the develop-
ment of social skills and competence, arguably making schooling the most important
infl uence on children apart from the family. Thus, the chapter is organized around six
contexts: genetic, biological, cultural, social, family, and school.
In Chap. 2 , the developmental psychopathology and contextual themes are
applied to anxiety and anxiety disorders, with emphasis on understanding the normal
developmental aspects of anxiety. Unlike many disorders, anxiety is a normal devel-
opmental process that not only occurs in all people on almost a daily basis, but can be
adaptive. When anxiety becomes so severe that it impairs personal, social, occupational,
vii
viii Preface
or academic functioning, interventions may be needed . The chapter summarizes the
research with regard to the six contexts and concludes with implications for clinical
practice.
Chapter 3 follows a similar format, recognizing that depression and mood disor-
ders do not have the normal developmental progression as does anxiety. The third
chapter follows the organization of Chap. 2 with regard to the six contexts and con-
cludes with a discussion of clinical implications.
Chapter 4 addresses the important concept of emotion regulation, an area that
has received increased research and practice attention in the last decade. Emotion
regulation refers to the ability of a child to learn how to manage emotions and learn
appropriate ways of expression. Some regulation processes are based on genetic and
biological factors, but they are highly infl uenced by environmental factors, particu-
larly parents, teachers, and peers who have strong infl uences on the development of
regulation skills.
Part II contains two chapters that address how to conduct differential diagnosis
of anxiety and depression, with emphasis on DSM-IV criteria. In Chap. 5 , the pri-
mary anxiety disorders are discussed: Separation Anxiety Disorder, Generalized
Anxiety Disorder, Obsessive-Compulsive Disorder, Social Phobia (Social Anxiety
Disorder), Specifi c Phobia, Posttraumatic Stress Disorder, and Panic Disorder.
Prevalence and epidemiology data are presented, along with primary symptoms and
secondary features, comorbid disorders, differential diagnosis considerations, and
typical assessment profi les. Chapter 6 follows the same format with discussion of
Major Depressive Disorder, Dysthymia, and Bipolar Disorder. Both chapters conclude
with discussion of a developmental psychopathology perspective on the anxiety and
depressive disorders, respectively.
Part III focuses on assessment of anxiety and depressive disorders, with Chap. 7
presenting a summary of clinical assessment measures that are useful with internal-
izing disorders. This chapter emphasizes general principles of clinical interviewing,
observation, and standardized rating scales and multidimensional measures. In
Chaps. 8 and 9 , more detailed description of the assessment of anxiety and depres-
sion are presented, including measures specifi c to each condition and how they are
used with other assessment procedures. At the end of each chapter, a case study is
provided that includes results from a psychological assessment.
Part IV contains Chaps. 10 – 13 that discuss interventions and prevention of anxi-
ety and depression. Chapter 10 presents cognitive–behavioral therapy (CBT) as the
primary direct intervention method for anxiety, as well as exposure, systematic
desensitization, manualized CBT programs, and pharmacotherapy. Suggestions for
conducting clinical and sample interview dialogues are presented. In Chap. 11 , a
similar format is followed for interventions for depression and mood disorders, with
discussion of three primary therapeutic interventions: CBT, Interpersonal
Psychotherapy, and Positive Psychotherapy. Discussion of treatment of the anxious-
depressed syndrome that has features of both anxiety and depression is presented.
Content about the relative effectiveness of CBT and medications is provided, as
well. Discussion of intervening with suicidal children and adolescents is presented.
Finally, the case example introduced in Chap. 9 is revisited with attention to devel-
oping interventions based on the assessment data.
Preface ix
Part IV also includes Chap. 12 , which addresses school-based interventions for
anxiety and depression. Emphasis is placed on screening for anxiety and depression
and using a three-tier, problem-solving approach to interventions that can be done
is schools. Primary topics include providing direct, indirect/consultative, and sys-
tems interventions in schools that are feasible and acceptable to school personnel,
students, and parents.
The last chapter in Part IV addresses approaches toward prevention of anxiety
and depression. Many of the mental health prevention programs for children and
youth, including anxiety and depression, have been implemented in school settings,
consistent with the perspective that schools provide the best opportunity to reach
large numbers of youth. Community-based prevention programs also exist; there-
fore, discussion includes general principles for developing effective prevention pro-
grams. Descriptions of evidence-based prevention programs for anxiety and
depression at the universal, selected, and indicated levels are presented.
Part V contains one chapter that addresses legal issues in educating anxious and
depressed students in schools. Children and youth with anxiety and depression often
are not identifi ed, but may need help to progress in school. The I ndividuals with
Disabilities Education Act (IDEA) and S ection 504 of the Rehabilitation Act of
1973 (Section 504) are the primary avenues for providing special education services
and accommodations for students who have disabilities. The chapter is organized
primarily around the IDEA and its defi nition of Emotional Disturbance and how
children and adolescents who are depressed or anxious may or may not be served in
special education. Issues regarding eligibility, evaluations, and procedural issues
are discussed within the context of illustrative court cases and the author’s extensive
experience as an administrative law judge/independent hearing offi cer for due process
hearings under the IDEA and Section 504.
In closing, the author hopes that the reader fi nds the book to be a relatively com-
prehensive treatment of anxiety and depression in children and adolescents, and that
it will be informative with regard to current research, how research is linked with
practice, and how the practitioner can apply research in everyday practice. Hopefully,
the practitioner will gain valuable information that can be used to provide services
to anxious and depressed children and adolescents using evidence-based practices
from a developmental psychopathology perspective. The book may be useful for
graduate students in clinical, counseling, and school psychology and related disci-
plines who are interested in anxiety and depression and how to use evidence-based
concepts and literature in their work. Ultimately, our goal should be to help children
and youth become psychologically healthy and happy adults. They deserve no less
than our best efforts.
Bloomington, IN, USA Thomas J. Huberty