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Occurrence of learning disabilities was determined in 30 inpatient children aged 6-12 with major depressive disorder (MDD). Learning disabilities (LD) occurred seven times more often compared to community base rates (33% v 4.7%). While rates of comorbid diagnoses, severity of depression, and children's and parents' reports (DICA-C, DICA-P) did not differ between groups, teachers' reports (TRS, TRF) indicated increased classroom problems and poorer adaptive functioning in MDD/LD subjects (P < 0.0001).

Sensitivity, specificity, and diagnostic confidence of the Children's Depression Inventory (CDI) and the dexamethasone suppression test (DST) in assessing childhood depression were determined. Parent and child forms of the CDI and plasma cortisol levels at 8 a.m. and 4 p.m. were used. Three groups of prepubertal children were sampled: (1) 63 depressed inpatients, (2) 14 non-depressed inpatient psychiatric controls, and (3) 21 normal community sample controls. Results suggest that scores greater than or equal to 15 on the CDI obtained from either parent or child provide a good screening instrument (sensitivity = 89%). If the DST is administered to all children with elevated CDI scores, diagnostic confidence is 97.5%. Cautions and recommendations for use of the CDI and DST are made.

Prior to the introduction of lithium, mania was underdiagnosed in the U.S.A. Almost 50% of adults who met DSM-III criteria for mania had previously been diagnosed to have schizophrenia. To determine if mania had similarly been underdiagnosed in prepubertal children, 157 cases of 'severely disturbed' children described in the literature were reviewed. Approximately one-half (16/33) of the children diagnosed in this study as manic according to DSM-III had originally received another diagnosis. These results indicate that mania should be considered in the differential diagnosis of psychotic children, particularly those with affective symptoms.