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The Dexamethasone Suppression Test (DST) has been useful in distinguishing among different types of depression in adults and has therefore been a useful diagnostic tool. Briefly, the ability of dexamethasone to suppress cortisol production is compromised in patients with certain types of depression. (Dexamethasone is a synthetic glucocorticoid drug. Cortisol is a hormone secreted by the cortex of the adrenal gland.) The present study sought to determine the utility of the DST in diagnosing depression in children. Forty-four children who had been diagnosed with depression by standard evaluation tools agreed to undergo the DST after completing an initial interview. (Consent was also obtained from a parent.) The test required that a blood sample be drawn to determine the baseline blood cortisol level. Dexamethasone 0.5 mg (milligrams) or dexamethasone 1.0 mg (dependent upon body weight) was administered, and another blood sample was obtained 17 hours later for measuring the level of cortisol. The results of the two tests were compared. Of the 44 patients, 22 did not suppress cortisol production after the administration of dexamethasone. A comparison with data from the standard instruments used to assess depression in these children indicated that there was no consistent relation between the diagnosis of depression and the effects of dexamethasone. Therefore, pending further study, the DST does not appear to have a similar ability to detect and differentiate depression in children as it does in adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

The study of depression in children is a relatively new field. Although it is progressing rapidly, little is currently known. The validity of diagnostic criteria and how to classify depression in children are areas of particular concern. With regard to the former issue, some argue that childhood depression can be diagnosed with the same used in diagnosing depression in adults. Others argue that this is not possible. With regard to the latter issue, the classification of depression in children is difficult because of the developmental stages that children go through. The Newcastle Depression Project addressed several areas within the study of childhood depression. First, it explored the use of the Standard Psychiatric Interview for diagnosing depression in children. Second, it compared different formulations of depression in children. Third, it explored the extent to which depression in children might be mixed with other disorders. Fourth, it explored issues in classifying depression in children. It was hypothesized that the validity of different diagnostic criteria would vary, with the most useful being based on the clinical interview, and that the proportions of mixed depression would depend on the type of associated disorder. The Child Depression Inventory was used to assess 275 children; 95 of these children were further examined with a structured interview during which the Standard Psychiatric Interview (SPI), Kiddie-SADS (Schedule of Affective Disorders and Schizophrenia), the Newcastle Instrument, and the Weinberg criteria were used. About 35 percent of the children were diagnosed to have significant depression. It was determined that childhood depression may be missed unless an evaluation of other symptoms, such as neurosis, conduct disorder, and phobic disorder, is conducted as well. Statistical analysis of the validation of diagnoses using the various instruments is discussed as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

With improvements in assessment and diagnosis of psychiatric disorders in adults has come the need for similar progress in child psychiatry. In the latter, clinicians have tended to focus on psychopathology rather than symptoms, and information is often obtained from parents and teachers rather than directly from the child. In the present study, the Kiddie-SADS (Schedule of Affective Disorders and Schizophrenia) assessment tool was modified to include independent interviews with both parent and child, and the modified version was administered to 87 children and one parent of each child. Agreement between parent and child was explored. Parents were not always aware of the intrapsychic distress that their children were experiencing and children reported more depressive symptoms than their parents described. Indeed, more than 50 percent of symptoms were reported in greater numbers by children than by their parents. Prepubertal children were in better agreement with their parents than adolescents. It is unclear whether this is due to the tendency of adolescents to hide their feelings from parents, or from parents' decreased sensitivity of teenagers' feelings. It is recommended that, in addition to indirect investigation through parents and teachers, clinicians directly ask even young children about their feelings. (Consumer Summary produced by Reliance Medical Information, Inc.)

The relation between life events and subsequent depression has been extensively studied in adults, but not in children. Among adults, depression has been linked to current provoking agents and vulnerability factors. In children, prospective studies have linked major life events, such as parental divorce, birth of a sibling, and hospital admission for the child, with certain psychiatric disorders, including depression. In the current paper, childhood depression was investigated with respect to life events, premorbid personality, social context, and maternal state. In this sample, some of the factors associated with depression were higher social class, better family employment, longstanding parental marriage, and better parental education. It is suggested, however, that these seemingly unusual findings highlight the tendency for the opposites of these factors to result in acting-out behaviors, such as conduct disorders, rather than depression. Surprisingly though, mothers of nondepressed children had a higher rate of depression and other affective disturbances than mothers of depressed children. Other factors associated with childhood depression included premorbid obsessive personality style, abnormal delivery, higher rates of absence from school than nondepressed peers, and less preschool exposure to bereavement. Other than illness and change in social relationships, life events were not significantly correlated with depression in this sample. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children born ''too small'' (weights below the 10th percentile) were considered developmentally disadvantaged five to seven years later, according to one study, while those born ''too soon'' (prematurely) seemed to develop normally if given appropriate neonatal care. Methods for treating such infants have changed, however, since the mid-1970s, when the study was completed, and conclusions regarding the developmental status of very small-for-gestational-age infants (below the fifth percentile) may need revision. This issue was approached by comparing development in a group of 30 10- and 11-year-old boys whose birth weights fell below the second percentile (part of a larger small-for-gestational-age study) with 30 controls matched for age and social class whose birth weights were normal. The children underwent physical, neurological, and cognitive testing. In addition, a variety of factors associated with maternal temperament, malaise, and intelligence were evaluated. Results showed no differences between the groups in intelligence or achievement in school. In addition, no differences were found between small-for-gestational-age boys and controls for many factors (social class, unemployment history, mothers' age or temperament). Several maternal factors differed for the groups, however, including smoking, the neuroticism score, and the malaise score (all higher in mothers of small-for-gestational-age children). Small-for-gestational-age boys tended to exhibit behaviors and temperament at school of the sorts associated with an attention deficit disorder similar to that reported in the earlier studies. The findings, substantially different from the earlier ones, may be the result of improved perinatal care, the disappearance of intellectual deficits in early childhood, or methodological problems when studies failed to correct for social class differences. Overall, the results suggest that the future of small-for-gestational-age children is likely to be a normal one. (Consumer Summary produced by Reliance Medical Information, Inc.)

QUESTION Are family disadvantages in early life associated with major depression in adulthood? DESIGN Population-based birth cohort study (Newcastle Thousand Family Study). SETTING Newcastle upon Tyne, UK. PARTICIPANTS Of 296 [...]