Affective disorders in children and adolescents

Abstract

Recent developments in the classification, description, and empiric study of affective disorders and related syndromes in the preadult years are highlighted. Because the bulk of extant work concerns the depressions, manic disorders are discussed only briefly. Major trends are summarized under three headings: psychiatric and diagnostic (nonbiologic) studies; hypothesis-testing and causal-explanation studies; and studies of developmental psychopathology. There is compelling evidence from a variety of sources that affective disorders among children and adolescents are more persistent than hitherto thought and have numerous negative associated features and consequences. The findings are discussed in light of the methodologic and conceptual problems that beset research in this area. Future research directions are indicated, among which the following deserve particular consideration: investigations of the long-term consequences of juvenile-onset affective disorders, further work on the logic of psychiatric classification to facilitate resolution of diagnostic dilemmas, expansion or revision of theories of depression to take into account issues and psychologic mechanisms specific to children and adolescents, further psychometric work with attention to developmental processes that constrain methods of assessment, and design and testing of innovative treatment and remediative approaches to juvenile-onset affective disorders.