Diagnosisof Depression in Child and Adolescent
Depressionmay affect any individual regardless of his or her age. Although onecan commonly observe the condition in adults, it also affects youngpeople, and most of them are adolescents. Clinicians that encounteryoung people affected by depression should, therefore, beknowledgeable on the development of a clinical diagnosis, assessment,and a treatment plan for the disorder. This case study will discussthe interventions that a therapist can apply for this diagnosisbyusing core and advanced competencies. The text also includes theresearch-based criteria that are consistent with the biopsychosocial(BPS) findings, as well as the case conceptualization.
Thecase study will focus on an adolescent boy aged 16 years, who isdisplaying signs of depression and self-destructive behavior. Theboy, named Fred, is the second child of divorced parents, he is anAfrican-American, and he comes from Jacksonville.However, he does nothave a social security number, and he is not part of the Medicaidprogram.
Hisguardian is called Vivian, and she is the client’s mother, as wellas the informant that brought him in when she noticed his presentproblems. She is a divorced African-American woman.
Oneof the components that inform a diagnostic formulation in this caseis his medical records for the past year. They illustrate hisself-destructive behavior such as self-cutting. At the same time, thereferral from his family practitioner indicates that hisconcentration and memory are poor, and the patient admits to havingsuicidal thoughts. Fred’s mother also reports that her son is nolonger interested in social activities while his school grades havealso dropped. Moreover, he has started smokingtobacco.
Theprimary reason that the patient was brought in for evaluation is thathe had made a suicide attempt by overdosing on prescription drugs.Fred’s case requires an investigation into the symptoms thatcharacterize his depressive disorder, the pertinent negatives, andthe events that trigger his mood changes. Irritability and sadnessare the core symptoms indicating that a person has a depressivedisorder (Sales & Irwin, 2013).
Historyof presenting problem
Thepatient lives with his mother, and she described him as beingirritable most of the times. Besides, the patient often quarrels withhis father whenever he visits him, and he explained that this is whyhe is often sad since he no longer feels emotionally attached to him.However, his fetus was exposed to neither drugs nor alcohol.
Althoughthe assessment of depressive symptoms is crucial in the developmentof a diagnosis and treatment plan, determining the severity of themood symptoms is also significant. The clinician would question thepatient about the activities that he currently does for fun. Afterthe patient names these activities, the clinician can ask him to ratethem on a scale on 1 to 10, and compare them to the fun activitiesthat he used to do before being depressed. The patient is at the agewhere sporting activities contribute to some of his social anddevelopmental challenges. If he used to participate in sports, but hewithdraws suddenly, the presence of a negative experience can help inclarifying his diagnostic status. The client attends Englewood HighSchool, and although he has always been a top student, his gradesstarted dropping recently.
Developmental/Physical and Family History
Thebiological domain of the BPS focuses on the genetic, psychological,and neuropsychiatric issues, as well as the aspects that directlyaffect the brain and its functional operations (Sales & Irwin,2013). The development of this element section will includecomponents such as the patient’s genetics, family history,temperament, physical development, and medical comorbidities (Thapar,Collishaw, Pine, &Thapar, 2012). Although other members of thepatient’s family did not have a history of mental disorder, Fred’smother reported having been irritable for a short period after herdivorce. This indication shows that the chronic social stressors andgenetics could be the predisposing factors that made the patientvulnerable to depression.
Theclient’s developmental milestones were on time, and he never hadother medical issues at the time his informants brought him in. Theclinician can utilize the precipitating factors of thebiopsychosocial model to make a diagnostic reasoning about the eventsthat led to the development of the patient’s depression. Theassessment of mood disorders also requires a clinician to establishthe time course, onset, as well as the fluctuations in the patient’smood. A timeline can help the clinician to determine the moments andevents that trigger the depressive symptoms in the patient.
Directhormonal influences could be part of the reason that the patient’stemperament has changed, and he engages in risky behavior such asself-cutting. The increase in hormones during puberty affects themanner in which the brain develops, and it might influencerisk-taking behavior among adolescents (Sales &Irwin, 2013). Thepatient might have engaged in the self-destructive behavior due tothe hormonal influencesand because he felt neglected by his fatherashe had lost contact with him. Pubertal maturation is part of thephysical development, and associating with older peers might make aperson engage in behaviors such as smoking.
Thebrain’s development continues into an individual’s adulthood, andsince the cognitive-control system matures slowly, risk-takingbehavior might likely occur during adolescence (Sales & Irwin,2013). The brain’s cognitive control system guides the ability toresist peer influence, emotional regulation, and impulse control, anddepression might occur when it fails to develop properly. The patientevidently finds it difficult to regulate his emotions since he oftengets sad and he hasresulted in self-cutting as a means of relievingemotional unresponsiveness.
Beforejoining Englewood High School, the client used to attend the AtlanticCoast High School, and he always used to perform well. He is in theeleventh grade, and he has never held back a grade. However, since hetransferred to his current school, his behavior, as well as grades,started deteriorating. The client’s school does not have anyspecial services.
Itwould also be necessary for the clinician to consider theperpetuating factors that make the depression continue. Although thepatient was not treated for his condition, his family doctor hadprescribed some medication with the hope that it could eliminate thepresenting symptoms. The client commenced this treatment three monthsago, but the drugs did not help with the severity of the condition,and the mood disorder symptoms such as appetite changes and agitationkept on recurring. The assessment of weight and sudden appetitechanges can reveal if an individual is depressed or not (Sales &Irwin, 2013). The clinician examining Fred should, therefore, findout whether there is another medical condition that is affecting hisweight and appetite.
Whenthe client’s mother was irritable following the divorce with herhusband, she responded positively to medication. The identifiedfamily member could have had a different mood disorder, but herpositive response to treatment indicates that the patient’sgenetics are resilient, and he can also recover. The patient does nothave a medical comorbidity, and this eliminates the possibility ofany prescribed medications interfering with his condition.
Theclient comes from a Christian family. Although Fred’s family usedto go to church together, they no longer do so since the divorce, buthis mother occasionally attends weekly services. Moreover, the clientnotes that his family does not have any special beliefs andpractices.
Theemotional development of the patient at this stage should reflect thekind of relationships that they form and the role it plays in theconflicts that might occur in their lives. The fact that thepatient’s parents divorced just recently indicates that Fred couldhave developed depressive feelings due to the strained relationshipwith his father since he no longer lives with him. The changes in thepatient’s personality structure and patterns of behavior alsoillustrate that he is depressed, and the clinician should find anappropriate treatment plan for him (Thapar et al., 2012).
Fredreports that he had developed an emotional attachment to his fatherbefore his parents separated, but he no longer communicates with him.Depression and self-esteem are some of the predictors of riskybehaviors among teenagers (Sales & Irwin, 2013). Denial could beone of the defense mechanisms that he adopted after his parents’break up, therefore, he refused to accept the truth that therelationship with his father is strained. Besides, the client’sdepression has affected his cognitive functioning since he no longerpays attention to activities and his reasoning is not sound. Thepatient’s initiation of tobacco use further shows that stress anddepression are the primary factors that made him develop thisrisk-taking behavior. However, the client does not maintainrelationships as well as he used to in the past.
CurrentEnvironmental Conditions/ Stressors
Someof the aspects that influence an individual’s behavior and that canbe linked to the patient’s diagnosis include their peerrelationships, neighborhood, school, and family (Sales & Irwin,2013). These factors comprise the individual’s environment and therole it plays in their mental health and risk-taking behavior.Parents significantly influence the behavior of the adolescents inthe family, and this explains the importance of the closerelationships between teenagers and their parents (Rebellow, 2015).Since the patient’s parentsseparated, he lacks the father-figuremodeling from his absent father. Thisaspect could have contributed tohis involvement in the risky behaviors.
Theclinician should investigate whether the patient receives emotionalsupport and acceptance from his parents since the absence of a closerelationship with the parents might lead to substance abuse. Parentalmonitoring also correlates to risk-taking during adolescence (Sales &Irwin, 2013). The absence of the patient’s father might have led toreduced monitoring in the activities that Fred involved himself in,and could have made him start using tobacco as well. Equallysignificant, the patient felt that his parents did not provide theattention that he needed, and this escalated his dejection.
Theclinician should understand the manner in which the client’sneighborhood might have provided him an opportunity to be involved insubstance use (Koplewicz&Klass, 2016). As Fred considered hisemotional relationships empty, he might have tried to look foremotional relief from the drug use.As the patient is seeking toadjust to a new life with the developmental changes that he isexperiencing, the school stressors could be the other precipitatingcharacteristic that deteriorated the depressive symptoms (Rebellow,2015). The patient’s grades in school have dropped as a result ofhis diminished interest in class work and other activities, and thismight make him feel guilty and worthless.
Whilethe client indicates that he is 16 years, he appears a bit older thanhis stated age, and his physical condition is average. Besides, hehas no difficulty in coordinating his movement, and his grooming isadequate while he dresses appropriately. The client only maintainsbrief eye contact, and he appears withdrawn. Moreover, his speech islogical, but he is not willing to engage in conversation. The clientseems inattentive during interviews although his thought process islogical. Fred also has poor judgment and insight, his intellectualability is average, and he appears to be sad and depressed.
Someof the client’s strengths include his lack of a medicalcomorbidity, which eliminates the possibility of any prescribedmedications interfering with his condition. Besides, his mother iswilling to participate in his treatment. His weaknesses include theloss of concentration and the lack of interest in maintainingrelationships. The client’s barriers to treatment include his useof drugs and the lack of the father-figure modeling from his absentfather.
Thesuicide attempt that the patient made illustrates that he has apsychiatric disorder that requires treatment. Although the depressivesymptoms might have been present for a long time, the appropriatetreatment would still help the patient recover from the disorder.After the clinician prescribes antidepressant medication, he shouldconduct a routine assessment for suicidality (Koplewicz&Klass,2016). The primary reason for taking this form of evaluation is thatif the patient fails to respond to the medication, the depressivesymptoms would still be there, and he might make another suicideattempt. However, his diagnosis has not changed.
Theclinician should utilize screening tools for misery to evaluatesuicidal ideation, but one should still inquire about the patientsymptoms to ensure the accuracy of the results. A treatment plan isnecessary for the patient to recover from depression and to reducethe risk of self-harm in the future. The clinician should also findout the availability of protective factors that would act as socialsupport for the patient once the treatment commences.
Consideringthat the patient had once tried medication with the hope of thealleviating his symptoms but it failed to work, it might still takelong to find the best treatment for him. However, his mother’spositive response to her treatment for irritability is a protectivecharacteristic in the biological domain. After the cliniciandetermines the patient’s level of depression, developmental level,and risk factors, they would settle on psychotherapy orpharmacotherapy as the treatment options.
Cognitivebehavior therapy is a therapeutic form that can be effective intreating depression for an adolescent. Since the clinician alreadyhas an idea of some of the social issues that the patient has, theycan use a combination of behavioral activation techniques toeliminate the depressive symptoms. The clinician can also applyinterpersonal therapy techniques to regulate the patient’semotions, improve his peer relationships, and help him solveproblems. The physician can also implement pharmacotherapy with theappropriate antidepressant medication. The practitioner can dischargethe client 12 weeks after administering the interventions.
Thepatient’s case requires an investigation into the symptoms thatcharacterize his depressive disorder, the pertinent negatives, andthe events that trigger his mood changes.Although the assessment ofthe dejection symptoms is crucial in the development of a diagnosisand treatment plan, determining the severity of the mood symptoms isalso essential.The changes in the patient’s personality structureand patterns of behavior also illustrate that he is depressed, andthe clinician should provide an appropriate treatment plan.Theclinician should utilize depression screening tools to evaluatesuicidal ideation, but one should still inquire about the patientsymptoms to ensure the accuracy of the results.
Koplewicz,H.S. & Klass, E. (2016). Depression in Children and Adolescents.London: Routledge.
Rebellow,R. (2015). Factors influencing deviant behaviour among adolescents.IndianJournal of Applied Research, 5(10),583-586.
Sales,J. M., & Irwin Jr, C. E. (2013). A Biopsychosocial Perspective ofAdolescent Health and Disease. In Handbookof Adolescent Health Psychology(pp. 13-29). New York, NY: Springer.
Thapar,A., Collishaw, S., Pine, D. S., &Thapar, A. K. (2012). Depressionin adolescence. Lancet,379(9820),1056–1067. http://doi.org/10.1016/S0140-6736 (11)60871-4