Areas of Specialization - Children and Adolescents
Depression in Children Treatment
Cognitive behavioral therapy has
been most widely researched and
validated as an effective treatment
for depression in children and adolescents.
Cognitive behavioral therapy consists
of psychoeducation regarding symptoms
and causes of depression, behavioral
tasks (e.g., pleasant activity scheduling,
mood monitoring) and challenging
negative cognitions and replacing
them with adaptive, realistic thoughts.
Returning to the case examples of
Jack and Lily, cognitive behavioral
therapy can be tailored to their
individual developmental needs.
Jack, a 6 year old boy, requires
a more behavioral approach as opposed
to focusing on his thoughts, since
his age and developmental level
limit his cognitive processing capacities.
For instance, an increase in family
centered pleasant activities (e.g.,
family dinners and weekend outings)
would be expected to elevate Jack's
mood and ultimately generalize to
his desire to return to playing
sports with his peers. For younger
children, this level of parental
involvement in the therapeutic intervention
is necessary to motivate and engage
the child in treatment.
Lily, being an adolescent, requires
a more integrative cognitive behavioral
approach. While the initial phase
of treatment may be similar to the
more behavioral approach (including
mood monitoring and increasing pleasant
activities) used with younger children
like Jack, Lily's treatment will
progress toward focusing on identifying
and challenging maladaptive thoughts
that contribute to her depression.
For example, Lily may blame herself
for poor grades, telling herself
that she is stupid for failing tests
and will never graduate from high
school or be successful. A cognitive
behavioral session would focus on
challenging and restructuring these
thoughts by changing her negative
self attributions "I'm
stupid" to external explanations
"I didn't study and
it was a hard test for everyone
in the class." Since Lily
had expressed suicidal thoughts,
and her mother is suspicious of
substance use, she may be at increased
risk for self-injurious behavior.
Thus, close monitoring of depressive
symptoms and immediate intervention
are crucial components of a treatment
plan. In sum, a comprehensive cognitive
behavioral treatment tailors interventions
to the individual child or adolescent.
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