Biomedical subjects

Joan L Luby

Publications and source records attributed to Joan L Luby.

13 recordsLinked to original sources

PubMed2006

Adaptive strategies for treating childhood mania.

The conduct of trials in children is beset with special difficulties associated with the dearth of treatment data, the considerable heterogeneity of pediatric patient populations connected with (for example) developmental stage, and the strong desire of parents to see that children are provided with the best possible care at all times. To address these issues, we propose the adaptive treatment strategy (ATS) study in which medication changes are adaptively determined according to the evolving treatment response of the individual child. To formalize this methodological approach, we parameterize an ATS as a "threshold" decision rule that monitors whether the patient's response trajectory crosses some threshold of failure. In this formulation, the threshold represents a priori judgments about when to give up on response to medication, and the goal is to find the right response thresholds for continuation, augmentation, or switching. Our exposition is developed in the specific clinical context of childhood mania to maximize accessibility of the ideas but applies more generally to other chronic mental and physical health disorders that are difficult to treat.

Adolescent↗

PubMed2006

Preschool depression.

Within the past five years, significant strides have been made in the characterization of preschool (3-6 years of age) depression. Advances in this line of research have been made possible by increasing attention to the impact of developmental stage on symptom manifestation and the development of measures that appropriately assess for the presence of these developmentally specific symptoms. Available empirical evidence demonstrates that preschool depression is characterized by a specific and stable symptom constellation, associated impairment, biologic markers, and family history of similar disorders. This article reviews the relatively new body of evidence supporting the validity of preschool depression.

Anxiety Disorders↗

PubMed2006

An observational analysis of behavior in depressed preschoolers: further validation of early-onset depression.

OBJECTIVE: To investigate whether higher levels of negative and lower levels of positive behaviors could be observed in a sample of depressed preschoolers. Support for the validity of preschool depression is now available; however, objective evidence of negative behaviors among depressed preschoolers is needed. METHOD: A structured observational parent-child interaction task was conducted. The behaviors of 152 preschoolers (ages 3.0-5.6) in three study groups (depressed, disruptive, and healthy) were examined with further analyses of depressed subgroups based on severity and comorbidity. RESULTS: Anhedonically depressed preschoolers emerged as demonstrating less enthusiasm, more avoidance, more noncompliance, and having a more negative overall experience than healthy controls. This more severe and proposed melancholic anhedonic subgroup also displayed less enthusiasm than nonanhedonically depressed preschoolers. Furthermore, the "pure" anhedonic depressed preschoolers without disruptive comorbidity emerged as the only depressed subgroup that was significantly distinguishable from healthy preschoolers. CONCLUSIONS: Findings provide the first objective evidence of more negative and fewer positive behaviors among depressed preschoolers. Notably, the finding that anhedonically depressed preschoolers demonstrated significantly less enthusiasm than those with nonanhedonic depression provides the first objective evidence of the manifestation of anhedonia, a key sign of preschool depression. The implications of the finding that the "pure" anhedonic depressed subgroup without disruptive comorbidity was most distinguishable from comparison groups are explored.

Age of Onset↗

PubMed2006

Preschoolers' depression severity and behaviors during dyadic interactions: the mediating role of parental support.

OBJECTIVE: To investigate the relationship between preschool depression severity, observed behavior, and parental emotional support in a population of 3.0- to 5.6-year-olds and their mothers. METHOD: One hundred fifty preschoolers who underwent a comprehensive mental health assessment during which DSM-IV diagnoses were derived were included in this analysis. Child and parent behaviors during challenging structured dyadic tasks were systematically coded. Dyads with preschoolers in three diagnostic groups of interest were explored: depression, disruptive, and healthy. Depression severity sum scores were derived for children in all of the groups. RESULTS: Depression severity accounted for a significant (p < .05) portion of the variance in preschoolers' persistence, compliance, and enthusiasm during dyadic tasks after controlling for the effects of age and gender. Depression severity was also significantly associated with parental emotional support, which was itself associated with all three preschool behaviors. When the effect of parental support was controlled for statistically, however, preschoolers' depression severity was no longer significantly associated with observed persistence or compliance, whereas the relationship between depression severity and enthusiasm remained significant. CONCLUSIONS: Maternal emotional support mediated the relationship between preschoolers' depression severity and their persistence and compliance but not the relationship between depression severity and enthusiasm. Findings have important clinical implications because they suggest that both external relational and internal child factors may be operating in preschool depression.

Child, Preschool↗

PubMed2006

Risk factors for preschool depression: the mediating role of early stressful life events.

BACKGROUND: Family history of mood disorders and stressful life events are both established risk factors for childhood depression. However, the role of mediators in risk trajectories, which are potential targets for intervention, remains understudied. To date, there have been no investigations of mediating relationships between risk factors and very early onset depression, a developmental period during which intervention may be more effective. The current study used regression analyses to examine the relationships between family history of mood disorders and stressful life events as risk factors for depression in a preschool sample. METHOD: Preschoolers 3.0 to 5.6 years of age participated in a comprehensive mental health assessment. Caregivers were interviewed about their children using a structured diagnostic measure to derive DSM-IV major depressive disorder (MDD) diagnoses and dimensional depression severity scores. Family history of psychiatric disorders and preschoolers' stressful life events was obtained. RESULTS: Both family history and stressful life events predicted depression severity scores 6 months later. Analyses examining the influence of family history of mood disorders and stressful life events on preschoolers' depression severity demonstrated that stressful life events mediated the relationship between family history and preschoolers' depression. CONCLUSIONS: Findings outline the key role of exposure to early stressful life events as a mediator of familial mood disorder risk in preschool onset depression. This finding in a preschool sample provides support for the hypothesis that psychosocial factors may have increased importance as mediators of risk in younger age groups. Findings suggest that psychosocial factors should be considered key targets for early intervention in depression.

Age Factors↗

PubMed2004

ThePreschool Feelings Checklist: a brief and sensitive screening measure for depression in young children.

OBJECTIVE: Childhood depression is widely underrecognized in primary health care settings. This phenomenon appears to increase with younger age. Evidence has been provided for a valid depressive syndrome among preschool children. Based on the need for the earliest possible identification of depression, the development of a brief screening measure to capture young children with markers of depression from these community settings was developed and tested. METHOD: A group of 174 preschool children underwent a comprehensive psychiatric assessment. The majority of this study group was ascertained from primary care settings using a 20-item checklist designed to capture depressive symptoms in young children. The assessment included the Diagnostic Interview Schedule for Children Version modified for young children and the Child Behavior Checklist. Ratings on the checklist were subsequently compared with these independent measures of psychopathology using several analytic strategies. RESULTS: The Preschool Feelings Checklist demonstrated high internal consistency, and 16 items showed strong associations with independent diagnostic measures of internalizing symptoms and major depressive disorder. The Preschool Feelings Checklist demonstrated high specificity and sensitivity for the identification of major depressive disorder at a cutoff score 3 or more. CONCLUSIONS: The Preschool Feelings Checklist is a brief and valid screening measure highly feasible for use in primary care settings. It demonstrated utility for the identification of preschoolers in need of formal mental health evaluation for depression.

Analysis of Variance↗

PubMed2004

Characteristics of depressed preschoolers with and without anhedonia: evidence for a melancholic depressive subtype in young children.

OBJECTIVE: This study investigated whether a melancholic subtype similar to that established in depressed adults can be identified in depressed preschool children. METHOD: A final group total of 156 preschool children between the ages of 3.0 and 5.6 years and their caregivers underwent a comprehensive psychiatric assessment that included a structured psychiatric interview modified for young children. The clinical characteristics of four study groups (N=156) were compared: depressed preschoolers with anhedonia, depressed preschoolers without anhedonia ("hedonic"), a psychiatric comparison group with DSM-IV attention deficit hyperactivity disorder and/or oppositional defiant disorder, and a healthy comparison group. RESULTS: Fifty-four depressed preschoolers were identified, and 57% of this depressed group was anhedonic, a symptom deemed to be highly developmentally and clinically significant when arising in the preschool period. The anhedonic depressed subgroup identified was characterized by greater depression severity, alterations in stress cortisol reactivity, increased family history of major depressive disorder, and increased frequency of psychomotor retardation as well as other melancholic symptoms, such as a lack of brightening in response to joyful events. CONCLUSIONS: The clinical characteristics of this depressed subgroup are consistent with those described in melancholic depressed adults and suggest that a melancholic depressed subtype can be manifest in children as young as age 3.

Affective Symptoms↗

PubMed2003

Alterations in stress cortisol reactivity in depressed preschoolers relative to psychiatric and no-disorder comparison groups.

BACKGROUND: Despite the robust and widely replicated finding of elevated hypothalamic-pituitary-adrenal (HPA) axis reactivity in depressed adults, studies of depressed children have yielded ambiguous findings. Animal models of early depression and studies of children experiencing early psychosocial deprivation have suggested that alterations in HPA axis reactivity are evident in early "depressive-like" conditions. The current study is, to our knowledge, the first investigation of HPA axis reactivity in very young children with a clinical depressive syndrome for which content validity has been established. METHODS: Depressed, psychiatric, and no-disorder comparison children aged 3 through 5.6 years were studied for HPA axis reactivity in response to experimental psychosocial stressors. The children were diagnosed using a developmentally appropriate, structured psychiatric interview. Salivary cortisol was obtained at 3 time points during a laboratory assessment before and after stressors involving separation from the parent and frustrating tasks. RESULTS: Repeated measures of multivariate analysis of variance revealed a significant interaction between the diagnostic group and 2 cortisol percent change scores. Depressed preschoolers displayed a pattern of increasing cortisol levels throughout the assessment in response to both separation and frustration stressors. In contrast, both comparison groups showed decreasing cortisol levels in response to the separation stressor. All groups displayed increasing cortisol levels in response to frustrating tasks. Preschoolers with a presumptive melancholic depressive subtype displayed these alterations at a greater magnitude relative to comparison groups. CONCLUSIONS: To our knowledge, these findings are the first to demonstrate altered HPA axis reactivity in depressed preschoolers. These alterations are consistent with those described in depressed adults and in animal models of early depression. These findings provide evidence for possible continuity of HPA axis alterations in depressive disorders across the lifespan and are discussed in the context of prior studies of HPA axis reactivity in clinically depressed children and adolescents, suggesting that younger age and inpatient status are features associated with altered HPA axis reactivity.

Arousal↗

PubMed2003

Depressed preschoolers with bipolar family history: a group at high risk for later switching to mania?

Earlier age of onset of an episode of depression and family history of bipolar disorder (FHBPD) are well known to be associated with increased rates of switching to mania in childhood major depressive disorder (MDD). These findings suggest that the youngest samples of depressed children who have FHBPD might be at very high risk for switching. The finding of a valid depressive syndrome in preschool children has raised the question of whether mania could also manifest at this early stage. We investigated FHBPD among three preschool study groups: a depressed group and two nondepressed comparison groups (attention deficit hyperactivity disorder/oppositional defiant disorder, no disorder). Increased FHBPD was found among the depressed group. Based on this, we explored whether the depressed subgroup with FHBPD (MDD + FHBPD) had a unique constellation of depressive symptoms compared to the depressed subgroup without FHBPD (MDD with no FHBPD). The MDD + FHBPD group was found to have an increased frequency of the MDD symptom of "restlessness and moves around a lot" as compared with the MDD with no FHBPD group. The question of whether this symptom could be an early precursor of later mania was explored. These findings taken together suggest that early risk factors for switching to mania may be present in a subgroup of depressed preschoolers. Longitudinal follow-up of depressed preschool samples to determine rates of switching to mania later in development is critical to determine whether such findings represent early risk factors. Future studies that directly investigate age-appropriate mania manifestations in preschool samples are now warranted.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

The clinical picture of depression in preschool children.

OBJECTIVE: To investigate the clinical characteristics of depression in preschool children. METHOD: One hundred seventy-four subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview for parents. Modifications were made to the assessment of major depressive disorder (MDD) criteria so that age-appropriate manifestations of symptom states could be captured. Typical and "masked" symptoms of depression were investigated in three groups: depressed (who met all MDD criteria except duration criterion), those with nonaffective psychiatric disorders (who met criteria for attention-deficit/hyperactivity disorder and/or oppositional defiant disorder), and those who did not meet criteria for any psychiatric disorder. RESULTS: Depressed preschool children displayed "typical" symptoms and vegetative signs of depression more frequently than other nonaffective or "masked" symptoms. Anhedonia appeared to be a specific symptom and sadness/irritability appeared to be a sensitive symptom of preschool MDD. CONCLUSIONS: Clinicians should be alert to age-appropriate manifestations of typical MDD symptoms and vegetative signs when assessing preschool children for depression. "Masked" symptoms of depression occur in preschool children but do not predominate the clinical picture. Future studies specifically designed to investigate the specificity and sensitivity of the symptoms of preschool depression are now warranted.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed2003

Modification of DSM-IV criteria for depressed preschool children.

OBJECTIVE: This study compared the severity of depression in preschoolers diagnosed by standard versus modified DSM-IV criteria for major depression. METHOD: A group of 145 preschoolers and their caregivers underwent a diagnostic assessment for preschool children. A factor analysis of depressive symptoms from the group was performed to derive a depression severity score. Scores were compared among four groups: standard DSM-IV major depression, modified DSM-IV major depression, DSM-IV attention deficit hyperactivity disorder and/or oppositional defiant disorder, and no disorder. RESULTS: A hierarchy in severity emerged, with significant differences among all four groups. Preschoolers meeting standard criteria displayed the highest severity, followed by those who met modified criteria. Both depressed groups had significantly higher severity than the two comparison groups. CONCLUSIONS: Standard DSM-IV criteria captured the most severely affected preschoolers, missing a substantial proportion of children with potentially clinically significant but less severe symptoms who were captured by modified DSM-IV criteria.

Age Factors↗

PubMed2002

Differential performance of the macarthur HBQ and DISC-IV in identifying DSM-IV internalizing psychopathology in young children.

OBJECTIVE: Three sites collaborated to evaluate the differential performance of the MacArthur Health and Behavior Questionnaire (HBQ) and the Diagnostic Interview Schedule for Children Version IV (DISC-IV) in identifying DSM-IV psychopathology in young children. METHOD: A sample of 120 four- to eight-year-old nonreferred (community) (n = 67) and referred (clinical) (n = 53) children was examined. Mothers reported on their child's mental health symptoms using the HBQ (a dimensional measure with a clinical cutoff score) and the DISC-IV. Teachers independently reported on the child's symptoms and impairment in school using the teacher HBQ. Children self-reported on their symptoms using the companion Berkeley Puppet Interview. RESULTS: On the basis of its derived clinical cutoff scores, the HBQ identified significantly more children with clinical symptoms of DSM-IVinternalizing psychopathology than the DISC-IV in both referred and nonreferred groups. There was a high level of agreement between the two measures in the identification of externalizing psychopathology. Children identified as having internalizing psychopathology by the HBQ were also rated as highly symptomatic and impaired by teachers. CONCLUSION: The findings support the general validity of the parent HBQ for the assessment of young child psychopathology and the hypothesis that it captures more internalizing psychopathology than the DISC-IV in this population.

Child↗

PubMed2002

Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria.

OBJECTIVE: To investigate the validity of developmentally modified DSM-IV criteria for preschool major depressive disorder (MDD). METHOD: Subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview with the parent about the child. Minor developmental modifications to the formal DSM-IV MDD criteria were tested, including translations of symptoms to describe age-appropriate manifestations and setting aside the duration criterion. Preschool children who met modified criteria were compared with psychiatric and normal control groups. RESULTS: Validation for the modified criteria was supported by a specific and stable symptom constellation, social impairment, greater family histories of affective disorders, and higher child-reported symptoms of depression on an age-appropriate puppet interview. Preschool children with MDD displayed "typical" symptoms of depression, as well as vegetative signs. Standard DSM-IV criteria failed to capture 76% of children who met these modified criteria. CONCLUSIONS: Evidence that preschool children can manifest typical symptoms of MDD when age-adjusted symptoms states are assessed is provided. Findings also suggest that standard DSM-/V criteria may not be sufficiently sensitive for preschool children, as they failed to capture a substantial proportion of symptomatic children. Minor modifications to DSM-IV criteria are recommended to capture clinically significant preschool MDD.

Child, Preschool↗