Attenuated LPP to Emotional Face Stimuli Associated with Parent- and Self-Reported Depression in Children and Adolescents.

Individuals diagnosed with a depressive disorder have been found to show reduced reactions to emotional information consistent with the hypothesis of an emotional context insensitivity. However, there are contradictory findings of enhanced reactivity and mood-congruent processing. Electroencephalography (EEG) recordings of the late positive potential (LPP) can display such blunted or enhanced activity. Due to these contradictory findings, there is a need to clarify the role of the LPP in the emergence and presence of depressive disorders especially in children. We used an emotional Go/NoGo task to investigate modulations of the LPP to emotional (fearful, happy, sad) and calm faces in a sample of children and adolescents (age 11;00-14;11) diagnosed with a depressive disorder according to diagnostic parent interviews (K-SADS-PL) (n = 26) compared to a group of age-matched healthy controls (n = 26). LPP positivity was attenuated in children and adolescents with a depressive disorder as well as with higher self-reported depressive symptoms, suggesting reduced reactivity to emotional and calm faces. This is the first study to find generally blunted LPP responses in a clinical sample of depressed youth across reporters. Such dysfunctional modulation of neural activity may represent a potential biomarker for depressive disorders. The results call for further prospective studies investigating the course of the LPP before and after the onset of a depressive disorder in youth.

Endocrinological and subjective stress responses in children with depressive, anxiety, or externalizing disorders.

In this study, we used a stress test to investigate endocrinological and subjective stress responses of 8- to 14-year-old children with internalizing or externalizing disorders and healthy controls. The sample (N = 170) consisted of clinical and community children. Parents were given a diagnostic interview to diagnose their children's psychiatric condition. We measured saliva cortisol and subjectively experienced arousal in children before and after the Trier Social Stress Test for Children. Children also rated their performance immediately after the stress test, and 1 hr later they rated their positive and negative thoughts about this stressful event. Children with internalizing or externalizing disorders exhibited a blunted cortisol response compared to healthy controls. Depressed children rated their test performance lower and reported more negative thoughts after the test in comparison to healthy controls, anxious children reported more arousal before and after the task, and children with externalizing disorders reported more positive thoughts. In regression analyses, cortisol and subjective stress responses were both predictive of psychiatric disorders. The study extends previous work on the relation between psychiatric disorders and children's stress responses to an experimentally induced stress task by including a broad range of psychiatric disorders and by integrating endocrinological and subjective stress responses.

Self-Esteem of 8-14-Year-Old Children with Psychiatric Disorders: Disorder- and Gender-Specific Effects.

In this study, we investigated the relation between global and domain-specific self-esteem and psychiatric disorders. A sample of 577 children aged 8-14 years was recruited via psychiatric hospitals and from the general population. Parents were given a diagnostic interview to assess children's psychiatric diagnoses (current/past). Parents and children completed questionnaires on child symptoms. Children completed a questionnaire on global and domain-specific self-esteem (scales: scholastic competence, social acceptance, athletic performance and physical appearance, global self-esteem). Self-esteem of children with current psychiatric disorders was lower than that of healthy controls (η p2 between 0.01 and 0.08). Concerning scholastic competence, social acceptance and global self-esteem, children with past psychiatric disorders scored also lower than healthy controls. Different current psychiatric disorders showed specific but small effects on dimensions of self-esteem (ß between -0.08 and 0.19). Moreover, we found a gender × group interaction, indicating that girls with depressive and adjustment disorders were specifically impaired in their global self-esteem and perception of their physical appearance. Findings might help clinicians to focus on particular domains of self-esteem during the diagnostic process and to define adequate treatment goals.

Implementing the K-SADS-PL as a standard diagnostic tool: Effects on clinical diagnoses.

Diagnostic interviews are valuable tools for generating reliable and valid psychiatric diagnoses. However, little is known about the diagnostic effects of implementing such an interview into the standard diagnostic procedure of a child psychiatric clinic. Therefore, we reviewed discharge diagnoses of psychiatric patients (age: 8-12 years; combined sample of inpatients and day hospital patients) over two intervals before and after implementing the semi-structured diagnostic interview K-SADS-PL as a diagnostic tool during intake. Each interval was a two year period spanning from 2009-2010 (pre sample; n=177) and from 2012-2013 (post sample; n=132). The number of diagnoses per patient and the co-morbidity rate increased significantly in the post sample. Furthermore, the percentage of children with a nonspecific diagnosis "other mixed disorders of conduct and emotions" (ICD-10: F92.8) decreased significantly after using the K-SADS-PL. Regarding the main diagnostic categories, a significant increase in the number of anxiety disorders and stress-related and somatoform disorders was found in the post sample. The results suggest that implementing a semi-structured interview into the daily routine of child psychiatry may have a substantial impact on discharge diagnoses. Practical implications are discussed and ideas for future research are given.

The acceptance of the K-SADS-PL - potential predictors for the overall satisfaction of parents and interviewers.

The presented study investigated the interviewee (parents) and interviewer acceptance of the semi-structured diagnostic interview Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children Present Lifetime version (KSADS-PL; German version). Seventeen certified interviewers conducted 231 interviews (interviewers conducted several interviews; interviewees were only questioned once). Interviewees and interviewers anonymously rated their acceptance right after the interview was finished. The nested data structure was analysed regarding an individual interviewer bias and potential predictors of overall satisfaction. Therefore, factors improvable by interviewer training were included, as well as fixed factors which cannot be improved by professional training. The overall satisfaction was evaluated as highly positive with significant higher interviewee and interviewer ratings in the research as compared to the clinical recruitment setting. An individual bias of the interviewer on his or her own acceptance over time, but not on the evaluation of the corresponding interviewee was found. Neither the professional background nor the gender of the interviewer had a significant contribution in predicting these differences. The interviewer model showed no significant change over time and only the interview duration and the interviewee acceptance were significant predictors for interviewer overall satisfaction. Regarding the interviewee model, just the interviewer acceptance was a significant predictor. Copyright Copyright © 2015 John Wiley & Sons, Ltd.

Early processing of emotional faces in a Go/NoGo task: lack of N170 right-hemispheric specialisation in children with major depression.

Emotionally biased information processing towards sad and away from happy information characterises individuals with major depression. To learn more about the nature of these dysfunctional modulations, developmental and neural aspects of emotional face processing have to be considered. By combining measures of performance (attention control, inhibition) in an emotional Go/NoGo task with an event-related potential (ERP) of early face processing (N170), we obtained a multifaceted picture of emotional face processing in a sample of children and adolescents (11-14 years) with major depression (MDD, n = 26) and healthy controls (CTRL, n = 26). Subjects had to respond to emotional faces (fearful, happy or sad) and withhold their response to calm faces or vice versa. Children of the MDD group displayed shorter N170 latencies than children of the CTRL group. Typical right lateralisation of the N170 was observed for all faces in the CTRL but not for happy and calm faces in the MDD group. However, the MDD group did not differ in their behavioural reaction to emotional faces, and effects of interference by emotional information on the reaction to calm faces in this group were notably mild. Although we could not find a typical pattern of emotional bias, the results suggest that alterations in face processing of children with major depression can be seen at early stages of face perception indexed by the N170. The findings call for longitudinal examinations considering effects of development in children with major depression as well as associations to later stages of processing.