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1、,教师在儿童抑郁症处理过程中的作用 A Teachers Role in Treatment of Childhood Depression,关于童年抑郁的教师须知,Until recently, the very existence of depression in children was questioned. Today, it is estimated that 20 percent of the school-age population manifests some symptoms of depression 直到晚近，儿童抑郁究竟是否存在仍然是个问题。但是如今据估计有20%的
2、学龄儿童表现出某些抑郁症状。,The “Who” of Childhood Depression “哪些人”患儿童抑郁症,Korup (1985) found that 10 percent of a sample of 226 six- to twelve-year-old students exhibited symptoms of depression. Leftkowitz and Tesiny (1985), in a study of 3,020 elementary school students, reported a 5.2 per-cent prevalence, whic
3、h is consistent with the average lifetime prevalence suggested by Robins et al. (1984). Using the Beck Depression Inventory, Sullivan and Engin (1986) reported that 26 percent of the tenth- and eleventh-grade students in their sample scored within the moderately depressed range, and 6 percent within
4、 the severely depressed range. In a classroom of thirty students, a teacher may anticipate that one or two students will exhibit symptoms of depression.,The “Who” of Childhood Depression “哪些人”患儿童抑郁症,“哪些人”患儿童抑郁症 Korup (1985)发现，226名6-12岁孩子组成的样本中有10%的人呈现出抑郁症状。Leftkowitz 和Tesiny (1985), 在研究3,020 小学生时发现有
5、5.2%的孩子有抑郁症。这与Robins 等人(1984)报告的平均终生发病率相一致。Sullivan and Engin (1986)等人利用Beck 量表发现26%10-11年级的学生有轻中度抑郁，6%有重度抑郁。在一个30人的教室里，教师可以预期有1-2人会呈现抑郁症状。,The “What“ of Childhood Depression 儿童抑郁症有什么表现,The Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association 1979) states that the
6、 primary symptom of depression is a “dysphoric mood“ (a loss of interest or pleasure in almost all daily activities). For the diagnosis of depression, a student must exhibit at least four of the following symptoms for a minimum of two weeks: change in appetite or weight, sleep disturbance, psychomot
7、or agitation or retardation, loss of interest in usual activities, loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and thoughts of death or suicide.,The “What” of Childhood Depression 儿童抑郁症有什么表现,精神障碍的诊断与统计手册告诉我们，抑郁症的基本症状是“抑郁心境”（dysphoric mood. depression: a st
8、ate of feeling acutely hopeless, uncomfortable, and unhappy ）（a loss of interest or pleasure in almost all daily activities对几乎所有的日常活动都失去了兴趣或愉悦）。为了确定一个抑郁症的诊断，以下症状中的至少4个必须持续至少2周：胃口或体重的改变，睡眠的障碍，精神运动的易激惹或迟钝，对日常活动兴趣的丧失，精力的丧失，无价值感或过份的负罪感，注意力难以集中，死亡或自杀的念头。,The “What“ of Childhood Depression 儿童抑郁症有什么表现,Cant
9、well (1983a) describes four historical schools of thought concerning depression in children. The first suggested that depression, such as that found in adults, did not occur among children. The second suggested that depression existed in children, characterized by symptoms not apparent in adults. Th
10、e third school of thought described “masked depression“ or “depressive equivalents“ among children. Depression was perceived to assume a different form in children. Children were thought to demonstrate boredom, restlessness, fatigue, difficulties in concentrating, and aggression, rather than the adu
11、lt behaviors of sleep disturbance, self-reproach, guilt, and loss (Garfinkel and Golumbek 1974). Cantwell indicates, however, that the behaviors that supposedly “masked“ childhood depression are found among adults as well. To alert professionals, the childs depression was not “masked.“,The “What“ of
12、 Childhood Depression 儿童抑郁症有什么表现,Cantwell (1983a) 描述了历史上4个关于儿童抑郁症的学派。 1，主张在成人中看到的抑郁症，在儿童中是没有的。 2，认为儿童中存在着抑郁症，但是其特有的症状在成人期表现不明显。 3，描述了儿童中“面具性的抑郁”或“抑郁的等价物。”在这个学派视野中，儿童抑郁症采取了与成人不同的形式。他们认为儿童会表现出厌倦、躁动，疲乏，注意力分散和攻击性（boredom, restlessness, fatigue, difficulties in concentrating, and aggression），而不是象成人那样表现出睡
13、眠反常，自我责备，负罪感和丧失感(Garfinkel and Golumbek 1974)。然而，Cantwell 指出，那些被认为给儿童抑郁带上面具的行为在成人中也能看到，为了惊醒专业人员，他认为儿童抑郁症并没有被“面具化。”,The “What“ of Childhood Depression 儿童抑郁症有什么表现,The most recent school of thought suggests that depression in children has a clinical pattern analogous to that in adults. Though there may
14、 be age-specific behaviors among infants, children, and adolescents, the diagnostic criteria for depression remain the same.,The “What“ of Childhood Depression 儿童抑郁症有什么表现,4， 最晚近的学派认为，儿童抑郁症具有类似于成人的临床模式。尽管在幼儿，儿童和青少年中会有一些带上年龄特征的行为，但是抑郁症的诊断标准未尝有变。,The “What“ of Childhood Depression 儿童抑郁症有什么表现,Childhood
15、depression is usually identified by inter-viewing the parents and the child, and by using behavior rating scales (Cantwell 1983b). There are several considerations for assessing depression among children (Weller, Weller, and Fristad 1984a). The behaviors exhibited by depressed children may be differ
16、ent from those exhibited by adults and may be related to the develop-mental level of the child. Kovacs and Paulaniskus (1984) found that less mature students exhibited greater disruptions in experiencing pleasure and were more self- deprecating. Older children exhibited disobedience, op-positional b
17、ehavior, and complaints of aches and pains. Herzog and Rathbun (1982) also reported develop-mental influences on symptoms of children who are depressed. They suggested that six- to eight-year-olds exhibited prolonged unhappiness, irritability, and somber affect. Older children exhibited sadness, apathy, helplessness, and irritability.,
