Diagnostik, epochale Trends und indizierte Prävention von introversiven Störungen bei Kindern und Jugendlichen

Introversive disorders such as anxiety and depression are among the most common psychological disorders during childhood and adolescence. They significantly impair child development, particularly with regard to school performance and social relationships. Anxiety disorders as well as depression are frequently overlooked and remain untreated in more than 50% of all children requiring treatment in Germany. In the publication-based cumulus in hand, three fields of studies in the area of introversive disorders are presented: 1st Diagnosis, 2nd Time trends and 3rd Indicated prevention and the importance of parent training. Ad 1.: Major depression and dysthymia represent the core disorders of depressive disorders. In addition, according to ICD-10, depressive symptoms are a main component of other diseases, such as, inter alia, adjustment disorders with depressive reaction or depressive conduct disorder. Apart from information obtained from the child or adolescent, diagnosing depressive disorders is based on information provided by the parents or third parties. The well-validated Child Behavior Checklist (CBCL) is used internationally as a screening tool for emotional and behavioral problems from a parental point of view. Two scales are available for the registration of depressive episodes and dysthymia: the CBCL syndrome scale Anxious / Depressed as well as the DMS-oriented CBCL scale Affective Problems. Within the framework of the present survey, the predictive power of the two CBCL scales for depressive core disease (core group) and other disorders featuring depressive symptoms (broader group) was analyzed, covering a representative clinical population of 1,445 outpatients and 698 inpatients aged from 11 to 18. Applying the CBCL scales to the outpatients resulted in findings of moderate predictive power for both depressive disorder groups. However, under inpatient conditions, only patients with depressive core diseases could be predicted. Ad 2.: Studies on epochal trends of mental disorders illustrate prevalence rates of mental symptoms or mental health disorders, respectively. Empirically assessed change rates of mental disorders in children have been equivocal on an international level during the last 10 to 25 years. Against this backdrop, country-specific as well as regional analyses are required in order to collect mental health data on a local basis and establish corresponding health care facilities as a consequence. The study in hand analyses the data from 2 CBCL-based cross-sectional surveys that were carried out among 8-11 year old schoolchildren in 1987 and 2008 in and around the city of Marburg. The prevalence rates for somatic problems proved to have risen significantly. Other introversive disorder patterns such as anxiety and depression or symptoms of externalizing problems did not change significantly. The children with the lowest socioeconomic status showed the highest symptom levels in both assessment years. Ad 3.: Given the high prevalence rates of introversive symptoms, the author of this article co-developed a prevention project for 8-12 year old children with introversive complaints. The basis for this was the cognitive-behavioral “FRIENDS”-program. So far, evaluation studies have proven the program’s efficacy, albeit individual children benefited from it to a varying degree. One potential variable for the differing degree of efficacy seems to be parental behavioral patterns such as over-anxiousness, over-monitoring behavior or parental communication styles. Parent training is intended to modify parental interaction with the child and thus increase success and sustainability of preventive measures. In the present study, the efficacy of simultaneous parent training in the indicated prevention of anxiety and depressive disorders in 8-12 year old children is examined in a randomized controlled trial. In this context, the additional parent training did not show a significant effect with regards to the reduction of introversive symptoms. Furthermore, the parents who participated in the parent training scheme did not consider themselves more competent in dealing with their children’s problems than parents, who did not receive parent training.