Therapy For Pediatric Clients With Mood Disorders

Therapy For Pediatric Clients With Mood Disordersan African American C

Therapy for pediatric clients with mood disorders, particularly among African American children, presents unique challenges and considerations. This case study examines an 8-year-old African American male presenting with depressive symptoms, explores clinical decision-making, medication management, and cultural considerations intrinsic to treatment. The aim is to deliver an evidence-based approach tailored to the child's needs, with attention to developmental and cultural factors that influence therapeutic outcomes.

Paper For Above instruction

The treatment of pediatric mood disorders, especially depression, necessitates an integrated approach involving accurate diagnosis, appropriate pharmacological intervention, and consideration of cultural and developmental contexts. In this case, the child, an 8-year-old African American male, exhibits classic signs of depression, including sadness, withdrawal, decreased appetite, irritability, and thoughts about death. These symptoms align with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for major depressive disorder, modified for age-related expression (American Psychiatric Association [APA], 2013). Understanding the cultural context of mental health in African American communities is vital, as historical mistrust, stigma, and disparities may influence engagement and adherence to treatment (Snowden, 2012).

During initial clinical assessment, the child's mental status examination reveals a generally alert, oriented child with coherent speech and preserved judgment and insight, which suggests cognitive functioning within normal limits despite depressive symptoms (Ginsburg et al., 2020). The child's affect is somewhat blunted, but appropriate smiles are observed, and he denies hallucinations or paranoia, indicating that psychotic features are absent. Importantly, the child discloses thoughts about death but does not endorse active suicidal ideation, posing a significant risk factor requiring ongoing monitoring (Birmaher et al., 2019).

The Children's Depression Rating Scale (CDRS) score of 30 indicates moderate to severe depression. Pharmacotherapy is typically recommended when significant symptoms impair functioning, especially when psychotherapy alone is insufficient (Vitiello & Stoff, 2018). The initial decision to initiate Wellbutrin (bupropion) 75 mg BID is noteworthy, as bupropion has FDA approval for depression in adolescents and a favorable side-effect profile, including a lower risk of weight gain and sedation compared to other antidepressants (Strawn et al., 2020). However, in children, SSRIs like escitalopram or fluoxetine are often considered first-line therapies (Cipriani et al., 2018).

Following the first decision point, the child is re-evaluated after four weeks. The report indicates difficulty with sleep, a common side effect or symptom associated with depression and medication adjustments. The decision to switch to Lexapro (escitalopram) 10 mg daily aligns with evidence supporting SSRIs as effective and generally well-tolerated in pediatric depression (Cipriani et al., 2018). The child's symptom reduction of 40% suggests partial response, consistent with clinical guidelines to continue medication while monitoring for efficacy and side effects (American Academy of Child and Adolescent Psychiatry [AACAP], 2010).

The third decision enhances treatment by maintaining the current dose, given tolerability and ongoing symptom improvement. While dose escalation could be considered, particularly if no further response is observed after additional trials, clinicians often wait 4-6 weeks to assess full medication response before making dose adjustments, respecting developmental pharmacodynamics in children (Vitiello & Stoff, 2018). Continued monitoring for side effects such as agitation, suicidal ideation, or behavioral activation remains essential, especially given the increased risk of suicidality associated with antidepressants in youth (Gibbons et al., 2020).

Cultural sensitivity plays a crucial role in treatment success among African American children. Incorporating culturally competent practices, including family involvement, addressing potential stigma, and integrating culturally relevant therapeutic approaches, can substantially improve engagement and outcomes (Snowden & Yamada, 2019). Community and family-centered interventions, along with psychoeducation, can help reduce barriers and foster trust in mental health care providers (Look et al., 2019).

In summary, managing depression in an African American pediatric patient involves an evidence-based pharmacological approach tailored to developmental age, regular clinical assessment, and culturally sensitive practices. Pharmacotherapy, combined with psychosocial interventions and family support, provides a comprehensive framework to address symptoms and prevent long-term adverse outcomes. Ongoing research highlights the necessity of culturally adapted treatment modalities and the importance of addressing disparities in mental health care access and quality (Snowden, 2012).

References

  • American Academy of Child and Adolescent Psychiatry. (2010). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 1159–1175.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Birmaher, B., et al. (2019). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 58(10), 1052–1063.
  • Cipriani, A., et al. (2018). Comparative efficacy and acceptability of antidepressants in children and adolescents with depression: a systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366.
  • Gibbons, R. D., et al. (2020). Suicidality and antidepressant drugs in young people: A reanalysis of the FDA data. BMJ Evidence-Based Medicine, 25(4), 148–154.
  • Ginsburg, G. S., et al. (2020). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1079–1100.
  • Look, M. A., et al. (2019). Culturally competent mental health services for African American children: Implications for policy and practice. Child & Adolescent Mental Health, 24(4), 301–308.
  • Snowden, L. R. (2012). Health and mental health policies' role in better understanding and closing persistent gaps in treatment access and quality. American Psychologist, 67(7), 514–524.
  • Snowden, L. R., & Yamada, A. M. (2019). Cultural competence and evidence-based practice in mental health services. Mental Health Services Research, 21, 9–28.
  • Vitiello, B., & Stoff, D. M. (2018). Mood disorders in children and adolescents. In K. H. Beitchman & D. J. Cohen (Eds.), Child and adolescent psychiatry (pp. 573–599). Springer.

Related Assignments