教師在兒童抑郁癥處理過程中的作用

1、,教師在兒童抑郁癥處理過程中的作用A Teacher's Role in Treatment of Childhood Depression,關于童年抑郁的教師須知,Until recently, the very existence of depression in children was questioned. Today, it is estimated that 20 percent of the school-ag

2、e population manifests some symptoms of depression 直到晚近，兒童抑郁究竟是否存在仍然是個問題。但是如今據估計有20%的學齡兒童表現出某些抑郁癥狀。,The “Who” of Childhood Depression “哪些人”患兒童抑郁癥,Korup (1985) found that 10 percent of a sample of 226 six- to twelve-yea

3、r-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, which is consistent with the average lifetime prevalence

4、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

5、range, and 6 percent within 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”

6、患兒童抑郁癥,“哪些人”患兒童抑郁癥Korup (1985)發(fā)現，226名6-12歲孩子組成的樣本中有10%的人呈現出抑郁癥狀。Leftkowitz 和Tesiny (1985), 在研究3,020 小學生時發(fā)現有5.2%的孩子有抑郁癥。這與Robins 等人(1984)報告的平均終生發(fā)病率相一致。Sullivan and Engin (1986)等人利用Beck 量表發(fā)現26%10-11年級的學生有輕中度抑郁，6%有重度抑郁。在一個

7、30人的教室里，教師可以預期有1-2人會呈現抑郁癥狀。,The "What" of Childhood Depression兒童抑郁癥有什么表現,The Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association 1979) states that the primary symptom of de

8、pression 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 t

9、wo weeks: change in appetite or weight, sleep disturbance, psychomotor agitation or retardation, loss of interest in usual activities, loss of energy, feelings of worthlessness or excessive guilt, difficulty concentratin

10、g, and thoughts of death or suicide.,The “What” of Childhood Depression兒童抑郁癥有什么表現,精神障礙的診斷與統(tǒng)計手冊告訴我們，抑郁癥的基本癥狀是“抑郁心境”（dysphoric mood. depression: a state of feeling acutely hopeless, uncomfortable, and unhappy ）（a loss of

11、interest or pleasure in almost all daily activities對幾乎所有的日?；顒佣际チ伺d趣或愉悅）。為了確定一個抑郁癥的診斷，以下癥狀中的至少4個必須持續(xù)至少2周：胃口或體重的改變，睡眠的障礙，精神運動的易激惹或遲鈍，對日常活動興趣的喪失，精力的喪失，無價值感或過份的負罪感，注意力難以集中，死亡或自殺的念頭。,The "What" of Childhood Depressi

12、on兒童抑郁癥有什么表現,Cantwell (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 s

13、uggested that depression existed in children, characterized by symptoms not apparent in adults. The third school of thought described "masked depression" or "depressive equivalents" among children. De

14、pression 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 adult behaviors of sleep

15、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

16、professionals, the child's depression was not "masked.",The "What" of Childhood Depression兒童抑郁癥有什么表現,Cantwell (1983a) 描述了歷史上4個關于兒童抑郁癥的學派。1，主張在成人中看到的抑郁癥，在兒童中是沒有的。2，認為兒童中存在著抑郁癥，但是其特有的癥狀在成人期表現不明顯。

17、3，描述了兒童中“面具性的抑郁”或“抑郁的等價物?！痹谶@個學派視野中，兒童抑郁癥采取了與成人不同的形式。他們認為兒童會表現出厭倦、躁動，疲乏，注意力分散和攻擊性（boredom, restlessness, fatigue, difficulties in concentrating, and aggression），而不是象成人那樣表現出睡眠反常，自我責備，負罪感和喪失感(Garfinkel and Golumbek 1974)。然

18、而，Cantwell 指出，那些被認為給兒童抑郁帶上面具的行為在成人中也能看到，為了驚醒專業(yè)人員，他認為兒童抑郁癥并沒有被“面具化?！?The "What" of Childhood Depression兒童抑郁癥有什么表現,The most recent school of thought suggests that depression in children has a clinical pattern an

19、alogous to that in adults. Though there may be age-specific behaviors among infants, children, and adolescents, the diagnostic criteria for depression remain the same.,The "What" of Childhood Depression兒童抑郁癥有什

20、么表現,4， 最晚近的學派認為，兒童抑郁癥具有類似于成人的臨床模式。盡管在幼兒，兒童和青少年中會有一些帶上年齡特征的行為，但是抑郁癥的診斷標準未嘗有變。,The "What" of Childhood Depression兒童抑郁癥有什么表現,Childhood depression is usually identified by inter-viewing the parents and the child,

21、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 dif

22、ferent 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

23、were more self- deprecating. Older children exhibited disobedience, op-positional behavior, and complaints of aches and pains. Herzog and Rathbun (1982) also reported develop-mental influences on symptoms of children who

24、 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.,The "What"

25、 of Childhood Depression兒童抑郁癥有什么表現,確珍兒童抑郁癥的方法是與父母和孩子面談，并使用某些行為量表(Cantwell 1983b)。在測評兒童抑郁癥時，有幾件事情需要考慮。抑郁兒童展現的行為也許不同于抑郁成人所展現的，這些行為也許與兒童的成長水平相關聯。Kovacs 和 Paulaniskus (1984) 發(fā)現那些不夠成熟的學生在高興的時候會表現出更多的破壞性行為，并且會有更多的自我貶低。年長些的孩子則

26、表現出不服從，對抗，和抱怨疼痛和不舒服。Herzog 和 Rathbun (1982) 報告了成長對于兒童抑郁癥癥狀的影響。他們認為，6-8歲的孩子表現出長時間的的不愉快，易怒，和憂郁的情感（prolonged unhappiness, irritability, and somber affect）。更大些的孩子表現出悲傷，冷漠，無奈和易怒（sadness, apathy, helplessness, and irritability

27、.）。,The "What" of Childhood Depression兒童抑郁癥有什么表現,Weller and associates (1984a) suggest that the range of cognitive and language skills among children of various ages affects their interpretations of questions

28、and responses during assessment. Weller and associates (1984a) and Carlson and Cantwell (1980) suggest that some depressed children demonstrate conduct or behavioral disorders. Depression is identified only after thoroug

29、h assessment. Describing depression in children is further complicated by the influences of different situations on behavior. Meyer and Hokanson (1985) found considerable situational specificity in self-reports of the be

30、havior of depressed persons. When stressed by intimates, depressed persons were most likely to exhibit sadness. When similar stresses are imposed by strangers, social withdrawal was the most frequent response. In school,

31、 behaviors may be influenced by the quality of the relationships with teachers and classmates.,The "What" of Childhood Depression兒童抑郁癥有什么表現,Weller 和他的同事(1984a)認為不同年齡兒童的認知和語言技能影響他們對問題的解釋和他們在測評期間的反應。Weller 及其同事(

32、1984a) 以及Carlson 和 Cantwell (1980)指出，某些抑郁的兒童表現出舉止或行為的障礙。只有通過徹底的測評，才能確診抑郁癥。由于不同場面對行為的影響，對抑郁的描述就更為復雜了。Meyer 和 Hokanson (1985) 發(fā)現明顯的場面特殊性對于抑郁當事人的自我報告的影響。當面對親密者的關切時，抑郁癥當事人最有可能展現悲傷。而面對陌生人的類似關切，他們最頻繁的反應是社交的退縮。在學校中，他們與教師和同學的關系的

33、性質會影響他們的行為。,The "What" of Childhood Depression兒童抑郁癥有什么表現,Rating scales for child depression, such as the Children's Depression Inventory (Carlson and Cantwell 1982) and the Hopelessness Scale for Children

34、(Kazdin, Rodgers, and Colbus 1986) are attempts to quantify depression and are usually used clinically (Kovacs 1981). Parent and child reports on clinical instruments have not been found to correlate, although clinical i

35、n-struments do distinguish depressed from nondepressed children (Kazdin, French, Unis, and Esveldt-Dawson 1983). Self-report seems to produce the most accurate information, and interviews identify more children with depr

36、ession than do standard evaluation procedures (Carlson and Cantwell 1980). Self-rating questionnaires may eventually be used as screening instruments in that they can be administered to large numbers of subjects, and are

37、 useful in identifying students for more thorough study (Hodgman 1985).,The "What" of Childhood Depression兒童抑郁癥有什么表現,測評量表如Children‘s Depression Inventory (Carlson and Cantwell 1982) 以及Hopelessness Scale for Ch

38、ildren (Kazdin, Rodgers, and Colbus 1986)。這些量表試圖對抑郁癥狀進行量化，并往往被用于臨床。沒有發(fā)現父母與孩子運用臨床工具給出的報告之間有相關性，盡管臨床工具確實能區(qū)分抑郁與非抑郁(Kazdin, French, Unis, and Esveldt-Dawson 1983)。自我報告似乎能產生最準確的信息，而面談比標準的評估方法能確認出更多的抑郁兒童(Carlson and Cantwell 1

39、980)。自我測評的問卷也許最終會被當作篩選的工具，因為它們可以用于大數量的被試，并且對于確定需要進一步研究的對象而言，也是很有用的。,The "What" of Childhood Depression,Teachers may identify several indicators of depression among their students. Korup (1985) found that depres

40、sed students had significantly lower grades in effort than students who were not depressed, although most were at grade level in reading and mathematics. Depressed students were unable to work or play alone or with other

41、s. Parents reported sleeping problems, physical complaints, and academic difficulties in their children yet were not aware of their children's social withdrawal, tiredness, depressed feelings, and thoughts of suicide

42、. Peck (1981) suggests that students may act out their depression through substance abuse, running away, petty crimes, and aggressive behaviors.,The "What" of Childhood Depression,教師可以在他們的學生中找到幾種抑郁癥的跡象。Korup (1

43、985) 發(fā)現，抑郁的學生努力的程度明顯比不抑郁的學生低，盡管在閱讀和數學方面，他們大部分人的成績仍然達到平均值。抑郁的學生難以單獨或與其他人一起做事或玩樂。家長報告，他們有睡眠問題，會抱怨身體不適，有學習上的困難，但是父母往往沒有覺察到他們的孩子有社交的退縮，疲倦，抑郁的情感，以及自殺念頭。Peck (1981) 提示我們說，抑郁的學生們也許會通過吸毒，離家出走，小型犯罪和攻擊性行為來發(fā)泄其抑郁情緒。,The "What&q

44、uot; of Childhood Depression,Peers report that their depressed classmates are unpopular, unhappy, and have problems in school achievement (Leftkowitz and Tesiny 1985). Children of both sexes who score in the lower quarti

45、le of reading and intelligence tests are generally at more risk for depression. Symptoms of depression that may be recognized by teachers are summarized in Figure 1.,The "What" of Childhood Depression,伙伴們報告說，抑郁

46、的同學不受歡迎，不愉快，而且學校的成就也有問題(Leftkowitz and Tesiny 1985)。不管男孩還是女孩，凡是閱讀和智商測試成績在下部的1/4者，一般來說都具有更高的抑郁的風險。表1總結了可以被教師察覺到的抑郁癥狀。,The "What" of Childhood Depression,表1.教師可以觀察到的童年抑郁的癥狀學業(yè)的征侯

47、情感的征侯學校表現下降 低自尊失去了參加活動的興趣 易激惹努力程度降低，成績仍屬平均 表達無價值或負罪感成績問題 不受歡迎，疏遠朋友 悲傷，不快樂

48、 總以為自己有病 社交活動減少,The "What" of Childhood Depression,表1.教師可以觀察到的童年抑郁的癥狀 社交/行為征侯 軀體的征

49、侯多動 疲倦難以單獨做事或玩樂 年幼學生尿床或大便失禁年幼的學生會有過度活動 精神運動的燥動或遲緩無精打采 睡眠問題攻擊，撒謊，偷竊 年長學生的躁動 破壞性行為

50、 體重減輕或增加身體不適的抱怨 胃口改變年長學生的躁動 精力喪失更年幼的學生的恐怖和/或分離,The "What" of Childhood Depression,表1.教師可以觀察到的童年抑郁的癥狀 認知的征侯自殺念頭的表達無法集中注意力,The "Why&qu

51、ot; of Childhood Depression 兒童抑郁癥的“為什么”,Current knowledge of the sources of childhood depression is inconclusive (Epstein and Cullinan 1986). Weller, Weller, and Fristad (1984b) suggest several interpretations of childh

52、ood depression. The psychoanalytic model interprets depression as the reaction to the loss of a loved one. The sociological model interprets depression as the result of a social structure that deprives the individual of

53、desirable social roles. In addition, there may be genetic and biochemical explanations of depression.,The "Why" of Childhood Depression 兒童抑郁癥的“為什么”,當前關于童年抑郁的根源的知識仍然不是結論性的(Epstein and Cullinan 1986)。Weller, Wel

54、ler, 和 Fristad (1984b) 提示了關于童年抑郁的幾種解釋。精神分析模式將抑郁解釋為由于親愛者的喪失而產生的反應。社會學模式將抑郁解釋為社會結構剝奪了個人所向往的社會角色的結果。此外，也許還有抑郁癥的遺傳學和生物化學方面的解釋。,The "Why" of Childhood Depression 兒童抑郁癥的“為什么”,Four of the models that Weller, Weller,

55、and Fristad (1984b) suggest seem more applicable among teachers. The behavior reinforcement model suggests that depressive behaviors are elicited by inadequate or insufficient positive reinforcement. Petti (1983) suggest

56、s that appropriate behaviors decrease through a lack of reinforcement. Powerlessness is produced as a response to the lack of reinforcement and the failure to elicit appropriate behaviors. Depressive behaviors are develo

57、ped, reinforced, and maintained by the limited reinforcement in the environment.,The "Why" of Childhood Depression 兒童抑郁癥的“為什么”,Weller, Weller, 和 Fristad (1984b) 所提示的4種模式更適用于教師。行為強化模式提示說，抑郁行為是不適當或不充分的正強化所引起的。Pe

58、tti (1983) 提示說，由于缺乏強化，適當的行為就會減少。正強化缺乏所引起的反應是勢孤力單的感覺，而且會疏于給出適當的行為。由于環(huán)境中只有很少的正強化，抑郁的行為就產生出來，被強化并被維持下去。,The "Why" of Childhood Depression 兒童抑郁癥的“為什么”,A second interpretation applicable in educational settings is

59、that of learned helplessness. The depressed student perceives behavior as independent of reinforcement, leading to a sense of hopelessness. The student develops a cognitive style of attribution that is outside of the sel

60、f (Petti 1983).,The "Why" of Childhood Depression 兒童抑郁癥的“為什么”,第二種適用于教育情境的解釋是習得的無能為力。抑郁的學生感到依靠他的行為是沒有辦法得到強化的，這就引起了毫無希望的感覺。這樣的學生就產生出一種歸因的認知風格，認為一切事情都不是他所能控制的(Petti 1983)。,The "Why" of Childhood Depress

61、ion 兒童抑郁癥的“為什么”,The third model applicable for teachers is that of cognitive distortion, in which negative conceptualizations of one's view of self, world, and the future are the source of the depression. Depressed

62、children demonstrate a negative cognitive set or hopelessness (Petti 1983). Haley, Fine, Marriage, Moretti, and Freeman (1985) found that depressed and distorted cognitions significantly correlate with psychiatric and se

63、lf-reports of depression.,The "Why" of Childhood Depression,第三種適用于教師的模式是認知的歪曲。該模式認為，一個人對自己，對世界，以及對未來的消極的觀點才是抑郁的源泉。抑郁的兒童展現出一套消極的認知或前途無望的感覺(Petti 1983)。Haley, Fine, Marriage, Moretti, 和 Freeman (1985) 發(fā)現，抑郁的和歪曲的認

64、知與抑郁癥的精神病學的或自我的報告之間有顯著的相關性。,The "Why" of Childhood Depression,A fourth model of depression that is applicable to schools and teachers involves life stress. In this model, stress and environmental changes that r

65、equire readjustment are the cause of depression. Nezu and Ronan (1985), in their analysis of 205 undergraduate students, concluded that negative life events can increase coping problems. The degree to which an individual

66、 actively copes with these problems is a function of coping ability. Effectively resolving problems decreases the likelihood of experiencing depression.,The "Why" of Childhood Depression,適用于學校和教師的第四種抑郁癥模式涉及到生活壓

67、力。根據這個模式，需要重新適應的壓力和環(huán)境的改變是抑郁癥的原因。Nezu 和 Ronan (1985), 根據他們對于205 名大學生的分析得出結論說，消極的生活事件可以引起應對的困難。個體主動應對這些困難的程度就是他們的應對能力的功能。有效解決問題的能力減少了抑郁的可能性。,What Is a Teacher to Do? 教師可以做些什么？,Cantwell (1983c) maintains that several facto

68、rs must be considered in planning treatment. The teacher, although unable to diagnose and plan the treatment of childhood depression, is invaluable in screening students for further evaluation and cooperating with treatm

69、ent. Here are some specific activities in which teachers may participate. 1. Assist in the identification of students at risk for depression. Students exhibiting the symptoms described should be referred to the school g

70、uidance counselor or social worker. Teachers may be able to assist in initial contacts with parents with whom they have good rapport. Working with children who are depressed is based on an analysis of the strengths and c