CPR4}q&?6;gp of Pages 24
Available online at www.sciencedirect.com
«^'~ .
o
ELSEVIER
^.
.
o* ScienceDirect
CLINICAL
psychology
REVIEW
Clinical Psychology Review xx(2007) xxx- xxx
Empirical evidence of cognitive vulnerability for depression
among children and adolescents: A cognitive
science and developmental perspective
Rachel H. Jacobs3'*, Mark A. Reineckea'b, Jackie K. Gollana'c, Peter Kanea'd
0Department ofPsychiatry Division ofPsycliology and Behavioral Sciences atNorthwestern University Feinberg School ofMedicine.
United States
bNorthwestern University Feinberg School ofMedicine, 710 N. Lake Shore Drive, Abbott Hall Suite 1205, Chicago. Illinois 60611, United States
cNorthwestern University Feinberg School ofMedicine, 446 E. Ontario St. Suite 7-100. Chicago. Illinois 60611. United States
dNorthwestern University Feinberg School ofMedicine. 446 E. Ontario St. Suite 7-100, Chicago, Illinois 60611. United States
Received 11 September 2007; received in revised form 23 October 2007; accepted 29 October 2007
Abstract
We summarize and integrate research oncognitive vulnerability todepression among children and adolescents. We first review
prospective longitudinal studies ofthe most researched cognitive vulnerability factors (attributional style, dysfunctional attitudes,
and self-perception) anddepression among youth. We next review research oninformation processing biases inyouth. We propose
that theintegration of these two literatures will result ina more adequate testof cognitive vulnerability models. Last, we outline a
program of research addressing methodological, statistical, and scientific limitations in the cognitive vulnerability literature.
© 2007 Elsevier Ltd. All rights reserved.
Keywords: Cognitive vulnerability; Information processing; Depression
Contents
1.
2.
Introduction
0
1.1.
1.2.
0
0
0
0
1.3. Cognitive development
Attributional style
2.1.
3.
Development of depression
Theoretical hypotheses of cognitive vulnerability models
Review .
0
Dysfunctional attitudes
0
3.1.
0
Review
* Corresponding author. Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Abbott Hall Suite 1205, Chicago,
Illinois 60611, United States. Tel: +1 312 835 1568; fax: +1 312 926 0406.
E-mailaddresses: [email protected] (R.H. Jacobs),[email protected] (MA. Reinecke),[email protected]
(J.K. Gollan), [email protected] (P. Kane).
0272-7358/$ - see front matter © 2007 Elsevier Ltd. All rights reserved,
doi:10.1016/j.cpr.2007.10.006
Pleasecite thisarticleas: Jacobs, R. H., et aL,Empirical evidence of cognitive vulnerability for depression amongchildrenand adolescents: A
cognitive scienceand developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006
!
R.H. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx
4.
Self-perception
0
4.1.
0
Review
5.
An integrative perspective
0
6.
5.1.
Review
Discussion
0
0
6.1.
0
Future research
Acknowledgements
0
References
0
1. Introduction
Using a developmental and cognitive science framework, we review and integrate recent research on cognitive
vulnerability to depression among children andadolescents. First, we review prospective longitudinal studies assessing
relations between putative cognitive vulnerabilities and the occurrence of depression. We then propose that the
incorporation of experimental paradigms and the assessment of information processing biases among children may
facilitate the testing of alternative cognitive vulnerability models. Last, we outline a program of research addressing
methodological, statistical, and scientific limitations in this literature.
/./. Development ofdepression
Major depressive disorder (MDD) oftenbegins during adolescence, is chronic and recurrent, and frequently places
youth at risk for recurrent MDDduring adulthood. Between 20%and50%percent of adolescents report experiencing
subsyndromal levels of depression (Kessler, Avenevoli, & Merikangas, 2001; Petersen, Compas, Brooks-Gunn, &
Sternmler, 1993). Lifetime prevalence rates of 1.5% (e.g., Costello etal., 1996) and7%(e.g., Kessler etal., 2005) have
been reported for depressive disorders among children and adolescents, respectively. Depression during adolescence
sharesfeatures ofthe depression that occursduringadulthood (e.g., Lewinsohn, Allen, Seeley, & Gotlib, 1999; Pine,
Cohen, Gurley, Brook, & Ma, 1998). Adolescence, then, represents a critical period of vulnerability. Seventy-five
percent of adultswith MDD experience their first depressive episode during childhoodor adolescence, whereas only
25%experience onsetofMDDin adulthood (Kim-Cohen et al., 2003). Thatsaid,patternsof depressive symptomsmay
differ over the course of development given the cognitive, social, emotional, and biological changes that transpire
(Cicchetti & Toth, 1998; Weiss & Garber, 2003). In addition, the observed genderdifference in depression emerges
in early adolescence (e.g., Angold, Erkanli, Silberg, Eaves, & Costello, 2002; Weissman, Warner, Wickramaratne,
Moreau, & Oltson, 1997). Depression is a common, persistent, and pernicious occurrence in the lives ofyouth. Any
comprehensive model of vulnerability for depression must address these observations.
1.2. Theoretical hypotheses ofcognitive vulnerability models
Several models have been proposed to explain the development and maintenance of depression among youth.
Cognitive vulnerability modelsstand at the forefront ofresearch activity. Beck (1967)definedcognitive vulnerability
as the presenceofmaladaptiveself-schemareflectingthemesofhelplessness and unlovabilitythat becomeactivatedby
negative life events or negative moods. Many cognitive vulnerability theories employ a vulnerability-stress paradigm
(e.g., Abramson, Seligman, & Teasdale, 1978; Beck, 1967), whereby cognitive factors interact with environmental
stressors to increase risk for emotional disorders. Indeed, stressfullife experiencespredict depression among children
and adolescents (see Grant et al., 2004a; Grant, Compas, Thurm, McMahon, & Gipson, 2004b). This relationship
appears to be bidirectional, as depressive symptoms also predict increases in objectively assessed stressors among
youth (Grant et al., 2004b). The assessment of stress in the study of cognitive vulnerability is crucial, as exposure to
mild uncontrollable stress during adolescence can impaircognitive functioning (Steinberg, 2004).
Specific criteria for defining cognitive vulnerabihty factors have been put forth. First, a cognitive vulnerability
fector must temporally precede depression andexhibit stability overtime (e.g., Alloy et al., 1999; Ingram, Miranda,
& Segal, 1998). Second, construct validity must be established, in that the cognitive vulnerability fector must
demonstrate predictive validity not better accounted for by an extraneous variable. Third, cognitive vulnerability
Please cite thisarticle as: Jacobs, R. H.,et aL, Empirical evidence of cognitive vulnerability fordepression among children andadolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10J016/j.cpr.2007.10.006
RJI. Jacobs et al. / Clinical Psychology Reviewxx (2007) xxx-xxx
3
factors arebelieved to be specific to particular disorders. Forexample, if dysfunctional attitudes serveas a vulnerability
fordepression, they must notalso predict conduct disorder (discriminant validity). Fourth, vulnerability isviewed asan
endogenous process thatis conceptualized as latent(e.g., Ingram et al., 1998). Thatis, the vulnerability mustrepresent
an enduring characteristic of the child, andnottheir family, relationships, or environment These general andspecific
theoretical hypotheses guide the scientific exploration of cognitive vulnerability.
1.3. Cognitive development
Adolescence represents a phase wherein cognitive vulnerability may occur andis likely to emerge. The cognitive
developmental 'prerequisites' arepresent and can emerge (Alloy, Abramson, Walshaw, Keyser, &Gerstein, 2006). The
adolescent transition ischaracterized bytheemergence ofa more self-directed andself-regulated mind (Keating, 2004).
Self-regulation is advanced through an executive suite of capabilities (Donald, 2001) as central conceptual structures
coordinate across domains (Keating, 1996). A developing executive control monitors andmanages cognitive resources
during adolescence (Kuhn & Pease, 2006). Thus, across development, increasing executive functioning ability
translates to an increasingly 'top down' mode of cognition.
A parallel coordination of information processing, or 'bottom-up' components allows for the strategic use of
emerging cognitive resources. In such, information processing and cognitive reasoning operate in concert. Indeed,
recentworkreveals thatadvances in levelofreasoning aresupported by 'bottom-up'changesin efficiency andworking
memory (Demetriou, Christou, Spanoudis, & Platsidou, 2002). These processes, in turn, are reciprocally affected
by 'top down' cognition. Moreover, processing speed increases from early childhood through mid-adolescence
(Demetriou et al., 2002). Forexample, adolescents arebetter able to ignore irrelevant stimuli on the Stroop taskthan
children (Demetriou, Efklides, & Platsidou, 1993). Increasing processing speed leads to greater efficiency intop down
processes, including social problem solving. Such research suggests that adolescents possess the cognitive
prerequisites for vulnerabilities to depression. If cognitive vulnerability is a valid model representing the onset of
depression among youth, we expect children to be capable of demonstrating maladaptive cognitions, which, in
interaction with the stress of the adolescent transition, result in depressive disorders.
2. Attributional style
Attributional style is thecognitive vulnerability fector thathasgarnered themost research and theoretical attention.
First proposed as a means of addressing limitations in the original theory of learned helplessness (Seligman, 1975),
Abramson et al. (1978) proposed that depressed individuals attribute negative events to internal, global, and stable
causes. In contrast, viewing the causes of negative events as external, specific, and unstable represents a positive or
adaptive style, andmay buffer or protect an individual from depression. A negative attributional style is hypothesized
to be a proximal contributor to the onset of depression. In further theoretical modification, hopelessness theory
(Abramson, Metalsky, &Alloy, 1989), introduced three separate cognitions thatcontribute to depression—a lowsense
of efficacy following life stress, viewing negative events ashaving negative consequences, andviewing thecauses of
these events as global and stable. These cognitions evolve into hopelessness, which is hypothesized to be a proxi
mal and sufficient cause of depression. Hopelessness depression reflects motivational deficits and dysphoric affect
stemming from a negative attributional style (Abramson, Alloy, & Metalsky, 1988). An elaborated cognitive
vulnerability-transactional stress depression model (Hankin & Abramson, 2001) accounts forthegeneral development
of depression aswell as specific outcomes, such astheemergence of a gender difference in depression. In this model,
negative events contribute to initial elevations of general negative affect Cognitive vulnerabilities suchas a negative
attributional style, then, moderate risk for depression. Depression, in turn, can lead to more negative life events,
creating a pathogenic cycle. The aforementioned models allseek to explicate therelations between attributional style
and depression.
2.1. Review
Twenty-one studies support the prospective effects of attributional style on depressed mood in children and
adolescents (see Table 1). Young children are capable of drawing inferences about events and evidence potential
for demonstrating a stable attributional style. In one study, third graders demonstrated greater pessimism in their
Please cite this article as: Jacobs; R. H., etaL, Empirical evidence of cognitive vulnerability for depression among children and adolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006
2
S •
Table 1
*• I-
Prospective cognitive contentstudies of vulnerability to depression amongyouth
4n
Study
Sample
N
Age
Depression Depression VulnerabiUty
(range)
status
measure
measure
and mean
Tune
frame
Attributionalstyle
Abela (2001)
School
382
3rd (8.9)
CCSQ,
CASQ
6 w
CCSQ,
CASQ
6 w
CCSQ,
CASQ
CASQ,
CCSQ
10 w
CD:,
i:
••'p."; O ,
Sx
CDI
and 7th
Control
Life stress
baseline
interaction
depression? tested?
CLES
5$
• .CD.-
Abela and
If
School
314
Payne(2003)
3rd (8.8)
Sx
CDI
and 7th
X
CHAS
(12.8)
§^
a* 2
So
~**" a '•
§ S
S '•*..
Abela and
School
79
(12.3)
Sx
CDI
Sarin (2002)
Abela,
Skitch,
Adams, and
Children of
140
depressed
6-14
Sx
CDI
(9.8)
X
S B*
«
Bennett and
iy
X
Stress of
parental
parent
onset of
depression
School
95
Bates (1995)
Brozina and
CLES*
weakest link
Hankin (2006)
I*
11-13
Sx
CDI
CASQ-R
6m
X
CHS, LES
(12)
School
480
Abela (2006)
8-13
Sx
CDI
(10.5)
CASQ,
CCSQ
6w
CASL
3w
X
DHQ
X
CHAS
2'g•§ a.
^ o
Conley et al.
(2001)
Dixon, and Ahrcns
§•8.
*
(1992)
Garber et al.
(2002)
School
147
5-10
Sx
CDI
(8.2)
Summer
CASQ x CLES predictedincreases in
depressive sx in 7th, but not 3rd graders.
Attributionsaboutconsequences x CLES
predicteddepression in 3rd and 7th,
Attributionsaboutself x CLES predicted
depression increases in 3rd and7th grade
girls,but not boys
(12.9)
:5v::8-:i
Summary of findings
CASQ-R
84
9-12(11)
Sx
CDI
KASTAN-R
lm
X
Own measure
240
(11.9)
Sx
CDI
CASQ
5y
X
LEIA
Gender and SE moderators of'weakest
link' x CHAS. Boys with low SE and girls
with high SE significant interaction
predicting increases in HS depression sx
CLES x'weakest link' predicted increasesin
HS depression sx only
Genderx weaklinkx parental depression
stressor. Childrenwith depressogenic
inferentialstyles greater elevations in
depression following elevations in parent's
level of depression. Stronger association in
girls
CHS x CASQ predicted CDI, no main
effect ofCASQ. More support found against
vulnerability models
CASQ x CHAS to predict increase in
depression, but only for those with low
depression at tl
CASI main effect, CASI x DHQx age
slightly higher levels of depression in
older childrenthan for younger (all
findings for positive subscale)
Hassles and hasslesx attributionsignificant
camp
School, but
78% of
children had
mothers with
a history of
mood
disorders
Adolescents becoming more negative in
CASQ over time also reportinghigher
depression over time. Initiallevel of
stressassociated with trajectory
of depression sx. Reciprocal models also
supported
"3
so
5
8
iu!-
2
"0
if
a. »
<
e»
CO
•
CD
S.
Gibb and
School
448
9-11(9.8) Sx
CDI
CASQ-R
6m
X
Alloy (2006)
Gibb etal. (2006)
School
448
9-11(9.8) Sx
CDI
CASQ-R
6m
X
(3
to
Peer
victimization,
CTQ-EA
s &
1*8
Peer
victimization,
CTQ-EA
Hamraen
et al. (1988)
Children of
79
(12.5)
Dx
depressed
K-SADS,
CASQ
6m
X
Brown and
Hankin,
Abramson,
If-
School
270
14-18
Sx
BDI,
HDSQ-R
CASQ-R
5w
Sx
CES-D,
Depressive
Adjective
CASQ
Approx X
2w
(16.2)
X
APES
and Siler
(2001)
9 5:
a* 2
89
If
M
SS.
School
439
(11.4)
Garber(1995)
If
to- *t
2f
<?* a
•§ a.
o
to a
Grade deficit
stressor
Depressivesx predicted by interactions of
negative explanatorystyle with stressors
Checklist
Lewinsohn
School
1508
(16.5)
Dx
et al. (1994)
K-SADS,
Items from
CES-D
KASTAN-R
1y
X
K-SADS,
CASQ
1y
X
X
Measured, but
no interactions
assessed
Lewinsohn
© s»
CASQ x APES predicted increasesin
depression sx. Gendermoderated this
interaction for BDI, so held for boys
but not girls. Held for HS depression
sx for both genders,HS did not mediate
relations
Hilsman and
s. 5.
rt
Main effect for stress, but not CASQ
Harris
CDI
mothers
EL
™
In 4th gradersCASQ mediates only, 5th
grademediator and moderatoreffects.
Depression also predicted negative
changes in CASQ. Best fitting models
include reciprocal relations
Depression predicted negativechange
in CASQ-R
School
et al. (2001)
Mccarty,
School
Vander Stoep,
and McCauley
(2007)
Nolen-Hceksema,
School
Girgus, and Seligman
et al. (1986)
Nolen-Hoeksema
School
1507
(16.6)
Dx
331
(12.0)
Sx
MFQ
CASQ-R
1y
168
(8-11)
Sx
CDI
CASQ
iy
LEQ
352
3rd and
Sx
CDI
CASQ
5y
LEQ
Harris
CES-D
etal. (1992)
Brown and
4th
pera
graders
ON &
Attributions predictedcurrent, past, and
first episode depression. OR for current
highest
CASQ x LE predictMDD onset, but at
higher levels of stress
Support for 'scar' models. Baseline
depression predictiveofmore
negative attributional style
CASQ predicted depression changes at
some time points over the year. Interaction
with life stress was significant
As children grew older, pessimistic
explanatory style significant predictor of
laterdepression. Among younger children,
life events only. Modest support for
diathesis-stress. Some evidence of scar
hypothesis
Panak and
Garber(1992)
School
521
3rd-5th
graders
Sx
CDI
CASQ
iy
Peerrejection
Interaction betweenstress (increase in peer
(a developmental rejection) and CASQ predicted depression
life stress
assessment)
(continued on next page)
I
5*
8
-a
*(7. j&
Table 1 (continued)
CD
<
O
CD
eo
Study
Sample
N
CD
n
i' s
8
g
ft
O
p. CD
3
5"
1
8
IO
8'
~*
frame
measure
and mean
Prinsteiu and
School
158
Aikins (2004)
15-17
Control
baseline
Life stress
interaction
Summary of findings
depression? tested?
Sx
CASQ
CDI
Peerrejection (a Peer rejection*CASQ predictive of dep.
developmental
for girls. Main effect for attributional
17 m
(16.31)
life stress
style overall
assessment)
Prinstein, Chea,
and Guyer
(2005)
School
159
15-17
Sx
CDI
Own
17m
Peer
(16.31)
victimization
Higher levels of critical self-referent
attributions associated with prospective
increases in
depressive symptoms under conditions
P-
of high levelsof boys' peervictimization
Main effect stressors, perceived self-worth.
a.
a"
*5
Time
measure
CD
II
Q
Depression Depression VulnerabiUty
status
ft*
cr
K
Age
(range)
Robinson,
Garber, and
Hilsman (1995)
School
371
(12.0)
Sx
CASQ
CDI
Developed for
study based on
Compas (1987)
15 m
mm
CASQ main and interaction with stressors,
3 way interaction with self-worth
major events
and hassles,
CD
<;
Q.
transition to
8
a
o
o
r? fl
§
a-.
s
3
13
©
o
CJ
Ro
o
2
cr
B-
o-
rr
^
8»
junior high
Schwartz and
School
397
Koenig (1996)
Southall and
Roberts (2002)
Spence, Sheffield,
14-18
Sx
BDI
ASQ
1.5 m
X
LEQ
Attributions predicted depression
Sx
BDI
CASQ
14 w
X
LES
3 way significant interaction and SEx
CASQ in non-symptomatic at baseline
Sx
BDI
CASQ-R
1y
X
NLE
CASQ-R main effect
Sx
"the
I
PASS-1
2y
feel"
d
peer-social
(16.0)
School
115
14-19
(16.5)
School
733
12-14
(2002)
Toner and
School
112
(12.5)
Heaven (2005)
9r
J2
C\ •u
Cn
o
T3
fi
to
o
o
-J
o
W
on ILQ
attributional
and BDS
style scale
CDI
CDAS
A post-hoc combinedgenerality attribution
(both positiveandnegativeevents to
stable/global factors) predicted depression
(A
!9.
o
13
Dysfunctional attitude.V
Abela and
O
B
00
o
o
o
er
0\
it
B
Skitch (2007)
Children of
140
depressed
6-14
Sx
(10.0)
parents
Abela and
Every
X
CHAS
6wfor
iy
School
184
(12.8)
Sx
CDI
CDAS
6w
School
1507
(16.6)
Dx
K-SADS,
DAS
iy
X
CHAS
Sullivan (2003)
6
8
o
S
(7
>
CDAS x CHAS significant for children with
low self-esteem,also significant for children
with low CDAS and high self-esteem
CDAS x CHAS predictedincreased
depression, in those with high, but not low
levels of self-esteem
o.
0
Q.
O
>9
(12.91)
and Donovan
Lewinsohn
et al. (2001)
CES-D
Brown and
Harris
DAS xNLE (p=.086) trend at high levels
of stress CASQ x LE predict MDD onset
at higher levels of stress, little effect vs.
low levels of stress
• ir:ni
R.H. Jacobs et al. / ClinicalPsychology Reviewxx (2007) xxx-xxx
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Please citethisarticle as: Jacobs, R. H., et aL, Empirical evidence of cognitive vulnerability for depression among children andadolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi: 10.1016/j.cpr.2007.10.006
2
*o
if
Table 1 (continued)
Study
Sample
N
::B'.:"''.?:
Age
Depression Depression Vulnerability
Time
Control
Life stress
(range)
status
measure
frame
baseline
interaction
Sx
CDI,RADS Harter's SPPC 7y
measure
and mean
p :B.'
Kistner et al.
School
(1999)
O. O :
108,
4th and
68 at
5th
Summary of findings
depression? tested?
Perceivedacceptance, but not actual
acceptance, predicted depression 7 years
follow-up graders at
later
start
c?,5
Kistner et al.
School
667
(9.4)
Sx
CDI
Harter's SPPC 6 m
Inaccurate self-perceptions predicted
increases in depressive symptoms and
depressive symptoms predicted
decreased accuracy. Bias didnotpredict
change in depression, rather depression
Kistner, David-Ferdon,
Lopez, and Dunkl
(2007)
School
641
3rd-5th
Sx
CDI
Harter's SPPC 6 m
Self-perception didnot predict changes in
Lewinsohn
School
(2006)
;:'rp:
••S-b:
•§: t
iff
ft
graders
H),
1508
(16.5)
depression
Dx
et al. (1994)
K-SADS,
Items from
CES-D
Harter's SPPC
iy
Measured, but
no interactions
assessed
Measelle, Ablow, Cowan, Community
S
predictednegative bias
School
(4.6)
Sx
BPI
BPI
248
(9.5)
Sx
CDI.TRF
Harter's SPPC 3y
Negative self-perceptions and
Harter's SSPC ly
change in depression
Genderpredicts depression until
Depression-anxiety subscale significantly
negatively correlated with competence and
motivation in Kindergarten and 1stgrade
3y
Repetti (2002)
Ohannessian
underestimations not associated with
School
75
(11.8)
Sx
CES-D
et al. (1999)
5^
Poo
H
si:
self-perception ofathletic competence
is added as covariate
Tram and Cole
(2000)
MB
O-to;
first onset
97
and Cowan (1998)
McGrath and
Social self-perception predicted current
depression andprevious depression, butnot
School
468
13-17
(14.5)
Sx
CDL PNID, Harter's SPPC Approx X
TRID
6m
APES
Self-perceived competence predicted
change in depressive symptoms
Note. Age ranges and means reported when available. Grades reported when age data was not available. Sx =symptoms; Dx =diagnosis; CDI =Children's Depression Inventory; CCSQ =
Children's Cognitive Style Questionnaire; CASQ « Children's Attributional Style Questionnaire; CASQ-R =Children's Attributional Style Questionnaire-Revised; CLES =The Children's
Negative Life Events Scale; CHAS and CHS =Hassles Scale for Children; weakest =weakest link; LES =Life Events Scale; CASI =The Children's Attributional Style Interview; DHQ =
Daily Hassles Questionnaire; KASTAN-R =Children's Attributional Style Questionnaire-Revised; LEIA =Life Events Interview for Adolescents; CTQ-EA « Childhood Trauma
Questionnaire —Emotional Abuse Subscale; K-SADS •» Schedule for Affective Disorders and Schizophrenia for School-Age Children; Brown and Harris =Brown and Harris; 1978; BDI =
Beck Depression Inventory; HDSQ-R =Hopelessness Depressive Symptoms Questionnaire-Revised; APES =Adolescent Perceived Events Scale; CES-D =The Center for Epidemiological
Studies Depression Scale for Children; MFQ =The Mood and Feelings Questionnaire; LEQ =Life Events Questionnaire; NLE » Negative Life Events assessed as modified version ofLife
Event Record; ILQ - Illinois Loneliness Questionnaire; BDS =Birleson Depression Scale; PASS-1 =Peer-social Attributional Style Scale; ASQ =Attributional Style Questionnaire; CDAS =
Children's Dysfunctional Attitudes Scale; BHIF =Baltimore How I Feel; DISC-IV =NIMH Diagnostic Interview Schedule for Children Version IV; CAPS =Child and Adolescent Perfectionism
Scale; CRSQ =Children's Response Styles Questionnaire; RADS =Reynolds Adolescent Depression Scale; PSI =The Problem-Solving Inventory; SSLES =Secondary School Students' Life
Events Scale; Harter's SPPC =Harter's Self-perception Profile for Children; PNMC =Peer Nominations Measure ofCompetence; TRS =Teacher's Rating Scale ofChild's Actual Behavior;
PRS =Parental Rating Scale; PNMC =Peer Nominations ofMultiple Competencies; BPI =Berkeley Puppet Interview; PNID =Peer Nomination Index ofDepression; TRID =Teacher's Rating
Index of Depression.
R.H. Jacobs et al. / ClinicalPsychologyReview xx (2007) jccc-jccc
9
attributions than seventh graders, were more likely to catastrophize, and viewed themselves as flawed following
negative life events (Abela & Payne, 2003). Consistentwith prediction, the interactionof life events and attributional
style appears to be a more potent predictor of depression as children age (Abela, 2001; Conley, Haines, Hilt, &
Metalsky, 2001; Nolen-Hoeksema, Girgus, & Seligman, 1992).Adolescents who demonstrate a positive attributional
style in sixth grade continue along the same lineartrajectory (in the positive direction) over time (Garber et al., 2002).
Similarly, adolescents who manifest a negative attributional style in sixth grade continue on a trajectory to a more
negative attributionalstyle. Taken together, findings indicatethat children and adolescents are capable ofdeveloping
the attributions that have been linked with depression. Longitudinal evidence suggests that as early as middle
childhood, negative attributions may place children on a trajectory toward an increasingly negative and pernicious
attributional style.
The nature and strengthofassociations betweenattributional style and depressionmay vary with development in
function and/or content. We note Cole and TAimer's (Cole & Turner, 1993; Turner & Cole, 1994) suggestion that
attributional style mediates, rather than moderates, associations between life stress and depression in early- to midchildhood. From this perspective, young children's negative attributions stem from adverse life events and are
internalized as negative attributional styles, creating vulnerability to depression. During adolescence, a more stable
attributional style interacts with life stress to produce depressive symptoms (Cole & Turner, 1993; Turner & Cole,
1994). Recent evidence supports this model. Attributional stylemediated and moderated relations between life events
and depression among fifth graders; whereas only a mediational role was presentin fourth graders (Gibb & Alloy,
2006). Congruent with Cole and Turner's (1993; Turner & Cole, 1994) model, these observations suggest a
developmental shift in the relations between cognition, life events, and mood.
On the otherhand, we note the 'weakest link* hypothesis, whichproposes that an individual'smostdepressogenic
inference leads to vulnerability to depression (Abela & Sarin, 2002). As such, an individual's most depressogenic
inference represents their degree of vulnerability. This model is descriptive in that individual attributions (global,
stable, and self) appear relatively independent among youth (Abela, 2001). In contrast, stability of the weakest link
among youth is moderate (test retest reliability=0.38) across six weeks. The weakest link model allows for the
possibilitythat attributional errors can vary from settingto setting.In an investigationofthis hypothesis among seventh
graders, the interaction of life stress by weakest link predicted increases in hopelessness depression symptoms (Abela
& Sarin, 2002). Recent tests ofthis model are also supportive (Abela & Payne, 2003; Abela et al., 2006). As such, the
weakest link hypothesis represents a refinement of attributional models of cognitive vulnerability, but would be
strengthenedthrough: 1) explication ofwhy a child would develop one weak link, as opposed to another, and 2) how a
child's weakest link may vary over time and across settings.
Developmental psychopathology models suggest that the cognitive, social, environmental, and self-regulatory
factors associated with risk to depressiontransactionally influence one another. The integrationofreciprocal modelsto
the study of attributional style represents an important conceptual advance. Latent factor growth modeling of
longitudinal data illustrates the parallelincreases in negative attributional style and depression severity. Adolescents
with initially higherand increasing levelsof depressive symptoms also demonstrate increasingly negative attributions
(Garber, Keiley, & Martin, 2002). Attributional styleand depression maybe mutually dependent In a comparison of
mediation, moderation, and reciprocal models, a reciprocal model gained the most support, wherein initial levels of
depressive symptoms predicted residual change in levels of stress and attributional style over the follow-up (Gibb &
Alloy, 2006). Evidence alsosupports depression as leading to negative attributional style(Bennett & Bates, 1995; Gibb
et al., 2006; McCarty et al., 2007; Nolen-Hoeksema et al., 1992). In sum, reciprocal models allow for dynamic
modeling within a developmental psychopathology perspective.
Studies reviewed thus for support relations between attributions and depressive symptoms among youth.
Attributions are related to past episodes and predict current and first episodes of depression (Lewinsohn, Clarke,
Seeley, & Rohde, 1994). The interaction of life events and attributional style predict onset of MDD, but only at
high levels of stress (Lewinsohn, Joiner, & Rohde, 2001). In the only study of children, evidence did not support
attributional style as a vulnerability to MDD onset (Hammen, Adrian, & Hiroto, 1988). An attributional weakest link
does, however, predict depressive symptoms among children of depressed parents (Abela et al., 2006). Such findings
are preliminary and warrant replication.
Turning to measurement, we note several developments. Almost every study reviewed uses the Children's
Attributional Style Questionnaire (CASQ; Seligman etal.,1984; CASQ-R; Kaslow, &Nolen-Hoeksema, 1991). Many
researchers, however, call for better instruments, acknowledging the psychometric weaknesses of the CASQ. The
Please cite this article as: Jacobs, R. H., etal., Empirical evidence ofcognitive vulnerability for depression'among children and adolescents: A
cognitive science and devetopmehtei perspective; Clinical Psychology Review (2007), doi:I0.1016/j.cpr.2007.10.006
10
RH. Jacobs et al. / ClinicalPsychology Review xx (2007) xxx-xxx
CASQ measures attributional style in line with the reformulated theory of learned helplessness, rather than hope
lessnesstheory. One new measure,the AdolescentCognitiveStyleQuestionnaire(ACSQ; Hankin & Abramson, 2002),
assesses the entire negative attributional construct proposedby hopelessness theory. Moreover, the CASQ has poor
internalconsistency(coefficient alphas=0.4-0.6; Gladstone & Kaslow, 1995).Accordingto guidelines (e.g.,Nunnally
& Bernstein, 1994), internal consistencies below 0.7 may lead to increases in Type II error. Recently developed
measures includethe Children's Cognitive StyleQuestionnaire (CCSQ; Abela,2001)and the Children'sAttributional
StyleInterview (CASI; Conleyet al., 2001)allowfor more reliable assessment ofattributional style. Futureresearch
can rely on these more psychometrically sound measures, thereby increasing the likelihood of accurately detecting
developmental differences in attributional style.
It isnoteworthy, however, thatdespite measurement limitations, thebulkof thecurrent evidence remains supportive
ofattributional styleas a cognitive vulnerability. Evidence is more consistent among adolescent, as opposed to child,
samples. Research in this area will be facilitated by the recent development of structured interviews assessing the
attributional style of young children (Conley et. al, 2001).
3. Dysfunctional attitudes
Evidence supporting dysfunctional attitudes as a vulnerability to depression derives from a setofstudies. Following
theory, which places dysfunctional attitudes at thecenter oftheetiology of depression (Beck 1967,1983), prospective
studies with adults support the role of dysfunctional attitudes in the development of depression (Alloy et al., 1999;
Joiner, Metalsky, Lew, & Klocek, 1999; Kwon & Oei, 1994). Results from the Temple-Wisconsin Cognitive
Vulnerability to Depression project (CVD; Alloy et al., 2006) indicate that first onset of a depressive disorder is
significantly more likely among individuals with high levels ofdysfunctional attitudes and anegative attributional style
man among individuals with low levels of these cognitions. In another example, increases in depression symptoms
result from the interaction of dysfunctional attitudes and a negative university admissions life stressor among high
school seniors (Abela &D'Alessandro, 2002). These datasupport dysfunctional attitudes as a cognitive vulnerability to
depression among adults.
3.1. Review
Six studies among youth (Abela & Sullivan, 2003; Lewinsohn et al., 1994; Lewinsohn et al., 2001; McCreary,
Joiner, Schmidt, & Ialongo, 2004) prospectively assess the effects of dysfunctional attitudes on depression (see
Table 1). In all studies, dysfunctional attitudes, either alone or in interaction with life stress, predict depression. The
interactionofdysfunctional attitudesand life stresspredictsa diagnosisofdepressionat the level ofa trend (Lewinsohn
et al., 2001).This exampleis a conservative test; however, as the effects ofimportantcovariatessuch as co-morbidnonmood disorders and family psychiatric history are controlled. 'Pessimism' (which includesitems from Weissman and
Beck's (1978) scale) predicts first onset ofdepression(Lewinsohnet al., 1994).Higher levels ofdysfunctionalattitudes
are observed among girls who met clinical cutoff scores for depression over the course of two years (Marcotte,
Levesque, & Fortin, 2006). Overall, evidencesupports dysfunctional attitudes in the prediction ofMDD among youth.
However, it is not clear that dysfunctional attitudes serve as a cognitive vulnerability strictly to first onset
depression, since 'pessimism' is also associated with current and past depression (Lewinsohn et al., 1994). More
perniciousand stable maladaptive cognitionsmay result fromrepeatedactivationduring episodes ofdepressedmood.
Dysfunctional attitudes may increase vulnerability to first onset of major depression during adolescence, as well as
increase vulnerability to future episodes. Parallel to findings within the attributional style literature, dysfunctional
attitudes may transactionally relate to mood.
Dysfunctional attitudes have not been explored in children until recently. This work is facilitated by the
development ofthe Children's DysfunctionalAttitudes Scale (CDAS;D'Allessandro, & Abela, 2000). A test ofBeck's
cognitivediathesis-stress theory ofdepressionrevealeda significant interactionofdysfunctionalattitudesby hassles,
but only among children with high self-esteem (Abela & Sullivan, 2003). The self-esteem effect ran contrary to
hypotheses.Anotherstudy identifieda significantinteraction- thistime in line with hypotheses- amongchildrenwith
high levels of dysfunctional attitudes and low levels of self-esteemin the prediction of moderately severe depression
(Abela& Skitch, 2007). Contraryto hypothesis, however, this interaction also appliedto childrenwith low levelsof
dysfunctional attitudesand high self-esteem. Age did not modifytheserelations despitechildrenas young as six being
Please cite thisarticle as: Jacobs, R. H., et al, Empirical evidence ofcognitive vulnerability fordepression amongchildren andadolescents: A
cognitive scienceand developmental perspective, Clinical Psychology Review(2007), doi:10.1016/j.cpr.2007.10.006
R.H.Jacobs et al. / ClinicalPsychology Reviewxx (2007) xxx-xxx
11
included, suggesting that young children can experience the deleterious effects of dysfunctional attitudes. In sum,
studies with children yield complex results, which may bedue todevelopmental ormeasurement issues. Self-esteem in
particular appears to impact the way in which dysfunctional attitudes impact children at risk for depression. Within
adolescent samples, dysfunctional attitudes appear to represent a vulnerability factor; however, it has yet to be
demonstrated that the reverse relation is not also true.
4. Self-perception
A competency-based model asserts that negative events in a child's life lead to maladaptive self-cognitions that
predispose a child todepression (Cole, 1990). Cole's model posits thatnegative self-perceptions regarding competence
may serve as a cognitive vulnerability factor for depression. This reasoning is congruent with cognitive models of
depression in emphasizing self-schemata asproximal todepression onset (e.g., Abramson etal., 1978,1988). Negative
self-perceptions arebelieved to result from thenegative competency evaluations of significant others, such as parents
and teachers. A child's self-perception of competency may interact with others' appraisals to influence depression.
Studies testing Cole's model represent a majority ofexisting research inthis area. We examine theexisting literature to
evaluate self-perception as a cognitive vulnerability to depression in youth.
Definitional issues are important when reviewing this literature. Self-concept and self-esteem represent broad
constructs andencompass a range of components including cognitive processes, personality style, affective processes,
andmotivational domains. Harter's (1985) scale of self-perceived competence is oneof the most frequently employed
measures of self-esteem among youth. Germane to research on vulnerability for depression are scales assessing
perceptions of personal competence, rather than omnibus measures of self-worth. Accordingly, we do not review
studies that include only Harter's general self-worth scale. This stems from a desire to incorporate a wide range of
possible cognitive vulnerabilities, yet still restrict ourreview to cognitive, as opposed to personality, phenomena.
4.1. Review
Table 1presents prospective studies that explore self-perception anddepression. Evidence supporting negative selfperception as a proximal vulnerability to depressive symptoms is found in eight (Cole, Jacquez, & Maschman, 2001;
Cole, Martin, & Powers, 1997; Cole, Martin, Powers, & Truglio, 1996; Hilsman & Garber, 1995; Kistner, Balthazor,
Risi, & Burton, 1999; Measelle et al., 1998;Ohannessian, Lemer, Lemer, & von Eye, 1999; Tram& Cole, 2000)of the
fourteen studies. Mixed evidence is found in threestudies (Cole, Martin, Peeke, Seroczynski, & Fier, 1999; Hoffman,
Cole, Martin, Tram, & Seroczynski, 2000; Kistner, David-Ferdon, Repper, & Joiner, 2006), with an additional three
studies (Cole, Martin, Peeke, Seroczynski, & Hoffman, 1998; Lewinsohn et al., 1994; McGrath & Repetti, 2002)
presenting evidence thatdepression predicts self-perception. Thus, theempirical base forself-perception asa cognitive
vulnerability in youth is decidedly mixed.
Evidence that self-perception results from depression, or thatthe relation may be reciprocal, is drawn from a few
well-designed studies. Among fourth graders followed prospectively through sixthgrade, depression symptoms predict
change in children's negative self-evaluations (McGrath & Repetti, 2002). Reciprocal relations arealso illustrated in a
study of third and fifth graders (Kistner et al., 2006). Similarly, inaccurate self-perception predicts increases in
depressive symptoms anddepressive symptoms, in turn, predict decreased accuracy in self-perception (Kistner et al.,
2006). Academic overestimation predicts depression at many grade levels, but the reverse relation yields stronger
effects (Cole, 1999). Underestimated competency predicts increases in depression within few grade levels; however,
thereverse relation is found in allgrades (Cole, 1998). Partial support forreciprocal models is also found by Hoffman
et al. (2000). These studies support the reciprocal, or transactional, relations between self-perception anddepression.
Yet another possibility isthat relations shift across development with self-perception leading todepression earlier in
development, while later indevelopment the opposite relation may emerge. Adevelopmental task ofmiddle childhood
isthe construction ofa personal sense ofone'sown competencies (Garber, 1984). Children may become increasingly
capable of drawing realistic judgments about their competence asthey grow. From a developmental psychopathology
framework, it is plausible that normative developmental stressors influence emerging perception regarding
competence, thereby increasing risk of depressive symptoms (e.g., Cicchetti & Toth, 1998). As such, inaccurate or
negative self-perception may serve as a mediator of the relation between life stress and depression. Tram and Cole
(2000) assessed these effects among ninth graders. Support was consistent for a mediational model whereby negative
Please cite this article as: Jacobs, R. H., et aL, Empirical evidence ofcognitive vulnerability for depression among children and adolescents: A
cognitive science anddevelopmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006
12
RJI. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx
events predicted changes inself-perception, and self-perception predicted changes indepressive symptoms. Incontrast,
little evidence for moderation emerged. Inthis regard, self-perception may represent a mechanism, whereby salient life
events affect mood.
Few studies examining relations between self-perception and mood have included simultaneous assessment of life
events. This issurprising and may contribute todiscrepant findings, asadverse events may benecessary to activate a
child's latent negative self-perception inaparticular domain. Inone study, a 'grade deficit stressor' was employed ina
sample ofsixth graders wherein children were asked todefine their own level ofacceptable grades (Hilsman &Garber,
1995). Children with negative self-perception of their academic achievement expressed more depressive symptoms
after receiving unacceptable grades than did students without negative self-perception. The inclusion of life stress
assessment inthe study of self-perception must beincorporated in future research to adequately test the role ofselfperception as a cognitivevulnerability fector.
We propose that the presence ofreciprocal, ortransactional, relations between self-perception and depression may
account forthemixed state oftheliterature. Findings may also differ depending onwhich aspects ofself-perception are
studied, at which points of development assessments are conducted, and what levels of baseline depression are
included. Temporal and causal precedence have not yetbeen well-established. The literature offers support for selfperception as contributing to depression, butoffers parallel support for self-perception asresulting from depression.
Self-perception does not predict onset of first-episode MDD among youth (Lewinsohn et al., 1994). Seff-perception
does, however, relate to current and past depression. Thus, it is currently unclear whether Cole's (1990) model
maps well onto a clinical diagnosis of depression. The possibility remains mat self-perception may simply represent
a concomitant ofdepressed mood. We also believe, inline with Cole (1990), that early indevelopment, self-perception
may serve as a mechanism, whereby life events affect levels of depression. That is, negative self-perception may
mediate thisrelationship. Later in development, self-perception may come to moderate thisassociation.
Methodological difficulties may also contribute to discrepancies between studies. Harter's (1985) measure,
although systematically constructed from a strong conceptual base, may contribute to divergent findings. Some
subscales demonstrate minimally acceptable reliability (Harter, 1985), warranting psychometric refinement Harter's
(1985) multifeceted scale may also lead to confusion among younger children. Researchers may wish to use the
Pictorial Scale ofPerceived Competence and Acceptance for Young Children (PSPCSA; Harter, 2002; Harter &Pike,
1984), which does not rely entirely onlanguage comprehension and allows for assessment ofyoung children. Lastly, it
ispossible that the construct ofself-perception istoo conceptually broad. Theoretical coherence inthis area of study
may lead to more congruent findings. In sum, research on self-perception among youth has not conclusively
establishedwhether it represents a cognitivevulnerability fector.
5. An integrative perspective
Overall, this body of literature implicates several cognitive factors in vulnerability for depression among youth.
As we have seen, research to date is not definitive and has produced complex results. Over-reliance on self-report
measures is a notable weakness. It is clear that children are capable of experiencing the type of cognitions under
discussion; however, whether or nota child canreliably hold these cognitions consciously in mind andreport them is
currently debatable. Similarly, the questionable reliability of extant measures is problematic.
Due tothese challenges, wepropose thatincorporating informationprocessing paradigms into thestudy ofcognitive
vulnerability allows for a more developmentally sensitive and adequate test Indeed, we note that Clark and Beck
(1999) define the cognitive model "as an information processing theory... understood in terms of the structures,
processes, and products involved in the representation and transformation of information" (pp. 109-110). According
to the cognitive model, biases in information processing are core aspects of depression. Information processing
paradigms, such asthe Stroop and dot-probe tasks, measure cognitive processes outside ofthe child's awareness. Such
measures may offer more objective tests of cognitive operations, while also allowing forexperimental manipulation.
Lower order phenomena, such as attentional biases, may represent themechanisms thatlead to cognitive vulnerability
products. Ifthis is thecase, thedevelopmental study ofthese processes would allow researchers to explore theorigins
of maladaptive cognitions. Moreover, information processing biases may represent markers for broader cognitive
vulnerability factors. Studies incorporating both self-report cognitive content and information processing para
digms allow researchers to refine cognitive vulnerability models, fostering theoretical andempirical advancements in
psychopathology research.
Please citethisarticle as: Jacobs, R. H.,et aL, Empirical evidence of cognitive vulnerability for depression among children andadolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi:I0.1016/j.cpr.2007.10.006
R.H.Jacobs et al. / ClinicalPsychology Reviewxx (2007)xxx-xxx
13
On the other hand, information processing paradigms often suffer from questionable reliability and validity.
Relations between theoretical constructs and information processing paradigms are oftenunclear(Vasey, Dalgleish, &
Silverman, 2003). Convergent validity withother measures hypothesized to tapsimilarunderlying concepts is lacking.
Similarly, little is known about the reliability of information processing measures (Vasey et al., 2003). This low
reliability canreduce statistical power (e.g., Nicewander &Price, 1983). Moreover, asVasey etal.(2003) point out,the
clinical utility of these measures in children is notestablished. Nevertheless, information processing paradigms offer a
valuable framework for conceptualizing and studying cognition in psychopathology (Vasey et al., 2003). While
experimental paradigms have pitfalls, they do nothave the same pitfalls asself-report methods. It is likely thathigher
order andlower order cognition reciprocally relate inthedevelopment ofspecific cognitive vulnerabilities. Aswe have
seen, topdown cognition constrains the manner in which information is processed at lower levels of thesystem, and
vice versa (e.g., Dalgleish, 2002). The consequences of these two processes in interaction may be greater than either
cognitive process inisolation. Integration ofthese methods would allow for theassessment of such interactive effects.
Anintegrative cognitive approach tovulnerability for depression represents a critical step inestablishing a cognitive
science base to guide empirically supported treatments (e.g., Cacioppo et al., 2007; Matthews, 2006). In order to
advance this integrative perspective, webriefly review the information processing literature testing emotional stimuli in
children and adolescents. The information processing studies we review are not longitudinal. However, we explore
cross-sectional findings and discuss how these paradigms can be applied to the study of cognitive vulnerability.
Samples include children and adolescents with a diagnosis of depression, varying levels of depressive symptoms,
recovered depressed, and children of depressed mothers. We do not review the procedures involved in information
paradigms, butrefer the reader to Matthews and MacLeod (1994) and Garber and Kaminski (2000).
5.1. Review
Table 2presents studies ofinformation processing biases and depression among children and adolescents. Level of
depression isassociated with greater recall ofnegative information relative topositive information inyouth (Bishop,
Dalgleish, &Yule, 2004; Cole &Jordan, 1995; Drummond, Dritschel, Astell, O'Carroll, &Dalgleish, 2006; Rudolph,
Hammen, &Burge, 1997; Taylor &Ingram, 1999; Zupan, Hammen, &Jaenicke, 1987; for null results see Dalgleish
et al., 2003; and Hammen & Zupan, 1984). This association is also found among children and adolescents with a
diagnosis ofMDD (Neshat-Doost, Moradi, Taghavi, Yule, &Dalgleish, 2000). Depressed youth demonstrate higher
rates ofrehearsal ofnegative memories (Kuyken &Howell, 2000). They recall positive information less well (Whitman
& Leitenberg, 1990) and reveal significantly fewer positive autobiographical memories (Drummond et al., 2006).
Lower rates ofpositive adjective endorsement also occur among psychiatric inpatient youth (Gencoz, Voelz, Gencoz,
Pettit, &Joiner, 2001). Furthermore, depressed youth rate more negative words as self-descriptive (Timbremont &
Braet, 2004). Youth atrisk for depression demonstrate memory biases for negative self-descriptions (Hammen, 1988).
These self-descriptions can interact with life stress to result in onset or exacerbation of depression (Hammen &
Goodman-Brown, 1990). Insum, information processing paradigms reveal abias toward negative stimuli among youth
with symptoms or a diagnosis ofdepression.
Information processing paradigms also highlight overgeneral memory biases among depressed children and
adolescents (Kuyken, Howell, & Dalgleish, 2006; Park, Goodyer, & Teasdale, 2002). Rumination appears to
exacerbate this effect (Park etal., 2002). There isalso evidence that depression impairs the memory ofnegative events.
Children and adolescents with clinically significant levels of depression (as measured by the CDI) show impaired
memory for negative events (Hughes, Worchel, Stanton, Stanton, &Hall, 1990). Depression severity is also related to
less specific negative memories among adolescents in residential treatment (Swales, Williams, & Wood, 2001).
Deficits inmemory for fearful feces are exhibited among children ofdepressed parents (Pine etal., 2004). Incontrast
no such effect is found in reaction times to the detection of threatening versus non-threatening faces (Hadwin et al.,
2003). Lastly, depressed youth present with significantly longer reaction times to negative emotional working memory
tasks compared to neutral tasks (Ladouceur et al., 2005). Thus, depression is related to memory biases in youth, but
these relations are complex and worthyof additional study.
Research regarding relations between deployment ofattention and mood issimilarly complex. More attention is
given to negative stimuli by depressed youth than the non-depressed (Kyte, Goodyer, &Sahakian, 2005), and slower
response rates on an attention cuing task are found among childrenofparents with depression (Perez-Edgar, Fox, Cohn,
&Kovacs, 2006). However, studies with attentional dot-probe tasks for words do not support attentional biases in
Please cite this article as: Jacobs, R.H., etal., Empirical evidence ofcognitive vulnerability for depression among children and adolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006
Table 2
Information processingamong youth
q\ a
g S.
Study
N
Age
Depression
Sample
Cognitive measure
Summary of findings
High and low non-clinicallydepressed
Emotional stories
children as assessed by DSRS)
recall task
Higher depression showed enhanced recallofnegative stories
relative to positive storiescomparedto low depressed group.
measure
in &
2. £•
s &
p. o
S-8'
€5 o"
8
P
M
Bishop etal.
(2004)
121
Cole and
394
(5-11)
DSRS
from school
(9-15)
CDI
(9-18)
DRSS
School
Incidental recall
15 diagnosed depressed, 22 diagnosed
Dot probe, Stroop,
subjective
probability, and
word memory
Subjective
Probability
Questionnaire
Dot probe, Stroop,
subjective
probability, and
Jordan
(1995)
Dalgleish
80
etal. (1997)
anxious, 43 controls
a v
f i1
Dalgleish et al. 71
(1998)
(9-18)
Dalgleish etal. 67
(2003)
(7-18)
Drummond
et al. (2006)
(7-11)
MFQ
24 recovered depressed (K-SADS) and 47
school control
S" g
ll
r s,
<$
DSRS
MDD, PTSD, GAD patients and school
control
Depressed estimatednegativeevents equallylikely to happento
them as others.
Recovered depressed ratenegative events as less likely to occur, all
estimated negative more likely to happen to others than themselves.
'KV>
No depression biases in comparison to other groups, but depressed
group was significantly higher than otherson anxiety self-report
word memory
70
CDI
School sample with CDI
cutoff AMT
S. 5.
5
Higher depression recall fewer positiveself-referential words, only
significant in grade 8.
•
Young dysphoric children recallmore specific negative and fewer
specific positive. Older dysphoric difficulty in retrieving specific
negative memories. In general, children's specific negative recall
improveswith age. Dysphoric bad significantly fewer positive
a
€
>>
AMs.
°. ffi
Ci 3
•
er
Gencoz et al.
58
(9-17)
CDI
Psychiatric inpatients with various chart
diagnoses, 44% non-bipolarmood
SRET
38 in
(6-10)
CDI
School
Visual search for
(2001)
5s»
•
»i
<=> s-
Hadwin et al.
(2003)
threatening and nonthreateningfaces
exp 1
S-8
Hammen
•ei
p'
to
o
O
"•
o
P
is
79
(8-16)
(1988)
CDI,
K-SADS
Hammen and
§8-
I"
16 children of depressed mothers, 10 of
bipolar, 18 ofmedically ill mothers, 35 of
Self-Schema Task
When controlling for baseline CDI, trendtowardself-schema scores
as predictorof affective diagnosis.
normal
R
P<ff
Lowerrates of positiveadjectiveendorsement and recall associated
with depression, but not anxiety.
No effects of depression on searchtime.
64
(8-16)
K-SADS
12 children of depressed mothers, 12 of
bipolar, 14 of medically ill, 26 of normal
Self-Schema Task
Significant association between onsetor exacerbation of depression
and the experienceof stressors relevant to child's self-schema.
Particularly marked effect for children of depressed mothers.
61
(7-12)
CDI
School
Incidental Recall,
Self-Schema Task,
Non-depressed higherproportion of positive self-descriptive words
(but not significant), no evidenceofnegative biasin depressed.
322
(10-13)
CDI,
School with cutoff
Recall and
Significant interaction between group status andvalence of story
events for recognition. Depression symptoms impair memory for
negative story events.
GoodmanBrown
(1990)
Hammen and
Zupan
(1984)
Hughes et al.
(1990)
PNID
recognition
'.. ::::• •
i
~ ..'.•
i"'."ir]i.
a*
«
8
-a
a
' •'':'!•.
: •(.•'.•%•
if
<••
Q
p. o
41
(9-14)
CDI-S
21 girls of mothers with recurrent MDD, 20 Dot probewith faces
girls ofmothers with no history of Axis 1
Kelvin et al.
102
14.0
MFQ
65
(12-18)
BDI-H
Community sample defined as at
risk by level of emotionality
DSM-IV diagnosis of MDD recruited from
community
AMALSS with prime
(1999)
Kuyken and
62
(12-18)
BDI-II
DSM-IV diagnosis from SCID recruited
from community
AMT
79
15.3
MFQ
30 patientsdiagnosedwith first onset
MDD (K-SADS) and school control
CANTAB, WCS,
affective Go-No-Go,
decision making
Joorman et al.
(2007)
Howell
•&&
B £
If
(2000)
Kuyken et al.
(2006)
Kyte et aL
(2005)
Ladouceur
i
75
(8-16)
CDI, BDI
et al. (2005)
16 MDD diagnosed(K-SADS) from
inpatient and outpatient clinics: 17 anxiety,
24 co-morbid depression and anxiety, 18
AMT
High risk daughters selectively attendedto negative facial
expressions.Control daughters selectively attended to positive facial
expressions
Adolescents with high emotionality endorsed morenegativeselfdescriptorsafter a dysphoric, but not neutral,mood induction.
Depressed more likely to retrievememories from observer
perspective andmorerecenttime period. Also rehearsed negative
memories and rated as more personally important.
MDD and no trauma demonstrated overgeneral memory bias.
Depressed greater attention to sad stimuli, moreimpulsivewhen
making decisions.
Emotional n-back
MDD andco-morbid significantly longer reaction timeson negative
(working memory
task)
emotional backgrounds compared to neutral.
low-risk normal control recruited from
:^S
*:8
5. 5-
:*•••}:•
si
Martin et al.
(2003)
© s>
j^. ••*»•
^
.2
"«
3rd and
6th
community
Children with low and high peer-rated
popularity
graders
95
5.0
None
Neshat-Doost
64
(9-18)
CDI, MFQ
et aL (1997)
55 children of mothers with depression
(SADS-L) and 40 control
19 DSM-IV/ICD-10 depressed, CDI, MFQ
cutoff, 19 mixed anxious/depressed and 26
Emotional Stroop with
negative social words
Forunpopularchildren,greater friendship valuingand greater
negative social word Stroop interference predictedincreasesin
depressive symptoms across 6 months.
Verbal and nonverbal
When dealt a losing hand, exposed childrenmade more negative
expressions card game expressions compared to non-exposed children.
Stroop
No significant differences.
controls recruited from clinics
38
(10-17)
et aL (1998)
CDI, DSRS
MFQ
19 patients with ICD-10 diagnosis and
cutoff score on CDI, DSRS, and MFQ
Recallandrecognition Depressed grouprecalled significandymore negativeadjectives, this
depressionrelated bias became strongerwith age. No bias in
DSRS
19 with DSM-IV MDD diagnosis, 24
school controls
task
155
(12-17)
MFQ,
96 clinically referred adolescents with
MDD, 26 non-depressed psychiatric,
and 33 community controls (K-SADS)
75 first onset MDD, 26 non-depressed
psychiatric assessed (K-SADS-PL) and
33 community controls
AMT
Adolescentswith current MDD more categoric overgeneral
memories than controls,but not more thannon-depressed.
AMT with prime
Rumination increased overgeneral memoriesto negativecues
in MDD patients.
16 children of parents with child onset
depression (COD) diagnosed (SCID) versus
community control
19 children of depressed parents (SCID)
and 133 anxiety or healthy
Posner task under
neutral and affective
conditions
Face memory task
Children of parents with COD were slower in theirresponserates
HDRS
134
(12-17)
MFQ,
HDRS
and
Teasdale
(2004)
Perez-Edgar
et al. (2006)
33
Pine et al.
152
(2004)
(6-10)
(9-19)
None
PARIS
I
I
No support for attentional bias.
(9-17)
(2002)
i
T5
recognition task.
Attentionaldot-probe
55
et al. (2000)
Park et al.
a'
memory tasks
and 19 school controls
Neshat-Doost
Park, Goodyer,
It
CDI
Murray et al.
(2001)
Neshat-Doost
If
63
compared with control children, subtle deficits in selective attention.
MDD offspring significantdeficits in memory selectively for fearful
faces, but not happy or angry faces. MDD not associated with
face-memory accuracy.
(continued on nextpage)
£
o
-a.
tl
a.
J?
ut
O
a
8
•|8
n
JV
Age
(range)
Depression
Sample
Cognitive measure
Summary of findings
School children divided into groups based
on depression measure
15 clinic-depressed, 18 clinic-nondepressed, and 17 control children
SRET
No significantdifferences on SRET.
Self-Schema Task
Significandy more positive words recalled by non-depressed children.
This relationdid not hold after effects of word recognition
School
Self-Schema Task,
measure
mean
B
to
rl
o
IS
r?
•JT §
B
Study
9.
H
P. o
a.
18
Table 2 (continued)
ca
Possel et al.
(2006)
Prieto, Cole,
and Tageson
(1992)
Reid et al.
92
(13-15)
SBB-DES
50
(8-12)
CDI
133
(8-14)
CDI
controlled.
Attentional dot probe,
Attribution vignettes
(2006)
•a
1
X
(9
•a
8
P-
1I
Q
a"
2f
S
5
ex
y
8
o
*•>
^
8
^2 1.
p.
«
13
o
o
go
<
a
2
fT
eO"
E
«3
3»
•i
o
8-
&> •o
<i*
'i
-8
si £•
o
to
o
o
•>J
»~
o
b
o
0\
(8-12)
CDI
School
I
,u
n
81
5:
1. S.
*J3
Rudolph et al.
(1997)
Swales et al.
46
14.2
BDI
(2001)
Tagbavi et aL
(1999)
67
(9-18)
DSRS
Taylor and
Ingram
(1999)
86
Timbremont
44
(2004)
Vrielynck,
Deplus, and
Philippot
(2007)
Leitenberg
(1990)
Zupan,
c
9"
Hammen,
0
and Jaenicke
g
(1987)
p.
to
a.
o
&
a
>
(8-12)
(8-16)
CDI
CDI
and Braet
Whitman and
&
&
| •'**•-"•:•'-
s
• ';'-;'.
• --in!
task
<i
a*
n
.
...; ••-)
'
'
,_.-,_
:
!
i
,
Q
-s»
o
a*
o'
Q
.' : *
';* : <
•- •,'•
•.•-,••
i!;
v
*J
O
g
B
: /: '. .':;!
to depression.
Story task with recall Depressed children significandy greater recall of negative maternal
andlevel of processing attributes thannon-depressed on recall from storytask.Nondepressed demonstrated greater recall of positive attributes on levelof
task
processingtask.
More depressed less specific,but many patients recalling the same
AMT
traumatic memory (parasuicide) over and over.
Attentional dot-probe No attentionalbias in mixed anxious-depressed children.
school controls
13
(JO
Residential patients with ICD-10
psychiatricdiagnosis and school control
24 anxious, 19 mixed anxious-depressed
primary diagnosis DSM-IV, 24 normal
Psychopathology (externalizing andinternalizing) was associated with
hypervigilance for threat cues,negative interpretations of social
situations, internal attributions, perception of hostile intent, and recall
of negative self-descriptions. None of these relations were specific
60
(9-13)
MDI-C
4th-6th
CDI
grade
81
(8-16)
19 depressed, 15 never depressed, and 10
remitted depressed (CDI cutoff)
in residential facility
15 depressed children, 25 never depressed
a
SRET with prime
SRETwith prime
Primed at risk children demonstrateda less positive self-concept and
a higher proportion ofnegative endorsed words recalled.
Remitted depressed rated more negative words as self-descriptive.
26 with score at least 1 SD above normative
20 children of women with depression
(K-SADS), 21 not depressed
K3
>}
%
AMT
Depressed children gave fewerspecificmemories.
Word association task
Evidence that depressedrecall positiveless well.
Self-schema incidental
Depressed demonstrated recall of negative self-descriptive adjectives.
memory task
Note. Ageranges and means reported when available. Grades reported when age data was not available. AMT =autobiographical memory task; SRET =self-referent encoding task; AMALSS =
Assessment ofMood Activated Latent Self-schema; CANTAB =Cambridge Neuropsychological Test Automated Battery, WCS =Wisconsin Card Sorting Task; DSRS =The Depression Self-Rating
Scale; K-SADS =Schedule for Affective Disorders and Schizophrenia for School-Age Children; CDI =Children's Depression Inventory; SCID =Structured Clinical Interview for theDiagnostic and
Statistical Manual for Mental Disorders; SADS-L = Schedule for Affective Disorders and Schizophrenia — Long; MFQ =The Mood and Feelings Questionnaire; ICD-10 =International Statistical
Classification of Diseases and RelatedHealth Problems 10th Revision; DSM-IV = Diagnostic and Statistical Manual of MentalDisorders — 4th edition.
I.V.U.!)-...
a
«
8
mean on CDI and 26 school controls
CDI
A
•fc
clinical, and 20 control
11.5
52
40 offspring of depressed mothers
(SCID) high-risk and 46 low-risk
o
a
<3
: >V".i '-• '
; • <•!,
R.H.Jacobs et al. / ClinicalPsychology Reviewxx (2007) xxx-xxx
17
depressed youth (Dalgleish et al.,2003; Neshat-Doost et al.,2000; Taghavi, Neshat-Doost, Moradi, Yule, & Dalgleish,
1999). Children with MDD are more easily distracted by negative pictures than neutral pictures, whereas control
children are more distracted by positive pictures (Ladouceur et al., 2005). Moreover, recent work suggests that
daughters of depressed mothers selectively attend to negative facial expressions, whereas control daughters selectively
attend to positive fecial expressions (Joorman, Talbot, & Gotlib, 2007). In this study, a dot-probe task was used, but
fecesinsteadofwords were selectedas stimuli.Ofnote, fecialexpressionparadigmsresult in more consistentfindings
than verbal within the adult literature, as do studies using longerstimulusdurations (e.g., Gotlib et al., 2004). In sum,
relations between depression and attention in youth are not yet well understood.
This body of literature affirms that symptomatically depressed youth demonstrate memory and attention biases.
However, thesestudies are overwhelmingly cross-sectional anddo not explicate whether thesebiases contribute to the
etiology or maintenance of depression. Results from longitudinal studies with adults suggest that information
processing paradigms may reveal key processing biases underlying depression. Cognitive biases predict change in
depressive symptoms in community samples (Rude, Wenzlaff, Gibbs, Vane, & Whitney, 2002). Pregnant mothers
recalling more negative words ona self-referential encoding taskdemonstrate more symptoms of depression following
childbirth (Bellow & Hill, 1991). Among adults with MDD, greater recall of positive words on the self-referential
encoding taskuniquely predicts a decrease indepression symptoms (Johnson, Joorman, &Gotlib, 2007). A tendency to
shift attention toward negative information following anemotional prime interacts withlife stress to predict increases in
symptoms of depression seven weeks later (Beevers & Carver, 2003). Thus, there is good evidence that information
processing paradigms are useful in predicting depression longitudinally among adults.
Among theyouth-focused information processing research, only one study followed participants longitudinally and
tested relations with depression (Hammen, 1988). A child's memory bias toward negative self-descriptions predicted
affective diagnosis across sixmonths (Hammen, 1988). However, this relation was only observed atthelevel ofa trend.
In a related literature, Martin et al. (2003) observed higher levels of Stroop interference among children whoattached
greater importance to friendships and whose peers rated them as having few friends. This interference predicts
increases in depressive symptoms over a six month period. Martin and colleagues propose that the Stroop paradigm
may be more sensitive to children's social concerns than traditional paper-and-pencil measures. A limited body of
evidence suggests that information processing paradigms may predict depression across time. Clearly, more research is
necessary to establish the prospective relations between these lower order processes and depression among youth.
The relations between information processing and cognitive content measures are relatively unknown among youth
as well. Inan adult example, individuals athigh cognitive risk for depression inthe CVD exhibited more self-referent
information processing biases than individuals with low cognitive risk (Alloy, Abramson, Murray, Whitehouse, &
Hogan, 1997). Similarly, among high cognitive risk participants, the self-referent information processing task battery
(SRIP; Alloy et al., 1997) partially mediated cognitive risk effects (Steinberg, Oelrich, Alloy, & Abramson, 2004).
Within the same sample, the negative SRIP composite interacted with cognitive risk to predict first onset, but not
recurrence ofdepression. While there is some evidence that these constructs relate among adults, how these cognitive
processes relate among youth is currently unknown. A recent study (Reid, Salmon, & Lovibond, 2006), however,
interviewed children about their attributional style and gathered data on attention allocation and memory recall.
Information processing and cognitive content biases were congruent and associated with psychopathology, although
not to depression specifically. The integrative study of information processing biases and cognitive content vul
nerabilities may result in theoretical refinement of cognitive models of depression among youth.
We conclude that information processing paradigms offer a useful tool for investigating cognitive vulnerability for
depression among youth. However, the information processing studies reviewed assess youth with a range of
internalizing diagnoses. Many ofthese studies did not propose specific hypotheses inrelation to differing diagnoses,
clouding the theoretical utility of results. Moreover, a notable distinction between the cognitive content and
information processing literature is the use ofemotional priming. Emotional priming - the experimental induction of
mood for the purposes oftapping latent cognition - isused successfully within the information processing literature,
but has not yet been incorporated into prospective longitudinal studies ofcognitive vulnerability among youth. On the
other hand, information processing studies rarely investigate the effects oflife stress onthe accuracy ofinformation
processing. Emotional priming prior to measuring cognitive content via questionnaires allows for amore powerful and
adequate test ofcognitive vulnerability models, as the induction ofa negative mood state may allow individuals to
report latent schema (e.g., Persons &Miranda, 1992). Integrating the assessment ofstress, orimplementing astressor in
the lab, would similarly result inan effective assessment ofcognitive biases within information processing paradigms.
Please cite this article as: Jacobs, R.H.; etaL; Empirical evidence ofcognitive vulnerability for depression among children and adolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006
18
RH. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx
Consequently, acombination ofinformation processing paradigms and self-reportquestionnaires permits researchers to
evaluate whether these higher and lower level cognitions do, in fact, influence one another in the development of
psychopathology.
6. Discussion
Several cognitive models ofvulnerability for depression have been proposed during recent years, and have attracted
empirical attention. Derived from research on cognitive concomitants ofdepression among adults, they propose thatthe
establishmentofmaladaptive schema, negative attributional style, and impaired self-perception may place youth atrisk
for major depression. Although evidence supporting each ofthese models has emerged, conceptual challenges remain,
and no single model adequately accounts for the full range offectors implicated inrisk for depression.
We envision significant advances in our understanding of cognitive vulnerability for depression through the
incorporation ofinformation processing paradigms into existing models. Capturing the relations between vulnerabi
lity fectors and depression may be facilitated through the study ofyouth within acognitive-developmental framework.
Interdisciplinary collaboration between developmental and clinical scientists will allow for broad conceptual
integration.
The use of emotional priming strategies and methodologies borrowed from research in experimental cognitive
psychology may shed light on cognitive vulnerability fectors among young children. According to Beck etal. (1979),
schemata "may be latent but can be activated by specific circumstances which are analogous to experiences initially
responsible for embedding the negative attitude" (p. 16). Germane toa discussion oflatent schemata, the mood-state
hypothesis proposes that cognitive vulnerabilities are accessible only during negative mood states (Persons &Miranda,
1992). This hypothesis is based on an associative-network model in which mood states cue related thoughts
(e.g., Bower, 1987). Persons and Miranda (1992) argue that, because depressogenic cognitions develop when one
experiences negative affect, cognition and affect are linked in memory. When not experiencing a negative mood,
cognitions related to negative affect may be inactive. Adolescents may experience more negative life events than
children (e.g., Ge et al., 1994), offering opportunities for latent cognitive schemata to become activated. The lower
average rates ofstress inearly childhood raise the possibility thatcognitive vulnerability fectors may bepresent, but not
activated. I£ despite emotional priming, cognitive vulnerability factors donot appear tobeassociated with depressive
symptoms among children as they are with adults, a developmental difference would be identified. Given the
possibility that lower order and higher order cognition appear to develop in tandem andreciprocally influence one
another, the inclusion of information processing paradigms will clarity the role of lower order and higher order
cognitive vulnerabilities. In sum, latent measurement of cognitive vulnerability through information processing
paradigms may allow fora broader understanding ofcognition inpsychopathology andaddress theoretical hypotheses
regarding cognitive vulnerability models.
Have the theoretical hypotheses of cognitive vulnerability models gained strong support in studies of youth (e.g.,
Alloy et al., 1999; Ingram et al., 1998)? First, the stability of cognitive vulnerability factors among children and
adolescents remains unclear. Datasuggest that a degree of stability exists withinadolescent samples, whereas among
pre-pubertal youth, onlyshort term stability of cognitive content have beenreported. We note thatJust et al. (2001)
question the assumption thatcognitive vulnerability represents an immutable trait We propose thatin the downward
extension of cognitive vulnerability models to youth, allowance mustbe made for the variable nature of developing
cognition. Second, findings to date have not demonstrated temporal precedence of proposed cognitive vulnerability
fectors. Future research must assess prior episodes and follow young samples to make the detection of these
phenomena feasible and likely. Third, research suggests that a number of cognitive fectors may be implicated in
vulnerability fordepression. These factors have rarely beenexamined simultaneously within thesame sample. Little is
known, men, about howtheymay interact in placing youth atriskfordepression. Literatures surrounding each of the
putative riskfactors haveevolved independently. Synthesis, through integrative research paradigms is needed. Fourth,
some evidence has emerged for the specificity criterion (e.g., Gencoz et aL, 2001; Robinson et al., 1995). Given the
centrality of this hypothesis to cognitive models of psychopathology, additional research is needed. Last, the
endogenous and latent nature of cognitive vulnerability in youth is likely. Cognitive vulnerability factors appear to
reside within the child. However, an increased attention to ecologically valid life stress assessment, as well as the
incorporation of information processing paradigms and emotional priming into research design, allows for more
thorough investigation. In sum,the central hypotheses of cognitive vulnerability models haveyet to be put to the test.
Please citethisarticle as: Jacobs, R. H.,et aL, Empirical evidence ofcognitive vulnerability fordepression among children andadolescents: A
cognitive scienceand developmental perspective, ClinicalPsychology Review(2007), doi:10.1016/j.cpr.2007.10.006
R.H. Jacobs et al. / Clinical Psychology Review xx (2007) xxx-xxx
19
We believe cognitive vulnerability research incorporating information processing paradigms will more adequately
address these theoretical hypotheses.
6.1. Future research
Several lines ofresearch will advance study and are detailed in Table 3. Framing the study ofcognitive vulnerability
within the broader domain of cognitive development will be essential. Age is, at best, a crude marker of ontogenetic
change (Rutter & Sroufe, 2000). Specific markers ofcognitivedevelopmentmust be realized. Sensitivity must be given
to how depressionand cognitive vulnerabilitymanifestin relationto the developmentof cognitive capacities and the
attainments of childhood and adolescence (Cicchetti & Rogosch, 2002). In addition to the integration of information
processing paradigms, the inclusion of neuropsychological measurement will be informative. Tracking normative
trajectories of cognitive and brain maturity will embed research on the etiology of mood disorders within a
developmental context. For example, a widely used tool, the Cambridge Neuropsychological Test Automated Battery
(CANTAB; see http://www.camcog.com), assesses executive functioning (for an example see Kyte, Goodyer, &
Sahakian, 2005). Such measurement allows for analysis of specific links between changes in depression and the
developmentofcognitive abilities, hi sum, these lines ofinquiry move scientists and clinicians toward a cognitive and
developmental base for the study and treatment of psychopathology.
In addition, integration with research in developmental biology and functional neuroimaging will advance our
understanding of the development of psychopathology among youth. For example, Cortisol and psychophysiology
assessment within studies of cognitive vulnerability may promote the identification of possible phenotypic and
endophenotypic markers ofrisk (e.g., Gottesman & Gould, 2003). As Bearden and Freimer (2006) note, the study of
heritable traits that can be reliably measured is fruitful in the study of psychiatric disorders. Identifying specific
processes and behaviors, or 'behavioral endophenotypes', advances the study of psychopathology (Cacioppo et al.,
2007; Prathikanti & Weinberger, 2005). In line with this argument, information processingparadigms may allow for
pre-morbid identification of vulnerability at younger ages. Linking these literatures is imperative work for psy
chopathology researchers.
The study ofcognitive models ofvulnerabihty for depressionhas illuminated mechanisms and factors important for
adolescent health. Much work, however, remains. This area is complex whereby individual, group, developmental,
biological, and environmental fectors impact cognition and depression. What is clear from existing cognitive
vulnerability research is that adolescence represents a phase wherein cognitive vulnerability is likely to become
apparent. However, giventhe presentdifficulty establishing temporalprimacyofcognitivediathesesto depression, we
recommend research with younger populations (e.g., ages 7-12 years) that incorporates information processing
paradigms. A developmental framework permits assessment of the child, accounting for their stageof growth within
Table 3
Recommendations for further research
Assessment
• Community children followed from middle childhoodthroughentry to middle schooL
• Careful assessment of prior depression episodes to distinguish vulnerability from scar.
• Attentionto pubertal maturation, cognitivedevelopment, latent and explicitmeasures ofcognitivevulnerability and stress.
• Onset of clinical disorder assessed every six months.
• Youth followedthrough remission andrelapse to establish whethervulnerabilities apply to firstonset only.
• Study ofrumination and problem solving as possiblecognitivevulnerabilities.
• Integration of emotional priming and information processing paradigms.
Analyses
• Mapnormal andabnormal trajectories through growth mixturemodeling to increase the likelihood thatreciprocal effects
between cognition and mood will be captured.
• Analyseswhich account forinitiallevel of depression, asmodelsmay only apply to asymptomatic at baseline sub-samples.
• Integrative and transactional models(e.g. Hankin & Abramson, 2001)assessing the rolesofvulnerabilities in relation to one
another.
Interdisciplinary • Establish developmental trajectories and'normal benchmarks' ofcognitive processes, allowing cognitive vulnerability factors
collaboration
to be distinguished from normative developmentaldifferences.
• Cortisolassessmentallowing for integration with biological underpinnings ofdepression.
• Establish a taxonomy systemwith established agenorms for stress (Grant et aL, 2004a) to facilitate developmental
frameworks andallow forcomparison of stressors across samples.
Please citethisarticle as: Jacobs, R. H.,et aL,Empirical evidence ofcognitive vulnerability fordepression among children andadolescents: A
cognitive science and developmental perspective, Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.006
20
RJI. Jacobs et al / Clinical Psychology Review xx (2007) xxx-xxx
the dynamic, continuous, and reciprocal interactions ofthe environment Such investigation firmly places cognitive
vulnerability research within the developmental psychopathology perspective. Not only will this work advance the
scientific study ofpsychopathology, but itwill produce implications for treatment and prevention ofdisorder among
youth (e.g., Cacioppo et al., 2007; Matthews, 2006).
Acknowledgements
Preparation of this manuscript was supported bya F31 (MH075308) to Rachel H. Jacobs.
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Please cite this article as:Jacobs, R. H., et aL,Empirical evidenceofcognitive vulnerability fordepression amongchildren andadolescents: A
cognitive science and developmental perspective,ClinicalPsychologyReview (2007), doi:10.1016/j.cpr.2007.10.006