Evaluation and Multimodality Treatment of a Depressed Prepubertal Girl Theodore A. Petti, M.D., Mitchell Bornstein, Ph.D., Alan Delamater, M.S., and C. Keith Conners, Ph.D. Abstract. This paper provides the framework for assessing and treating chronically de- pressed, multiproblem children. A clinical case study was chosen as the vehicle to illustrate, in a sequential manner, an approach which utilizes intensive milieu interventions, dynamic. ally oriented psychotherapy, antidepressant medication, and behavior therapy (social skills training) to convey the rationale and methodology for a pragmatic, comprehensive, multi· modal approach to the therapy of chronically depressed children. Journal <if the American Academy of Child Psychiatry, 19: 690-702, 1980. During the past decade, childhood depression has become recog- nized as a major clinical entity. Work has begun to identify and treat children manifesting depression, but instrumentation and measurement are still at a rudimentary level. Attempts have been made to screen for depression in children through semistructured interviews (Weinberg et aI., 1973; Kovacs et aI., 1976; Petti, 1978; Puig-Antich et aI., 1978). Various workers have attempted to categorize childhood depres- sion and to describe its cardinal features. Cytryn and McKnew (1972) offered a twofold classification, "masked depressions" and "pure depressions"; though the former was noted to be more prev- alent, they have since dropped support for this concept (Cytryn et Dr. Petti is Assistant Professor of Child Psychiatry, University of Pittsburgh School of Medicine. Dr. Bornstein was a Doctoral·. candidate and Mr. Delamater a research assistant when this work was done. Dr. Conners is Professor !if Psychiatry and Director ;g Research at George Washington University and Children's Hospital, National Medical Center, Washington, D.C. Reprints may be requested from Dr. Petti at Western Psychiatric Institute and Clinic, 381/ O'Hara, Pittsburgh, PA 15261. We wish to thank Maria Kovacs, Ph.D. for her helpful suggestions and Ms. L. Hertweck, R.N. and the staff of the Children's Psychiatric Intensive Care Service for their considerable assistance. 0002-7138/80/1904-0690 $01.16 © 1980 American Academy of Child Psychiatry. 690