A new tool accurately assesses three types of anhedonia in adolescents, new research shows.

The novel Multidimensional Adolescent Anhedonia Scale (MAAS) assesses anticipatory, consummatory, and recall anhedonia, which will help improve diagnoses in research and clinical settings, the investigators say.

Anhedonia, the loss of interest and pleasure in activities, is often the first sign of depression in adolescents.

Current methods of assessing anhedonia in teens are limited, study investigator Bita Zareian, a PhD student at the University of British Columbia, Vancouver, Canada, told Medscape Medical News.

“Adolescence is when depression starts to dramatically increase, and I thought it was important to have a reliable way to assess it. I realized that the current self-report measures for anhedonia in adolescents are limited,” she said.

For example, some tools only assess anhedonia in one area of life or only assess one type of anhedonia. Others only assess anhedonia in adults “and do not take into consideration that there are differences in the experience of anhedonia between adults and teens,” Zareian added.

The findings were presented at the Anxiety and Depression Association of America (ADAA) Conference 2021.

Inability to Experience Pleasure

To develop the 24-item MAAS questionnaire for use in youth aged 16 to 20 years, the investigators reviewed the literature on anhedonia and adolescents and then tested it on 585 older teens.

Zareian noted that with anticipatory anhedonia, individuals are unable to anticipate that something is going to be pleasurable. An item on the questionnaire asks the participant to rate the statement, “I used to look forward to my future but now I do not” and to report how much that comment resonates.

Consummatory anhedonia refers to the current enjoyment of activities. Participants were asked to rate the statement, “I do not feel as excited about things as before, or I don’t enjoy things as much as I used to.”

Recall anhedonia is the inability to recall past pleasurable events as enjoyable. “An item that assessed recall anhedonia would ask how the person relates to this statement: ‘I feel nothing when I think about happy memories,’ ” Zareian said.

In addition to the MAAS, the participants also completed the Positive and Negative Affect Schedule, the Center for Epidemiological Studies Depression Scale for Children, the Anticipatory and Consummatory Interpersonal Pleasure Scale – Adolescent, the Dimensional Anhedonia Rating Scale, the Snaith-Hamilton Pleasure Scale, Shipley, and the NASA Activity Scale.

Results showed that adolescents who had high scores on the MAAS had moderate to high scores on other measures that traditionally signify anhedonia.

Among participants with high MAAS scores, levels of depression and negative affect were elevated, and levels of positive affect were low.

MAAS scores were not related to intelligence or level of physical activity, “suggesting that MAAS is not assessing experiences that are unrelated to anhedonia,” said Zareian.

The new MAAS is promising for older teens, and the researchers are currently studying it in persons aged 12 to 18, she noted.

“We want to make sure it works for both younger adolescents as well as the older ones and that we are able to replicate these findings in another sample before concluding that this is a good measure, but the results have been promising,” she said.

Zareian added that because anhedonia is often the first sign that a teenager is developing depression, the MAAS may also prove useful in helping parents and pediatricians recognize its onset sooner ― and perhaps provide early intervention.

“I think it’s important to make this type of research available to everyone in a way that all can understand and use. Parents and teachers are the first people who might notice these changes in their teens,” she said.

An Incremental Advance

Commenting on the findings for Medscape Medical News, Charles B. Nemeroff, MD, PhD, Matthew P. Nemeroff Professor and chair, Dell Medical School, the University of Texas at Austin, noted that anhedonia is often overlooked, “but the inability to experience pleasure is really the cornerstone of what major depression is.”

Nemeroff, who is president-elect of the ADAA, was not involved with the research.

Anhedonia is not usually broken down into various components, he noted.

“Normally, there is a single item on the various depression rating scales that has to do with the ability to express pleasure. These researchers have developed not only a new anhedonia scale but one that is breaking down the various components of anhedonia that people don’t normally think about,” he said.

“In my mind, this represents an incremental advance in being able to measure anhedonia,” Nemeroff concluded.

Zareian and Nemeroff have reported no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) 2021: Abstract S1-102. Presented March 18, 2021.

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