Parenting: Growing in Good Health
Even Kids Get the Blues: Depression in Children
By Jill Brady
Every week for three months 8-year-old Danny terrorized the dollhouse in his psychotherapist's office. He'd use the figurine of a small boy to violently throw all of the furniture and other family-member figurines out of the dollhouse windows.
He had recently been expelled from school for frequent fighting with other students.
Danny's anger was obvious to many. What may not have been as obvious was Danny's serious depression; A condition that could end up costing him his health, his future or even his life.
According to recent studies published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) and the Journal of the American Medical Association (JAMA), up to 2.5 percent of children and up to 8.3 percent of adolescents in the U.S. suffer from major depression.
Depression is occurring earlier in life today than in past decades and may predict more severe mental illness in adult life. In addition, depression in children and adolescents is associated with a significantly increased risk of suicidal behaviors, according to a 1999 JAMA study.
This risk is all too real. According to the National Vital Statistics Report put out by the Department of Health and Human Services, suicide was the third leading cause of death in 10 to 24-year-olds in 1997.
"Depression definitely exists in children," says Vickie Beck, MSN, CS-P, a psychotherapist and child specialist connected with the University of Maryland and Mercy Medical Center, who has treated children for the past 15 years.
"It can go unrecognized and result in secondary problems, like failing in school because they can't concentrate. They are so unhappy all the time that they're not getting along with other kids and have social problems," she says.
Unlike depressed adults, who are more likely to internalize their struggle and withdraw socially, depressed children are more likely to be extremely irritable and have angry outbursts in a variety of life situations. The key is to recognize the difference between the normal highs and lows of different development stages in a child's life, and a serious mood disorder like depression.
According to the physicians' fact sheet about depression in children and adolescents published by the National Institute of Mental Health (NIMH), some signs of depression in children include a persistent sad or irritable mood for two weeks or more, increased severity of mood swings and irritability, difficulty concentrating, significantly disturbed sleeping and eating patterns, poor school attendance and performance, a lack of interest in play and turbulent relationships with peers and parents.
Evidence of the turbulence of Danny's relationships grew more severe as he played with the dollhouse each week. Towards the middle of his treatment, he would build barricades with the dollhouse furniture to prevent the father and mother figurines from entering, while using the small boy figurine to scream to them that they would not be allowed in the house.
Danny's father had never been in his life, while his substance-abusing mother tended to drift in and out. He had been raised in an inner city, and at the time Danny was brought in for treatment, he had been sent to live with his grandmother due to his mother's abrupt departure. As if the situation were not hard enough for an 8-year-old to handle, he had lost his grandpa the year before -- the one family member he had been able to connect with.
The stress and trauma in Danny's life was obvious, however that alone would not necessarily mean he'd develop depression.
Ironically, the very people towards whom he directed most of his depression-based irritability and anger may have played a role in how he could have developed the disorder in the first place.
"Mood disorders run in families. When I'm doing my evaluation, I take a good look at family history, not just mom and dad. I look at cousins, grandparents, aunts and uncles," says Beck.
According to the NIMH fact sheet, children who develop depression are more likely to have other family members with the disorder, frequently a parent who experienced depression at an early age, than people who first develop depression as adolescents or adults.
A genetic vulnerability to childhood depression combined with certain risk factors can trigger the disorder. Some of the factors that can put a child at risk include stress, loss of a parent or loved one, attention, conduct or learning disorders, chronic illness such as diabetes, abuse, neglect, or other trauma, including natural disasters.
Even though early identification and treatment of depression can reduce its severity and negative impact on the child's functioning, a diagnosis of depression in a child is often met with resistance from parents and teachers.
This resistance is often related to how they perceive the child's behavior. According to the NIMH fact sheet, "Instead of communicating how bad they [children] feel, they may act out and be irritable toward others, which may be interpreted simply as misbehavior or disobedience."
In Beck's experience, parents and teachers "can be in denial and want to blame the child because they think they can do better if they try. They label the child as bad." Part of her job is to help parents and teachers "begin to understand what might be behind it and that the kid is doing the best he can."
At worst, this resistance and labeling can prevent the child from receiving the treatment he or she needs to overcome depression.
The good news is that there are effective treatments for childhood depression that can get the child back on the right path. The interventions generally include short-term psychotherapy, making adjustments to problematic home or school situations, and medication in some instances.
The psychotherapy aspect of treatment is designed with the cognitive ability of the child in mind because "children and young adolescents with depression may have difficulty in properly identifying and describing their internal emotional or mood states," according to the NIMH fact sheet.
Therapists will typically encourage older children to talk about their feelings in a supportive environment to change their negative distortions of themselves, the world and their future that can fuel depression. Therapists call this technique Cognitive-Behavioral Therapy (CBT).
Another form of psychotherapy, Interpersonal Therapy (IPT), currently under investigation but showing promising results so far, helps the child work through difficult personal relationships that may contribute to depression. The four areas of focus deal with grief, changes in life roles, resolving interpersonal disputes and improving communication skills.
Since younger children are more likely to have difficulty identifying and expressing their feelings, therapists will sometimes mix play therapy with other psychotherapy techniques.
Play therapy typically involves giving the child a toy such as a sand tray or dollhouse with small figurines to play with and act out feelings. It can provide a safe way to express emotions that may be overwhelming, and for which the child may not have words.
According to a recent study in the Archives of General Psychiatry,the recovery rate from a single episode of major depression in children and adolescents is quite high.
In Danny's case, early detection of his depression and appropriate therapeutic techniques helped him to overcome his depression in a relatively short period of time.
When Danny came in for his
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