Children and Depression

There is probably not a child in the country who hasn’t, at one point or another, said to his parents “I’m depressed”. Children and teenagers tend to use exaggerated language to describe quite ordinary occurences – an unpleasant experience is a “nightmare”, a minor problem becomes a “disaster”, a period of unhappiness with the world is “depression”.

But the parent of a child with authentic depression knows that their feelings of despair move into another realm entirely. This kind of sadness lasts not for days but for weeks and often months, and is so debilitating that it cripples the child’s normal life, sometimes rendering them incapable of getting out of bed and in some cases causing them to threaten to end their life.

An added complication, experts agree, is that depressed children don’t necessarily display the same symptoms as depressed adults. A child’s condition might be masked by, among other things, tantrums, excessive fatigue, obsessive behaviour or lack of appetite. The doctor’s task is often to read between the lines.

If you are worried that your child is clinically depressed, consider the following list of 29 symptoms. If your child displays the first two signs plus any other two in the list for more than two weeks, it is advisable to see a doctor:

Prolonged sadness; losing interest in activities once enjoyed; disrupted sleep patterns; low attention span; significant change in appetite; becoming withdrawn and uncommunicative; reportedly behaving badly at school; flashes of anger at seemingly small things; physical agitation; inability to be alone; restlessness; crying easily; showing signs of panic; not joining in things he or she once did; apparent loss of friends; talking about how “bad” or “useless” they are; nervousness/jumpiness; inability to organise themselves; negativity about life; saying “no one likes me”; lack of energy; clinginess; playing computer games obsessively; self-harming; mood swings; drop in school performance; displaying and describing fear; repeatedly complaining of ailments such as stomach aches; complaining generally.

In her new book about childhood depression, Happy Kids, Alexandra Massey says that an additional symptom may be aggressive and threatening behaviour towards others, such as bullying or vandalism. She says that adolescents in particular often “act out”, obscuring their depression with aggression and antisocial acts. “Disaffected behaviour could be a symptom of depression, as depression is about buried anger as well as buried sadness,” she says.

“Many of the common symptoms of depression may be interpreted as normal patterns of behaviour. There is also the obstacle of language because children don’t express themselves as an adult would.” She says that if you ask children if they are depressed, they usually reply “I don’t know”.

The parent or teenager should first consult their GP and ask to be referred to the local Child and Adolescent Mental Health Services (CAMHS). School counsellors can also advise a young person who thinks that they might be depressed on how to get help. If depression is diagnosed, it is important to inform the child’s school which, if the child needs prolonged time off, may organise work to be sent home or a part-timetable in which the child can perhaps go home at lunchtime or have free access to a “quiet room” where he or she can escape the hurly burly of school life.

Professor David Cottrell, an expert in child and adolescent psychiatry from the University of Leeds and a trustee of the children’s mental health charity Young Minds, says: “There are different ways of supporting a child back into school, such as teaching them strategies and techniques to deal with their feelings and thoughts. But a key part of the plan is working with the school. Most are very caring and supportive".

Where possible it is advisable for depressed children to be taught in smaller-than-normal groups during their recovery. Talking treatments, family therapy and drug treatments may be offered, but antidepressants are usually prescribed only in conjunction with therapy. Because such children often have multiple problems, several modes of treatment may be needed.

But Massey says there is much that a depressed child’s parents can do to help them at home. The first is simply to listen and empathise without rushing to try to “fix” the problem. Having their fears – however irrational – acknowledged rather than well-meaningly dismissed with a “but don’t be silly, of course everyone doesn’t hate you!” is crucial.

“We have to ‘get down to our child’s height’,” says Massey. “We have to feel their world and suspend our belief about how the problem can be resolved.”

The parent must remain objective: if their child confides that something their parent has said upset them, they mustn’t interrupt with “but of course I didn’t mean that”.

Massey says that few things are more reassuring to a child than physical touch – a hug or a ruffle of the hair. But sometimes a depressed child will recoil from such contact and feel violated if it is attempted, in which case their need for space should be respected. The way to help a withdrawn child, she says, “is to be there, be available, be still and be consistent”. One thing that nearly all depressed children and teenagers have in common is low self-esteem, but there are various ways to boost it. Massey’s tips include:

— Whenever you see your child, give him/her a big smile.

— Tell your child about all the people in his extended family who love him.

— Have a quiet five minutes with your child and talk over something in which you both took part.

— Helpful, positive things to say to your child include: I’m so proud to be your mum/dad. I love the way you do that. Great behaviour today. I’m so glad that you’re mine.

Children remember positive things that we say to them. They store them up like squirrels storing nuts and “replay” those statements to themselves, says Massey. Most of all, depressed children need to feel safe. “Children need to be reassured that their parents have everything under control. They need to know that they feel loved and cherished. They need to believe us when we say that we are 100 per cent behind them.”

Most episodes of depression in children and adolescents last less than nine months. After a year, 70 to 80 per cent will have recovered, but one child in ten remains persistently depressed. About half of young people will relapse within two months of getting better. About a third of children and adolescents who have depressive illnesses will have recurrent episodes, including into adulthood. It is thought that recurrence of depression is more likely the earlier in life it starts, the more times it recurs and the more severe it is.

Cognitive behaviourial therapy, which teaches the patient to address his or her negative thoughts, is among the best “talking treatments”. It is usually given in weekly sessions of 50 minutes, or may be given in groups. Antidepressants may be offered for severe depressive illness, or where the depression fails to respond to talking treatment. They are given in combination with talking therapy. The most common drug prescribed for children and teenagers is fluoxetine (Prozac). Antidepressants can take up to six weeks to work, however, and parents should be especially watchful for any adverse side-effects during this time.

In more extreme cases, children who have missed early “nurturing” experiences because of abuse or poor and disrupted parenting, and who may suffer from depression and underdeveloped emotional and linguistic skills as a result, may be offered a place in a “nurture group”. These are small classrooms for ten or 12 children within a normal school in which the children can work one to one with adults. They have become popular in the past ten years, since testing regimes became more rigid.

Professor Paul Cooper, director of the Leicester University School of Education, says: “The environment is more homely, with soft furnishings – and having breakfast, for instance, is a central part of the curriculum. There is intensive interaction between the teachers and children, and the evidence we have suggests that there are long-lasting effects.”

Overall, says Alexandra Massey, there are many reasons for optimism for a parent with a depressed child.

“It’s important to understand that children have an enormous ability, in comparison with adults, to change themselves in a relatively short period of time,” she says. “Given the right external conditions, their capacity for emotional healing and growth is staggering.”

Children have not had time to build up the impenetrable defences that adults have, and they are not stuck as rigidly in patterns of behaviour. Whereas adults may take years to recover, children can do so in months or even weeks.

“I have seen some astounding transformations in desperately unhappy children,” she says. “Having an unhappy child can make any parent feel like a failure. It can seem like the end of the world – but it’s not. It’s the beginning of a new world, and amazing things can happen.”

In the UK, children can call Childline on 0800 11 11 to discuss thier anxieties and other factors that are making them depressed. The service offers counselors who are trained and equiped to specifically help children.

'We risk losing sight of the person'

Whenever I work with a family where an unhappy child has been brought in as the patient the first thing I do is congratulate that child for bringing the family into treatment.

Unhappiness in children can be understood as their crude and honest way of signalling an unhappy system. They are communicating that there are things wrong within the wider picture of their life. This might be in the family or their general environment: the estate where they live or their school. It might be bigger problems in society. But rather than taking a patient-centred view, we should take a systemic view of the problem. Rather than assuming that it is the child who is ill, we should look at the system.

Parents are sometimes all too anxious to get a diagnosis of depression for their child because to an extent that can lessen their responsibility for what is wrong. I am not for a moment saying that this makes them bad parents. My issue is that as soon as you give something a label it detracts from that individual’s human experience. As soon as we get bogged down in clinical diagnosis of “depression” we risk losing sight of the person.

I have no doubt that there are young people who are exhibiting behaviour and emotions that are severe enough to be described as depression. Whether we want to label them as being depressed, given their age and the stage of their development with all the connotations and stigmas that depression carries, is another question.

I have worked with kids for 18 years and they know so much more now. Thanks to the media, the internet and new technology, they have instant access to information. So they know about the threat from global terrorism, but what they see is usually the most skewed, extreme or sensational side as reported by the media. When they hear it they think it is happening everywhere. We have to help them to believe that the world is a safe place. Otherwise children become unhappy and vulnerable children become depressed because their feeling of safety is undermined. This is shown by the 1977 Stress Vulnerability Model, which proposes that people with a vulnerability to psychosis are at a proportionate risk of developing a psychosis as their stress levels increase.

That this information is more freely available to them isn’t a bad thing, but for much of the time they are gaining access to it in a very unsupervised way. And they don’t know what to do with it – it overwhelms, frightens and pushes them into responsibilities before they are ready to take them.

There is also more expectation placed on a child through targets and testing. At the same time parents are pushing their children to excel. You don’t hear about those kids so much because they are largely hidden behind the respectability of their families: they are not hoodies mooching around an estate.

But I see plenty of them in my clinics. I am seeing kids as young as 3 who are struggling to defecate because they have been rushed into potty training too early by parents who want to get them into the best local nursery as a feeder to the best preparatory schools.

But I think part of the reason why we are seeing an apparent rise in child and adolescent depression is that we are more aware of children’s unhappiness than we have ever been. We are also in more of a rush to label things. We live in a society awash with psychiatric and psychotherapeutic explanations for behaviours. Again this can be a good thing and a not so good thing.

What can happen is that a child behaves in a certain way and people say “that’s depression”. It may not be depression. The child may be having difficult life experiences at a transitional moment of development or during a family crisis. Huge numbers of children exhibit emotional and behavioural problems that may be transient – a moment in time in their development. If we give a name to that condition we create an expectation of illness, and then there is a good chance that the child will become that ill person. Offering a biological and medical explanation, which is what a diagnosis is, for a child’s “ill health” leads to similar solutions, ie, prescribing, and we may undermine the chances of that child and the family overcoming the problem themselves, holistically.

Of course there are a significant number of children who are very, very unhappy and need treatment that may or may not include medication. But psychiatric diagnosis is random, based on a constellation of symptoms. We are buying into a medical model of mental health that takes away from the notion of the individual.

So what does the individual expression of what can be labelled clinical depression in a child tell us? I suggest that we look beyond the symptoms and think more broadly about what they symbolise – we need to look at what these young people are telling us about the environment we have created for them: a chaotic, random and harsh environment that, if not mediated, explained and as necessary censored, ignores the essential beauty of an innocent and carefree childhood.

That is the more important consideration.

— After a year 70 to 80 per cent will have recovered, but 1 child in 10 remains depressed

— A third of children and adolescents with depressive illness will have recurrent episodes

Original Source - The Times Of London

Author - DR TANYA BYRON

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