By Ruth Klein, Ph.D.
Until fairly recently, it was believed that children were unable to experience depression. However, research has shown that children do, indeed, experience depression, with symptoms both similar to and different from those typically associated with adult depression. Statistics reveal that as many as one in every thirty children suffers from depression. Among adolescents, that number rises to as high as one in every eight.
Early onset depression places children at risk for many difficulties throughout their lives. Suicide is the second leading cause of death in children and the third leading cause of death in adolescents ages 15-19.
Undiagnosed and untreated depression can lead to very serious results. However, parents and other adults can learn what warning signs and symptoms to look for. The good news is that, once diagnosed, depression is treatable.
What causes depression?
Depression results from a combination of one or more factors, which may differ from person to person. Inheritance may play a role; that is, individuals with close relatives suffering from depression may be more likely to experience depression themselves. This may be due to the genetic transmission of brain chemicals (called neurotransmitters).
Other causes of depression include experiencing significant and potentially traumatic life events (death of a loved one, other losses such as major illness, divorce or a move), chronic illness, environmental stressors (poverty, neglect, or violence/chaos), family stress, abuse, inconsistent parenting, and witnessing traumatic events.
What are some of the symptoms of depression in children?
Symptoms of depression differ, depending on the age of the child. Because children do not always have the vocabulary or coping mechanisms to deal with overwhelming feelings, they express these feelings behaviorally. In contrast to adult depression, in which the person enjoys nothing, children are capable of finding activities they enjoy, no matter how bad they feel. Another difference is that depressed children may exhibit irritability rather than the sad mood we commonly associate with adults who are feeling depressed.
What are some of the warning signs of depression?
Major warning signs of depression in children and adolescents include:
- Sudden changes in behavior
- Aggressive, angry or agitated behavior
- Increased risk-taking
- Changes in appetite or sleep patterns
- Lower self-esteem
- Giving up valued possessions and settling unfinished business
- Withdrawing from friends, activities, and family
- Changes in dress or appearance
Children often change as they grow and develop, so one or two of these changes do not automatically mean that your child is depressed. However, your child exhibits several of these warning signs, or if the problem continues for a significant period of time or interferes with your child’s social, home, or academic performance, consult your health care provider.
What should I do if I suspect my child or teen is depressed? How can depression be treated?
First, consult your health care provider and have your child examined to rule out any other medical conditions. If there are no other medical conditions contributing to your child’s depressive symptoms, request a referral to a licensed mental health care professional with experience in treating childhood and/or adolescent depression.
The treatment of depression must be tailored to meet the individual needs of the child and family. Usually treatment starts with a thorough evaluation by a licensed mental health provider (or a clinician, such as a social worker, counselor, or psychologist). This professional will obtain information from the parents and the child about symptoms, history and other relevant circumstances. The clinician may also (with your permission) want to discuss your child’s situation with his/her teacher, pediatrician, or other professionals. The evaluation may take place over several sessions to make sure that information is complete and accurate.
Once the evaluation is completed, the clinician will usually make treatment recommendations. These may include psychotherapy, medication management, and/or referrals to other professionals such as a physical or occupational therapist, nutritionist, or psychologist for educational testing.
Most often, psychotherapy is the treatment most clinicians recommend first. There are different types of psychotherapy that help children cope with the negative feelings and behaviors associated with depression. Some of them are identified below:
Cognitive Behavioral therapy (CBT) is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. The client and therapist discuss the thoughts and feelings that lead to certain behaviors and identify “distortions” or misconceptions that may lead to ineffective ways of interacting.
Play therapy is a form of treatment used for very young children, or those who have difficulty expressing their feelings verbally. Through the use of play, the therapist is able to identify themes or areas of difficulty that are then addressed with the child and family. Play is also used through therapeutic and traditional game playing, which helps to establish a trusting relationship with the therapist and may be used to model appropriate social behavior.
Behavior therapy is an approach to psychotherapy that treats emotional difficulties through techniques designed to reinforce (increase) desired behaviors and reduce inappropriate or ineffective behavior.
Family therapy is often recommended to support the family and teach new ways of communication and interaction.
The type of treatment chosen or provided will depend upon the nature of the problem, the age of the child and other factors. Regardless of the approach used, coordination and ongoing involvement with the family are important to obtain information and to help support the treatment.
If psychotherapy alone is ineffective, a trial of anti-depressant medication may be recommended to address the biochemical component of depression. If medication is being considered, parents should first seek consultation with a child psychiatrist to discuss whether this treatment is appropriate.
The treatment of depression is not an exact science; it may take weeks or sometimes even months to see results. Open communication with your child’s mental health provider is critical so that everyone involved – you, your child, and your child’s providers – will be able to work as a team to ensure the success of the treatment.
By Ruth Klein, Ph.D., Director of Mental Health Services, Jewish Community Services, Baltimore, MD
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