It is normal for children to experience
moments of sadness and discouragement. However, sometimes children will
experience prolonged feelings of sadness, anxiety, and hopelessness which may
interrupt normal interest in ordinary, everyday activities such as going to
school, playing, sleeping, and eating. Research shows that about 5% of children
and 10% to 20% of adolescents experience significant depression (Reynolds &
Johnson, 1994).
Depression, unlike a physical illness, is
hard to detect. Depression is often overlooked in children because it can happen
at the same time as more visible problems such as defiance, aggression, or
acting out (National Institute of Mental Health, 2006). The main purpose of this
article is to describe the signs of childhood depression so you can recognize
it in your child. Once known, any symptoms your child shows can be dealt with
in an appropriate manner that will help your child, you as a parent, and other
members of your family.
What
is Childhood Depression?
Childhood
depression is a mood disorder in which a child experiences persistent extended
periods of sadness, hopelessness, and/or irritability that hamper everyday life
- such as daily routines, social relationships, and school performance
(Weitzman et al, 1982). Childhood depression can interrupt normal activities,
last for long periods of time, and extreme cases have been known to end in
suicide during adolescence (Ebmeier, Donaghey, & Steele, 2006).
Recognizing
Depression
Depressive feelings can result from many
stressful circumstances. If you have a family history of depression, your child
is more likely to experience depression (Williamson, Forbes, Dahl, & Ryan,
2005). Like other mental illnesses, depression may also result from a chemical
disorder in the brain. Lastly, research suggests that both genetics and the
environment play a role (Boomsma, van Beijsterveldt, & Hudziak, 2005).
It may take some time to come to grips with
the fact that your son or daughter's depression will affect your everyday life.
You may feel uncertain and scared at not knowing what to do. You may even feel
burdened by the extra time and effort that you'll need to parent your child or
frustrated that your child can't function normally. You might or be in denial
of the fact that your child is depressed and has
different needs than their siblings. It is important that you accept these
feelings and allow yourself to experience them without feeling responsible or
guilty.
Signs
to Look For
Here
are some signs to look for if you think your child is depressed.
- Persistent
sad and anxious mood.
- Sleep
problems - unable to sleep, sleeping too much.
- Restlessness
or irritability.
- Sad
thoughts and perceptions.
- Loss
of interest in activities once enjoyed.
- Decreased
energy, becomes tired easily.
- Feels
guilty, helpless, and worthless.
- Can't
make decisions, concentrate, and remember.
- Physical
symptoms that do not respond to treatment.
Depressive symptoms often vary by the age of
the child. For example, younger children are likely to be more irritable,
complain of physical symptoms (e.g., stomachaches, headaches), and look
depressed. In contrast, trouble sleeping, being tired, loss of interest in
previously enjoyable activities, and having suicidal thoughts tend to increase
with age.
Parental
Influence
Parental influence is
important. Findings show that the more involved a child's parents are, the more
the child is able to be successful at being able to control their emotions
(2002). For example, research has found that mother and child influence each
other. When a mother is depressed, her child is more likely to struggle with
his emotions. In the same way, when a mother notices that her child is
withdrawn, unable to be soothed, and uninterested during play, a mother is more
likely to withdraw. This becomes a vicious cycle as both mother and infant
withdraw from each other (Volling, 2002; Silk, 2006; Mezulis, 2004). When this
happens, it may be best to have others step in and help.
The Family: A Proclamation to the World
states: "Disability, death, or other circumstances may necessitate
individual adaptation. Extended families should lend support when needed"
(¶ 7). A way to help maternal depression would be to involve another caregiver,
such as a father, grandmother, or trusted friend (Ainsworth, 1962, p. 45-46).
Infant
tendencies continue on during early childhood. Both mothers and fathers can
help their children. A study showed that fathers who were actively involved at
home had children that behaved better in kindergarten than those who didn't. A
father's ability to be proactive in a child's life can really make a difference
(Mezulis, 2004). Parental involvement and quality of care are major factors in
childhood outcomes.
Authoritative
Parenting
The
way you parent your child who is depressed can make a big difference. For a
speech prepared for presentation at the World Congress of Families II,
presented in Geneva, Switzerland (1999), Dr. Craig Hart listed three reasons
why parenting can make a difference in the life of a child despite outside
influences.
1. Teach
morals and values.
Children are able to
make good choices when they share family beliefs in moral, religious, and
political interests taught by parents.
2. Help
children overcome less desirable behaviors.
A proactive parenting
style can help your child. Difficult behavior can be successfully dealt with
when parents are gentle, sensitive, and nurturing. It is also necessary to set
firm limits and have close family relationships.
3. Enhance
your child's positive traits and behaviors by providing opportunities for
further development.
Finding ways for your
child to explore and develop talents and hobbies is a good way to encourage
their development despite other disabilities.
The most effective style of parenting is the
authoritative style because it allows a parent to adapt to a child's nature.
Authoritative parents adjust their parenting tactics to meet the needs of their
child. By doing so, a parent can promote a positive emotional environment,
discipline fairly, set limits, and help children learn to make their own
decisions (Hart, 1999, p. 10). Implementing this style of parenting will allow
you as a parent to teach responsibility and accountability, encourage social
interaction, communicate openly with your child, maintain a positive attitude,
and continue to encourage school involvement.
Seeking
Professional Help
In most cases, the
first step in getting help for a child with depression is to visit with your
pediatrician. This diagnosis will allow the pediatrician to refer your child to
a specialist, such as a psychologist or psychiatrist.
Under the care of a mental health
professional, some ways of treating childhood depression include interpersonal
treatment, cognitive-based treatment, and psychotropic medication. The most
current research shows that although all treatments have their benefits, it
requires use of more than one method to treat a child (Dopheide, 2006).
The following are a few examples of possible therapy
options taken from the Society of Clinical Child and Adolescent Psychology and
the Network on Youth Mental Health:
Interpersonal
Therapy
Interpersonal Therapy (ITP) helps children
understand and deal with their feelings and problems so that they can become
less depressed. It is usually a one-on-one therapy session that allows the
therapist to work with the child and their family.
Cognitive-Behavioral
Therapy
Cognitive-behavioral therapy (CBT) teaches
children how to change their negative thought processes and behaviors. During a
CBT session, children learn about depression and how it is related to the way
it can make them feel and act. Depending on the child's needs, a child may be
taught about communication, problem-solving, anger management, relaxation, and
social skills in an individual or group setting.
Psychotropic
medication
Although in most cases different methods of
therapy can help children deal with their depressive feelings, there may be
some times when the use of medication may be necessary. Since the long-term
effects and/or effectiveness of medication for younger children is still under
investigation, it is best to use medication as a last resort and under
direction of a pediatrician and/or psychiatrist.
Although
work is still being done regarding effective treatments for mental illness, it
is clear that medication is a mediating influence that should be reserved for
only severe cases of depression or used in moderate cases only after other
treatments have been attempted.
Some
other resources that are available to individuals and families include the
following:
- Recommended
health specialists such as psychiatrists, psychologists, social workers,
or mental health counselors.
- Community
mental health centers.
- Hospital
psychiatry departments and outpatient clinics.
- University-
or medical school- affiliated programs.
- Outpatient
clinics.
- Family
service, social agencies, or clergy.
- Private
clinics or other facilities.
- Local
medical support groups
Involving
the Whole Family
Share what you know
with others. When family members understand what depression really is, they are
able to be more understanding because they realize that a child's abnormal
behavior is out of the child's control (Lopez, Nelson, Snyder, & Minz, 1999).
This helps family members and friends become more open and sympathetic to
difficult and challenging behavior (Fridstad, Gavazzi, & Soldano, 1999). The
more understanding parents and siblings are to a child suffering from mental
illness, the more likely the child will be able to cope with abnormal behavior.
Conclusion
Depression is
treatable. Recognizing depression is the first step in helping a child.
Parenting style, therapy, and medication are all methods of dealing with
depression in a way that is practical and helpful.
Written
by Amy Soto, Research Assistant, and edited by Jared Warren, Assistant
Professor, Department of Psychology, and Stephen F. Duncan, Professor, School of Family Life, Brigham Young University. Fall 2007.
Internet
Resources
American Academy of Child &
Adolescent Psychiatry:
http://www.aacap.org
Depression
and Bipolar Support Alliance:
http://www.dbsalliance.org
National
Alliance for the Mentally Ill:
http://www.nami.org
National
Foundation for Depressive Illness:
http://www.depression.org
National
Institute of Mental Health:
http://www.nimh.nih.gov
National
Mental Health Association:
www.nmha.org
National
Mental Health Information Center:
http://www.mentalhealth.samhsa.gov/child/childhealth.asp
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