Recognizing and Dealing with Childhood Depression

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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.15

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.12 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 within 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.19 Childhood depression can interrupt normal activities, last for long periods of time, and extreme cases have been known to end in suicide during adolescence.5

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.20 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.3

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. 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 withdrawal from each other.18,16,11 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 friend1 (pp. 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.11 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, Dr. Craig Hart listed three reasons why parenting can make a difference in the life of a child despite outside influences.8

  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.

  1. 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.

  1. 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 (p. 10).8 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.4

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.10 This helps family members and friends become more open and sympathetic to difficult and challenging behavior.7 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. 

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

Substance Abuse and Mental Health Services Administration:

http://www.samhsa.gov/

References

  1. Ainsworth, M. D. (1962). Reversible and irreversible effects of maternal deprivation on intellectual development. Child Welfare League of America, 42-62.
  2. Baumrind, D. (1996). Parenting: The discipline controversy revisited. Family Relations, 45, 405-414.
  3. Boomsma, D. I., van Beijsterveldt, C. E. M., & Hudziak, J. J. (2005). Genetic and environmental influences on anxious/depression during childhood: A study from the Netherlands twin register. Genes, Brian, & Behavior, 4(8), 466-481.
  4. Ebmeier, K. P., Donaghey, D., Steele, J. D. (2006). Recent developments and current controversies in depression. Lancet, 367, 153-167.
  5. Fox, D., & Fox, J. (2001, October). Easing the burdens of mental illness. Ensign, 32-36.
  6. Fristad, M. A., Gavazzi, S. M., & Soldano, K. W. (1999). Naming the enemy: Learning to differentiate mood disorder "symptoms" from the "self" that experiences them. Journal of Family Psychotherapy, 10(1), 81-88.
  7. Hart, C. H. (1999, November). Combating the myth the parents don't matter. Paper presented at the World Congress of Families II, Geneva, Switzerland.
  8. Ladouceur, C. D., Dahl, R. E., Williamson, D. E., Birmaher, B., Ryan, N. D., & Casey, B. J. (2005). Altered emotional processing in pediatric anxiety, depression, and comorbid anxiety-depression. Journal of Abnormal Child Psychology33(2), 165-177.
  9. Lopez, S. R., Nelson, K. A., Snyder, K. S. & Minz, J. (1999). Attributions and affective reactions of family members and course of schizophrenia. Journal of Abnormal Psychology108, 307-314.
  10. Mezulis, A. H., Hyde, J. S., & Clark, R. (2004). Father Involvement Moderates the Effect of Maternal Depression During a Child's Infancy on Child Behavior Problems in Kindergarten. Journal of Family Psychology, 18(4), 575-588.
  11. National Institute of Mental Health (1991). Implementation of the national; plan for research on child and adolescent mental disorders (Publication No. PA-91-46). Washington, DC: U.S. Department of Health and Human Services.
  12. National Institute of Mental Health (2006). Depression. Retrieved from http://www.nimh.nih.gov.
  13. Paradise, L. V., Kirby, P. C. (2005) The treatment and prevention of depression: Implications for Counseling and Counselor Training. Journal of Counseling & Development, 83, 116-119.
  14. Reynolds WM, Johnston HF. (1994) The nature and study of depression in children and adolescents. In: Reynolds WM, Johnston HF, editors. Handbook of depression in children and adolescents. New York: Plenum Presspp. 3–17.
  15. Silk J. B., Altmann J., Alberts S. C. (2006). Social relationships among adult female baboons (Papio cynocephalus) I. Variation in the strength of social bondsBehav. Ecol. Sociobiol. 61, pp. 183–195 .
  16. Society of Clinical Child and Adolescent Psychology and the Network on Youth Mental Health. Retrieved from http://www.wjhharvard.edu.
  17. Volling, B. L., McElwain, N. L., Notaro, P. C., & Herrera, C. (2002). Parents' emotional availability and infant emotional competence: Predictors of parent-infant attachment and emerging self-regulation. Journal of Family Psychology, 16(4), 447-465.
  18. Weitzman, M., Klerman, L. V., Lamb, G., Menary, J., and Alpert, J. J. (1982). School absence: A problem for the pediatrician. Pediatrics, 69(6), 739-746.
  19. Williamson, D. E., Forbes, E. E., Dahl, R. E., Ryan, N. D. (2005). A genetic epidemiologic perspective on co morbidity of depression and anxiety. Child and Adolescent Psychiatric Clinics of North America14(4), 707-726.