Recognizing and Dealing with Childhood Depression

It is normal for children to experience moments of brief sadness and discouragement as a natural reaction to everyday situations that may be unexpected or difficult. However, sometimes children will experience prolonged feelings of sadness, anxiety, and hopelessness. These can 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 because it often isn't as obvious as a fever or asthma. Also, depression is often overlooked in children because it frequently happens at the same time as more visible problems, such as defiance, aggression, or acting out.¹³ 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 long periods of sadness, hopelessness, and/or irritability that hamper everyday life - such as daily routines, social relationships, and school performance.¹⁹ In contrast to the short-term feelings of sadness most children have, childhood depression can interrupt normal life, last for long periods of time, and extreme cases have been known to end in suicide during adolescence.⁵

Recognizing Depression

Sometimes, depressive feelings come because of family stressors such as divorce or physical abuse. Conflict between family members can also cause depression. Parents that are very demanding, who have very little give and take with their child, and behave in a way that shows criticism and rejection of the child can create depressed feelings.² If you have a family history of depression, your child is more likely to experience depression.²⁰ Like a number of other mental illnesses, depression may also result from a chemical disorder in the brain. Research shows that depression most often develops from a mixture of biological and environmental factors.³ In other words, both genetics and environment play a role.

Even if you know the cause of your child's depression, 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 deny 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, easily tired.
• 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 more likely to be more irritable, complain of physical symptoms (e.g., stomachaches, headaches), and look depressed. In contrast, trouble sleeping, being tired, losing interest in previously enjoyable activities, and having suicidal thoughts tend to increase with age.

Parental Influence

The influence that parenting has on a child is important. For example, findings show that the kind of relationship that parents have with their infants will affect the emotional stability of the infant, which will then carry on into childhood. A child needs to be able to control emotions.^18,16,11 The research performed shows that both parent and child react to how the other is behaving. However, findings showed that the more involved a child's parents were, the more a child was able to show self-control (e.g. soothing, distracting, redirecting) during infancy, the more the child was able to display similar but more advanced behaviors during childhood.¹⁸ For example, there seems to be a relationship between maternal depression and a child's ability to control their emotions. Research shows a mother dealing with depression is most likely to have a child who keeps their feelings inside. Then, because the child withdraws, won't be soothed, and seems uninterested, the mother will feel sad that her infant isn't responding to her and she will withdraw as well. This becomes a vicious cycle as both mother and infant withdraw from each other.^18,16,11 In such circumstances, it would be best for mothers to deal with their depression and to do their best to interact with their infants as much as possible.

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 lessen the effects of maternal depression would be to involve another caregiver such as a father, grandmother, or trusted friend.¹

Another study shows that infant tendencies continue on during early childhood. This study shows that if the father is involved, the effect of maternal depression lessens, which in turn influences a child's behavior in kindergarten. Children who were most at risk were the ones with mothers who were depressed and had fathers that showed little to no warmth. However, this finding explained that the children with good paternal warmth (involvement and care) had fewer problems with keeping their emotions inside. A father's ability to use authoritative parenting was also a positive factor in a child's behavior, whether the mother was depressed or not.¹¹ Thus, parental involvement and quality of care are major factors in childhood outcomes.

Authoritative Parenting

How you choose to parent your child who has depression can really 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

2. 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.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 would be a visit with a pediatrician. This first meeting with the child's pediatrician can help you understand what care will be needed to help a depressed child. A pediatrician is the best source for a referral to a mental health professional that will be able to diagnose your child. This diagnosis will allow the pediatrician to refer your child to a specialist, such as a psychologist or a psychiatrist.

Some ways a mental health professional might treat your child's depression include interpersonal treatment, cognitive-based treatment, and psychotropic medication. The most current research shows that although all treatments have their benefits, it requires the use of more than one method to treat a child.⁴

• When considering different types of therapy be sure to ask clarifying questions such as:
• What are the therapist's qualifications?
• Do your child's symptoms merit the therapy?
• Will the whole family participate in therapy?
• Will your child's therapy include some form of medication?
• If medication is necessary, what might the side effects be?

Examples of Therapy Options

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) is a well-established treatment that is primarily used for teenagers. However, modified methods of this kind of therapy may be used to help children. ITP helps teens understand and deal with their feelings and problems so that they can become less depressed. Usually, ITP is a one-on-one therapy session that allows the therapist to work with the child and his or her family.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is the therapy shown to be the most helpful for clinically depressed children. CBT allows children to change their negative thoughts and behaviors. During a CBT session, children will learn what it means to have depression and how the way they feel is related to the way they think 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 sometimes 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 the 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

The best initiative you can take as a parent is to learn as much as you can about your child's expected experiences with depression, and in turn, share that information with your family and friends so that they can help support your child. Research shows that when family members and friends understand a mental illness, they are able to interact with the child better because they can understand that the apparent abnormal behavior is out of the child's control.¹⁰ Therefore, this would help family members and friends become more open and sympathetic to difficult and challenging behavior.⁷ It seems that the more understanding parents and siblings are to a child suffering from mental illness, the more likely the child will be to cope with his or her 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. Listed below are internet resources that may be helpful in learning more about depression.

Written by Amy Soto, Research Assistant, and edited by 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, Brain, & Behavior, 4(8), 466-481.
4. Dopheide, J.A. (2006) Recognizing and treating depression in children and adolescents. American Journal of Health-System Pharmacy, 63, 233-243. doi:10.2146/ajhp050264
5. Ebmeier, K. P., Donaghey, D., Steele, J. D. (2006). Recent developments and current controversies in depression. Lancet, 367, 153-167.
6. Fox, D. & Fox, J. (2001, October). Easing the burdens of mental illness. Ensign, 32-36.
7. 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.
8. Hart, C. H. (1999, November). Combating the myth the parents don't matter. Paper presented at the World Congress of Families II, Geneva, Switzerland.
9. 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 Psychology, 33(2), 165-177.
10. 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 Psychology, 108, 307-314.
11. 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.
12. 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.
13. National Institute of Mental Health (2006). Depression. Retrieved from http://www.nimh.nih.gov.
14. 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.
15. 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.
16. Silk J. B., Altmann J., Alberts S. C. (2006). Social relationships among adult female baboons (Papio cynocephalus) I. Variation in the strength of social bonds. Behav. Ecol. Sociobiol. 61, pp. 183– 195.
17. Society of Clinical Child and Adolescent Psychology and the Network on Youth Mental Health. Retrieved from http://www.wjh.harvard.edu.
18. 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.
19. 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.
20. 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 America, 14(4), 707-726.

Caring for a child who is struggling with major depression can be a daunting task. Although at times it may seem overwhelming, there is hope and comfort in the gospel of Jesus Christ. We can gain an eternal perspective from the doctrine stated in The Family: A Proclamation to the World which states:

All human beings-male and female-are created in the image of God. Each is a beloved spirit son or daughter of heavenly parents, and, as such, each has a divine nature and destiny...In the premortal realm, spirit sons and daughters knew and worshipped God as their Eternal Father and accepted His plan by which His children could obtain a physical body and gain earthly experience to progress toward perfection and ultimately realize his or her divine destiny as an heir of eternal life (¶2 and 3).

Adversity: It is Temporary

We were created in the image of God. We are his children. We have the potential to be like him despite our earthly challenges. We chose to come to earth to "obtain a physical body and gain earthly experience" in order to become more like God and to be able to live with him again.

Since we are on the earth, we are susceptible to the effects of the Fall, meaning that we will experience "opposition in all things" (2 Nephi 2:11). Therefore, we are temporally vulnerable to earthly disease and illness. However, this life is a "probationary state" (2 Nephi 2:21), therefore, it is only temporary.

President Joseph Fielding Smith explained that "all spirits while in the [pre-mortal life] were perfect in form, having all their faculties and mental powers unimpaired. ... Deformities in body and mind are ... physical. Physical means 'temporal'; temporal means 'temporary.' Spirits which are beautiful and innocent may be temporally restrained by physical impediments".⁶

Despite the fact that we must experience opposition and difficulties, in 2 Nephi 2:25 it says that "Adam fell that men might be; and men are, that they might have joy." How can we possibly have joy when challenges in family life prove otherwise?

Finding Happiness Despite Adversity

Happiness in family life is most likely to be achieved when founded upon the teachings of the Lord Jesus Christ. Successful marriages and families are established and maintained on principles of faith, prayer, repentance, forgiveness, respect, love, compassion, work, and wholesome recreational activities (¶ 8).

"Wherefore, whoso believeth in God might with surety hope for a better world," the scriptures teach, "which hope cometh of faith [and] maketh an anchor to the souls of men, which would make them sure and steadfast" (Ether 12:4). Having a firm foundation in the gospel of Jesus Christ allows one to be strong during trying times. Jesus Christ taught the people of his time that he was the "light of the world" and that "he that followeth me shall not walk in darkness, but shall have the light of life" (John 8:12).³

Another way to find happiness despite obvious adversities is to remember that your suffering loved one needs help. As stated in the proclamation, "disability, death, or other circumstances may necessitate individual adaptation" (¶ 8). Satisfaction can come from finding ways to help a child deal with depression in ways that are unique to his or her temperament, preferences, and special needs.

You will be blessed for your efforts when you help. President Boyd K. Packer taught, "You parents and you families whose lives must be reordered because of a handicapped one, whose resources and time must be devoted to them, are special heroes. You are manifesting the works of God with every thought, with every gesture of tenderness and care you extend to the handicapped loved one. Never mind the tears or the hours of regret and discouragement; never mind the times you feel you cannot stand another day of what is required. You are living the principles of the gospel of Jesus Christ in exceptional purity. And you perfect yourselves in the process".⁶

Helping Those in Need

In Jerusalem, at the pool of Bethesda there was a "great multitude of impotent folk, of blind, halt, withered, waiting for the moving of the water.

"For an angel went down at a certain season into the pool, and troubled the water: whosoever then first after the troubling of the water stepped in was made whole of whatsoever disease he had" (John 5:2-4).

Today, getting help is much easier. But those who are suffering may not know how to help themselves out of the darkness that they feel. That is why it is important to seek out those who feel depressed in order to aid them in receiving "treatment from skilled health-care providers and love, care, and support from everyone else".⁴ Support from family members, spiritual leaders, friends, health professionals, and medication has the potential to really help and make a difference.

Although help is readily available, complete healing doesn't always happen, and persistent symptoms may not be cured. "If healing does not come in mortal life, it will come thereafter. Just as the gorgeous monarch butterfly emerges from a chrysalis, so will spirits emerge. That day of healing will come. Bodies which are deformed and minds that are warped will be made perfect. In the meantime, we must look after those who wait by the pool of Bethesda".⁶

Sometimes the process of healing and coping with mental illness can take some time. Do not give up on getting help or think that what you are doing isn't making a difference. The Prophet Joseph Smith said that "'all the minds and spirits that God ever sent into the world are susceptible of enlargement'".⁶ Every effort that is made to help with mental improvement is worth it.

The Sacred Duty of Parents

Husband and wife have a solemn responsibility to love and care for each other and for their children. "Children are an heritage of the Lord" (Psalms 127:3). Parents have a sacred duty to rear their children in love and righteousness, to provide for their physical and spiritual needs, to teach them to love and serve one another, to observe the commandments of God and to be law-abiding citizens wherever they live (¶ 6).

A misconception about mental illness is that all mental illness is caused by sin (Alma 36:12-15).⁴ We must realize that chronic mental illness can happen in any family. We now know that mental illnesses have multiple causes, including genetic and biological factors - factors we usually cannot control". However, it is important to teach children to obey the commandments of God in order to avoid depressive and discouraging feelings that come from sin.

It is through the atonement and through the teachings of Jesus Christ that individuals are able to overcome challenges.

Healing Comfort through the Atonement

The Atonement covers more than sin. It covers more than we can do for ourselves. It covers what we cannot control.

"As we rely on the Atonement of Jesus Christ, He can help us endure our trials, sicknesses, and pain. We can be filled with joy, peace, and consolation. All that is unfair about life can be made right through the Atonement of Jesus Christ".⁵

We can rely on Jesus Christ because He knows how to help us and comfort us. Alma 7:11-12 states that "he shall go forth, suffering pains and affliction and temptations of every kind; and this that the word might be fulfilled which saith he will take upon him the pains and sicknesses of his people ... and he will take upon him their infirmities, that his bowels may be filled with mercy, according to the flesh, that he may know according to the flesh how to succor his people according to their infirmities."

We can rely on the Savior the way that Joseph Smith did when he was in Liberty Jail when he had to endure affliction. "If thou be cast into the deep; if the billowing surge conspire against thee; if fierce winds become thine enemy; if the heavens gather blackness, and all the elements combine to hedge up the way; and above all, if the very jaws of hell shall gape open the mouth wide after thee, know thou, my son, that all these things shall give thee experience, and shall before thy good.

"The Son of Man hath descended below them all. Art thou greater than he?

"Therefore, hold on thy way ... for God shall be with you forever and ever" (D&C122:7-9).³

Be reassured that you are not alone in your suffering. The Savior literally knows how you feel. He knows how to help. It's comforting to both the mentally afflicted and their caregivers that Christ said, "Come unto me, all ye that labor and are heavy laden ... take my yoke upon you, and learn of me; for I am meek and lowly in heart: and ye shall find rest unto your souls. For my yoke is easy, and my burden is light" (Matt. 11:28-30). All can come unto Christ.

Keeping an Eternal Perspective

President Spencer W. Kimball noted, 'If we look at mortality as a complete existence, then pain, sorrow, failure, and short life could be a calamity. But if we look upon life as an eternal thing stretching far into the pre-earth past and on into the eternal post-death future, then all happenings must be put in proper perspective'".²

God's plan is perfect and has a purpose. We were created in God's image which gives us hope that we can be like him. The Fall allows us to choose how we will deal with our challenges. We can choose to have faith. We can believe in the power of the Atonement to help us endure those challenges that we now face. Living gospel principles that are founded on the teachings of Jesus Christ help us endure this temporary state well, and can prepare us to eventually become perfect and gain eternal life.

Written by Amy Soto, Research Assistant, and edited by Stephen F. Duncan, Professor, School of Family Life, Brigham Young University.

References

1. Fox, D. & Fox, J. (2001). Easing the burdens of mental illness. Ensign.
2. Kimball, E. L. (1982)(Ed.). The Teachings of Spencer W. Kimball. Salt Lake City: Bookcraft.
3. Light in darkness. Ensign, June 1998, 16.
4. Morrison, A. B.(2005). Myths about mental illness. Ensign.
5. The Church of Jesus Christ of Latter-day Saints (2004). Preach my gospel. Salt Lake City, UT: Intellectual Reserve, Inc.
6. Packer, B. K. (1991). The moving of the water. Ensign.