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January 27, 2013

Childhood depression is real

Reuel S. Amdur

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Depression is not just an adult illness. Children can also suffer it, even as young as kindergarten. And when we speak of depression, we do not mean just the occasional spell of pouting or a pique of temper. We mean a condition that is persistent, long-term, and intense. It interferes with normal functioning, such as in school and in family relationships. More likely than with adult depression, childhood depression can be expressed in anger and defiance, not just in withdrawal and silence.

What is childhood depression?  There are different kinds of depression, but one that deserves special mention is bipolar disorder, previously called manic-depressive disorder.  It combines depression and mania.  As well, depression can occur with other illness, for example anxiety, obsessive-compulsive disorder, attention deficit disorder (ADD), and attention deficit hyperactive disorder (ADHD).  Older children may be into drugs and alcohol.

A depressed child is apt to complain about being unhappy all the time.  Lots of crying is typical.  Such a child will often have sleep problems—too much, too little, trouble getting up.  School work often begins to suffer.  There may even be a wish to die.  In more dangerous cases, a child may even have a plan for suicide. 

Why do children become depressed?  Human behavior, including child behavior, is a combination of heredity and environment.  Let’s take a look at heredity.  To a varying degree, inheritance plays a role.  A wag once remarked that parents inherit mental illness from their children.  Well no, but it works in the other direction.  A family history of depression or other mental illness can be a causative factor in depression.  Yet, there is no certainty that the child will inherit the condition, and without the family history of mental illness a child may still become depressed.

Depression can sometimes be the consequence of medicines for other problems.  Because depression is characterized by chemical changes in the brain, it can occur in adolescence due to hormone activity.

Then there are environmental conditions that may occur.  Child abuse, severe deprivation, neglect, or family conflict will sometimes trigger depression.  Or there can be a combination of hereditary and environmental factors, for example a family breakdown on top of a genetic predisposition.

The big question is what to do about it.  To begin, there is one approach that does not work—punishment.  If you think that your child might be suffering from depression, you and your child need professional help.  There are a few places to start.

If you have a family physician, you could begin there.  He might refer you to a pediatrician or a psychiatrist, both paid for under Medicare.  You might also start with school.  Some school systems have special health services including nurses, social workers, psychologists, and even psychiatrists in some cases, who might be able to point you in an appropriate direction.  Should you find that you need to seek resources not covered under Medicare, you might need to consult a psychologist or social worker in private practice.  However, not all health professionals will be able to assist you with the problem.  There is specialization and focus in all these professions.

Another approach would be to consult an agency in child protection such as a children’s aid society or an agency providing family services, either to provide the help directly or to help you locate what you need.

Treatment for your child could take a number of different forms, for example medication, either alone or with psychological treatment.  One common treatment for depression is cognitive behavioral therapy, which attempts to change maladaptive thinking in order to change behavior and feelings.  Play therapy, especially for younger children, is another option.  Other kinds of psychotherapy may also be used, depending on the particular evaluation of the child and the competencies of the therapist.

Where you go to get the help you need will vary depending on your financial resources and where you live, but don’t just hope the problem will go away.  It probably will not, not some time soon and quite likely not at all.

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