Identifying Depression in Children & Adolescents:
A case of the Moodies or More?
by Doris E. Shafombabi,Ph.D.
Though previously considered an adult health
problem, depression affects many young people today. An estimate provided by the
Mayo Clinic indicated that 1 in every 33 children, and 1 out of every 8
adolescents are victims of depression. Growing up in the 21st century is much
more difficult than it was in the past. A definition of depressions should be
offered to put things in proper perspective:
Depression can be defined as a persistent experience
of sad or irritable mood as well as loss of the ability to experience pleasure
in nearly all activities in life. Major Depressive Disorder, sometimes called
clinical depression, is different from having a bad day or a bad week. It is
different from sadness due to grieving the death of a loved one.
I have underscored the word persistent because
children and teenagers may go through periods of "moodiness" related to social
crises that are predictable during that developmental period. Being rejected by
a member of the opposite sex or not getting picked for a team sport are common
examples of things that could bring on a case of the "moodies" for your child.
But a true depression doesn't go away quickly as soon as another desired
activity becomes available. It is pervasive and creeps into every area of life
so that the young person is not able to see anything good or hopeful about any
aspect of life.
Parents and other community caregivers should be
alert to significant behaviors that are not just passing moods. While there is
no patented formula for determining the severity of symptoms, their are risk
factors to consider. The following Risk Factors for depressions were noted in
the Surgeon General's Report on Child Mental Health in 2000.
- persistent sad and irritable mood
- loss of interest in activities once enjoyed
- significant change in appetite and body weight
- physical signs of agitation
- excessive lethargy and loss of energy
- feelings of worthlessness and inappropriate guilt
- difficulty concentrating
- recurrent thoughts of death or suicide (NASP 2003)
The symptoms may manifest in a number of ways, so
don't expect classic withdrawal to be the only tell tale sign. There may be
outbursts, shouting, unexplained irritability or crying. Children and
adolescents who are depressed, often show extreme sensitivity to rejection or
school failure, even if others in their peer group have failed. Change in school
performance (negative) and frequent absences from school or class may also be
symptoms. Initiating or increasing drug or alcohol use are also symptoms of
concern. Now before you become overly concerned about things you've seen on this
symptom list, be aware that the presence of one or two symptoms does not mean
your child is clinically depressed. But a pattern showing many of these
characteristics could be worth investigating with a mental health professional.
Depression is treatable just like diabetes or
arthritis. The earlier the treatment is started, the better the outcome for
stability and a normal life. A complete treatment plan could involve
psychotherapy (talk therapy) and psychiatric medication. As the individual
improves, medication may be reduced. Many African American parents are negative
towards the issue of medication. Some have had bad experiences when dosage was
not carefully monitored and side effects were severe. In some cases medication
may not be needed. But where symptoms have become severe, such as children who
have suicidal ideas, or can no longer function normally, it could be just as
dangerous to refuse anti-depressive medication as it would be to refuse insulin
for a diabetic child. Every parent needs to collaborate with their psychiatrist
on this issue and give frequent feedback on how your child reacts to the
medication. Abruptly stopping medication without checking with a doctor is not a
solution. Always look for a doctor who is receptive to your questions and
doesn't mind phone calls to receive feedback on the effects of medication.
We have highlighted some of the risk factors and
warning signs of depression so we should also underscore the fact that there are
Protective Factors that seem to build a "buffer" against depression. Protective
factors often cited by mental health professionals are:
- Good communication- keeping lines of communication open between the child and adults in their lives.
- Family/community Connections- child has a sense of being accepted and connected to a unit of individuals. This gives a sense of belonging.
- Strong Verbal Problem Solving Skills-developing skills of negotiation and compromise helps to prevent extreme behaviors.
- Ability to delay gratification- is important for developing flexibility and skills of accommodation that are required in life.
To this official list of protective factors, I would
add Curbing Competition. I am not advocating that our young people should not
strive for excellence in what they do. However, that striving sometimes becomes
obsessive and reaches fever pitch. Parents and other caregivers would do well to
teach children that they are not failures if they don't place 1st in everything.
Stressing giving the best effort possible is the alternative message that may
protect children from feelings of depression and worthlessness.
The most important thing to remember if you feel
your young person has symptoms of depression is to get help. Ignoring it will
not make it go away. You would not ignore a fever that went on for even a few
days. Depression is a health issue. It is treatable and there is increasingly
less stigma attached to receiving treatment. Don't let pride or shame keep you
from getting your child help before the situation turns into a crisis that you
really cannot manage.
Doris E. Shafombabi,Ph.D.
Nationally Certified School Psychologist
Philadelphia, PA
depsych@yahoo.com
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