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Childhood Depression
A note about clinical diagnosis: There is considerable disagreement about the meaning of psychiatric diagnoses. Basically, a diagnosis refers to a pattern of behavior; some of these patterns have been very closely correlated with discernible biochemical or neurological markers, while others have not. For example, we see clear biological differences in the blood chemistry of certain kinds of depressive people, while there is (so far) no such biological basis for obsessive-compulsive behavior.
Also, psychology and psychiatry evolved in a time when the medical model of behavior was the dominant view. Therefore, diagnosis came about as a way of attempting to identify what the patient “had,” as if it were a disease like measles, mumps, or cancer.
Nowadays, we are more aware of social conditions which might induce various patterns of behavior, so we aren’t quite as definite that there is something “inside” a person that makes them act the way they do.
But, if we didn’t have some way of categorizing patterns of behavior, we’d be starting from scratch each time someone came to see us, and would have no basis on which to decide what kind of treatment could be effective, whether medication might help, etc. So diagnoses serve some purpose, even though the idea of categorizing a human being is objectionable to us. The important thing is, to see each person as an individual (in fact, to “start over” every time a new client walks in the door), and to use the diagnosis as a useful but not all-defining tool to help make sense of things- as far as it goes.
The discussions of clinical patterns/syndromes/diagnoses are presented on this website in that spirit.
*For an interesting discussion of the realities of diagnosis, see The Dictionary of Disorder: How one man revolutionized psychiatry, by Alix Spiegel in the January3, 2005 New Yorker magazine.
Depression in Children
Not only adults become depressed. Children and teenagers also may have depression, which is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.
About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.
The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.
If one or more of these signs of depression persist, parents should seek help:
•Frequent sadness, tearfulness, crying
•Hopelessness
•Decreased interest in activities; or inability to enjoy previously favorite activities
•Persistent boredom; low energy
•Social isolation, poor communication
•Low self esteem and guilt
•Extreme sensitivity to rejection or failure
•Increased irritability, anger, or hostility
•Difficulty with relationships
•Frequent complaints of physical illnesses such as headaches and stomachaches
•Frequent absences from school or poor performance in school
•Poor concentration
•A major change in eating and/or sleeping patterns
•Talk of or efforts to run away from home
•Thoughts or expressions of suicide or self destructive behavior
A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way to feel better.
Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.
Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.
From: THE DEPRESSED CHILD, American Academy of Child and Adolescent Psychiatry No. 4 (10/92) (updated July 2004)
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