Depression is no longer a thing for the adults. But are you doing anything about it?
PSYCHOLOGISTS and psychiatrists now agree that depression is as much a reality for some children as it is for adults. Though there aren’t any current figures available to indicate the rate or incidence of depression among children in Pakistan, clinical experience shows greater incidence of children and adolescents being diagnosed with serious depression. It is therefore important for parents and other caretakers of children to be cognizant of some basic information about childhood depression so that they may be able to detect normal sadness from serious depression in children.
The following information is but a brief overview of depression in children, along with some causes and its treatment.
MANIFESTATION OF DEPRESSION IN CHILDHOOD OR ADOLESCENCE: With some exceptions, most symptoms of depression that are generally present in an adult diagnosed with clinical depression are also present in a depressed child. Some typical presentations of clinical depression in a child may include.
* Depressed or irritable mood. Children are more likely to manifest the latter.
* Sleep difficulties.
* Significant and unexplained weight gain or weight loss, or failure to gain weight as expected for a given age.
* Decrease or decline in activities previously engaged in or enjoyed, for example, social withdrawal or failure to engage in peer activities.
* Motor slowing or hyperactivity.
* Reported or noted lethargy or low energy.
* Feelings of low self esteem or worthlessness.
* Difficulties in concentration; may be evidenced by decreased academic performance.
* Death wish or thoughts of harming or killing self.
If a child shows any of the above signs persistently, especially if these behaviours are a change from her/his previous functioning, the caretaker should have the child assessed by a psychologist, a psychiatrist or a paediatrician familiar with child psychiatry.
It should be noted that the presentation of the above symptoms may vary depending upon the child’s developmental stage. Thus while an infant may be more quiet and lethargic, may show failure to thrive, look sad and appear socially non-responsive, a preschooler is more likely to show increased anger and tantrums, variations in mood, and increased clinginess to parent. Similarly, a school going child of six to eight years may show sleep difficulties, behavioural problems, increased noncompliance, decreased academic performance, or may develop fears, phobias or separation anxiety. Children older than nine years of age are able to express their sad or hopeless feelings. Children of this age group are also more likely to think about or act on suicidal thoughts.
Preadolescents and adolescents are also more likely to engage in self-destructive activities, such as alcohol or substance abuse, than younger children. Hence the manifestation of depression in the young varies depending upon her/his age and cognitive, emotional and interpersonal abilities.
CAUSES OF CHILDHOOD DEPRESSION: There may be a myriad of factors involved in the development and persistence of depression among children or adolescents. More often than not, it is usually a combination of different factors that plays a role in depression. Broadly speaking, these factors may be classified as into individual, familial/interpersonal and biological.
Individual factors may include social skills leading to interpersonal difficulties, difficulty in self-control or self-regulation of emotions, resulting in inappropriate expressions of feelings or behaviours, low self-esteem, or a tendency for negative thinking and negative appraisal of self, others or events.
Additionally, presence of another disorder such as Attention Deficit Hyperactivity Disorder or Learning Disorders may also lead to depressive symptoms.
Familial or interpersonal factors related to depression may include familial or parental discord, experiencing or witnessing emotional, physical or sexual abuse; poor or irregular parenting styles or insecure parental attachments, to name a few. Other interpersonal events such as deaths, separation, divorce or any other sudden changes or losses may also lead to depression in children.
Finally, biological factors such as heredity may predispose a child to developing mood disorder. Thus a child with family history or depression, specially if in one or both of the parents, has a higher likelihood of developing clinical depression at some point in her/his life, compared to a child with no family history for depression.
Biological causes of depression may also include dysfunctions of the neuroendocrine system such as growth hormone abnormalities or thyroid dysfunction.
As mentioned earlier, the above mentioned factors are often interrelated. For example, a child with a depressed parent (genetic disposition) may experience that parent as emotionally unavailable, ineffective in setting limits, or perhaps emotionally or physically abusive (familial, interpersonal stresses).
Such a child may develop low self-worth (due to lack of positive interaction with parent) and poor social skills (due to lack of an appropriate parental role model) making the child susceptible to depressive symptoms.
TREATMENT: In line with the different factors mentioned above, treatment of childhood depression should ideally address all the different elements that may have a role in the child’s mood disorder. If the depression is secondary to another disorder, such as Attention Deficit Hyperactivity Disorder, or a Learning Difficulty, then the primary disorder must be addressed and treated.
Other factors such as poor social skills, poor regulation of mood or behaviour, or negativistic thinking about oneself and/or others, may be addressed in individual counselling. A clinical psychologist or child psychiatrist may help the child develop more appropriate social or self regulation skills and more effective coping strategies.
Inclusion of family, particularly the parents, is always important when working with the young. Sessions with the family may include educating the family about the child’s disorder, facilitating the parents in identifying and modifying familial patterns that may be contributing to the child’s depression, and/or providing the parents with effective parenting skills.
For moderate to severe depression, medical interventions such as anti-depressants may also be necessary in addition to individual and family counselling.
Clinical depression is a terrible disease, no matter what age group it afflicts. The positive side of it though, is that it is a treatable disease. Parents, other caretakers, and health providers should be familiar with behavioural and emotional manifestations of depression in children. Any clinical signs should warrant a consultation with a professional. Timely recognition and intervention for the depressed child means greater chances of restoring the laughter and the hope that we all associate with the word “childhood”.
Depression is no longer a thing for the adults. But are you doing anything about it? 
