Depression in Children: Symptoms, Causes, Diagnosis and Treatment

Introduction

Image: Deborah 1963A few years ago, my mother unearthed some pictures of me as a baby which I had never seen before. One showed me at about eight months old, crawling on the grass of Golden Gate Park. I was looking directly at the camera, my tongue sticking out of the corner of my mouth, and I was laughing. My face was lit from within, and looked happy, confident and even a little mischievous.

I was absolutely transfixed by that photograph for days. I would continually take it out of my wallet and stare at it, torn between laughter and tears. For a while I couldn’t figure out what it was about the picture that drew me. Finally it hit me; this was the only picture of myself as a child that I had seen which showed me laughing. All the photos I had ever seen depicted a child staring solemnly or smiling diffidently, but never laughing. I looked at the Golden Gate Park picture and wished that I had remained that happy, and that depression had not taken away my childhood.

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Recognizing Depression in Children

Image: Boys in the Pasture by Winslow Homer
Boys in the Pasture by Winslow Homer

Most of my childhood was blighted by clinical depression. After I was diagnosed at age 27, my parents told me that they knew something was wrong, but didn’t know what. Not surprising, since I grew up in the 1960s and 70s, and depression in children wasn’t even considered a possibility until the 1980s. But even today, years after the medical community acknowledged that children could be clinically depressed, it is not easy to recognize.

There are a couple of reasons why this is the case. Although more and more people are becoming aware that clinical depression is not a mood but a disease, there are still plenty of people who don’t realize that. So while they might be able to find reasons why an adult might be depressed (trouble with the person’s job or marriage, financial difficulties, etc.) there are generally few reasons that a child might be displaying a sad demeanor, barring major loss of some kind or a dysfunctional home life.

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10 Ways to Help When Your Child is Depressed

Image: Calm Morning by Frank Weston Benson
Calm Morning by Frank Weston Benson

Being a parent is rewarding, but tough. One of the hardest things to deal with is your child’s pain. If your child is depressed, you probably are scared and feel helpless. Even I, with years of writing about and researching depression, have felt this way in the face of my son’s depression. There are some ways in which you can help your child, though.

1. Recognize that clinical depression is a disease.

Internalizing this fact will help your child in two ways. One, it will hopefully keep you from blaming yourself or your child. This is no one’s fault. Second, if you think of depression as a disease instead of a choice your child is making, you won’t say anything thoughtless like, “Why don’t you just pull yourself together,” “But what do you have to be depressed about?” or “Stop feeling sorry for yourself.”

2. Don’t freak out.

This will definitely not help your child. Clinical depression can be successfully treated more than 80% of the time. As long as your child has a good doctor and supportive parents, he or she has a very good chance of recovering. Notice that last part – while everyone with depression really needs a good doctor, supportive parents are absolutely critical for a child with depression.

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Diagnosing and Treating Dysthymia in Children: When Depression is Chronic at an Early Age

Portrait of a Child by John Singer Sargent

When I was finally diagnosed with depression at age 27, after twenty years of suffering from one type of depressive disorder or another, it was because I was going through a major depression at that particular time. It was only the third major depression I had experienced, and all three had occurred after the age of twenty. For all their ferocity, however, I don’t feel that the major depressions did the most damage to my social life, the direction my life took and my psyche. Without question, that honor is reserved for the dysthymia that had been a part of my life, and a part of me, since I was seven.

A few years ago, my mother found a picture of me as a baby crawling on the grass. For days, I couldn’t figure out what was so odd about the picture. It finally dawned on me that I was grinning in it, and with the exception of school pictures, I had never seen a photo of myself with anything more than a tentative half-smile. For the most part I looked serious, detached and sometimes, sad.

The psychiatrist who first told me, “I believe that you’re suffering from depression” might have been a bit surprised at how relieved I was. But for me, the diagnosis was a relief. I had known most of my life that something was wrong with me. I was thrilled that this something had a name and could be treated.

My psychiatrist felt it was clear that I had been suffering from depression, in one form or another, since I was a child. It may seem hard to believe that someone could go undiagnosed for so many years, but there were a couple of factors at work. The first was that I grew up in the 1960s and 70s. No one believed back then that children could suffer from depression. My parents did know that something was wrong with me, but they had no idea what it was or what to do. More importantly, however, my depression went unnoticed because I suffered from dysthymic disorder, not major depression.

Major depressive disorder (MDD) and Dysthymic Disorder (more commonly known as dysthymia) do have a lot in common. Both are marked by a low mood, low self-esteem, fatigue or low energy, indecisiveness and hopelessness. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) “Dysthymic Disorder and Major Depressive Disorder are differentiated based on severity, chronicity and persistence.“

In other words, MDD and dysthymia are like rain storms. Both of them drop water from the sky. But if major depression is like a violent thunderstorm, like a thunderstorm it usually passes fairly quickly (although it may seem like an eternity). Dysthymic disorder is like a steady drizzle under a gray sky that goes on and on for days.

Dysthymia is considered early onset dysthymic disorder (EODD) when the symptoms begin before the age of 21. Unfortunately, EODD can be very tricky to spot. After all, if a child has had EODD from an early age, before her personality has been fully formed, how does she (or her parents) know that she suffers from a depressive disorder?

But diagnosis and treatment of EODD is absolutely essential. A child who grows up under the influence of a depressive disorder is going to be at a tremendous disadvantage, not to mention how miserable his childhood is going to be.

Even if I had suffered from major depressions during my childhood, they would not have as much damage as the dysthymia. The drizzle and gray sky that went on day after day, eroding my sense of self and keeping me from being anything other than a spectator in life, was the real devastating force. And under that gray sky I made a lot of important decisions that set me on certain paths: what interests to develop, what type of friends to choose, how to prioritize school and play, where to go to college, what to study in college and who to date. Without question, many of those decisions would have been different if I didn’t have EODD.

Don’t just assume that your child is negative, apathetic, anti-social and lacking in ambition. It’s possible that EODD has been a part of his life so long that the symptoms have woven themselves into your (and their) perception of his personality. If your child has been exhibiting any of the symptoms of depression, even in a milder form, it is crucial that you consult a professional.

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Bullying and Ostracizing Tied to Depression and Anxiety in Special Needs Children

Children with special needs have always been a favorite target for bullying and teasing. It’s easy to see why – they’re different. Being different is generally not seen as a good thing when you’re a child in elementary or middle school.  Except for the occasional rebel, most children don’t want to be stand out from the crowd. Certainly, no child wants to be different because they have special needs.

In a small study presented at the Pediatric Academic Societies annual meeting on April 29th, researchers claim that children with special needs who are bullied or shunned by their peers are at a greater risk for anxiety and depression. And surprisingly, it is this, more than any aspect of their disability and its challenges, that was a predictor of depression and anxiety.

The researchers recruited 109 children from ages 8 to 17 during a routine visit to their physician at a children’s hospital. The children and their parents or guardians completed a questionnaire that screens for depression and anxiety, and the children also completed a questionnaire that asked them about bullying and exclusion from their peers.

The patients in the study had one or more conditions such as: attention-deficit hyperactivity disorder (39 percent); cystic fibrosis (22 percent); type 1 or 2 diabetes (19 percent); sickle cell disease (11 percent); obesity (11 percent); learning disability (11 percent); autism (9 percent); and short stature (6 percent). Several children had a combination of these conditions.

A couple of years ago I was the unhappy observer of this phenomenon. My son entered first grade a confident, outgoing child who had no trouble making friends. His kindergarten teacher had been wonderful, but his first grade teacher constantly scolded and berated him for his ADHD behaviors. His classmates followed her lead, as children often do, and began to both tease and shun him.

I saw his self-esteem sink lower and lower as the school year went on. He became despondent and started making statements like, “I hate myself.” We weren’t able to get him moved into another teacher’s class, so we just counted the days till school ended.

Fortunately, his second grade teacher was a completely different kettle of fish. She knew of the difficulties he had had in first grade, and made it a point to praise him in front of other children, and when she had to discipline him for any behavioral issues, she didn’t make it personal.

My childhood depression was definitely exacerbated by the bullying and ostracizing that I was the subject of. It’s important for educators and parents to be aware that special needs children may be at a particular risk of depression and anxiety due to their circumstances. While it may not be possible to put a stop to a child being bullied and excluded, intervention and treatment with therapy can diminish the impact and long-term emotional damage.

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