When a child is depressed

Fortunately, in many cases, those “blues” are temporary, and dissipate without |causing any harm to the psyche. Depression, though, is very different and doesn’t only affect adults but also |children, some of them as young of pre-school age. 

In the West, it is estimated that about seven-per-cent of children suffer from depression. In Thailand, studies on this topic are not very common though a recent study |conducted among secondary school children found that between three and five per cent of the students displayed symptoms related to depression. It is higher among |secondary school students or teenagers who are already struggling with the transition to adulthood. 

Symptoms of depression are quite similar across cultures and age groups. In younger kids, when they are unable to verbally communicate their feelings, depression presents as behavioural problems. If a child doesn’t play or talk as much as she used to, isolates herself from her peers, has nightmares and disturbed sleep patterns, loss of appetite, and/or tears and tantrums, it is a signal that something might be wrong. While all children have occasional bad days and also respond negatively to incidents or events in their lives, any long-term change of behaviour is a cause for concern. When such behaviour becomes persistent, i.e. lasts longer than 2-4 weeks, it is likely to be a signal of mental problems.

Among school-going children, depression may present as worsening academic performance, avoidance of homework, difficulty in working with peers, arguments and fights with friends. It may also present as sadness or aggression and the child may act out. Among teenagers, aggression is the more common sign of depression, but it may also present with isolation, lack of interest in hobbies and studies, unfinished homework, and other ways.

As always, early diagnosis leads to a quicker recovery. Parents and guardians can support early diagnosis by closely observing their children, and allowing them to share their thoughts and feelings regularly. This will help identify problems early and support children through them. If you notice any changes in the child’s behaviour, talk to them about it. Let them know they are free to talk to you or to a professional. Teenagers, especially, may find it very difficult to seek help. We need to tell them that seeking help doesn’t mean one is weak, it is a healthy way to deal with difficult feelings and situations.

While most kids are brought in by their parents, some are brought on the recommendation of teachers, usually for emotional problems, and acting out. For a clear diagnosis, the doctor will interview the children as well as their parents, teachers and friends. Sometimes, a questionnaire is sent to the school and the teacher sends her responses back. This helps form an overall picture of their life, and the changes over time. Though a questionnaire, or even psychological tests are sometimes used for diagnosis, the interview and detailed history taking are key to a proper diagnosis.

The main treatment for depression in children is a combination of psychotherapy and medicines. Cognitive Behavioural Therapy (CBT) is very useful in helping children and adults overcome depression; though it takes a little time to begin showing improvements. Parents and family members are also counselled to support the child.

If depression includes suicidal thoughts and urges, loss of significant function, then urgent help is required. In such cases, medicines are used for immediate relief and psychotherapy is continued over a long period to help them. Sometimes, anti-depressants may be used for short periods among children. Once they have clinically improved, it will be discontinued.

In adults, depression is mostly caused by a chemical imbalance in the brain. In children, it may be directly related to their relationships. Relocation, divorce, death of a loved one, or loss of some kind, could trigger depression in children. 

Among children with mental health issues, co-morbidities are quite common. A child with ADHD may have other problems like anxiety disorder, Obsessive Compulsive Disorder, learning problems, dyslexia, and so on. Such children face many problems such as learning failure, relationship problems, bullying, and peer group problems, so they could be at higher risk of depression. If parents suffer from depression, then children are at higher risk of depression. 

Depression affects both the emotional and social life of children. Over the long term, depression can lead to relationship problems, conduct disorders, low achievement, and risky behaviour such as drunk driving, drugs, and stealing. Depressed children need a quick diagnosis and support as early as possible.

 

DR PUNNADA SULAIMAN is a Paediatric Child and Adolescent Psychiatrist at Samitivej International Children’s Hospital, Sukhumvit. Call (02) 711 8236-7.

 

 How to protect your child from depression

Spend time with your children

Let them share their life with you

Make time to listen to them

Acceptance and listening are key

Do not judge or advise them

Tell them that you will listen to them, |and support them