Childhood depression is a very true but sometimes elusive illness that affects the young today. We consume a peruse at what it actually means and how unity and relieve in the family can back fight its fill over a child.
At the recently concluded Asia Pacific Suicide Prevention Convention 2006, we learnt a few startling facts about children and suicide. For example, in a worldwide witness, 7.3% to 38% of the children surveyed demonstrated suicide ideation, which is the belief of wanting to waste themselves. In Singapore, conclude to 4.7% of children entertain this morbid belief. While the figure may be alarming, there is no need to fear as it is actually not exclusive to contemplate about suicide.
Ask anyone in the street if he had opinion about suicide before and the reply will most probably be a `yes’. Thinking about something as serious as killing oneself and actually doing it are two different matters. Out of all childhood suicides, approximately 23.5% are associated with mental illness such as depression, schizophrenia and others. Seeing the numbers and concept that depression is one of the key causes that drive our young to suicide. It is time we understand a exiguous more about this elusive illness called “Childhood Depression”.
The Definition of Childhood Depression
In a 2004 article published by the American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/factsfam/depressd.htm, childhood depression is defined as “an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.”
Feelings of depression are represented in the forms of mood, physical, mental and behavioural changes in a child. Dr Ken Ung, Senior Consultant Child, Adolescent & Adult Psychiatrist & Psychotherapist at Adam Road Hospital describes the signs of childhood depression as persistent “irritability or loss of interest, loss of appetite and weight, dreadful sleep, lethargy, headache, stomach hurt, loss of concentration, preoccupation with self-harm or suicide, refusal to go to school, increased temper tantrums and antisocial behaviours such as smoking, drinking and running away from home. Any combination of these changes that lasts for more than two weeks could spell a child falling into depression and warrants a closer eye.
Many of the symtoms listed are actually applicable to both adults and children but there are telling differences. Age, in a non-categorical plan, does design a inequity in the presentation of depressive behaviour. “We don’t tend to categorize (childhood depression) in terms of age groups,” says Dr Ung, ” but we can generally say that adolescent depression tends to peer more like adult type depression, whereas, childhood depression can be more `a typical’ perhaps manifesting in bodily wretchedness and behaviour changes. The closer the age of a child to adulthood – the more we can request to search for an adult-type depression.
Types of childhood depression
There is no sure categorization of childhood depression. According to Dr Ung, “Typing depression is notoriously difficult and fashions near and go. We now tend to type it according to severity i.e. tranquil, moderate and severe. Sometimes, we expend the term `reactive’ depression to denote the type that is due to a reaction to some stress (such as the sudden passing of a loved one) . Although very rare in children, `psychotic’ depression refers to the presence of psychotic symptoms, which are symptoms that point to that the person has lost touch with reality, i.e. hearing voices, believing irrational, bizarre or wonderful thoughts.”
Another childhood psychiatry expert, Dr Sharon Chan of Sharon Chan Child Guidance Clinic, who has been practicing child psychiatry since 1988 concurs, “I am not clear that there is such a categorization (of childhood depression) .. because the entity is calm controversial, it follows adult depression patterns (sic) – chronic, single episode or recurrent, adjustment disorder, bipolar etc.”
Bipolar disorder, also known as manic-depression, is a type of mood disorder marked by obscene changes in mood, energy levels and behaviour. Symptoms can launch in early childhood but more typically emerge in adolescence or adulthood. Children with bipolar disorder usually alternate expeditiously between extremely high moods (mania) and extreme moods (depression) . These expeditiously mood shifts can effect irritability with periods of wellness between episodes, or the young person may feel both extremes at the same time. Parents who have children with the disorder often represent them as unpredictable, alternating between aggressive or comic and withdrawn.
Stages of childhood depression
According to a Harvard Medical School Publication, ” The record changes with age. Up to age three, the signs (of childhood depression) may include feeding problems, tantrums, and lack of playfulness and emotional expressiveness. AT ages 3-5, poor children may be accident-prone and subject to phobias. Even before age 5, they may exhibit signs of self-reproach by apologizing unnecessarily for minor mistakes and transgressions like spilling food or forgetting to set aside clothes away. Children of early school age (6-8) sometimes indicate depression with vague physical complaints and aggressive behavior. They may cling to their parents and avoid unique people and challenges. At ages 9-12, some current symptoms are morbid thoughts and lying awake worrying about schoolwork. By then, children have enough luminous capacity and social thought to believe about reasons for their depression, and they may blame themselves for disappointing their parents.”
When asked for his concept on this analysis, Dr Ung says, ” I reflect that this is a generous guide by and substantial. Nevertheless, this is merely a guide and should not ne taken as dwelling in stone. For example, a 12 year mature boy may display signs of depression by aggressive behaviour and phusical complaints.”
For Dr Chan, “Depression before the age of six is very rare. In fact, I do not mediate that there is general agreement that it exists. In a young child, the well-liked emotional condition is apprehension, not so powerful depression. From six years onwards, I would agree with the given description.”
Children under stress, who experience loss, or who have attention, learning, conduct or alarm disorders are at a higher risk for depression. Depression also tends to race in families.
Lena’s experience
Lena (not her true name) is a 17 year-old student who recently suffered a relapse and fell into depression once more. Lena has been haunted by depression since the age of 12. Once again, she has no appetite for food, is feeling plain and confused, lost alot of weight and is isolating herself from others.
Lena’s mother, 49 year mature clerical staff Sonia (not her actual name), recounts her daughter’s experience with depression, ” It all started after Lena’s father passed away. At first, nothing seemed substandard. SHe was very dismal but she did not shed a walk at his funeral. It was a year after that she started to miss him badly. This was compounded by being bullied in school and stressed by schoolwork. Always a mild child, Lena became even more withdrawn. She had exertion sleeping, would wail for no reason, refused to eat and talked about hurting herself.”
Seeing her daughter’s condition, Sonia brought Lena to a Polyclinic which referred them to a psychiatrist at a hospital. Lena was given antidepressants and started having regular therapy sessions with psychiatrists and counsellors. She tried to follow their advice of not thinking negatively, to focus on developing her interests and to do a timetable for each day. Everyday was a struggle but she managed to recover with time.
“She said she liked the counselling sessions where she could talk to someone about her feelings and problems.” say Sonia of Lena’s reaction to treatment. “Slowly, she got better to the point that she was more ecstatic and could laugh and giggle like a normal young girl. She even enrolled in yoga classes that helped her gained fitness and to relax.”
For Sonia, being supportive of Lena through the down times and being sensitive to her needs are her priorities. “I told her that her health is more well-known than studies. When I’m at work, I try to call her and talk to her whenever I can. She will narrate me things like, ” Mummy, I’m useless and I don’t know what to do,” and I will try to abet her to glance on the radiant side, not to mediate too remarkable..etc.. I have to try to give her lots of treasure, my beefy help and attention.”
Treatment
What most doctors agree on is that medication should not be outmoded unnecessarily on children and that when veteran, it should be accompanied with the proper counselling and therapy. ” It’s engaging that new studies have not been able to present that antidepressants work in children. This could be because children are not mini adults and what works for adults may not work for kids,” says Dr Ung.
There is also shrimp research of how antidepressants work on children and prescription drugs may increase the risk of self-harm for some vulnerable ones. However, Dr Ung adds, “To sustain a perspective on things, the increase of antidepressants prescriptions is miniature, probably around 2% in affected children given indolent medications (placebos) to about 4% of those on active medication.”
Counselling, it seems, plays the key role in helping children recover from depression. “A obedient counsellor will try to bag information from parents, child and school and will try his or her best to co-ordinate the counselling to incorporate all these parties. Cognitive-behavioural therapy is one of the commonest forms of counselling techniques traditional nowadays – it seeks to change the negative thoughts of the child to more realistic and sure ones and also t back the child earn action/behavioural changes that will relieve seize the mood,” adds the psychiatrist.
Cyber HelpWith the computer-savvy generation of today, some children or teens may settle to remark their thoughts and feelings in cyber area. http://www.depnet.com is a community website launced in March to provide information and counselling services for depression. A `diary’ services allows members to post daily updates on their mental and emotional experiences while a `letterbox’ service provides them with an opportunity to ask questions to a panel of experts. Most importantly, a service like this seeks to educate the public on the existence of depression and assist those who are melancholy to observe back. Following examples, unhappy children may be inspired by a strong sense of community to step out of a possible spot of isolation. Adults too, can visit to derive more information and advice before deciding how best to behold attend.
belief is Key.
“Sometimes, uncomfortable children are mistakenly labelled as idle, stubborn or difficult,” says Dr Chan. This is largely due to a lack of knowledge and view on the adults’ portion. Children, unlike adults are dependent on their families and guardians to identify their troubles and peer befriend.
Dr Ung adds,” One well-liked misconception is that the child is excited. This is totally not so. Another is that the child is `weak’. Some famed people who are strong of character and have suffered depression include Abraham Lincoln. Another misconception is that it is incurable or that the child is `bad’. Depression is a very treatable condition and the change of behaviour from depression should not be improper for `badness’.