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"Childhood and adolescent depression is a significant issue in this
country," says Cleveland Clinic pediatric psychologist Vanessa Jensen,
Psy.D. The problem can range from mild to severe, and at its worst, can increase
a teen’s risk of suicide.
The American Academy of Child & Adolescent Psychiatry (AACAP) estimates
that about 5 percent of children and adolescents in the general population
suffer from depression at any given time. The incidence of depression starts to
climb between ages 7 and 10, Dr. Jensen says, but can occur as young as 2. It
peaks in adolescence, from ages 14 to 16, at the same time becoming more common
in girls.
What depression in kids looks like
"The ‘blues’—or sadness—is a normal, transitional reaction to a
serious event, such as a loss. For instance a breakup with a girlfriend or
boyfriend, a best friend moving away, or a death," says Dr. Jensen.
"Depression is more intense, more persistent, and impairs a child’s
ability to function in day-to-day life." She says that loss can precipitate
depression. In such cases, a child doesn’t "bounce back" emotionally
after what would be considered a normal amount of time. Depression also can
develop gradually without a precipitating event.
Depressed children may have difficult relationships with parents and
siblings, may withdraw from friends or activities and feel overwhelming
hopelessness. Teens may sleep more than normal or have sleep disturbances. While
sleep requirements will vary, throughout childhood and adolescence, kids need
approximately 9 to 12 hours per night. In addition to exceeding the normal
number of hours of sleep per night, sleep disturbances include routinely waking
up tired, needing to be roused from a deep sleep most mornings, difficulty
falling asleep at night or having difficulty falling back to sleep in the middle
of the night due to excessive worrying. Depressed kids also may eat too much,
eat the wrong foods, or not eat enough.
Some depressed kids display a lack of motivation or "flatness."
They have no energy. On the other hand, some depressed kids may be easily
agitated and unable to focus. "If a kid is normally pretty easy going, but
over a period of time or all of a sudden shifts to being very upset, irritable
or angry in response to any request, these could be symptoms of
depression," says Dr. Jensen.
The AACAP says signs of childhood depression include:
- frequent sadness, tearfulness, crying; hopelessness
- decreased interest in or inability to enjoy activities
- persistent boredom; low energy; poor concentration
- social isolation, poor communication
- low self-esteem; guilt; extreme sensitivity to rejection or failure
- increased irritability, anger, or hostility; difficulty with relationships
- headaches and/or stomachaches
- frequent school absences or poor performance
- a major change in eating and/or sleeping
- talk of or efforts to run away from home
- thoughts or expressions of suicide or self-destructive behavior.
Causes of depression vary
Depression may be the result of genes passed down from a parent,
environmental circumstances, or a combination of both, says Dr. Jensen. Studies
show that depression tends to run in families. One parent with a history of
depression increases a child’s chance of developing depression. If both
parents have experienced depression, the child’s chances are even greater.
Traumatic events in a child’s life, such as abuse or poverty, may increase
the risk of developing depression. Poor parenting skills can cause depression in
children. Constantly sending negative messages—telling a child he or she is
worthless, unattractive, stupid, or the like—increases a child’s chance of
developing depression.
When to seek professional help
Regardless of the cause, if a child shows signs of depression, getting
professional help early is crucial. The pediatrician is a good place to start,
says Dr. Jensen. A pediatrician can rule out a medical problem that can cause
depression-like symptoms, such as stomachaches, headaches or lethargy. If
depression is suspected, a pediatrician can recommend a child psychologist,
psychiatrist or therapist. Dr. Jensen also recommends asking friends or family
members for the names of mental health professionals. "Above all, you need
to find someone you and your child are comfortable with and whom you
trust."
Treatment
For children with mild depression, cognitive-behavioral therapy is usually
the first step. Cognitive-behavioral therapy is a type of psychotherapy that
involves helping individuals develop coping skills that allow them to better
handle upsetting situations and teaches them how to change destructive or
negative thoughts. Family members may be asked to participate in therapy
sessions. In cases involving prolonged or severe depression, medication may be
recommended to complement the psychotherapy. Rarely is medication prescribed for
depressed children who are under age 5 or 6. Psychotherapy, however, can be
effective for pre-schoolers. To help the youngest children, psychotherapy is
directed at parents, the objective being to teach them how to help their child.
Children and adolescents rarely require hospitalization for depression.
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