Childhood Depression

What is Depression?

Most adults and many children and adolescents have a few bad days here and there, sometimes three or four in a row. When this happens, your mood is bad, you feel like jumping on people for nothing. You sleep, but you do not rest. You eat, but you are not hungry. Your life is one big chore. Everything that was fun is work and what usually is work is like walking with lead boots. Often you have stomach aches, headaches, aching, dizziness and other symptoms, but the doctors can not find anything wrong. When family and friends want to talk, you do not listen. If you can, you stay alone and wish they would all just go away. And you think about what you have got to do, and you wish you could put it off for ever. And about what you have done, and about what could go wrong, and how you could never live like this for 30 more years.

Of course not everyone has all those symptoms every time. When people are clinically depressed, they have this for weeks, months, and often years. Nearly everyone knows someone who has been severely depressed as 6% of the world's population has had an episode of severe depression like this. Suicide occurs in 15% of depressed people.

Depression in school-age children may be one of the most overlooked and under treated psychological disorders of childhood, presenting a serious mental health problem. Depression in children has become an important issue in research due to its many emotional forms, and its relationship to self-destructive behaviors. Depressive disorders are of particular importance to school psychologists, who are often placed in the best position to identify, refer, and treat depressed children. Procedures need to be developed to identify depression in students to avoid allowing those children struggling with depression to go undetected. Depression is one of the most treatable forms of disorders, with an 80-90% chance of improvement if individuals receive treatment (Dubuque, 1998). On the other hand, if untreated, serious cases of depression in childhood can be severe, long, and interfere with all aspects of development, relationships, school progress, and family life (Janzen, & Saklofske, 1991).

The existence of depression in school-age children was nearly unrecognized until the 1990's. In the past, depression was thought of as a problem that only adults struggled with, and if children did experience it, they experienced depression entirely different than adults did. Psychologists of the psychoanalytic orientation felt that children were unable to become depressed because their superegos were inadequately developed (Fuller, 1992). More recently, Clarizio and Payette (1990) found that depressed children and depressed adults share the same basic symptoms. In fact, only a few minor differences between childhood and adult depression have been found.

Childhood Depression

Depression in children has become difficult to treat due to a lack of referrals for treatment, "parental denial, and insufficient symptom identification training" (Ramsey, 1994). In addition, recognizing and diagnosing childhood depression is not a simple task. According to Janzen and Saklofske (1991), depression can develop either suddenly, or over a long period of time, "it may be a brief or long term episode, and may be associated with other disorders such as anxiety". The presence of a couple of symptoms of depression is not enough to provide a diagnosis. A group of symptoms that co-occur, and accumulate over time should be considered more serious.

According to Fuller (1992), childhood depression may account for a variety of behaviors, for example, "conduct disorders, hyperactivity, enuresis, learning disability, and somatic complaints". Fuller (1992) also reports that depression in children may coexist with "irritability, low self-esteem, and inability to concentrate". Also, children may "internalize depression maladaptively", perhaps expressing it through conduct disorders, hyperactivity, or attention deficit disorders (Fuller, 1992).

Diagnosis

Many School Psychologists are not required to diagnose affective disorders in students, but do need to assess and develop interventions for them. The DSM IV appears to provide much help to School Psychologists to determine the symptoms that indicate a particular disorder, and to relay that information to professionals outside of the school. According to Callahan and Panichelli-Mindel (1996), it may be difficult to provide a diagnosis when childrens' symptoms do not easily fit any categories. Also, a child that does not clearly fit into a diagnostic category may go without treatment when treatment is needed (Callahan & Panichelli-Mindel, 1996). The child's diagnosis appears to be the most important aspect in planning the appropriate treatment or intervention. Thus, misdiagnosing a child could be harmful. Dubuque (1998) suggests that school staff should be "alert" to the symptoms or signs of depression in children, for example: "persistent sadness or hopelessness, inability to enjoy previously favorite activities, increased irritability, frequent complaints of physical illness, such as headaches and stomachaches, which do not get better with treatment, frequent absences from school or poor performance in school, persistent boredom, continuing low energy or motivation, poor concentration, a major change in eating or sleeping patterns, poor self-esteem, a tendency to spend most of their time alone, suicidal thoughts or actions, abuse of alcohol or other drugs, or difficulty dealing with everyday activities and responsibilities". Information on childhood depression should be passed on to community members, children, and families with children (Dubuque 1998). Training programs can be implemented for school staff about childhood depression (Dubuque, 1998).

To assist in identification of children in need of intervention, a variety of instruments to assess depression in children are available, including: "The Children's Depression Inventory (CDI), The Children's Depression Scale (CDS), The Reynolds Adolescent Depression Scale (RADS), The Reynolds Child Depression Scale, and The SAD Persons Scale" (Ramsey, 1994). Reynolds (1990) reports that although School Psychologists do not usually use clinical interviews but they appear to be one of the most effective means of assessment of depression. Clinical interviews allow an exploration of symptoms, information regarding whether possible symptoms are related to depression, or other factors (Reynolds, 1990).

According to Dixon, (1987), there are four types of depression: normal, chronic, crisis, and clinical. the four types