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Childhood Depression

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Depression in Children and Adolescents

What is depression?

Depression is the most common mental disorder, not only for adults, but for children and teenagers as well. The DSM-IV classifies depression as a mood disorder. It states that an individual has suffered a "major depressive episode" if certain symptoms persist for at least two weeks, including a loss of enjoyment in previously pleasurable activities, a sad or irritable mood, a significant change in weight or appetite, problems sleeping or concentrating, and feelings of worthlessness. These symptoms of depression fall into four categories: mood, cognitive, behavioral, and physical. Depression affects how individuals feel, think, behave, and how their bodies work. People with depression may experience symptoms in any or all of the categories, depending on personal characteristics and the severity of the depression (Ainsworth 2000).

Victims of depression often describe feelings of emptiness, hopelessness, unreasonable guilt, and profound apathy. Their self-esteem is usually low, and they may feel overwhelmed, restless, and irritable. The changes occurring with depression understandably result in alterations in behavior. Most individuals with moderate-to-severe depression will experience decreased activity levels and appear withdrawn and less talkative, although some severely depressed individuals show agitation and restless behavior, such as pacing the floor. "Depression is more than a mental illness. It is a total body illness (Curtis, p. 132)".

Major depressive disorder, also know as clinical depression, is the serious and often disabling for of depression that can occur as a single episode or as a series of depressive episodes over a lifetime. A single episode may last as little as two weeks or as long as months to years (Mondimore, 1990). Some people will have only one episode with full recovery. Others recover from the initial episode only to experience another episode months to years later. There may also be clusters of episodes followed by years of remission.

Depression in Children

How do we determine whether children are depressed? All children feel unhappy from time to time. Sadness is a normal, natural response to many life events, from losing a soccer game or moving away from old friends to a death in the family. "Although when that sadness runs too deep, lasts too long, or occurs too often, it may be a sign of clinical depression (Egger, 2002)." For many years, childhood depression went unrecognized. Many mental health professionals believed that children were not emotionally mature enough to experience true depression. It was not until the early 1980s that clinicians and researchers began to realize that childhood depression was a distinct, recognizable disorder. The National Institute of Mental Health (NIMH) estimates that over 1.5 million children and adolescents are seriously depressed (Wingert, 2002).

Since most experts now agree that childhood depression exists, many are applying psychological theories of adult depression to children. Two of the better-known theories both have their roots in psychoanalytic theory. The first theory is based on the work of Sigmund Freud. It revolves around the idea that the loss of a "love object", such as a parent, pet, or important relationship, can cause depression. Psychoanalysts usually offer this second theory as well: that depression is really anger turned inward against the self. This means that a young child may be enraged at his father for physically abusing his mother, but instead of confronting him - which is too scary and dangerous - the child turns his rage on himself and becomes sad and eventually depressed (McKnew 1983).

Once they reach school age, children become less egocentric and are able to see things from another's point of view. They can be quite sympathetic and empathetic, particularly toward other kids who may be crying or having a difficult time. By the time they are around eight years old; most children are capable of understanding fairly abstract concepts. School-age children tend to move away from magical "there's a monster under my bed" fears and into more reality-based anxieties (McKnew, 1996). They may worry about passing a spelling test, being accepted by their peers, or having their house blown away by and approaching tornado. This developmental maturity helps explain why school-aged children are more likely than younger children to have clinical depression.

Which Children are Most at Risk?

Children typically go through some very trying stages as they grow up. Sometimes, however, an abrupt change in a child's behavior or manner is more than a passing stage; instead in can be a symptom of a serious emotional problem like depression. Depression is not easy to identify in children. In fact, until the early eighties when it was recognized as a true disorder, even professionals often missed it. One reason was that it was shaped by the knowledge of depression in adults. So, unless the same intense sadness and tearfulness was seen in the child, or unless it was known that the child experienced feelings of worthlessness and hopelessness, depression was not suspected. Now it is realized that children, who are just learning how to express the many emotions they feel, may communicate their distress very differently from adults.

Research confirms the many variations in the symptoms of childhood depression (McKnew, 1996). In one 1987 study, researchers at the University of Pittsburgh and New York State Psychiatric Institute found that younger kids who were depressed complained of physical problems such as stomachaches and restlessness, experienced great anxiety when separated from their parents, and developed fears of places and situations. Depression is a recurrent disease, if a child has had it once; he is more likely to have recurrence when he is a teenager or even when he is an adult (Empfield 2001).

Teenage Depression (Adolescent Depression)

Depression may also be difficult to diagnose in adolescents. Every teenager experiences a series of challenges in life, from dealing with the physical pain and hormonal changes of adolescence to separating from parents and finding their own distinct identity (Empfield 2001). These challenging tasks often cause a great deal of confusion and anxiety; consequently brief bouts of sadness, marked by tearfulness, moping, pessimism, and occasional hostility, are entirely normal during the teenage years. Teenagers can be moody, as everyone knows; but every moody teenager is not suffering from depression. Most teenagers, even the ones who are really



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