What Is Childhood Depression, Really?

Raising Depression-Free Children : A Parent's Guide to Prevention and Early Intervention
by Kathleen Panula Hockey

Book Description

Childhood depression is on the rise and increasing faster than the rate of adult depression. The problem is so serious that the World Health Organization has predicted that by the year 2020, when today's children reach adulthood, depression will rank as the second leading cause of “lost years of healthy life” --behind only heart disease. In spite of these predictions, most books and articles emphasize identification and treatment, not prevention.

But, there is hope. Researchers have documented the reality of depression prevention in fields such as Resiliency Parenting, where the research actually suggests that depression in children can be prevented. Hockey suggests that reducing the anticipated numbers of depressed adults means we must begin with children who can be taught from a very young age how to live hopefully and optimistically. Depression is not, solely, a matter of genetics and biology; there are very specific things that parents can do to reduce their child's risk of depression or relapse.

Hockey describes preventive interventions based on research-backed techniques and clinical works. Along with case histories, she shares her own parenting failures and successes; her blend of personal experience and professional know-how will inspire readers to take action on behalf of their children. For parents of infants through twelve year-olds, Raising Depression Free Children offers:

• Basic information on the topic of childhood depression and prevention

• Parenting strategies to help reduce the risk for, or recurrence of, childhood depression

• Activities that provide parents with specific tasks to identify problems early on and promote resiliency

• Activities that help parents clarify their attitudes and beliefs about depression

CHAPTER 2

What Is Childhood Depression, Really?

Depression is painful.

-John Preston, You Can Beat Depression

Childhood Depression

Thirty years ago, it was common belief that only the most “mentally disordered” children experienced depression. This perception changed some in the 1980s. However, the greatest theoretical shift occurred in the mid-1990s with advances in brain imaging technology. Suddenly, researchers could see changes in brain function among depressed individuals. Shortly thereafter, clinical depression became more commonly thought of as a medical disease rather than a condition of weak will. More specifically, it was defined as a brain disorder in which “the neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly.” Just like other diseases, such as diabetes or heart disease, depression has many different types and levels of severity. Just as any adult could experience depression, so could any child. The causes of depression are complex and unique for each child.

The National Institute of Mental Health estimates that 2.5 percent of all children and 8.3 percent of all adolescents will experience some form of clinical depression. Some estimates suggest as many as one in eleven children may experience some form of clinical depression before the age of fourteen.

The National Institute of Mental Health has also sponsored research indicating that without proper treatment, childhood depression tends to repeat throughout childhood and into adolescence and adulthood, with each successive episode becoming more severe.4 Depression in children has also been linked to eventual cigarette smoking, substance abuse, academic difficulties, physical and health problems, and suicidal behaviors. This is why intervention and relapse prevention is so important for children who have already experienced even a mild form of depression or exhibit depressive symptoms even though not diagnosed with clinical depression.

Symptoms of Clinical Depression

To date, no specific set of clinical criteria exists that exclusively describes childhood depression. Clinicians rely on the criteria outlined for diagnosing adults found in the American Psychiatric Association's fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The DSM-IV lists nine criteria for a major depressive episode. Simplified, they are

• feeling depressed, sad, or melancholy most of the day, nearly every day

• the inability to experience pleasure or excitement even when doing activities that used to be pleasurable

• serious weight loss or weight gain in a short period of time

• sleeping too much, too little, or not well

• sluggish or jittery movements that are noticed by other people

• feeling tired and experiencing low motivation or loss of energy nearly every day

• feeling guilty a lot, feeling worthless, feeling inadequate

• having trouble thinking clearly, being unable to concentrate or make decisions

• feeling helpless and hopeless, having thoughts of death or suicide or having a plan for suicide

An adult must have at least five of these nine symptoms during a two-week period in order to be diagnosed with major depression. The symptoms must also be preventing a person from functioning well in daily life.

The only comment found in the DSM-IV about children is that “in children the depressed mood can be an irritable mood.” In other words, a child may have angry outbursts or frequent temper tantrums.

David G. Fassler, M.D., and Lynne Dumas, in their book “Help Me, I'm Sad,” outline specific symptoms for diagnosing clinical depression in children according to age group, from infancy to adolescence. They list a total of forty-six symptoms of clinical depression for children. This illustrates the complexity of diagnosing childhood depression and the incompleteness of the DSM-IV.

If you are concerned that your child is clinically depressed, don't try to diagnose her yourself. Take her to her primary care physician and also a licensed mental health professional. Some organizations that can assist you in locating a physician or other professional are listed in the “Resources” section of this book.

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© 2003 Hazelden Publishing

About the Author

Kathleen P. Hockey is a clinician, author, and recognized speaker in the area of childhood depression and prevention. She received her MSW from the University of Michigan in 1984 and is a member of the National Association of Social Workers and the Academy of Certified Social Workers. In 1993, Ms. Hockey obtained her Diplomate in Clinical Social Work. For the last twenty years, Ms. Hockey has treated children and families in both psychiatric inpatient and outpatient settings as well as in community service agencies. She is currently practicing brief, strategic and cognitive therapies with children, teens, adults, and families at her private practice in Richland, Washington.