Identifying and Helping with Childhood and Adolescent Depression            .pdf version

by Ernest J. Bordini, Ph.D., Licensed Psychologist         CPANCF.COM   (352) 336-2888

All rights reserved Clinical Psychology Associates of North Central Florida       Gainesville - Ocala Florida  

Depression is a major health problem. From 10 to 25% of Americans will suffer depression at some time in their life.  Many people often suffer their first episode of depression in adolescence. There are some statistics that suggest childhood and adolescent depression as well as child and adolescent suicide may be on the rise.

Recognizing childhood and adolescent depression can sometimes be difficult. Although most parents can recognize many of the more obvious signs of depression such as depressed mood, frequent crying, appetite loss, or suicidal thoughts many of the more subtle signs can be missed or attributed to something else.

Withdrawal from peers, loss of interests, fatigue, frequent unexplained physical complaints, low self-esteem, pessimism and hopelessness should also receive attention, particularly if symptoms are present most of the time for two weeks or more.

Anger and irritability are often associated with childhood depression and are sometimes the major presenting feature.  Since childhood depression may have a somewhat different presentation and children may not complain about being sad, it is understandable why the underlying depression may be missed.

If a child or adolescent is demonstrating multiple signs and symptoms of depression there are several things parents can do (adopted from recommendations by the National Institute of Mental Health).

1. Take your child for a medical check up if they have not had one recently

2. Obtain appropriate diagnosis and treatment from a qualified licensed psychologist or psychiatrist.

3. Help your child or adolescent set realistic and obtainable goals. Small short term goals with immediate rewards are often the most effective

4. Help them break large tasks to small ones and help them set priorities

5. Temporarily reduce expectations

6. Encourage activity with others

7. Increase their participation in pleasurable activities such as movies, taking a walk, exercise, a ballgame, trip to the beach. Be gently insistent if necessary, but don't try too much too soon.

8. Manage major stressors

9. People rarely "snap out of it", be patient, support their efforts

10. Engage the adolescent to communicate and listen carefully

11. Offer hope and encouragement

12. Do not accuse the child of "faking it", being lazy, injure self esteem, or increase their sense of guilt.

13. Do not ignore suicidal hints or talk and educate your adolescent to report threats made by others

14. Secure potentially lethal materials such as firearms and medication

Psychological techniques that have found to be helpful in treating adolescent depression include individual and group treatment approaches that use “cognitive restructuring” relaxation-training, and role-playing. Supportive treatment and interpersonal therapy has also been found to be helpful.

Antidepressant medications are particularly effective in severe cases at normalizing physical symptoms of depression such as sleep difficulties, appetite difficulties, and problems with thinking and energy. Medication can be used in conjunction with psychotherapeutic approaches and sometimes alone.

Studies done in the last 15 to 30 years have demonstrated the effectiveness of cognitive behavioral interventions for many forms of depression. A number of studies indicate these interventions are at least as effective and sometimes more effective than antidepressant medication alone. Combined treatment is often the most beneficial, although access to psychotherapy is sometimes hampered by managed care.

Cognitive-restructuring or cognitive behavioral techniques have been found to be helpful for a variety of disorders including anxiety and depression. This approach focuses on irrational beliefs, negative self-statement, and negative expectations and working toward more appropriate thoughts likely to result in positive self-esteem and behavior that will generate pleasure or positive outcomes.

Role-playing is sometimes used to practice these more appropriate communications and behavior. This can be done individually with the therapist or in groups.

Relaxation training is particularly effective for anxiety reduction since it can be readily learned and is an incompatible response with tension and anxiety. For many children and adolescents it is an effective demonstration of how they can control their feelings and provides a concrete sense of mastery.

Children and adolescents with depression should develop and refine skills to help them control mood and cope better with situations that contribute to depression. In addition to education about contributors to depression, children may learn to develop greater self regulation and control through relaxation training, identifying and increasing the range of pleasant activities, con¬structive or positive thinking, social skills, communication, and problem solving.

Failing to adequately treat mood swings and depression can result in an escalating pattern of failure and loss of self-esteem, negative self-expectations, a sense that one is not in good control of themselves, and increased difficulties with peers and family. However, it is encouraging to note that with adequate treatment most episodes of depression are successfully treated within 6 months to two years resulting in better self-esteem, achievement, academic and interpersonal adjustment.

For more information about depression and other psychiatric disorders check out the resources page at the Clinical Psychology Associates of North Central Florida (CPANCF) website athttp://cpancf.com under APA public information.