All kids have their ups and downs, especially teenagers. But when should a parent worry that a moody or withdrawn child may suffer from a more serious problem that requires professional help?
This month, Marlene Maron, chief psychologist/manager of psychological services at Fletcher Allen Health Care in Burlington, offers insight and advice for recognizing and addressing depression in children and adolescents.
KIDS VT: What are some warning signs that a child may suffer from depression?
MARLENE MARON: A depressed child or adolescent can look sad, irritable or empty for most of the day — nearly every day — for at least a week. He or she may appear angry, anxious, tearful and complain of stomach- or headaches. You may see decreased energy and social interaction. Activities that a child once enjoyed suddenly aren't fun anymore. He or she may appear restless, have trouble concentrating or making decisions. There may be difficulty falling asleep, staying asleep, excessive sleep, weight gain or loss, feelings of hopelessness, helplessness and complaints of boredom. A child may feel excessive guilt or worthlessness. Especially problematic are expressed thoughts of death — not just, "I wonder what it's like to die?" — but actual thoughts of suicide.
KVT: At what age do these problems typically occur?
MM: They can manifest at any age but look different depending upon the child's age. With preschoolers, very young kids and even babies, you may see withdrawal: sleeping, staring off, less engagement and fewer social interactions. With school-age kids, it may be sadness, irritability, academic decline and resistance to engage in activities. With adolescents, you may see social withdrawal or isolation, less attention to personal hygiene and disengagement from a previously richer life.
KVT: What are common triggers for childhood depression?
MM: Extreme stress, anxiety and a family history of depression can increase vulnerability to depression. A death in the family, parental divorce or separation or other losses, such as a breakup with a boyfriend or girlfriend, can be triggers. So can loss of friendships, bullying and identity struggles. Extreme disappointment and/or perceived failure can also be catalysts for depressive episodes. What may seem insignificant to adults can be really significant and painful to a child.
KVT: What's a parent's first step in addressing the problem?
MM: If the parent sees a child exhibiting persistent, out-of-character behavior, a good first step is to check in with the child. A parent can ask, "What's going on? You don't seem yourself. You seem really sad." The child may say, "I am," or "I don't know," because with depression, sometimes there's truly no identifiable stressor or trigger and that can make a child feel crazy. The next step may be to talk to your child's pediatrician or primary-care provider.
KVT: What if it's depression?
MM: If it's mild to moderate depression — say, the child seems very unhappy, is attending school and trying to do his or her normal activities and is not acutely suicidal — the first step would be psychological intervention. That would include education of the parent(s) and psychotherapy for the child. If it's moderate to severe, many studies suggest that a combination of psychotherapy and medication are most effective.
KVT: Is childhood depression becoming more prevalent?
MM: I'm not aware of an increase in the incidence of childhood depression. I have seen an increase in requests for treatment of anxiety, which can be associated with depression. The latest estimate is that about one in eight children has a bona fide diagnosis of depression. But I do think recognition is increasing, which is a good thing because it means that more kids who need help will get it.
KVT: Why does it seem like more kids suffer from depression?
MM: We're hearing about struggling teens and suicide in our area in the media and at school and community forums. It's hard to be a kid right now because life is hard for many families. Life is so fast-paced. There are all these demands and an unbelievable amount of stimulation coming from TV, the internet and other places. For a vulnerable kid not well-anchored in a family or group of friends, it's easy to get lost. If there is no treatment, the likelihood of substance abuse and other high-risk behaviors is higher, and those problems can snowball and contribute to others.
KVT: Can parents expect a child's depression to be "cured"?
MM: Yes! A child may have a biological vulnerability to depression, but biology isn't always destiny. Just because mom or uncle Bill had depression doesn't mean your child is going to. With treatment, kids can do much better, and there are some who are completely depression-free after treatment, particularly if they're treated early. For kids with recurrent depressive episodes, evidence suggests that good treatment can result in less frequent and briefer episodes. Parents have good reason to be hopeful that their child can bounce back and cultivate skills that can be applied to difficult times throughout his or her lifetime.