Festive Fourth gatherings, fireworks, backyard barbecues—they all signal summer, a time of year when everyone is expected to gush with giggles, laugh and parade around with a happy countenance. And, many will.
But what could be worse than having your usually bubbly child looking lifeless, despondent and possibly depressed?
Everyone feels a little blue sometimes, even kids. Try being excluded from the neighborhood kickball game, getting ridiculed or bullied on the school bus or feeling split between divorcing parents. Such scenarios might be enough to move your child from feeling a little sad to being downright depressed.
“Everybody has good days and bad days, but if it’s prolonged, then I’d say it’s an issue,” says Kathleen Frank, a family counselor in Brookfield. “If it starts affecting kids’ relationships, where they start isolating themselves away from peer relationships, and it starts affecting different areas of their life, like school, then it’s time to seek help.”
The problem, Frank and others say, is that depression doesn’t always manifest itself as overwhelming sadness in kids.
“Depression is difficult in general in children,” notes Paul Norton, a developmental behavioral pediatrician.
If you suspect that your child is depressed, Norton says take stock of broad mood or behavioral swings. “Children are always changing in behavior, so often it’s difficult to know when you’re talking about depression, especially with adolescents,” he says. “It can be a little tricky.”
What might start as anxiety about a big move, a breakup, or the death of a parent or pet, can often “spiral down to depression,” he says. Children who are bullied, experimenting with drugs or are suicidal are often likely to be depressed as well.
Frank says to take note of the whole picture. “Young children are less likely to say that they’re sad,” she says. “But if you see crying, aggressiveness, physical symptoms such as headaches or stomach aches—they can’t express themselves. They don’t have the ability to do that yet, so it comes out in physical and somatic ways.”
It’s hard for a parent not to wonder if she somehow impacted her child’s emotional state but Frank says not to rush to judgment.
“Kids have so many things going on in their world, and they don’t understand them,” she insists. “It’s more about environment than anything else. A child can go to school, not know how to make friends or get bullied, lots of things can happen.”
Although heredity can contribute to depression in children, Frank says it often stems from safety or fear brought on by a divorce or different family situation or from the trauma of neglect or past physical or sexual abuse.
A bad day that lasts more than a few weeks certainly may warrant an appointment with your child’s doctor. “Go to their pediatrician first to make sure that it’s not a medical issue,” Frank says.
Norton agrees. “If it’s not reversing itself, have a talk about that with your pediatrician. They’re very good about what is clearly OK. It might be normal adolescence or childhood (behavior),” he says.
If it is determined that your child needs to speak to a counselor about his depression, Frank says to clue him in on what to expect and who he will speak with and where. “I believe in letting children know what is happening, so the fear is removed,” says Frank, who lists such information on her website. “You want them to feel as comfortable as possible.”
Getting at the cause, treating depression
During office visits with small children, Frank uses play therapy as a form of communication to figure out the cause of their emotional slump and to see where solutions might lie.
“They don’t have the ability, the language to express themselves in ways that adults can. So, it’s used to help them express themselves,” she explains. “For example, I’ll work with kids, and they will play out themes happening in their life. I can see it and evaluate it. It’s their way to express themselves, at their level.”
Some diagnosed cases of depression in children are treated with medicine, but not all. Frank, who holds a master’s degree in counseling psychology, believes in the power of therapy.
“Oftentimes kids can come in with depression, but when they have this neutral space bubble, that helps,” she says of therapeutic in-office sessions. Counseling sessions can cost up to $80 an hour and are typically covered by insurance plans.
Medications, like antidepressants, are also viable treatment options. “We now have medications that are safe and effective,” says Norton, who has practiced pediatric medicine for 26 years. “Many people are concerned because they hear that the antidepressants cause dark or suicidal thoughts, but actual depression goes down when they’re used.”
Depression is not a chronic illness, but Norton says it can recur. “If you look at people who have had depression as adults, it’s more likely to be a recurrent thing,” he says. “It does seem that no matter what we do it almost always get better.” •
Tips to stave off depression:
• Set aside 10 minutes a day for a check-in with your children. Find out what’s going on in their world so they feel important and heard. Develop a clear line of communication.
• Develop solid support systems and help your child to develop social skills to enhance peer relations.
• In preparation for an appointment with a physician or counselor, bring a list of things you plan to discuss, like the behaviors and events that preceded the changes, or anything else that might be of concern.
There’s no fail-safe way to recognize a depressed child, but pediatrician Paul Norton, an associate clinical professor at the Medical College of Wisconsin, says the following mnemonic device, MESSESS, might point to a child who is more than a little blue:
M-Mood: With adults, depression almost always becomes an internalized behavior, where they become withdrawn with less energy, Norton explains.
E-Energy: Children are more likely to have more energy and may become angry and act out.
S-Sleeping: They might sleep more or less.
S-School: Most depressed kids’ grades suffer, but that’s not universal. If you have no other specific reason why a child would have a significant drop off in grades it might be attributable to depression.
E-Eating: Most children who are depressed eat less, but some eat more.
S-Social: There may be a change in social patterns. They might stop seeing their friends or stop participating in their regular activities, like playing soccer.
S-Satisfaction: The usual things that make someone happy no longer do so. It could be confused with an adolescent with boredom.
Lisa Jones Townsel is a freelance writer who treads ever-so-lightly to make sure her energetic kids remain mentally balanced.
This story originally appeared in the July 2011 edition of metroparent magazine.