| Coping With Childhood Depression
When Karen got the phone call from twelve-year old Katie's teacher, she thought it would be about her daughter's school project or field trip. She was stunned when the teacher described a Katie that Karen didn't know. Mr. Webster said he was concerned because, over the past month, Katie had stopped participating in activities she normally volunteered for. She didn't raiser her hand in class. And she wasn't turning in assignments on time. He wanted to meet with Karen and her husband Mike because this was a significant change for Katie, an outgoing honor student. Karen and Mike were shocked. They hadn't noticed a real change in Katie's behavior at home. But, then, they hadn't been home much. Katie's younger sister, Beth, had recently been diagnosed with a condition that would require surgery. They were overwhelmed with Beth's care, and now this. It felt like their world was falling apart. Once upon a time, behavior changes in children were seen as weakness, or obstinance, on the part of the child. People used to think the child just needed more discipline, or needed to "get over it." Today, we understand that behavior changes can signal depression. (See box A) "Many people think that kids can't be depressed - what do they have to be depressed about?" says Brian Quinn, PhD, a clinical social worker in private practice in Huntington, NY and author of The Depression Sourcebook. He points out that one of the biggest obstacles to proper care for depressed children as innocent and carefree - it can be difficult to imagine that they can suffer depression that is as debilitating as in any adult. A second roadblock, Quinn explains, "is that parents don't want to see their child hurting." They want to protect their children, and sometimes denying that a problem exists is part of that protective process. "It's very important that right from the start, parents understand that having a depressed child doesn't mean they did anything wrong. Parents often carry a lot of unnecessary guilt over things they couldn't control." Experts agree that it can be difficult to detect depression in children because they don't usually fit the stereotype of the person who is withdrawn and down. The younger the child, the less able he or she is to describe the feelings, so the child simply acts out. Quinn points out that very often "kids act bad instead of acting sad." Marcia Cohen, RN, CS, MS, a psychiatric clinical nurse specialist at Columbia Presbyterian Center in New York City, agrees. "Irritability is very often the first sign that something's wrong, particularly with a younger child." Quinn elaborates, "Often these kids are very difficult to please. They are cranky, and it seems that nothing will satisfy them. They can seem hypersensitive to perceived slights by their friends and may become very self-conscious about their appearance." This can be particularly frustrating for harried, busy parents who long for harmony at home. In older children, parents often may be alerted to a problem when a child spends more time isolated in his room. Cohen offers this tip: "Pulling away from parents is a normal part of adolescence. You know there's a problem when this time in their room is associated with few friends and a decrease in social interaction. I think the key for any parent of a teenager is if the telephone stops ringing." (See box B) Karen and Mike met with Mr. Webster, who voiced his concerns that Katie might be depressed. He hadn't been aware of her sister's illness, and that information made him even more concerned. After the meeting, Karen and Mike sat down with Katie to discuss the situation. Katie assured them nothing was wrong, and that she was fine. Mike and Karen weren't convinced. Karen was taking Beth in to see the pediatrician that week, so she decided to ask him about Katie's behavior. He told Karen to bring Katie in for a physical exam. Cohen, who also has a private psychotherapy practice in New York, says that any youngster suspected of being depressed must have a thorough physical exam first to see if there is a medical explanation for their symptoms. She says, "Two common problems are Lyme disease and thyroid disorders. Lyme disease can just wear kids out, and an underactive thyroid can make them sluggish and withdrawn." Either illness can mimic symptoms of depression, as can mononucleosis and low blood sugar. Often, depressed children end up at the pediatrician anyway because they complain of headaches and stomachaches. To the child, this can be an acceptable way to stay home from school, or to get help when it's too scary to come right out and talk about their feelings. "Many times, a child has been referred to me after opening up to a pediatric nurse practitioner," Cohen says. "They wouldn't talk to their parents, but they felt safer with the nurse." This can present a challenge to the health professional - getting time alone with the child. "Parents naturally want to protect their children, and they believe that staying with the child throughout the exam will be supportive. But sometimes we have to be firm and ask them to step out so we can talk to their child alone." While leaving their child may be very difficult for parents, many times children are reluctant to open up because they don't want to let their parents down. Often, an honest discussion with the child at the start that this is nobody's fault, and that the child won't get in trouble will help break the ice. If a child's physical exam shows no medical reason for the behavior changes, a psychiatric evaluation is in order. This can be done by a psychiatrist, clinical social worker, advanced practice registered nurse or clinical psychologist. I f a child will need medication, any of the non-physicians can refer the child to a prescribing psychiatrist. In some states, the advance practice registered nurses may prescribe medication as well. The most important thing is to find a professional who is experienced with children. Children aren't simply miniature adults - they think differently, process information differently and heal differently. So, be sure and find a pediatric specialist who can develop a trusting relationship with your child. Don't be discouraged if the first therapist doesn't work out; sometimes it takes trial and error to find just the right fit. Therapy for children is often structured around play. Children may not be able to sit and talk about their feelings as an adult would, so they are encouraged to express themselves doing what they do best - playing. Play may include using dolls to act out situations (this is often done if sexual abuse is suspected), or by asking the child to draw pictures and tell a story. However, while children need time alone wit the therapist, "treatment cannot be successful without including the parent," Cohen says. Therapists walk a fine line. "Children do have a right to confidentiality," Cohen points out, "but it is not absolute. At the outset, parents and children must be told." Issues of safety include drug use, physical or sexual abuse, or a suicide plan that is clearly thought out and lethal. Most often, the therapist will help the child figure out a way to share things with his or her parent. In some cases, medication may be needed. But, Cohen says, "Don't ever let someone prescribe an antidepressant without intensive therapy to go along with the pills." With managed care, parents may have to push the insurance company themselves to be sure their child gets appropriate therapy, not pills alone. Karen and Mike took Katie to a nurse psychotherapist at the same hospital where Beth was being treated. After a couple of sessions, the problem became clear. Katie was very upset about her sister's illness. About a week before Beth was diagnosed, Katie had pushed Beth away from her computer, accidentally hitting Beth in the stomach. Katie thought that accident might have been the reason for Beth's surgery. Katie's fear was compounded by the fact that her parents seemed to be consumed with Beth's condition. It left Katie feeling responsible, scared and alone. Experts agree that a child's depression does not exist in a vacuum. Usually things going on in the family contribute to the situation. "Fifty percent of children in child guidance clinics report substance abuse in the family," Quinn notes. "Many people think that has to mean illegal drugs; but many times, parents self-treat their own depression with alcohol, cigarettes and prescription drugs without seeking treatment themselves." "Kids are like a barometer - their moods rise and fall with emotions in the home," Cohen explains. She notes that children often get very worried about things they overhear and may misinterpret. Common concerns include: parent's health (particularly in one-parent families), money, moving away from their friends, and divorce. Even if the family is intact, children may worry that something that happened to a friend's family could happen to theirs. Beware of what children hear from the top of the stairs when parents don't think they're listening. "Loss - actual or imagined - is often a key trigger," Quinn says. Something that seems relatively insignificant to a parent, such as the death of a goldfish a child had for a month, can have a big impact on the child. Or parents may be delighted about a promotion and the move to a new city that comes with it, but the child may be devastated about leaving his friends and security. Sometimes, upsetting things happen at school or with friends that parents don't even know about. Once Katie's concerns were revealed, the nurse therapist helped her explain things to her parents. They were relieved, but saddened for what Katie had gone through. Mike said they had tried to shield Katie, so she wouldn't have to worry. They arranged special time with Katie - just the three of them - so she could feel special, too. Beth's surgery was a success, and within months things were back to normal. Karen, Mike and Katie learned an important lesson about talking about their concerns and keeping the lines of communication open. As with any potentially serious illness, if childhood depression is caught early and treated promptly, the odds for a complete recovery are high. Not knowing children can be depressed, coupled with denial that it could be happening in their family most commonly delay treatment. If you suspect your child or a child you know is depressed, don't pretend that the depression will go away on its own. By speaking up, you can not only improve the quality of that child's life, but maybe even save the life itself.
.
.
|
