Sad sacks…depression in children

Why is it that in today’s society, depression has become a major public health issue? Dr John Irvine talks about how depression affects children.

Depression among today’s kids is on the increase. Previously regarded as the province of parents and adults, it’s now being seen more and more in children and is tipped to be their biggest killer, bar none, by the year 2020. This prediction comes from Dr. Ken Nunn, Associate Professor of Psychiatry and Head of Child and Adolescent Mental Health at the New Children’s Hospital at Westmead in Sydney.

There are many reasons to explain the escalation including increased family breakdown and anger in the home, diets and loss of hope and faith in the community. But the one I want to highlight is the increasing pace of life - parents are so busy egocentrically surviving that they can’t decentre and nurture the young - there’s a trend, as the Americans call, for parents to disengage from their own offspring.

If your kid seems sad and not enjoying life then check him/her out on these symptoms.

• worries a lot
• feels worthless
• seems and looks sad
• talks about killing themself
• sulks a lot
• cries a lot
• needs to be perfect
• tries to hurt themself
• anxious about everything
• feels no-one loves them
• feels everyone picks on them
• feels guilty about everything
• very self conscious
• worries that they might do something bad
• lonely and feels they have no friends
• very nervous

If your child is showing strong symptoms on more than 6 of these, then chances are that they are depressed and in need of a check-up. But what kind of check-up?

Medical check up - get sad kids fully checked out medically as there could be a number of things depressing their systems - anaemia, thyroid, glandular fever, allergies or food intolerances.... anything which makes them feel off the pace or not coping. If the symptoms occur just after exertion and exercise then a medical check is also needed.

Perception check up – check them out through the eyes of others who know them well and know how they behave away from home (eg teacher, grandparent). If the symptoms shrink away from home then taking a look at what’s going on at home may be what’s needed.

Home tone check up - check out the home tone. From my clinic experience the more common depressors are divorce, fighting, no time with favourite parent, new baby, favouritism, parents too busy, or brother or sister with special needs

Here are some ideas for immediate help.

1. With little kids, you can use your body language to convey the feelings that you care, you love them, you listen, and that there’s no problem that mum’s or dad’s strong, loving arms can’t fix. Let them talk about things that make them sad if they want to, but don’t put words in their head. When my kids are sad I just give lots of cuddles and talk to them, but most of the time I just listen. That’s all they usually want, just someone to know how they feel, then things seem to be a lot better.’  If you feel that it’s an attention seeking habit, then don’t use their sad behaviour to attract extra attention from you. Suggest that they feel this way because their battery is run down and they can have a rest in their room until they feel strong and happy again. Sometimes a good sleep is all that’s needed.
2. Some older kids are verbal downers, they talk their way down to depression. In this case, you can try to develop a family habit of intercepting a nose dive and thinking of things that can make the family feel better. Something good at child care or school, someone who was nice to them, something funny that the dog did, someone they could phone to cheer them up etc.
3. Some kids are visual downers, they can see the whole thing unfolding as a catastrophe. If that’s their style then help them develop an image that has good positive associations and makes them feel better. If they say that they can’t, then try to challenge them with this thought – ‘just as your mind is so clever that it can see all the problems, it can also see all the good things if we work hard enough’. When Uncle Peter died and then Snoopy, Nan’s dog died, we talked about how old things die. I told Taylor (aged 4) that Uncle Pete and Snoopy were in heaven and still watched her and still loved her and that she could talk to them, cuddle them and play with them in her dreams. She could see them watching from heaven, they looked like stars as they were so far away. She is happy with this and can now talk easily about people dying without getting upset.
4. If parental depression is the problem then that’s the urgent priority. Kids may not listen but they do copy! I realised part of my daughter’s depression was my doing; I really crashed after my husband went off with a younger version. So I decided to do something about it. We worked out that we liked dancing so we’ve started (in different groups of course). It’s made us both feel better.

I suppose you heard about the kid who was all sad after his grandad died. His other poppy took him under wing and said to him, ‘Well, let’s work out where Grandad is. It’s one of the three R’s - he has either rotted in the ground, or reincarnated in some other form, or he’s resurrected, which means he’s up in heaven waiting for us to join him.  Which do you think?”
The boy answered ‘I think he’s in heaven’.
‘Right’, said Poppy, ‘would you like to go there?’
The boy shuffled his feet in the dirt, ‘Ah, not yet, Poppy.’

An American epidemiological study of 9-to-17 year olds, conducted by the National Institute of Mental Health, estimates that the prevalence of any depression is more than 6%, with 4.9% having major depression. Depressive disorders confer an increased risk for illness and personal and social difficulties that remain after the depression has been treated.

Children who develop major depression are likely to have a family history of depression. Other risk factors include stress, loss of a parent or loved one, attention, conduct or learning disorders, chronic illness such as diabetes, abuse or neglect and other trauma including natural disasters. There is also an increased risk of substance abuse and suicidal behaviour in adolescents, with adolescent girls are more at risk of depression than boys.

Case Study: Untying the knot

Peter’s parents broke up. His mum got custody, and got depressed. Dad got mad and got out. And Peter, as you could guess, got both mad and depressed and got the tummy aches that wore his inner pain. Later on dad and his new partner asked to have Peter for the holidays. Many solicitor bills later it happened, it worked well and Peter asked his mum if he could stay. Mum threatened to get rid of his dog, Sally, if he didn’t come back. So back came the tummies, tears and even suicide threats.

Fortunately his step-mum stepped in. She got a stay of execution on the grounds of intestinal insanity and got a few things started with him. He picked up beautifully. The sad part is I had another call the other day, not from Peter but from welfare to say that Peter’s gone back home to his mum and the tummy aches have come back. When will some parents learn that no matter how much they’ve been hurt, unless they handle divorce sensibly, they don’t really untie the knot, they just shift it!

Symptoms of Major Depressive Disorder Common to Adults, Children, and Adolescents

• Persistent sad or irritable mood
• Loss of interest in activities once enjoyed
• Significant change in appetite or body weight
• Difficulty sleeping or oversleeping
• Psychomotor agitation or retardation
• Loss of energy
• Feelings of worthlessness or inappropriate guilt
• Difficulty concentrating
• Recurrent thoughts of death or suicide.

Five or more of these symptoms must persist for 2 or more weeks before a diagnosis of depression is indicated.

* Source: National Institute of Mental Health, Bethesda, MD USA

Ways Symptoms May Manifest in Children and Adolescents

• Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomach aches or tiredness
• Frequent absences from school or poor performance in school
• Talk of or efforts to run away from home
• Outbursts of shouting, complaining, unexplained irritability, or crying
• Being bored
• Lack of interest in playing with friends
• Among adolescents, alcohol or substance abuse
• Social isolation, poor communication
• Fear of death
• Extreme sensitivity to rejection or failure
• Increased irritability, anger, or hostility
• Reckless behaviour
• Difficulty with relationships.

Useful books and websites

Who’d be a parent – the manual that should have come with the kids, Dr John Irvine

A Handbook for Happy Families, Dr John Irvine

Available from Dr John Irvine's website.  

Black Dog institute

Beyond Blue:  the national depression initiative 

Children, Youth and Women’s Health SA 
 

By Dr John Irvine

Dr John Irvine is an educational psychologist, a consultant psychologist, a counsellor and a widely recognised specialist on children’s behaviour. He is the author of significant books for parents such as A Handbook for Happy Families and Who’d Be a Parent? His relaxed and warm advice deals with the practicalities of managing real families in everyday life.

This article was first published in Australian Family Magazine, October 2002. Udated July 2009.