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CHILDHOOD DEPRESSION


We have recently heard a lot of questions about the motives of individuals who randomly shoot and kill other people in schools, malls, and movie theaters. This has led to discussion and debate on guns in our society, as well as what role, if any, other factors such as violent video games play.

As a child psychologist, I have evaluated numerous children and adolescents—ages 8 to 18—who have committed violent crimes against others. In addition, I used to work in a maximum security prison where the majority of the inmates had violent offenses.

As I look for themes to these actions, it is difficult trying to find a common denominator. Some of these individuals came from ‘broken’ families, whereas for others, this was not an issue. Some committed their crimes while under the influence of drugs or alcohol, but most didn’t. Some struggled with intellectual and cognitive impairments, whereas others scored well above average in this regard.

In reviewing my files on these cases for this article, I find that three things stand out as identifiable factors: 1) in every instance of violence, the individual had ready access to a weapon; 2) every one of these people were male; and 3) the majority of these people struggled with depression at the time of the offense, depression that was often undiagnosed or untreated.

I won’t enter into the ‘gun debate,’ as this is a losing proposition. If the killings in 2012 alone weren’t enough to shift our perspectives on this issue, there is little I can put here that will result in much attitudinal change on the part of the reader or society.

What I can weigh in on, however, is the growing prevalence of childhood depression. Granted, most youth with depression do not hurt or kill others. If anything, they are at greater risk of killing themselves, and suicide is the third leading cause of death in individuals ages 5-14.

Identifying and diagnosing depression in children and teens can be difficult. This is because the common symptoms of depression in adults—such as feelings of worthlessness or emptiness—are often absent in children. While an adult with depression is more likely to withdraw, a child with depression is more prone to acting out. In fact, chronic irritability on the part of the child—especially when it occurs first thing in the morning—is a hallmark sign of depressed mood.

We generally think in terms of two major causes of depression for children. The first is genetics. We know that depression runs in families, such that if a child has a relative who committed suicide, she is three- to four times as likely to do the same. The other major contributor for depression is loss. In fact, this is the most significant contributor to childhood depression, representing everything from the loss of a parent (as in death or divorce), to the loss of a friend or a pet.

In my clinical work with children and families, I often find there is a ‘disconnect’ between how a child is feeling and the extent to which a parent is aware of this. Rarely is this because the parent is insensitive or indifferent to the needs of the child. Rather, the factors that contribute to a child’s mood can be extensive, and in some instances, the parent simply holds a different perspective.

Take adoption, for example. While most adults think of adoption as ‘family building,’ for most children, it represents loss; loss of a birth parent, loss of siblings, or loss of previous identity. This is why the research shows that children’s favorable views of adoption sometimes lessen as they grow older, when they are able to put the pieces together in their mind as to how and why they were adopted.

Another example is divorce. When divorce happens, the parents are usually struggling with challenging feelings of their own; anger, sadness, guilt, shame, anxiety, etc. Quite frankly, it is really hard to be present for a child when we have so much ‘background noise’ in our own lives.

In the majority of cases on which I’ve worked, the children are unable to provide me with much of a reason or explanation for why their parents divorced, even several years after the fact. When I talk with the parents about this, they are often surprised, as they maintain that they did tell the child why the divorce was happening. Unfortunately, a lot of parents only tell this to the child one time, and even then, it is explained during a time of heightened stress and challenge for the family. For other parents, they mistakenly believe that what is best for them—leaving an unhappy marriage—will be best for the child. While this may be true in practical ways—such as leaving an abusive situation—many children simply have a hard time rebounding from this loss.

With respect to symptoms, here are some of the common ways that depression can appear in children and adolescents:

• Irritability or anger
• Social withdrawal
• Spending more time alone when at home
• Decreased interest in friends, school or activities
• Change in appetite; increase or decrease
• Change in sleep; sleeplessness or excessive
• Destructive behavior
• Crying spells
• Difficulty concentrating
• Physical complaints
• Bizarre thoughts
• Giving away possessions
• Thoughts/talk of death or suicide

From a treatment standpoint, there are a variety of interventions to address childhood depression. Most of the research to date suggest that psychotherapy and medication—when used in combination—yield better results than therapy or medication alone. In my opinion, family therapy typically works better than individual counseling for the child. Before starting down the path to treatment, it can sometimes be helpful to first identify the causes of the depression. This is where a psychological evaluation can be helpful.

Independent of what option you choose to identify, diagnose, or treat depression in children, it is important to take their words and feelings seriously. Parental empathy, attunement, and support can go a long way toward helping a child feel better. Even though we don’t always have answers for what troubles a child, we can provide them with our presence and support.





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Copyright © 2015, Christopher J. Alexander, Ph.D.. All rights reserved.