Major Depression in Children and Adolescents: Hurting and Healing

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Major Depression in Children and
AdolescentsHurting and Healing

• Adria Fredericks, M.Ed.

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Learner Objectives
Participants in this seminar will be able to

• Identify risk factors of major depression in
  children and adolescents
• Describe age-related symptoms and possible dual
  diagnoses
• Define various treatment methods
• Act as referral agents to health care
  professionals and other sources of information

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Glossary

• Bipolar A mood disorder in which debilitating
  depression on one pole becomes mania on the other
• CBT (Cognitive Behavioral Therapy) A treatment
  of choice for depression which deals with
  changing thoughts and behaviors, usually in
  adolescents
• Comorbidity Two disorders occurring at the same
  time, e.g. depression and panic disorder
• Dysthymia A chronic depression, not as serious,
  which can last for years, and at times develop
  into more serious episodes (double depression)

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Glossary (continued)

• Major depression A critical mood disorder that
  affects vital signs, lasts at least two weeks,
  and can threaten the lives of its sufferers
  through suicide
• Play therapy A treatment of choice for
  depression in children who do not yet
  conceptualize well, which allows them to express
  through play
• SSRI (Selective Serotonin Reuptake Inhibitor) 
  Anti-depressant drugs

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Definition
Major depression is an illness that can affect
any age, sex, ethnic group or class

Characteristics include

• Feeling sad (sadness that wont go away)
• Feeling guilty
• Eating and sleeping too little or too much
• Loss of energy and interest
• Lack of focus

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Definition (continued)
Characteristics also include

• Feeling nervous, irritable, angry and unable to
  relax
• Feeling badly about self
• Thinking about hurting self
• Thinking about death and suicide

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Definition (continued)

• In infants, major depression may look like
  apathy, withdrawal, and developmental delay or
  inability to reach developmental milestones
• In children, major depression may look like the
  above plus be expressed through lingering somatic
  complaints (stomachaches, head- aches, etc.),
  while some children over-compensate by needing to
  achieve and please others
• In adolescents, major depression may look like
  the above plus be expressed through acting out,
  eating disorders, substance abuse, cutting and
  suicide, which are comorbid

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Prevalence

• Major depression affects 1 percent of
  preschoolers, 2 percent of children and 5-8
  percent of adolescents
• The incidence of depression appears to be
  increasing, with onset occurring at earlier ages,
  along with a greater risk for developing other
  disorders
• Boys and girls are equally at risk until
  adolescence, when depression in girls occurs with
  much greater frequency

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Prevalence (continued)

• Suicide is the most serious result of untreated
  major depression
• The adolescent suicide rate has tripled since the
  1970s, with twice as many attempts made by
  adolescent girls compared with boys, the latter
  having been four times more successful in
  completing the act
• Completed suicides for children under 10 are
  rare, but do occur

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How we identify the problem

• In children, look for withdrawal from play,
  friends and family, changes in sleeping and
  eating patterns, and pay attention to physical
  symptoms, problems at school, increased emotional
  distress or agitation
• In adolescents, look for withdrawal from
  activities, friends and family, and pay attention
  to changes in self-maintenance habits, problems
  at school, degree of anger and acting out,
  substance abuse and talk of death or suicide

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Biological factors

• Much research on some of the core symptoms of
  depression in adults reveals that little is known
  about the biological basis for depression in
  children and adolescents
• Investigations have focused on the neuro-
  endocrine systems in the body, and the changes
  that occur in the interactions between the
  nervous and endocrine systems as the child
  becomes an adolescent, including stress factors
  and hormonal influences

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School factors

• Children and adolescents with major depression
  have reduced energy and difficulty focusing on
  tasks, may be tardy, absent and unable to deal
  with assignments
• They may be overwhelmed by what is required of
  them, and may express anger and act out
• Problems with peers and teachers may develop, and
  school can become a place of few successes and
  many failures

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Family factors

• Genetics and family dynamics seem to be two
  important contributors to major depression
• Children and adolescents who have a depressed
  parent(s) are three times more likely to
  experience some form of depression, as well as
  other mental and physical disorders, than those
  who do not
• Stress from loss, abuse, neglect or other trauma
  within families may significantly affect the
  moods and coping abilities of children and
  adolescents

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Cultural factors
In some cultures, depression may be expressed
through somatic complaints rather than sadness or
guilt

• Latino and Mediterranean Nerves or headaches
• Asian Imbalance or disturbance of chi
  (lifeforce or energy)
• Middle Eastern Problems of the heart
• Native American Heartbreak

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Cultural factors (continued)
Cultural ideals and stereotypical gender roles
also add stress to what may already be very
stressful situations at home and in school
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National legal safeguards
IDEA (Individuals with Disabilities Act)
stipulates that alternative placements (to full
inclusion in a regular public school classroom)
must be made available to students with
disabilities, including

• Regular classrooms with support personnel
• Special teachers
• Special classrooms
• Special schools
• Day treatment/hospitals
• Homebound education
• Special classes in detention centers and prisons

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National legal safeguards (continued)

• Section 504 protects against discrimination in
  programs that receive federal funds from the U.S.
  Department of Education
• ADA (Americans with Disabilities Act) extends
  protection against discrimination to the state
  and local levels whether or not they receive
  federal funds

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Legal Safeguards in Pennsylvania

• Chapter 14 of Title 22 of the PA Code delineates
  the rights of children with disabilities (and
  their families) to qualify for public special
  education so that they can participate fully in
  their communities
• Chapter 15 of Title 22 of the PA Code provides a
  non-discrimination policy for children with
  disabilities (and their families) that adheres to
  Section 504 of the IDEA

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Legal Safeguards in Pennsylvania(continued)

• Contact
• OCR (Office for Civil Rights)
• OSERS (Office of Special Education and
  Rehabilitative Services)
• Commonwealth of PA - Department of
  Education/Instruction

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What can you do?

• Refer families to their primary care physicians
  to rule out other medical conditions that may be
  creating depressive symptoms
• Refer families to specialists (psychiatrists,
  psychologists, counselors) who can better screen
  for and treat major depression
• Create a stable, secure atmosphere for
  children/adolescents in which they feel safe

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What can you do? (continued)

• Encourage children and adolescents to talk to
  someone about their feelings, and to express
  themselves through art, music and writing
• Know whats available and share the information
• Be compassionate

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What to avoid

• Being judgemental/critical
• Having unrealistic expectations
• Being inflexible
• Taking behavior personally

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Treatment

• Medication
• SSRIs (Selective Serotonin Reuptake Inhibitors)
  are the most effective drugs currently used to
  treat children and adolescents with major
  depression
• At this time, the only recommended SSRIs are
  Fluoxetine (Prozac) and Sertraline (Zoloft)

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Treatment (continued)

• Therapy
• Play therapy is appropriate for children
• For adolescents, CBT (Cognitive-Behavioral
  Therapy) has been shown to be the most effective
  therapy for changing negative thought patterns
  and behavior

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Case study of a child

• Please refer to the Study Guide to read about
  Annie, a small girl with a big problem

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Case study of an adolescent

• Please refer to the Study Guide to read about
  David F., a depressed adolescent on a dangerous
  path

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Information for parents

• Please refer to the Parent Brochure

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Where you can get more help

• NAMI PA (National Alliance on Mental Illness of
  Pennsylvania) Helpline [phone]
  www.namipa.org
• NIMH (National Institutes of Mental Health)
  Helpline [phone] www,nimh.gov
• NMHA (National Mental Health Association)
  Helpline [phone] www,nmha.org
• Please refer to the Study Guide for a more
  comprehensive list

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References

• American Psychiatric Association Diagnostic and
  Statistical Manual of Mental Disorders, Fourth
  Edition. Washington, D.C., American Psychiatric
  Association. 1994 (pp. 339-345).
• Ramchandani. (2004). Treatment of major
  depressive disorders in children and adolescents
  Electronic version. BMJ, 328, 3-4.
• Sarafolean, M. (2000). Depression in school-age
  children and adolescents characteristics,
  assessment and prevention Electronic version.
  HealthyPlace.com, Depression Community, 1-4.

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References (continued)

• National Alliance on Mental Illness (2007).
  Understanding major depression and recovery
  (Brochure). Duckworth, K., M.D. Author.
• Surgeon General (2006). Depression and suicide in
  children and adolescents Electronic version.
  Mental Health A report of the Surgeon General,
  chapter 3, section 5.
• For a complete list of references, please refer
  to the
• Study Guide

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Contact information

• Adria Fredericks, M.Ed.
• The Center for Counseling Arts
• 1901 East Carson Street
• Pittsburgh, PA 15203
• Phone [phone]
• Fax [phone]
• Email aaf20_at_pitt.edu