SIGNS AND SYMPTOMS OF DEPRESSION IN CHILDREN AND ADOLESCENTS; What parents should look for -Article by R.Manoj Clinical Psychologist, Child Psychologist and Counselor-Chennai

Depression in children is a reality. The early recognition, acceptance and addressing the situation proficiently, is the best way forward for parents to keep their own aspirations about their children alive. Otherwise they may only make their own life stress and make their children feel that they are nor worthy enough to live. Recognize clinical depression and accepting the fact will help your child in three ways. One, it will prevent you from blaming yourself or your child. Second, it would prevent you from making stupid emotional comments about your child’s behavior and third feel guilty for any extreme steps taking by your child when he or she starts feeling the pressure as unmanageable.

Listed below are few signs and symptoms which you should look for in your child which would be early warnings for you, of your child being prone to depression. But a word of caution- Don’t just read the symptoms and when you see a few of them in your child, brand the child as being depressed. The symptoms as be listed to just guide you to seek the help of a professional whenever you observe that there is some sudden or gradual change in your child. Only qualified professional clinical psychologist or a psychiatrist can conclude whether the symptoms exhibited are those or depression or whether its that of any behavioral problems or emotional distress.

To provide a better and easy recognition I have grouped the signs and symptoms under four major functional areas of everyone’s life.

Behavioral

• There may be sudden or gradual changes in activity levels. They may show lack of interest in the activities which were pleasurable to them or even their day to day responsibilities which they had been doing without ant push.  The child may either show lethargy in his activities or involve excessively in activities which the parents had been denying him from doing
• School, refusal and high resistance to academic related activities  are one of the  symptoms which is commonly seen
• Frequent expression of being tired and being bored about everything failure to involve in any of  his  activities Inspite of  consistent encouragement can also be witnessed
• There may be noticeable increase of Sluggishness in their actions, reactions and even play and entertainment related activities
• The children may withdrawal tendencies. They may suddenly or gradually move into isolation or keep themselves occupied in activities which are done in isolation such as playing video games. Places of isolation becomes their preferred and favorites ones and you can find them escaping to such places at the first opportunity.
• There may be a sodden or gradual loss of interest in family affairs or involvement with their favorite family member or even friends.
• In some children there may a dynamic opposite behavior. They make show an increased level of dependency and express exaggerated sense of insecurity in the form of fear of doing even very simple things such a short absence of parents.
• Sometimes the children may show  excessive interest in praying, repeating a few acts etc to ward of their fear
• In some cases they may involve in self injurious behavior  hitting or biting themselves and in other times they may involve in reckless or aggressive behavior for which they are sure to be punished physically. Sometimes it may even go the extend of attempting suicide
• Sometimes they may become over demanding and throw temper tantrums whenever their demands are not met
• In case of adolescents there are possibilities of the child involving in substance abuse which includes, tobacco,  alcohol and other dangerous psychotropic drugs

Emotional

• The child may look sad cry frequently for even simple issues or provocations which can be explicitly look as unreasonable. Some times the crying spells may for long spells even without any provocation
• The child may be show highly sensitive reactions such as being upset, disturbed, offended or disappointed even for simple criticisms or negative experience
• There may be significant increase in expressed anger, and even aggressive reactions even with out ant reasons. sometimes they may pick up fights with their friends parents or siblings without any provocation
• The child may become anxious, tensed and even panicky for no apparent reasons. they may show startled reactions even regular happens that happens abruptly such as noise of the horn etc
• Expression of fear about even simple things, known people and situations , environments they have been already exposed to. They even show excessive avoidance to everything they fear about
• They may be seen worried, brooding a lot, getting irritated and frustrated even for very simple happenings frequently. They may also have difficulty in making choices regarding simple things

Physical

• There may be significant change in appetite which may range from starving to overeating. This may even lead to significant weight loss or weight gain in a short period of time. Sometimes these children are found to be skipping regular meals and spending time munching junk foods excessively.
• They may also having sleeping problems which range from lack of sleep  to excessive sleep. in some cases the sleep is disturbed, the sleep cycle is disrupted  and they may also have nightmares because of which they feel drowsy most of the time.
• The children who are depressed may also fake illness. In some other cases they may complain of  pain in various parts of the body or even show symptoms of some specific illness which cannot be diagnosed by physical examinations.
• Enuresis (bed wetting) and encorpasis (inability to control their bowel movements) which develops after the control is already established also point towards depression

Cognitive signs

• There may be deterioration in attention and concentration which reflects in most of their activities. they may also been seen drifting in to their fantasy world irrespective of the task they are engaged in  They also have difficulty with their short term memory because of the same.
• They may have feelings or worthlessness and self depreciating thoughts which is expressed by self criticisms  and good for nothing mind-set even for simple failures.
• Poor self esteem and low self confidence which is expressed consistently through their inability to complete even simple tasks is one more important indicator.
• They may show pessimistic attitude towards everything, every event and even everybody they come across
• They have significant feelings of guilt and express the need to be punished even over their perceived faults. They blame themselves even for mistakes in which either they have limited role or no role at all.
• These children may express the belief that they are destined to suffer nad have to live their life the way it is which is a indication of strong feelings of hopelessness
• They have strong feelings of helplessness and they have strong feelings that nobody can help them and hence they  have difficulty in seeking help. They feel they are all alone in this world because they believe that there are nobody around whom they can trust, who would understand and help them
• Suicidal thoughts which are expressed as death wishes are the clear signs of depression and if these thoughts are witnessed,  then have no doubts, the child is suffering from depression.

Depression should be addressed just like any other physical illness. Children cannot not articulate their emotions or even identify that they are depressed. So it’s the responsibility of the adults specifically the parents and teachers to recognize it by observing the changes that happen in their behavior, emotions, physical health and habits and their cognitive process and take appropriate measures. It’s not necessary that the child should have all the symptoms mentioned above for the child to be diagnosed. If the child has even half of the symptoms mentioned above you need to become cautious because you child may be in depression or prone to depression. If your child is experiencing even half of the above said symptoms, it is a good to get an evaluation by a professional clinical psychologist with experience in handling childhood disorders. If their child is either found to be depressed or prone to depression then effective intervention measures and appropriate support can be provided to prevent the condition from escalating and also safe guard them from  social isolation, losing their self confidence, developing negative self-esteem and safety risks that result from persistent depression

Depression in children and adolescents – not a myth but a candid reality

Article by R.Manoj Clinical psychologist psychotherapist and counselor with expertise in child and adolescent psychology

Many parents who come with specific behavioral or academic problems are taken aback when their child is diagnosed for depression and when they are told that their child is depressed. The usage of the term depression itself make the parents so uncomfortable that either they try to argue within the professional say that these may be temporary blues which every one experience on regular basis caused by transient events or just fail to turn up for the next session. Some even request the professional not to mention the term “depression” in the report whenever the same is demanded by the professional or the institution that referred the child for consultation.

One of the least recognized and acknowledge fact is children having depression. These are primarily because most of the adults feel that, children have no problems, worries or responsibilities which would make them prone to depression. But what they fail to understand is that the children’s problems, worries and responsibilities are big enough for them to become stressed and if adequate support is not available it can very well lead to depression. More over they are dependent on parents in every way, and the parents expect their children to live a life as per the parents aspirations and manage the problems by the methods and directions provided by the parents Any independent move by the child to handle their problems on their own or in consultation with anybody else is only felt as an act defiance which only leads to further pressure from the parents to tow the expected lines. These factors only creates a feeling of powerlessness, lack of control and helplessness in children which only escalates the status in the children who are already stresses or prone to depression.

In case of adolescents most of the behavioral, cognitive and emotional changes are viewed as a natural part of their developmental process and parents turn a blind eye to the the deterioration's even when its obvious. It’s a well known fact that adolescence is period of stress and storm and they have to handle multiple pressures both internal and external which can easily make them prone to depression. But parents never even think about the possibility even though they know that their child is undergoing a lot of turmoil which can be difficult for them to manage by themselves.

The other important reason why parents find it difficult to acknowledge this fact is because, children are not so articulate as adults in expressing their emotions. Most of the time it is manifested through behavioral problems or deterioration in performance, on various functionalities for which parents have their own interpretations which actually clouds their rational mind from looking into the possibility of the child being depressed.

One more factor, that make diagnosis of depression even for professionals is that most of the behavior and cognitive symptoms when existing alone can be diagnosed for other disorders such as mood deregulation disorder, oppositional defiant disorder, intermittent explosive disorder, attention-deficit/hyperactivity disorder, conduct disorder, anxiety disorders and autism spectrum disorders specifically asperger’s syndrome. In case of adolescence it can also be diagnosed for substance use disorders. Many a times even when the parent decide to take a professional help they only project a single behavior or problem which they feel as most significant or the most disruptive ignoring many other changes which they feel insignificant or the after effect of the significant one. This can mislead the professional and unless and otherwise the professional is willing to spend time to collect all other relevant information they may misdiagnose it for some other specific disorder.. The difference between these disorders and childhood depression in childhood depression there are multiple symptoms along with explicitly noticeable emotionality. The other important difference is that the changes in behavior, thought process and emotions occurs in a short period of time which is quiet obvious to people who see these children regularly

What every parent needs to understand is that depression in children are a reality, a highly prevalent mental health issue and its life threatening. The increase in the number of suicides among children and early adolescents for flimsy reasons which is just a nano percentage of the depressed population is the proof for the same. The prevalence rate of depressive disorder is estimated to be 2% in children and 4-8% in adolescence and 70% of children with a single depressive episode will experience a recurrence within five years, with the Lifetime prevalence of depressive episode being 20% by the end of adolescence.

Untreated depression in children, can lead to devastating consequences, including consistent problems in school, at home and with friends, the loss of critical developmental years, increased risk for antisocial behavior and in some cases even suicide. Just like every other health issues depression in children can also be cured with early diagnosis and appropriate intervention. 

Developing communication Skills - Parent's Role and Responsibilities By R.Manoj Child and Adolescent Psychologist, Chennai

            The need for effective communication skills is felt only when the children are in the final stages of their academic life. Efforts to build it by attending workshops or undertaking training programs at this stage has been ineffective in a major chunk of the population

            Most of parents leave the development of communication skills to chance, nature, and opportunities that they hope to come in by-and-by Communication is a basic skill that has to be developed from childhood and early intervention has been found to give the best results. The onus rests on the family as a whole and Parents in particular. This is because children spend more time with their parents and also have a deeper involvement with them and the family as a unit has lifelong contact with its members. Parents also play a very important role in determining many of the contacts a child has with society as well as society's contacts with the child. Developing communication skills in their wards does not take any extra efforts from the part of the parents. All they have to do is

         Use the most of the available time to engage in conversation with your family members. By encouraging conversation you set an example to the children that they are also free to talk. Make yourself available whenever your child when your child wants to talk to you. Don’t ever say that I have no time to hear your goofs or I have other better jobs to do. Even if you have a hectic schedule always find some time every day to have a free talk with your child.

               Be unconditional and open to any ideas or opinions of the child even if you feel that what they say are bloopers or blunders. Always show genuine interest in whatever they say and regularly reassure them that their ideas are being listened to and valued. This increases their confidence and makes them comfortable in building up the conversation.

               Do not pass any negative comments on any of their opinions, ideas, thoughts or fantasies. Make them feel that you have understood their feelings and emotions. Always verbally endorse the same so that the children are never at doubt whether you grasped them clearly. This would make them more at ease to freely express all that comes to their mind.

              Even when you are probing into any of the deeds of the child don’t ever try to extract single word answers or make him reply in a “yes” or “no”. Be careful enough not to stop with “why it happened” but always encourage him to explain in detail, describing all the happenings associated with the incident.

                 Whenever you feel that the child is in an emotionally aroused state do allow him to express his feelings in his own words. Empathize with them to understand the intensity of the same which they may not be fully aware of.However restating or rephrasing what children have said in milder terms will be useful in bringing down the intensity of the powerful emotions they are experiencing.

             Repeating some of the words and phrases used by the child will be effective keeping them at ease and increasing their confidence enabling the extension the conversation. But by stating them in your own words you expose the child to wider vocabulary and usage of appropriate words and terms can give them a deeper understanding of words. This will help in improving their vocabulary and guide them to express themselves as accurately and clearly as possible in future.

                   If your child has been reluctant in talking to you try to look for any opportunities to pick up a conversation. This can be done by asking their opinions or ideas on incidents which they are usually interested in. Project as if both of you have some common platforms regarding, which you can talk about. Share all your views about the child especially the positive ones. Also allow him to share freely all his views about you. Do not heist to ask suggestions on things of common interest.

            Do not try to force the children in entering into conversations or put pressure to continue till such time that they get bored or exhausted. Watch for signs such as to staring into space, giving silly responses, or asking you to repeat several of your comments which indicates that it is time to end a conversation. Force can create aversion and alienate the child from you.

                Do not add fragments of advice every time you talk. Also be careful enough not to insist on maintaining high standards of vocabulary or grammar during conversations.

                 Parents set a powerful example of good or poor communication. One of the basic requirements for improving communication is audience and remember that the greatest audience any children can have are his parents who are important to them and interested in them.