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Childhood Depression:
A Phase or Something More?

Most of us consider childhood to be a carefree, happy time of life.

Sure, it has its moments. Skinned knees, ear infections, chores that get in the way of playing, disagreements with friends, to name a few. But, with a bandage here, antibiotics there, a few hugs and kisses and a little time, things usually get back to the normal routine.

An increasing number of children, however, suffer pain that doesn’t respond to bandages or hugs. They know something is different, but often can’t pinpoint the problem. Their parents, even the most attentive, may not even suspect something is amiss.

These kids suffer from a medical illness called depression. Despite our tendency to think children live carefree, happy lives, the U.S. Center for Mental Health Services reports that as many as one in every 33 children and one in every eight adolescents may suffer from depression.

Depression is not the same as being sad, although we tend to use the two words interchangeably. It is normal for a child to be sad when a best friend chooses to play with someone else at recess.

It is normal for a child to be down when Mom has to leave on a business trip. It is also normal for a child to turn inward when a grandparent gets sick and dies. But, when a feeling of sadness lingers and begins to affect the child’s daily routine, it is not normal. It may be the onset of depression, and it needs to be evaluated.

In the late 1970s, childhood depression officially was recognized as a medical illness. This mood disorder affects a person mentally, emotionally, physically, and socially. Despite its impact, recognizing it can be extremely difficult.

"Symptoms of depression  in childhood are basically common difficulties children have like temper tantrums, hyperactivity, disobedience and, in girls particularly, somatic complaints — headaches, pains, stomachaches," says Dr. Scott Armentrout, director of psychological services at Warm Springs Counseling and Training Institute in Boise. "What makes the symptoms of depression different from what you encounter normally are their frequency, intensity, and duration."

Contrary to social thinking, children do not suffer depression because they are bad kids or because they have bad parents. It is clearly an illness, even though its exact causes are still under debate.

Research suggests one cause is a change in the levels of three specific brain chemicals: serotonin (regulates sleep and memory), norepinephrine (affects alertness and energy levels) and dopamine (controls emotion and movement). An imbalance in these chemicals is believed to trigger clinical depression or leave a susceptible person more at-risk for depression should a life event occur.

There also is research to support that depression tends to run in families, suggesting a genetic factor. According to the U.S. Surgeon General’s Report on Mental Health, published in December 1999, "Children of depressed parents are more than three times as likely as children with nondepressed parents to experience a depressive disorder."

Internal and external causes also may be contributing factors. Children who struggle to fit in, have difficulty learning or dealing with frustration, or experience changes in their life such as death, divorce, a move, or a new sibling may be more at-risk for depression.

Dr. Armentrout says it is important to recognize that an accumulation of factors can be at work, rather than one single event being the catalyst. "If an event is the last straw of a series of things, it can push a child over into discontrol and into a clinical depression."

Unwittingly adults can make the situation worse says Cathy Thomas, a counselor with the Meridian School District. "The child with undiagnosed depression can be mistakenly labeled as uncooperative by their parents, disruptive by their teacher, and unmotivated by their coach."

One of depression’s more outwardly signs can be a change in behavior. Although it is easy to attribute behavioral changes to stress, there is a difference between stressed out and depression. "A break from stressors leave a stressed person feeling better," notes Kevin Geraghty, MSW, a licensed clinical social worker with Shoreline Psychological Associates. "A break for someone with depression leaves them feeling ‘so what.’"

Communication is critical, and active listening is absolutely vital. When a child says they feel stupid, ugly, or worthless, our immediate reaction is to point out the child’s many attributes. Dr. Armentrout says that can actually exacerbate the situation. "If a child doesn’t feel good about him or herself and someone tells them how great they are, the incongruence between how they feel about themselves and what a parent says hurts. They don’t feel understood. They don’t feel like anyone is listening."

If you suspect your child might have depression, ask for help. Dr. Armentrout suggests, "Check in with your child’s teacher. Teachers are almost experts on their students. After all, they spend six and a half hours a day with them." Another good source is your pediatrician who can help you differentiate between what is normal development and what is not. Often, they also can offer objective insights regarding a child’s temperament.

A comprehensive screening is crucial for an accurate assessment of the child to rule out other factors such as a learning disability, attention deficient disorder, or a response to a major event or situation. Teachers, school counselors, and pediatricians can refer you to screening resources in the community.

Geraghty notes that many Treasure Valley employers, as part of their benefits’ package, offer Employee Assistance Programs that provide confidential screening services at no additional cost to their employees. Also, Intermountain Hospital in Boise provides free evaluations.

Society has attached a stigma to mental illness. Sadly, only one in five children get the help they need. For those who do, there is a light at the end of the tunnel. Treatment, often a combination of therapy and medication, boasts an 80 percent success rate, making depression among the most treatable of all medical illnesses.

Written by Charnell Dahl-Veenstra, a freelance writer and editor residing in Boise, Idaho.

Idaho Federation of Families for Children's Mental  Health — For families and their children with emotional, behavioral, and mental disorders. A statewide parent-run organization focused on the needs of children and youth with emotional, behavioral, or mental disorders and their families, with excellent links to other local and national sites, including the Federation of Families for Children's Mental Health.

National Mental Health Association Site contains fact sheets on a vast variety of subjects relating to children and adults.

National Alliance for the Mentally Ill (NAMI) — Grassroots, self-help, family advocacy organization dedicated to improving the lives of people with severe mental illnesses. The Idaho Chapter of NAMI is a non-profit education, support, and advocacy corporation, linking family support groups committed to improving the quality of life for people with a brain disorder, and their families.

American Association of Suicidology — Nonprofit organization dedicated to the understanding and prevention of suicide. This site is designed as a resource for anyone concerned about suicide, including AAS members, suicide researchers, therapists, prevention specialists, survivors of suicide, and people in crisis.

The Research and Training Center on Family Support and Children's Mental Health — Activities focus on improving services to families whose children have mental, emotional, or behavioral disorders through a set of related research and training programs. Site includes a National Clearinghouse with fact sheets and information for families or providers.

For Parents

Being Prepared: Know When to Seek Help for Your Child — When to seek help for a child.

For Professionals

National Network for Child Care — For child care providers on caring for children with special needs.