In our culture, sadness and depression have become almost interchangeable terms. In this article, we're going to use the term "episodic depression" when referring to a level of sadness that children experience that interferes with their functioning.
Almost all kids will go through periods of sadness at one point or another. "Depression" itself is a clinical term that's become part of our culture. Kids, as well as adults, will use the word "depressed" when they're feeling sad about something. But know that there are many levels of meaning here, from feeling a little down all the way to clinical depression.
If your child seems distressed, despondent or sad for a prolonged period of time, have them seen by someone with diagnostic skills. Be sure to have a pediatrician rule out any underlying issues that might be causing depression.
Rather than clinical depression, in this article I'll be addressing the periodic episodes of depression that kids go through--times when they seem to get "stuck" and don't know how to move forward. Kids often don't have the skills to handle their overwhelming emotions, but as parents, we can help coach them through the tough times and teach them coping skills.
What Episodic Depression Looks Like
When your child is down, you may see them exhibit a variety of symptoms: lethargy, irritability, anger, impatience, changes in eating or sleeping patterns, acting-out behavior, high distractibility, crying, confusion and a general sense of sadness. During these times, it's important to try to determine what's triggering the episodic depression your child might be experiencing. Whatever the cause, once you determine what the problem is, you can help your child develop the coping skills to manage that problem.
For each child, the event or situation that has triggered the episode of depression is different. It can be anything from a death in the family to a divorce, social problems to difficulty at school--which may further inhibit your child's ability to empower themselves. The result is that they can't make decisions very well; in fact, there might seem to be an absence of decision-making in their lives.
Know that when your child is depressed, their coping skills have collapsed. And I want you to think of collapsing in terms of the speed at which they lose their coping skills--think of a building collapsing. And so it might look like this: one day your child is coping with things okay, and the next day, they can't seem to solve the same functional or social problem. For some reason they can't get along well with authority and they have a hard time meeting their responsibilities. These are sometimes the symptoms of episodic depression. So if there's a chance your kid is going through episodic depression, the most important thing is that you help them maintain their coping skills until the underlying issue is resolved.
Episodic depression can stem from something that's happening at school, such as a bullying situation. If you have a younger or middle school-aged child, you need to find out if the trigger of this episode is something that should be managed by the school. Schools have to take responsibility to keep kids emotionally and physically secure. There's much too much intimidation, bullying and abuse going on these days, and schools have to be much stronger in having a code of conduct in how kids treat each other. You'll also want to talk to your child's teacher and find out how your child is doing in school. Has the teacher observed any changes in your child's personality? Do they have schoolwork they can't manage? It's always a good idea to say, "Here's what we've been noticing at home. What do you see?"
I want to note here that parents should be very wary of the medication used to treat depression in children. Personally, I'm not for or against medication, it's strictly a child-by-child determination, but it's important to be aware that some drugs that have worked with adults have been used on kids to a bad effect. Many of the SSRI family of antidepressants have been found to aggravate symptoms of sadness and desperation in kids. Sometimes these meds exacerbate the problem a child is experiencing and make self-destructive behavior more likely. So make sure that you talk candidly with your child's doctor, do research online, read up on it as much as you can, and understand the risks if you decide to go that route.
When depressed kids act out
Misbehavior and acting out are two of the symptoms of depression that you'll see in a child, and sometimes, two of the primary symptoms. In fact, a lot of the kids that I've seen diagnosed with depression had a very intense acting-out component to their behavior. Why? Because they could not access their problem-solving skills. When people can't solve their problems, they act out in one way or another, and when children can't solve a problem, they tend to act out their feelings. The most important thing parents can do is help their kids access their problem-solving and coping skills, whether they're medicated or not, and give them the support they need to develop them. If you're a depressed kid with no coping skills and you go on medication, then you're a medicated kid with no coping skills.
It's just that simple: children need added direction, structure and support when depressed. One of the most important things parents need to know is that during those periods of sadness, your child still needs to take responsibility for solving problems; that does not stop. In fact, letting your child avoid their responsibilities because they're down is a big mistake. If you're an adult and you tell me you're depressed, I will tell you what tens of thousands of therapists will tell you: "Get up off your butt and go do the dishes. When you're done with the dishes, go down to the park and walk the dog. Buy the paper and read it." In other words, the whole idea about depression is you still have to live your life.
Listen, growing up is hard, and if kids find a place to hide out, they will. Many kids find a place to hide out through acting out behavior. And they hide out there until they're young adults, by being verbally and physically disrespectful and abusive. That's how they really avoid growing up.
A word of caution: if depression builds and kids feel like they're falling behind in life, they can start feeling more and more hopeless, more and more stuck, and more and more guilty. For some, thoughts of suicide start to look good. In fact, in one study that came out in the '90s, researchers found that 80 percent of the kids they were tracking who contemplated suicide were not clinically depressed. The kids who contemplated suicide the most seriously were those who were faced with problems they didn't know how to solve and who had the means to kill themselves. Some even made attempts, and tragically, several were successful.
The researchers concluded that if you teach kids problem-solving skills (and if they have no access to weapons or other means to harm themselves), adolescent suicides would go down. The study also found that children and adolescents don't have the problem-solving skills it takes to solve the very complex dilemmas teens get themselves into sometimes. People think of suicide when it's the only solution they believe they have left. Sadly, for some kids, it looks like an easier solution than public humiliation, shame or dealing with a difficult adolescent issue.
Next week, James Lehman, MSW will discuss how to help your child identify depression and use the new coping skills you will teach them. He will also show you how to help your child focus on and complete their responsibilities, even when they're feeling down. James will explain why, although it's difficult to see our kids go through episodes of depression, it's also an opportunity to help teach them coping skills they'll be able to carry with them for the rest of their lives.