Children And Adolescents For Depression example essay topic

Depression in Children and Adolescents What is depression? Depression is the most common mental disorder, not only for adults, but for children and teenagers as well. The DSM-IV classifies depression as a mood disorder. It states that an individual has suffered a "major depressive episode" if certain symptoms persist for at least two weeks, including a loss of enjoyment in previously pleasurable activities, a sad or irritable mood, a significant change in weight or appetite, problems sleeping or concentrating, and feelings of worthlessness.

These symptoms of depression fall into four categories: mood, cognitive, behavioral, and physical. Depression affects how individuals feel, think, behave, and how their bodies work. People with depression may experience symptoms in any or all of the categories, depending on personal characteristics and the severity of the depression (Ainsworth 2000). Victims of depression often describe feelings of emptiness, hopelessness, unreasonable guilt, and profound apathy. Their self-esteem is usually low, and they may feel overwhelmed, restless, and irritable.

The changes occurring with depression understandably result in alterations in behavior. Most individuals with moderate-to-severe depression will experience decreased activity levels and appear withdrawn and less talkative, although some severely depressed individuals show agitation and restless behavior, such as pacing the floor. "Depression is more than a mental illness. It is a total body illness (Curtis, p. 132) ". Major depressive disorder, also know as clinical depression, is the serious and often disabling for of depression that can occur as a single episode or as a series of depressive episodes over a lifetime. A single episode may last as little as two weeks or as long as months to years (Mondimore, 1990).

Some people will have only one episode with full recovery. Others recover from the initial episode only to experience another episode months to years later. There may also be clusters of episodes followed by years of remission. Depression in Children How do we determine whether children are depressed? All children feel unhappy from time to time. Sadness is a normal, natural response to many life events, from losing a soccer game or moving away from old friends to a death in the family.

"Although when that sadness runs too deep, lasts too long, or occurs too often, it may be a sign of clinical depression (Egger, 2002)". For many years, childhood depression went unrecognized. Many mental health professionals believed that children were not emotionally mature enough to experience true depression. It was not until the early 1980's that clinicians and researchers began to realize that childhood depression was a distinct, recognizable disorder. The National Institute of Mental Health (NIMH) estimates that over 1.5 million children and adolescents are seriously depressed (Wingert, 2002). Since most experts now agree that childhood depression exists, many are applying psychological theories of adult depression to children.

Two of the better-known theories both have their roots in psychoanalytic theory. The first theory is based on the work of Sigmund Freud. It revolves around the idea that the loss of a "love object", such as a parent, pet, or important relationship, can cause depression. Psychoanalysts usually offer this second theory as well: that depression is really anger turned inward against the self. This means that a young child may be enraged at his father for physically abusing his mother, but instead of confronting him - which is too scary and dangerous - the child turns his rage on himself and becomes sad and eventually depressed (McKnew 1983).

Once they reach school age, children become less egocentric and are able to see things from another's point of view. They can be quite sympathetic and empathetic, particularly toward other kids who may be crying or having a difficult time. By the time they are around eight years old; most children are capable of understanding fairly abstract concepts. School-age children tend to move away from magical "there's a monster under my bed" fears and into more reality-based anxieties (McKnew, 1996). They may worry about passing a spelling test, being accepted by their peers, or having their house blown away by and approaching tornado. This developmental maturity helps explain why school-aged children are more likely than younger children to have clinical depression.

Which Children are Most at Risk? Children typically go through some very trying stages as they grow up. Sometimes, however, an abrupt change in a child's behavior or manner is more than a passing stage; instead in can be a symptom of a serious emotional problem like depression. Depression is not easy to identify in children. In fact, until the early eighties when it was recognized as a true disorder, even professionals often missed it. One reason was that it was shaped by the knowledge of depression in adults.

So, unless the same intense sadness and tearfulness was seen in the child, or unless it was known that the child experienced feelings of worthlessness and hopelessness, depression was not suspected. Now it is realized that children, who are just learning how to express the many emotions they feel, may communicate their distress very differently from adults. Research confirms the many variations in the symptoms of childhood depression (McKnew, 1996). In one 1987 study, researchers at the University of Pittsburgh and New York State Psychiatric Institute found that younger kids who were depressed complained of physical problems such as stomachaches and restlessness, experienced great anxiety when separated from their parents, and developed fears of places and situations. Depression is a recurrent disease, if a child has had it once; he is more likely to have recurrence when he is a teenager or even when he is an adult (Empfield 2001). Teenage Depression (Adolescent Depression) Depression may also be difficult to diagnose in adolescents.

Every teenager experiences a series of challenges in life, from dealing with the physical pain and hormonal changes of adolescence to separating from parents and finding their own distinct identity (Empfield 2001). These challenging tasks often cause a great deal of confusion and anxiety; consequently brief bouts of sadness, marked by tearfulness, moping, pessimism, and occasional hostility, are entirely normal during the teenage years. Teenagers can be moody, as everyone knows; but every moody teenager is not suffering from depression. Most teenagers, even the ones who are really acting out, do not have clinical depression. The average age of onset of depression in adolescents is about fifteen, but it is not uncommon in children from ages ten to fourteen (Fassler 1997).

After age fifteen, girls are about twice as likely as boys to be depressed. Gender doesn't seem to affect the duration of depressed episodes, however, as both girls and boys suffer for more or less the same period of time. An episode will last six to eight months and then end. So, why not just tell the teenager to try to "tough it out" and let the depression go away on its own? Several problems with this approach make it very dangerous. First, depression can be extremely painful, comparable in severity to the worst kinds of physical pain.

No one would ask a teenager to "tough out" even one hour of pain, for example, from having their bones crushed or even just filling a cavity in a tooth (Empfield 2001). Next, not all depression goes away so conveniently. In some cases, symptoms may last for years; while in other cases the patient recovers between episodes, but never enough to be feeling really well. Perhaps most important of all, untreated depression is a major cause of suicide. There are certain ways in which the diagnosing depression in a teenager can be confusing.

For example, adolescents sleep a lot. That is normal, and not in itself a sign of depression. Similarly, weight gain and weight loss, provided they are not extreme and do not involve binging and purging, can be ordinary events in a teenager's life, and not a sign of illness. In general, the vegetative signs, the physical symptoms, which often accompany depression, are less useful in diagnosing depression in adolescents than in adults. Teenagers like everyone else, experience unhappy events, but unhappy or unpleasant events do not cause depression by themselves. Still, an unhappy event can be the trigger for an episode of depression in an adolescent who is already vulnerable to the disease.

To justify a definitive diagnosis of major depression, a psychiatrist will have to find that at least five of the nine diagnostic symptoms have been present over a two-week period, and one of the five must be either depressed mood or loss of interest of pleasure in normally pleasurable activities. Which Teenagers are Most at Risk? If a teenager fails a test in school, ends a romantic relationship, or suffers the death of a loved one or the divorce of his parents, he may feel depressed; but that does not mean that he is suffering from clinical depression. Often the adolescent figures out a way to make up for the failure, begin a new relationship, reconcile themselves to the loss, get over the setback, and go back to normal life. But for some adolescents this sort of sad but common event can be the initiating factor in an episode of serious illness that then takes on a life of its own, bearing little or no connection to the event or events that precipitated it (Empfield 2001). No one expects a teenager to grin and bear it with every setback; life has sad events that anyone is entitled to feel sad about.

But if the sadness or grief is out of proportion to the event, or lasts much longer than seems normal or appropriate, or gives way to physical symptoms, then there may be a more serious problem to be dealt with. Adolescents operate in three areas that are quite separate: at home, with friends, and at school. "While a teenager's behavior at home is obvious to his parents, they do not always know what is happening elsewhere. Friends may be unaware of problems at home, the school authorities may be unaware of problems with peers, and parents may be ignorant of both their child's relationship with friends and the extent of academic difficulties. Even if parents make a conscientious effort to find out how their teenager is doing, they are not always the most objective observers, usually preferring to see things in the best possible light (Empfield, p. 63)".

Therapy - view of children / teens Even if medication is necessary, as it often is in cases of major depression, most adolescents do not see a psychiatrist first. They are more likely to see a school counselor, a social worker, or a psychologist. Well-trained people in these fields are able and qualified to provide helpful psychotherapy. Major depression is a biological illness. Biological illnesses of all kinds, not just psychiatric illness, are affected by environmental and psychological stimuli. If a child or adolescent is susceptible to depression, an unhappy event, trips to an unfamiliar place or a criticism from a teacher, parent, or friend are events that can trigger or worsen a depressive episode (Hazell, 2003).

In other words, the reason for the occurrence or severity of an episode of depression at a given moment can be psychological and therefore psychological treatments are useful and appropriate in relieving symptoms. The Causes of Depression (Psychoanalytic Theory, Cognitive Theory) Psychoanalytic Theory Why do these children and adolescents suffer from depression? There are many theories that center on the causes of depression. Sigmund Freud formulated one well-known theory, the psychoanal lytic theory. Sigmund Freud looked to the mind for the cause of depression and other mental illnesses, eventually developing the school of theory and treatment of mental illness that came to be known as psychoanalysis.

Freud and his followers in Europe and the United States elaborated on his theories. Freud and Karl Abraham emphasized the connection between depression and mourning through the individual's conscious and unconscious preoccupation with the lost loved one, especially with the ambivalent feelings they believed are associated with all human relationships. According to this theory, the anger and aggression associated with an individual's ambivalent feelings for a lost loved one are turned inward against the self, leading to depression. (Clarizio, 1989) According to psychoanalytic theorists, the impact of early human attachments and loss in early childhood, such as separation from a parent, may predispose the individual to depression in later life when additional losses occur. These theorists also point out that loss of self-esteem is an almost universal phenomenon in significant depressions. Modern therapists who subscribe to this psychoanalytic theory believe that the loss and unexpressed rage may be related to significant events other than loss of relationships, such as being passed over for a desired promotion, being the victim of an assault, being involved in a serious accident or failing academically.

Psychoanalytic Treatment The form of therapy developed by Freud, known as psychoanalysis, involves delving into the individual's past relationships, emotional associations, and beliefs. It is based on Freud's theories regarding primitive instincts and the conflicts, usually that are unconscious, which arise from instinctual demands that must be suppressed or modified to allow the individual to adjust successfully (Ainsworth, 2000). This form of therapy analyzes the individual's instinctual drives, conflicts, anxieties, defense mechanisms used to cope with the premise is that developing insight will result in psychological growth and decreased symptoms. The underlying root causes of depression are thought to be loss and anger that has not been effectively managed and may not be consciously recognized. Psychodynamic psychotherapy, also referred to as insight-oriented psychotherapy, is a later derivative of psychoanalysis.

This form of treatment relies more on an understanding of the patterns of strong attachment to others displayed by individuals, especially as relates to problems in their lives. It also deals with defense mechanisms used to contain emotional discomfort. The belief is that once individuals become aware of the inner drives and conflicts that cause anxiety, anger, or despair, they can adjust their behavior to more effectively deal with those drives and thus relieve emotional discomfort (Fassler, 1997). For example, through psychotherapy many depressed patients develop an awareness of previously unrecognized grief over the loss of a relationship, or a position, or something else that was important to them. They begin to understand the connection between their loss and the feelings of anger or rage that were deeply submerged beneath the guise of depression because of their inability to deal directly with the loss. Once these connections are made, depressed individuals often experience relief as they develop more beneficial responses and replace impotent rage with mastery over their dissipating anger.

Psychodynamic psychotherapy typically involves a series of individual sessions between the therapist and the child. In them, the therapist uses a variety of techniques to help the child express his thoughts, feelings, and fantasies, and to uncover hidden or unconscious ideas and conflicts that may be affecting his behavior (Fassler, 1997). Helping children make the connection between their unconscious emotions, like being angry at their big brother for getting cancer, and their actions, picking fights with other children on the playground, often frees them up to behave and interact in a healthier manner. Psychotherapy with adolescents generally relies on talking about feelings and problems. Psychotherapy for younger children who have trouble putting all their experiences, thoughts, and feelings into words takes a different form. In addition to asking the child direct questions and listening to his answers, the therapist uses more indirect methods to communicate, such as painting or drawing, encouraging fantasy play, (often using puppets or dolls) in which the child can act our different life scenarios, or reading stories about characters going through similar experiences.

For most young children, these methods offer less threatening and less scary ways to explore their innermost thoughts (Ainsworth, 2000). In some ways, the psycho dynamic approach works more easily with children than with adolescents. With children, emotionally significant events are more recent, so it is often easier to get to the issues surrounding them. And since children tend to be so emotionally expressive anyway, psycho dynamic psychotherapy can often be a highly effective treatment for children with depression. Although psycho dynamic psychotherapy can be effective in treating children and adolescents for depression, the treatments often considered most beneficial are the cognitive-focused treatments. Cognitive Theory Cognitive theories emphasize the importance of the ways in which people think about life and themselves.

According to cognitive theorists, mood is related to the individual's belief system. When our beliefs are pessimistic in nature and we focus on what is wrong or negative in ourselves and our environment, rather than on what is good, the natural outcome is a depression (Rehm, 1981). The well-known cognitive theorist, Aaron Beck, described a cognitive triad for depression: a negative view of self, a negative interpretation of experiences, and negative expectations of the future. According to this theory, depression is not the primary illness, but a secondary manifestation of a pessimistic belief system. A child who believes that he is worthless, that his future is bleak, and that the world around him is scary or unsafe, often becomes depressed, according to cognitive theory (Fassler, 1997). Learned helplessness and learned hopelessness are features of cognitive theories.

People with learned helplessness tend to believe that stressful events are permanent rather than temporary and drastically affect their whole life experience rather than only a component of their lives. This idea suggests that when children or adolescents are constantly told that they cannot control current or future events no matter what they do, they come to believe that they are helpless (Fassler, 1997). Cognitive theorists also believe that once people assume the typical pessimistic stance preceding depression, they tend to view all life circumstances in the same manner. As a result, individuals rehearse their beliefs and behaviors and see each circumstance that blends easily with their belief system as yet another proof of the truth of those beliefs. Depressed people learn and maintain their depressive stance through rehearsal and reinforcement. "The natural outcome of such a belief system is low self-esteem, self-doubt, a tendency to ruminate about past unhappy experiences, decreased pleasure capacity, and pessimism about the future.

All of which are common symptoms of depression. (Empfield, p. 55) "Cognitive Treatment Cognitive therapy centers on the belief that the way people think about the events in their lives, the way they perceive themselves and the world around them, and their ability to solve problems strongly influence the way they feel and behave. Through cognitive therapy, the therapist works to recognize negative thoughts to understand how and why they are contributing to sad feelings. The therapist helps the child or teenager learn to reevaluate events and see them is a different, more positive light. One of the most important techniques in cognitive therapy is attribution retraining. Instead of thinking "I failed the test because I am stupid", the child learns to see that he failed the test because he did not study hard enough or because he did not study the correct material.

The child also learns that in most situations he is not a helpless victim of circumstances, but someone who can exercise some control over his life. Part of the work of the cognitive therapy is to help patients modify such negative behaviors is by using a variety of techniques. One of the most useful for children is the Star Chart system. It works on the theory that children will change their behavior to obtain a reward. To develop a star chart, the therapist helps the child identify one or two positive ways of managing or expressing troublesome feelings. Then a plan is designed in which a child can ear a star whenever he behaves in certain appropriate ways.

Earning a preset number of stars brings the child various rewards (Fassler, 1997). Some adolescents personalize events, interpreting any setback, however minor, as proof that they are bad people. Many studies show that adolescents experience these kinds of disturbances in the ways they process information, and that they are so common they can be considered one of the features of depression (Ainsworth, 2002). In cognitive therapy, they are taught to recognize these kinds of faulty logic in their automatic thoughts, and to develop alternatives that are more accurate and more helpful. Teenagers are often encouraged to keep written records of dysfunctional thoughts, taught to recognize cognitive errors by examining the evidence, and shown how to develop alternate methods of thinking. The latter stages of the therapy concentrate on developing methods of dealing with stress, techniques that will prevent relapse after therapy is concluded (Empfield, 2001).

Suicide (Major risk - If depression is not treated)

Bibliography

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