Major Depression in Children and Adolescents:

Hurting and Healing

Major Depression in Children and Adolescents:

Hurting and Healing

Adria Fredericks, M.Ed.

Learner ObjectivesLearner Objectives

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

Participants in this seminar will be able to:Participants in this seminar will be able to:

GlossaryGlossary

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)

Glossary (continued)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

DefinitionDefinition

Feeling sad (sadness that won’t go away) Feeling guilty Eating and sleeping too little or too much Loss of energy and interest Lack of focus

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

Characteristics include:Characteristics include:

Definition (continued)Definition (continued)

Feeling nervous, irritable, angry and unable to relax

Feeling badly about self

Thinking about hurting self

Thinking about death and suicide

Characteristics also include:Characteristics also include:

Definition (continued)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

PrevalencePrevalence

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

Prevalence (continued)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

How we identify the problemHow 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

Biological factorsBiological 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

School factorsSchool 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

Family factorsFamily 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

Cultural factorsCultural factors

Latino and Mediterranean • “Nerves” or headaches

Asian • Imbalance or disturbance of “chi” (lifeforce or energy)

Middle Eastern • Problems of the heart

Native American • Heartbreak

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

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

Cultural factors (continued)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

Cultural ideals and stereotypical gender roles also add stress to what may already be very stressful situations at home and in school

National legal safeguardsNational legal safeguards

Regular classrooms with support personnel

Special teachers

Special classrooms

Special schools

Day treatment/hospitals

Homebound education

Special classes in detention centers and prisons

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

National legal safeguards (continued)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

Legal Safeguards in PennsylvaniaLegal 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

Legal Safeguards in Pennsylvania(continued)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

What can you do?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

What can you do? (continued)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 what’s available and share the information

Be compassionate

What to avoidWhat to avoid

Being judgemental/critical

Having unrealistic expectations

Being inflexible

Taking behavior personally

TreatmentTreatment

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)

Treatment (continued)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

Case study of a childCase study of a child

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

Case study of an adolescentCase study of an adolescent

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

Information for parentsInformation for parents

Please refer to the Parent Brochure

Where you can get more helpWhere you can get more help

• NAMI PA (National Alliance on Mental Illness of Pennsylvania) Helpline (800) 223-0500 www.namipa.org

• NIMH (National Institutes of Mental Health) Helpline (301) 443-4513 www,nimh.gov

• NMHA (National Mental Health Association) Helpline (800) 969-6642 www,nmha.org

Please refer to the Study Guide for a more comprehensive list

ReferencesReferences

• 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.

References (continued)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

Contact informationContact information

Adria Fredericks, M.Ed.

The Center for Counseling Arts

1901 East Carson Street

Pittsburgh, PA 15203

Phone: (412) 431-8552

Fax: (412) 431-8561

Email: aaf20@pitt.edu