Common issues and behaviours
Feeling down is normal
Depression in children: it is a fact that everyone feels down now and then and that is normal. The thing about low moods within the normal fluctuations in life is that such moods can provide opportunities for growth and development of the selves into mature and responsible adults with some degree of personal skills and resilience. The lack of personal skills and coping skills in children and adolescents combined with a lack of life experience are partly the causes of the high degrees of stress and anxiety in young people. Throw in hormones in the teenage years and you have the reasons why doctors are reluctant to describe medication to young people. No amount of drugs of any kind will ever be a quick fix for these issues. They just have to live through it and grow up.
About seeking help
Seeking help for depression and anxiety for yourself or for someone you care about, you don’t have to decide whether you are within a “normal” range of depression, if you are clinically depressed or whether you maybe have schizophrenia or are bi-polar. It can be useful to view seeking help as the start of a journey to learn new skills, including the skill to seek help, don’t try to preempt the conclusion by placing a diagnosis on yourself. Cognitive-behaviour therapy, coping skills and the opportunity to talk things over will benefit anyone and even when medication is indicated and prescribed, counseling will usually run concurrently.
Mental health websites have endless information about depression and truly, it is hard to tell the difference between these self-help outlines of symptoms and the symptoms of eating a bad curry or having a hang-over. One of the main assumptions about depression is to confuse it with sadness. While depression can include feelings of sadness for some people, sadness is not depression. Even doctors get this wrong and will refuse intervention because the patient is not sad enough.
Depression in children and young people
Do not compare to adult expectations and behaviours
Depression in children and young people can be very different from depression in adults, which is why you want to seek out health professionals who specialise in children and young people.
The following are some behaviours that are commonly noticed by people around a young person struggling.
Compare with the Normal for the person in question
Parents and carers often first notice that schoolwork starts to slip, it becomes hard to get to school, doing sport is not interesting anymore, they don’t want to see friends.
Often very non-demanding activities take their place, such as playing games, watching videos. This is a way of putting the brain into a redundant mode, like placing it in neutral because anything else is becoming too hard to deal with.
Hot on the heels of redundant mode activities comes the non-tolerance of increasingly more things that intersect with their lives: think noise, what people say or do around them, things around them, it can be anything. Become aware when something they used to tolerate or that most people tolerate becomes unbearable for them, makes them angry. They can become unable to put things in perspective and will put the worst possible interpretation on anything others say or do: “they said that because they hate me”, “you are stupid”, “I hate you”, etc.
The thing about these scenarios and behaviours is that they are not uncommon but makes the person very difficult to live with. If you are lucky, you seek help and find that learning personal skills and coping strategies can remedy the situation. We are still at a stage of symptoms where everything can be due to immaturity. A doctor is unlikely to prescribe medication.
Distinguish Immaturity from Mental Health
The intolerant behaviour can be figuratively described as escalating along a continuum and you have to make it clear to any health professionals you see where on that continuum you are – how does it affect everyday living for the young person and for the family. Can the young person go to school, do they do the activities they used to do like sports, can they get out of bed, do they open the curtains, do they talk to people in person or on the phone, do they still wash, do they eat a normal diet etc. the things you look for depends on what is normal for the person and the family.
Addressing depression in children at School
Can the young person still go to school? If not, is this because they are just continuing to display a non-interest in academics or continuing a history of low achievement or are they going off with friends or is the behaviour out of character. Has there been a change over only the course of weeks or months?
School level intervention is important. You have several options here. It is possible to talk to schools about things like dropping subjects, going to school part-time and getting work to complete at home, completing only some assignments, changing start and finish time at school. Depression is typically characterised by being very lethargic in the morning so the child may by negotiation, for example, start at the second or third period. In secondary school, it is possible to negotiate to do e.g. traineeships outside of school and have that count towards a school leaving certificate on finishing year 10.
There are many options worth pursuing if you find your child unable to cope. You may have to get the help of a health professional to negotiate the best options with the school. Even at such a high level of incapacity from depression, you may find that a doctor will not recommend medication. Remember to stay with your gut on what you think is best for your child, do not seek convenience but what you think is right. Medication would only be one part of a treatment regime anyway, however, other treatment measures could fail without it for some kids.
Depression in children and high support schooling options
When you seek solutions to the behaviour you experience from your child, the impact on the family and the prospects for you child must be paramount. Many teens end up on the street or in out-of-home care because the family is no longer able to look after them and their complex needs. They are acting out too much and might be self-medicating with alcohol and illicit drugs. If you are staring down the barrel of this possibility, I think you have been let down and it is time to keep looking for new avenues of support.
There are a few schools around Australia that are run either from a hospital or by charities and that do schooling on a boarding school basis. Here the child will get an education and will be kept safe and they will be provided counseling and counseling will usually be offered to the family as well. These schools are not well advertised. You can approach your local hospital community mental health unit for children and young people to inquire about any such options in your area, the police and the local state school may also be able to assist with information about such options. In the school directory on this website, you can filter a search with these terms: Addiction Support, At-risk-youth, Education Support, Positive Learning Centre, Youth Support, Youth+. Every school and State has picked their own terminology and run a variety of specialist programs so there is no easy way to streamline this search option.
If bullying is part of the issues your young person is experiencing, read Covert Bullying and the opinion piece Schools need increased literacy on bullying. To consider the issue of mental health in schools, read Wellbeing and School performance PISA 2003-2015.
If you would like to consider alternative schooling options, read Homeschooling, distance education and other flexible options.
Aggression is very common in young people with depression. Talk to the school and other organisations and individuals who are in contact with your child to get an impression of how their moodiness impacts them outside the home. Familiarity breeds disrespect and if the young person only misbehaves and shows aggression in very familiar surroundings, then that informs you very much about their state of mind. Even a person who is depressed can often muster the ability to keep up a facade in public. When a young person shows aggression and disrespect with authority figures outside a familiar environment, you are approaching Oppositional Defiance, which is a behaviour disorder. You are here still dealing with attitude, not a genetic or organic condition.
Aggression is symptomatic of depression in children, which makes depression very hard to diagnose because aggression is normal, especially in teenagers. Aggression must be a red flag for you as a carer, especially when it is escalating and is interfering with the young person’s opportunity to have a normal life with normal activities like seeing friends and going to school.
Anything described above will apply equally to a normal teen and to someone who is clinically depressed. A strong indicator for medicinal intervention is if the young person also starts to have problems expressing themselves, have problems responding to questions and is sinking into something that is more than lethargy and moodiness. It can be hard to tell because a teenager may just be unwilling to speak to you because you are a horrible parent or carer and can do nothing right anyway. Advancing depression can steep the young person in a state resembling catatonia, it is like everything is just stopping up like the brain has become a tar pit where everything moves at a snail’s pace. At the same time, he/she is likely to behave like a wounded animal, lashing out at everything because of the reduced capacity to processing anything. A psychiatrist or pediatrician recognising this state is likely to prescribe medication to be used in conjunction with professional counseling.
Counseling when medication is indicated is like poking a wounded animal – you are just not going to get a good result. Your child’s psychologist should be able to indicate whether there is any progress, give it at least five sessions and possibly change psychologist or counselor as they have to be a good fit. However, if medication is indicated, then you may never find a “good fit” so it is a catch-22 as the saying goes, damned if you do, damned if you don’t.
Counseling is probably the single most useful tool for improving coping ability and behaviour and communication. Counselors specialising in young people and especially oppositional defiant behaviours will come to the young person’s house if they do not show up for sessions. If you are struggling to get your child to sessions, find out about whether this is an option when looking for a counselor. You may find that the real option of the counselor showing up in their room is enough to unstick even the most defiant young person from the house.
Self-harming is common and can be a symptom of depression in children and teenagers. However, human behaviour is so much more complicated than being able to put such behaviour down to one mental health factor.
It can be from attention seeking and manipulation, of the type, “give me that or else…..”; which is usually enough to rattle poor parents into compliance or at least steadfast nervousness.
It can be a group-belonging activity as there are many people on the internet that they might like to identify themselves with or there may be people at school who do self-harm. Self-harming can be addictive once started and gives a bit of a high.
Self-harming in conjunction with depression is used as a stress outlet and a way to deal with extreme emotions and the physical injury then provides short-term relief.
Self-harm can very quickly have unintended consequences and must, therefore, be treated seriously and you need to find a professional to help you deal with and respond to such behaviour. When you talk to a health professional, you should try to put the behaviour in a context to make it possible to best extract why the behaviour is occurring.
Youth suicide is not uncommon, some of these are intended, the rest are the result of self-harm gone wrong or the use of illicit drugs in an attempt to self-medicate.
The expression of suicidal ideations can be attention seeking and is often viewed such by health professionals, which will do nothing to reassure parents and carers. Attention seeking in these sort of scenarios should more appropriately be termed ‘a call for help’.
Disordered eating in teens is a topic all by itself and I will just touch on how it is common with depression in children and teenagers to also have disordered eating. Disordered eating can cover many behaviours and preferences but typically includes unreasonable restrictions of some kind such as becoming vegetarian or vegan, “clean eating” etc. It can be called a disorder if it is very restrictive without sufficient cause and is interfering with normal social interaction and is causing stress to the person themselves.
Any and all of the behaviours above are indicative of depression in children but also of a range of other mental health issues and conditions and social situations and personality. Even nutrition can be an issue, the most recognised include low iron and high iron (yes, ironic), B6 and B12 deficiency, all of which can be caused by genetic conditions as well as deficient diet. There can be a range of viral and bacterial infections such as Lyme disease, mononucleosis (glandular fever, Epstein-Barr) that can result in depressed mood and disordered thinking.
The lesson really is to empower yourself with information but also to start the journey to get assistance by contacting health professionals. Maybe not everyone will be helpful for you, but just keep on going and go with your gut instinct. You know your child best.
If you want to read more about the process of getting help for a young person and what to expect, go to Intervention Pathways – getting help for depression and anxiety.
Go to The Royal Australian and New Zealand College of Psychiatrists (RANZCP) to find more mental health information and to find a child psychiatrist.
Go to The Butterfly Foundation to find information about eating disorders.