Download Major Depression in Children and Adolescents

Major Depression in Children
and Adolescents:
Hurting and Healing
Adria Fredericks, M.Ed.
Learner Objectives
Participants in this seminar will be able to:
 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
Glossary
 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)
 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
Definition
Major depression is an illness that can
affect any age, sex, ethnic group or class
Characteristics include:
 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
Definition (continued)
Characteristics also include:
 Feeling nervous, irritable, angry and
unable to relax
 Feeling badly about self
 Thinking about hurting self
 Thinking about death and suicide
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, headaches, etc.), while some children overcompensate 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
Prevalence
 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)
 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 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 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 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 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 factors
In some cultures, depression may be
expressed through somatic complaints
rather than sadness or guilt
 Latino and Mediterranean • “Nerves” or
headaches
 Asian • Imbalance or disturbance of
“chi” (lifeforce or energy)
 Middle Eastern • Problems of the heart
 Native American • Heartbreak
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
National legal safeguards
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
 Regular classrooms with support personnel
 Special teachers
 Special classrooms
 Special schools
 Day treatment/hospitals
 Homebound education
 Special classes in detention centers and prisons
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 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)
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?
 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)
 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 avoid
 Being judgemental/critical
 Having unrealistic expectations
 Being inflexible
 Taking behavior personally
Treatment
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)
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 child
Please refer to the Study Guide to
read about Annie, a small girl with
a big problem
Case study of an adolescent
Please refer to the Study Guide to
read about David F., a depressed
adolescent on a dangerous path
Information for parents
Please refer to the Parent Brochure
Where 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
References
•
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)
•
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 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: [email protected]