Prevention & Treatment
In the past, it was believed that children don’t experience depression. However, it is now recognised that even young babies can suffer from depression, sadness, and lowered mood. Approximately 2% of children and 4-7% of adolescents experience depression every year. Depression is a possible cause of a change of behaviour in children who become moody, sulky, angry, rebellious, or tearful, or otherwise behave out of character over a period of weeks.
Why children develop depression is not totally clear, but genetics, environment, and belief systems play a role. Depression often goes undiagnosed, especially in children and adolescents, but effective treatment can help prevent future episodes of recurring depression. Diagnosis of depression in children is not easy, and depression is best diagnosed by a health professional who specialises in children’s disorders (eg a child psychiatrist, psychologist, or paediatrician).
Depression is very treatable. In adults, antidepressant medication is useful for severe depression; however, in children antidepressant medications have not been demonstrated to be effective, and are not recommended. Specific types of psychological therapies have been shown to be effective in overcoming depression for people of all ages. Psychological therapies have the advantages of teaching skills to overcome depression and manage stress better, and decrease the likelihood of future episodes of depression. Modified forms of CBT (cognitive behavioural therapy) are frequently used for treating children and adolescents. There is much that can be done to overcome childhood depression; in addition, there are a number of strategies that make it less likely that children will develop depression.
Optimism predicts physical and psychological coping throughout the lifespan. In other words, people who look for the positives in what happens to them and are prepared to work at achieving their goals are likely to have better physical and mental health, and a decreased risk of developing depression. Children can be assisted to develop an optimistic outlook, which sees problems as temporary obstacles that can be overcome.
Develop Problem Solving Skills – To build confidence and skills, teach children that there are always at least two possible responses to a situation. More often than not, action can be deferred until the options are identified. Teach everyday problem solving eg “We don’t have enough money for all the groceries, but if I put the chocolate back, we can afford the rest,” or “How can we divide this food up so everyone has some?” or “The car won’t start. I bought petrol yesterday, so it can’t be that. I’ll check whether the battery is flat” etc. Teach systematic problem solving. Teach children to systematically stop, specify the problem, identify possible solutions, consider likely outcomes, and then apply the solution that seems best. For example, if your child is upset, help him/her to identify exactly what they are upset about. Then encourage him/her to list all possible ways of tackling the problem. Then discuss each option in turn and identify what might happen next as a result to each. Finally, choose one strategy to implement, and arrange a time to talk about it again and evaluate how it worked out and what s/he might do differently next time.
Allow safe risks – Too often we try to protect our children by preventing them from being exposed to risks, rather than recognising that risks are inevitable, and that it’s only by taking risks that we grow. Sheltering or ‘babying’ our children, rather than providing them with the skills they need to overcome problems, disempowers them and increases the likelihood that they’ll feel overwhelmed and depressed.
Encourage by recognising efforts – It’s easy to focus on outcomes, but effort is more important. People who are naturally talented and don’t work at developing their skills miss the opportunity to learn about themselves and develop the skills necessary to negotiate other life difficulties – often it’s not the most talented individual who achieves in life, but rather than one who was most prepared to work at it. Schools tend to focus on achievements – winning the debating competition, winning sporting grand finals, achieving near perfect grades, etc. Although these things are fine, they are meaningless in themselves, and fail to recognise the real achievements – the student who worked hard and got their best grade (even if it was only a C), or the student who overcame physical limitations to compete in a sporting event. Children learn our values. Unless we acknowledge the effort that one student puts in to achieve a B might be 100 times the effort with which another gets an A%2B, we are teaching that effort is not worthwhile and achievement is everything. Life is unfair, but we all need to feel that effort pays off and that we can celebrate the outcome of our efforts, regardless of the result.
Promote Life Skills – One of the downsides of modern day life is the limited opportunity that children have to contribute. In order to feel that they have skills, to feel that their contributions matter, to develop a good understanding of what they are able to do, and to experience the satisfaction that comes from overcoming failure, children need to be allowed to attempt difficult tasks. Parents sometimes feel it’s unfair to expect children to help out around the house. The reverse is true – it is unfair not to give children the opportunity to contribute. It is by helping out around the house that children learn important lessons about how the world works. In the process, their self-esteem increases, they learn about problem solving, and they develop skills in a safe environment. Allowing children not to contribute suggests that they are superior to their parents and others who assist them. That does no favours for either the children or the others in their environment.
Teach about emotions – When children are young, their thinking shuts down when experiencing strong emotions. This can feel overwhelming and often triggers out-of-control behaviour, such as tantrums. If children are taught the names of emotions and encouraged to talk about their feelings, strong emotions will feel less overwhelming. Parents can assist by talking about their own feelings, and by accepting children’s right to have their feelings, even if they are not comfortable for the parent to witness.
Develop goal-focused behaviour – Children develop confidence from having the chance to work towards achieving goals of their own choosing, whether that be saving up for an object or making something. A goal that a child works towards over time has much more meaning when reached than the same object provided by someone else. This also teaches the ability to defer gratification and self-discipline, essential skills for success in the adult world.
Assist the development of social skills – Children are less likely to become self-critical about themselves and negative about the world if they regularly mix with others. Participation in sporting or recreational groups helps children have a sense of who they are and how they fit in, and provides them with the skills necessary to make friends and resolve conflict.
Encourage participation in sport – Using the body in a range of physical movements provides feedback about physical abilities and sense of body in space. This sort of feedback helps provide self-identity that provides some protection against depression. Exercise also burns off the adrenaline that is generated by stress, and can create endorphins, the feel-good chemicals.
Healthy eating – Eating a variety of fruits and vegetables every day provides the body with the nutrients it needs to moderate emotions and operate optimally. Without adequate nutrients, the body focuses on essential functions rather than regulating emotions, making depression and anxiety more likely.
Although temperament / personality plays a role in defining how the world is viewed, children can be assisted to view the world as a potentially friendly and rewarding place, rather than one to be feared.
Treatment by a psychologist who specialises in treating depression in children is required for severe depression. Less severe depression can be helped by using the previously mentioned strategies, particularly increasing healthy eating and exercise. In addition, children are likely to benefit from more frequent participation in activities they enjoy, including listening to music and mixing with friends. Many children are helped by drawing or writing about their feelings, but are also likely to benefit from talking with family and other trusted people about their experiences.