BLOG 5: CHILDHOOD…DEPRESSION? DON’T BE SILLY… (Video Talk)

Occasionally feeling sad is commonplace. Curiously, it is an emotion that can make life more interesting, with lots of art, music and poetry having been inspired by sadness. Depression, on the other hand, is more serious, with the number of people living with depression in the UK rising by nearly half a million in just three years. In this blog I will explore how children manifest depression, how teachers and school psychologists gauge the severity of the disorder and whether depressed children qualify for special education programming.

According to Axis I: Clinical Syndromes within the Diagnostic and Statistical Manual of Mental Disorders IV-Revised (DSM-IV-TR, 2000), children manifest depression in a manner analogous to adults, with some developmentally appropriate differences i.e. decreased school performance, and age-specific differences i.e. separation anxiety. Childhood depression is not easily alleviated and it will become apparent in a few moments that it is more than just a single symptom of sadness: it comprises a multitude of symptoms that reliably co-occur (Carlson & Cantwell, 1980). We can divide these symptoms into categories also used to describe depression in adults: affective, cognitive, motivational, physical and vegetative symptoms (Davidson & Turnbull, 1986).

So, how do children manifest these symptoms of depression? (A brief list):

EMOTIONAL SYMPTOMS

  • Dysphoric (Sad) Mood – feeling “crumby”, “empty”, “blue” and “down” – this symptom is not specific to childhood depression, however, what may distinguish the experience of this symptom from other disorders is the severity, frequency and duration of the sadness.
  • Angry or Irritable Mood – a highly problematic symptom, a common emotion among depressed children (Kashani et al. 1995); anger has been found to be extremely resistant to therapeutic change (Turner, Holtzman & Mancl, 2007).
  • Anhedonia (inability to experience pleasure from enjoyable experiences) – Case Study: M.G. smoked two packs of cigarettes a day, however, he experienced such severe anhedonia and a lack of motivation that he chose not to go outside to smoke a cigarette when he had the option to (Luna, 2002).
  • Loss of Mirth Response – depressed children are less capable of responding to humour.

COGNITIVE SYMPTOMS

  • Negative Self-EvaluationsKendall, Stark and Adam (1990) show that depressed children negatively evaluate their performances, abilities and other personal qualities.
  • Difficulty Concentrating – becoming lost in a world of negative thoughts; Kashani, Barbero and Bolander (1981) reported that 77% of depressed children had difficulty concentrating and making decisions.

SOCIAL SYMPTOMS

  • Social Withdrawal – child declines invitations to play.
  • Decreased Academic Performance – 71% of a sample of depressed children had academic difficulties (Brumback, 1977); 62% of Kaslow et al.’s (1984) sample were experiencing a decrease in academic performance – connected to negative self-evaluations.

PHYSICAL/VEGETATIVE SYMPTOMS

  • Fatigue – differentiated from lack of sleep in having no energy, impacting upon the child’s daily activities
  • Change in Appetitie/Weight – anorexia nervosa; bulimia nervosa.
  • Aches and Pains – in Brumback’s (1977) sample 50% of the depressed youths experienced somatic complaints.
  • Sleep Disturbance – insomnia, hypersomnia, circadian reversal, non-restorative sleep.

GAUGING THE SEVERITY OF DEPRESSION: There are three key concerns surrounding the way in which depression in children is gauged/diagnosed by parents, teachers and school psychologists. The first is that because children’s externalising or disruptive behaviours attract more attention and are more readily expressed, compared to a child with internal, subjective suffering – depression is sometimes overlooked, might not be recognised, might not be assessed (Hammen & Rudolph, 2003). Secondly, due to the high level of comorbidity in childhood depression, with particular reference to conduct and other disruptive behaviours, it is often believed that depression is ‘masked’. Thirdly, some features of the symptoms of depression –such as irritable mood, difficulty concentrating and fatigue – are more likely to be typical of children than of adults, meaning that age-specific modifications of the diagnostic criteria are needed in order for school psychologists to recognise a child suffering from depression.

SPECIAL EDUCATION PROGRAMMING: DO DEPRESSED CHILDREN QUALIFY?: Depression is overlooked in the special education population, as it frequently co-exists with at least one other disability, such as a conduct or attention deficit disorder (Heller, Holtzman & Messick, 1982). However children can ‘qualify’ for special education if their depression is severe enough.

Children can enter special education through two different routes: Medical Referral and Psycho-Educational Assessment Referral (Bussing et al., 1998). Medical referral usually takes place at an early age and those children usually exhibit the following types of disabilities: sensory (hearing/visual impairments), physical (orthopaedic impairments), medical (chronic illnesses) or mental (cognitive disabilities).

Children who enter through the second route tend to do so later on in their educational careers, perhaps presenting the following types of disabilities: specific learning disability, other health impairment (ADHD), autism, emotional disturbance (pervasive levels of depression) or speech and language impairments.

In conclusion, children manifest depression in a similar manner to adults, however, consideration must be taken regarding developmental and age-specific manifestations. Children suffering with depression may not be recognised due to a ‘masking of their depressive symptoms’ and such features being more typical of children than adults.

Sadly, depression alone is usually not enough to warrant special education programming, however if it is accompanied by other disabilities then a child may qualify for such programming.

Below is my corresponding talk:

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9 thoughts on “BLOG 5: CHILDHOOD…DEPRESSION? DON’T BE SILLY… (Video Talk)

  1. Really interesting blog! However i would like to highlight an alternative perspective on the topic… perhaps we shouldn’t be encouraging greater use of special education teaching for children with depression, but greater drug use to improve their condition. Emslie et al (1997) used a double-blind design to assess the effectiveness of the drug fluoxetine in comparison to a placebo, in treating children aged 7 to 17 with Major Depressive Disorder. They found 56% of participants who received fluoxetine showed significantly fewer depression behaviours, determined by the Children’s Depression Rating Scale, than those who received the placebo. Therefore perhaps the most effective way to teach children with depression, is not through the use of Special Educational Needs programmes, but by treating the biological root of the disorder. This will in turn limit the associated behavioural problems you mentioned. Surely this is also a more cost effective method?

    Emslie, G.J., et al. (1997). A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Archives of General Psychiatry, 54(11), 1031-1037. doi: 10.1001/archpsyc.1997.01830230069010

    • I see your point, Sarah, however…at such a young age children’s brains have not yet fully developed, so the impact of the drug on them cannot be understood. Granted, antidepressant medication is an effective way to treat depression in both children and adolescents, however they also pose a risk of harmful side effects and other complications. Antidepressants carry strong warnings about their possible link to suicidal behaviour in children and adolescents; in fact, the Food and Drug Administration (FDA) concluded – after an extensive analysis of clinical trials – that antidepressants may cause or worsen suicidal thinking of behaviour in children and adolescents. Hazell et al. (1995) found that antidepressants were no more effective than a placebo in the treatment of depression in children. So do we really want to be giving our children such medication when they are already vulnerable? On the other hand, antidepressants can be effective in allowing the child to lead a happy fulfilled life, carrying out normal everyday activities. It’s a tricky one!

      • Good point!! There are clear positives and negatives of administering drugs to our children. However, there is a similar dilemma for putting children with depression into Special Educational Needs programes. As you state in your initial blog, children are only accepted into such programes if their depression is serve. Arguably depression is not a form of learning disability, but a state of mental health. If it becomes directly paired to such learning impairments, greater negative consequences could occur. Pijl, Frostad and Flem (2008) found if children are labelled as having ‘special needs’ they have greater difficulty building social relationships and are less popular. Hastings, Hewes, Lock and Witting (2007) found teachers also had lower expectations of children with special educational needs. Linking this to the Self-fulfilling prophecy, such expectations may be internalised by the students and in turn they may then act in accordance to such negative beliefs. Therefore perhaps we should also be hesitant in encouraging children with depression to enter special educational programmes!

        Pijl, S, J., Frostad, P., & Flem, A. (2008). The social position of pupils with special needs in regular schools, 52(4), 387-405. doi: 10.1080/00313830802184558

        Hastings, R.P., Hewes, A., Lock, S., & Witting, A. (2007). Do special educational needs courses have any impact on student teachers’ perceptions of children with severe learning difficulties? British Journal of Special Education, 23(3), 139-144. doi: 10.1111/j.1467-8578.1996.tb00965.x

      • You raise an interesting point, perhaps if children could be screened or tested for depression upon entering school and then at regular intervals throughout their educational career then those needing help won’t be missed. Reynolds (1986) designed a procedure to screen and identify children and adolescents who manifest clinically relevant levels of depression. The procedure was designed to avoid identifying children and adolescents as clinically depressed when their depression was of a transient and episodic nature. It consisted of self-report measures; reassessment of those students scoring above the predetermined cut-off score on the first testing; and a clinical interview of depression for those who scored above the cut-off on the second testing. Perhaps those recognised as depressed could have counselling available to them in an anonymous fashion, so that only a counsellor is aware of their condition, in order that teachers and peers won’t be aware of their situation. A problem with this technique, however, is that subsequent stages are based on the initial self-report from the students, and they can manipulate this depending on whether they want to be recognised as depressed.

  2. I also wrote about depression this week! What I find frustrating is the lack of interest in such a poorly understood but prevalent problem in our society. Although it qualifies as a mental health condition, I had never even considered children being taught separately or receiving different treatment for depression in schools. Whilst I briefly covered some of the cross overs between depression and ADD/ADHD, it was my understanding that it was only in American schools that children with depression could talk to the therapist or something similar.
    Jureidini, Doecke, Mansfield, Haby, Menkes, Tonkin (2004) conducted a review on the efficacy and safety of antidepressants for children, especially serotonin reuptake inhibitors. They found that adverse affects had been downplayed and that control groups significantly improved in many studies showing the usefulness of therapy over drug use alone.
    I think I stand alone from both you and Sarah, in that I think a focus on preventative measures (such as mindfulness) for depression would serve us better than separating kids out or doping them up.

    References
    Jureidini, J, N., Doecke, C, J., Mansfield, P, R., Haby,M, N., Menkes, D, B., Tonkin, A, L. (2004). Efficacy and safety of antidepressants for children and adolescents. BMJ, 328 pp. 879–883

  3. You make a good point – mindfulness could be a great way to both help those with depression, and if included in the curriculum it could aid all students. Once a person experiences a major depressive episode the likelihood of recurrence is very high. Ma and Teasdale (2004) compared Mindfulness-Based Cognitive Therapy (MBCT), which is designed to prevent relapse and recurrence to Treatment-As-Usual (TAU); in both the initial and replication studies, MBCT clearly protected individuals from relapse. Introducing mindfulness into schools could therefore prevent such an onset of depression and aid those already suffering from it.
    Lee et al. (2008) also evaluated the effectiveness of MBCT for children for internalising and externalising depressive symptoms. Their study showed the effectiveness of using MBCT as a potential treatment for such symptoms in children. Mindfulness could be the way to go, Jack!

  4. Pingback: Comments I made for Blog 5 | Sarah's Blog

  5. I agree that providing special education for children who are depressed will help students as one issue depressed children may face is bullying.

    Sweeting et al (2010) found that through a longitudinal study (N = 2,586) there was a positive relationship between bullying and depression. Now this may make you think that bullied people become depressed, however Sweeting et al (2010) also found that at the age of 15 the relationship for males it showed a path from victimization to depression. Therefore this research suggest that being depressed makes you more likely to fall into victimization such as bullying.

    So often the education system is trying to stamp out bullying, maybe this may help individuals likely to be more likely to be bullied or victimized get the support they need.

    Reference

    Sweeting, H. Young, R. West, P. and Der, G. (2010) Peer victimization and depression in early–mid adolescence: A longitudinal study. British Journal of Educational Psychology
    76, (3), pp 577–594, Retrieved from- http://onlinelibrary.wiley.com/doi/10.1348/000709905X49890/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

  6. Pingback: Blog Comments | Science of Education

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