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):
- 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.
- Negative Self-Evaluations – Kendall, 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 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.
- 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: