Six tips to help children and adolescents who have symptoms of depression
Psychologist Dr Claire Hayes on how to spot the mental illness in our children and what we can do to help.
Recently I had an interesting conversation with a friend who is in her 70s. She was puzzled about why children and young people talk about 'being depressed' and wondered how they could possibly know what that means. While we may all wish to think that childhood is the best time of life, the reality can be very different. Many struggle to cope with the contradictions of modern life.
On one hand, they are the generation who have so many wonderful opportunities, and yet we know that tragically Ireland continues to have one of the highest rates of teenage suicide in the world. Recent research found that 8pc of Irish adolescents aged between 12 and 19 experienced depressive symptoms classified as 'severe' or 'very severe' (Headstrong, 2012). What is happening?
Many of us share my friend's bewilderment and worry about what we can do to instil a sense of hope and self-belief in young people, when sadly they do not seem to have it themselves.
This article is the first of a series of three. Its focus is on how we, as adults, can recognise if the children and young people we love and care for could have depression and if so, to know what steps we can take to help them cope.
The second and third articles look at depression from the perspective of parents and teachers. The World Health Organisation (WHO) has forecast that by 2030 depression will be the number one global burden of disease in the world, greater than coronary heart disease and strokes. These articles are intended to inform, support and challenge so that we work together to prevent WHO's prophecy from coming true.
Depression in children and adolescents is a real and serious problem. We know that children and adolescents who experience depression may experience other difficulties such as anxiety, conduct disorders, attention deficit disorder, eating disorders, difficulties with alcohol and other substances. We know that the younger children are when they first experience mental health difficulties, the more likely it is that they will go on to experience mental health difficulties as an adult. This is understandable as people who have depression can see themselves as failures and have a sense of hopelessness about themselves, their world and their futures.
It can be difficult to spot depression in children and adolescents
Last week RTÉ News showed children starting school for the first time. It was very easy to focus on the children who sat in their new uniforms with tears flowing down their cheeks and hope that they were helped to settle in quickly and easily. It was also very easy to miss the children who sat quietly, being 'good', not wanting to cause any trouble and perhaps silently feeling terrified about what was happening. If we take a conservative estimate that 10pc of children will meet the criteria for a diagnosis of depression, how can we spot the two or three children in any class who may be at risk? More importantly, what can we do to help them?
The move from primary school to secondary school can also be difficult. Adolescence has always been a challenging time for some young people. While mood swings can be distressing and difficult, they can also be normal.
Young people can become very introverted, withdraw from their peers and compare themselves very unfavourably to others. The symptoms of depression in adolescence are similar to the mood swings normally associated with adolescence and so depression can be difficult for parents, teachers and young people themselves to spot.
The symptoms include low mood, increased irritability, difficulty in sleeping, withdrawing, a sense of worthlessness and possible suicidal ideation. If you are concerned that depression may be a factor it is important that you bring your child or adolescent to a GP. As some young people will be quick to answer 'fine' and others 'terrible' when asked how they are, it is good to focus on how many of those symptoms you have noticed.
A diagnosis of depression is usually made when four or five of these symptoms are present practically all day, every day for two weeks. Adolescents with depression have been found to differ from adults in that they may exhibit more irritability or moodiness than true sadness, and that signs of depression may emerge more when they are alone or with family than when they are with friends (Teicher, 2007).
It is important to remember that depression can be treated. Your GP may prescribe medication and/or recommend support from a psychologist, therapist or a school guidance counsellor. Cognitive behavioural approaches to understanding depression and learning to cope with it have been found to be very helpful (Hayes, 2004, 2006, 2011).
Six tips to help children and adolescents who have symptoms of depression
1. Pay attention to what they are doing than just on how they are feeling
Most of us want children and adolescents to feel happy and we worry that if they are unhappy they may have depression and possibly consider suicide as an option. While it is important to gently acknowledge how someone is feeling, it is more important to help them focus on doing things that we know are helpful. This includes:
- eating healthily (excessive sugar, caffeine and alcohol can affect mood)
- getting regular exercise
- doing at least one thing each day that is fun (legal and healthy too!)
- staying connected with friends (or reconnecting if they have begun to withdraw)
- confiding in at least one trusted adult
- acknowledging what they are doing well
2. Begin to recognise thoughts as 'helpful' or 'unhelpful'
Anyone who has a tendency towards depression will have thoughts such as 'I'm not good enough', 'what's the point?' and 'no-body cares'. It can be exhausting and futile to try to convince someone who is thinking that way that they are wrong. Instead, it can be very helpful for us to acknowledge thoughts like these as unhelpful and focus instead on helpful actions, such as those listed.
3. Become aware of the power of beliefs
People with depression often believe that they are not good enough and that nothing will ever work out for them. It can be exhausting and ultimately a waste of time to try and convince someone that they are actually wrong. No matter how many examples you give young people to say that they are worthwhile, they will immediately have another one to prove you wrong. A very simple solution is to use the word 'maybe' when you are talking to them - 'maybe there is a point', 'maybe they are not as bad as they think', 'maybe it is ok for them to feel down'. The word 'maybe' opens the conversation up to focusing on what they can do to feel better!
4. Pay attention to 'intensity', 'duration' and 'frequency'
While it can be normal for children and adolescents to have periods where they feel awful and down, to think that no one understands them, to believe that there is no hope, and to act in ways that are clearly unhelpful, it is not normal for them to be like this all the time. If you are concerned that the child/teenager in your life is displaying symptoms of depression constantly over a period of one to two weeks (without an obvious cause such as the death of someone they loved), please consult your GP for advice and support.
5. Learn as much as you can about depression and how to deal with it
The Aware website (www.aware.ie) is an excellent resource and has a library of lectures, which experts have given on behalf of Aware over the past three years. One that is particularly relevant is Dr. Sarah Buckley's Depression in Adolescents which is available at http://www.aware.ie/listen-or-watch-back-to-the-january-lecture-online/ and is an excellent resource for parents and teachers.
6. Know that there is ALWAYS hope
If a child or young person in your life is diagnosed with depression, it can be very tempting for adults to blame themselves, worry and then to get into 'protective mode'. My experience, having worked with many people of all ages, is that there is always hope. People can be helped to gently and compassionately acknowledge their feelings as making sense, become aware of the power of their thoughts to make them feel 'good' or 'bad', question and challenge their beliefs and most importantly, focus on doing things that are helpful.
If you are concerned about depression, please visit your GP who will advise re the appropriate support.
The word 'depression' can be very frightening, but children and adolescents who are helped to cope successfully can learn skills and build resilience that they will draw on for the rest of their lives.
Dr Claire Hayes is Clinical Director of Aware and has 20 years experience as a clinical psychologist and educational psychologist in private practice.
Next week in Health & Living: Parents can have depression too - practical advice for understanding and managing it
Aware's Beat the Blues introduces adolescents aged 15 to 18 years to cognitive behavioural approaches to developing resilience in coping with issues including depression using the Coping Triangle framework (Hayes, 2006, 2011). It is delivered free of charge to schools in an 80-minute session by trained Aware contractors.
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