Managing depression in children
Listen to brain and mind specialist Professor Ian Hickie chat with James O'Loghlin on helping kids beat the blues.
At a glance
- One in four kids over the age of 12 have significant depressive symptoms.
- For girls, depression generally appears between the ages of 11 through to about 14.
- For boys, depression generally appears between 12 through to 16.
- Don't be afraid of it, ask your child how they are feeling, are they OK? Keep communicating with them.
- Seek professional help; ask your family doctor or school counsellor if you aren't sure where to go.
Signs your child may be suffering from depression
If you see a number of these problems starting to develop, it's time to ask the question, could this be a more significant emotional disturbance than general teenage moodiness or attitude?
- A persistently bad, often irritable mood
- Not experiencing pleasure
- Not reacting to the environment the same way
- Sleep disturbance
- Changes in behaviour, changes in sleep and appetite, and the persistence of that state for more than a few days in a row, typically for some weeks
- Doing badly at school
- Not joining in with other social activities with other kids and withdrawing from peers
- Abusing drugs and alcohol
- Self harm
Hello, it's James O'Loghlin here and welcome to School A to Z.
We're talking to Professor Ian Hickie from the Brain and Mind Institute, part of the University of Sydney, about depression in school-age kids – how to recognise it, what to do about it. Depression is a thing that we've only really worked out the name of recently. But it is something that can affect school-age kids and it's important to know what the signs are, how to recognise it and what to do about it.
Ian Hickie, welcome.
Professor Ian Hickie
Thank you James.
What sort of numbers are we talking about? How many school-age kids do we think exhibit symptoms of depression?
About one in four kids, once they pass the age of puberty. So for ages about 12, 13 onwards throughout their teenage years, about one in four kids will have significant depressive symptoms. And about a half of those the symptoms might be severe enough to really interfere with their life or require some degree of professional help, some degree of counselling or support, or appropriate family or school-based interventions. Very important to say depression is not common in kids prior to puberty. So really in primary school it's rare to see genuinely depressed kids. You mainly see anxious kids, you mainly see kids having trouble with anxiety separation, settling in and other sorts of problems. But there is something about the onset of puberty that actually changes the way that kids experience in the world, change their emotional range and makes the onset of depressive symptoms more likely.
Is there more of it now than there was 50, 20 years ago or are we just better at detecting it?
Two things have happened. One is the rates of depression in young people genuinely seem to have increased. Actually, basically going right back to the end of the Second World War, in every generation since then, the rates of depression in young people appear to have increased across that period of time. But the other big factor is definitely people being more sensitive about the emotional welfare of kids. And therefore noticing, reporting, realising that it has significant impacts on their lives and that really we should do something about it. So two things have gone on – probably a genuine increase in the frequency of the problem, but also a greater social awareness of the problem so we are doing more about it.
It is really important to recognise depression early and then provide the appropriate supports and treatments and interventions. And that way, stop it becoming a major problem for young people and preventing a lot of the secondary problems – secondary problems like alcohol and drug misuse, problems in social environments, problems coping in school, and most important of all, reducing the chance of self-harm.
You've talked about depression becoming more prevalent after puberty. Many parents, when they describe teenage kids talk about things like – well, they don't want to talk to me, uncommunicative, likes to be on their own. How do we separate if you like symptoms of adolescence, teenagers rebelling against their parents, from symptoms of depression?
It's a really important issue sorting out normal development because normal development as a teenager does include developing moods, does include developing a different relationship with the world, becoming more independent, becoming more combative with the world, more challenging, certainly going out in the world in an independent way from parents. It doesn't in any sense include, however, becoming desperate about the world, feeling the world is absolutely no good, feeling hopeless or useless in the world or wanting to harm yourself. They're not actually normal ends, they are extreme ends of emotionality and usually indicative of greater sets of problems. The other thing about moodiness, normal emotionality is exactly that, normal emotionality. You should react to the environment. When people get really depressed in fact, they become less reactive and more stuck in particular moods in a particular way. So, being very clear about that, between normal reactivity and normal emotions, what the rest of us understand as the development of an independent experience of the world versus becoming stuck in really bad moods.
And yet this is really tricky isn't it for parents because when kids reach adolescence they are, particularly the oldest kid, they are having to learn about what it is like to be a parent of a teenager for the first time. So getting that sense of what is normal and whether their kid is inside or outside those boundaries is difficult. How can they negotiate that?
I think one of the problems is that parents are terrified – actually of having teenage kids. Maybe based on their own experiences, the world they see around them. And I think at the moment often parents feel disenfranchised. They're not sure that they really should continue to have the sort of conversations with their kids that they had when they were younger. They feel intimidated by the commercial world, by the peer world, by the pseudo maturity of in fact kids at this stage. Kids themselves actually say they really need to maintain contact with smart adults, and adults that have been through the experience themselves. You mentioned it's the first time for the parents, but this is the first time for the kid themself, that they've been through these sets of experiences. And they need to be able to talk to people, not just other kids who are going through the same experience. So actually talking to older kids, talking to mentors, talking to teachers and importantly continuing to talk to their own parents is actually really important to get this change in emotionality within its correct context.
OK. Before we move on to managing depression, just a last word on symptoms, just things for parents to look for – appetite, sleep, behaviour, anything else?
The main things to look for are this persistently bad mood, often irritable mood. But then withdrawal, not sticking out with friends, not experiencing pleasure, not reacting to the environment the same way. And certainly then developing things like sleep disturbance become important on an ongoing basis. So you're looking at changes in behaviour, changes in sleep and appetite, and then really the persistence of that state for more than a few days in a row. And typically over some weeks. So that then typically results in doing things like doing badly at school, not joining in with other social activities with other kids, withdrawing from peers. When you see that sort of constellation of problems start to develop, then it's time to ask the question could this be a more significant emotional disturbance?
So, may it often have an adverse effect on school life?
Absolutely. One of the key things here is not just moodiness, it is really important because of its impact on kids' education, on their school performance and perhaps most importantly of all from a parent's point of view, their social development, their capacity to move on and develop an independent and rich life.
Boys and girls – more prevalent in either?
Starts earlier in girls and girls certainly report more persistently depressed moods. So for girls, really the key periods from 11 through to about 14, for boys – it's about 12 through to 15, 16, for the onset of these particular sets of problems. Boys – it's a bit harder to know. They under report it. But they do a bunch of other stuff like starting to abuse alcohol and other drugs, getting into fights, being more irritable, and although we don't tend to call that depression in the same way that we call it in girls we are very concerned about those similar sets of emotional changes.
What can parents do if they think they have a child who is suffering from depression?
Well the first thing is to not be afraid of it and be prepared to actually ask a kid how they are actually feeling and are they OK, and what is actually happening in their world. So that staying in contact is really important. If they feel and, if the kids themselves feel it is a really significant problem, then going on to get further information first of all, secondly to monitoring the situation, so keeping a record of it, seeing what is actually happening, does it persist? And then if it persists and it's impacting on a kid's life and if a parent or the child themselves is concerned, then starting to get professional help. Through things like local doctor, through school counsellors, through other health professionals. Because the earlier the problem is attended to, the more likely it will be dealt with in a simple straightforward counselling-style environment with the best possible outcome.
Parents would probably feel reticent to talk to people at the school about it, to talk to teachers, but is this a good idea? As it could provide an added perspective on what's happening in the child's life I guess.
There are really two important environments for teenage kids. One is home and the other is school. So when there's a lot of stuff going on that you don't understand, actually discussing with the school whether they know what's going on – difficulties in the school environment in the social context, different new challenges, things that are happening in peer relationships that you might not be aware of, are worth finding out about. Often, many teachers are excellent at picking up changes in kids in ways that their parents may not be that aware of and seeing those and being able to report whether it is problematic or not, whether it's really having a major impact on their life. So the more open the parents are able to be and the more responsive the school environment, the better. Personally I have worked with some great schools where there are great teachers who are really aware of the need to handle these issues sort of sensitively during this period. So parents and teachers being able to discuss these issues and then, where there is sufficient concern, involving health professionals or psychological professionals early rather than late is often a good idea.
And finally, if the response that the parents gets indicates that the child thinks they're the problem – you know, my parents are the problem, how can I have such out of touch, uncool parents – and that puts up a bit of a brick wall, any ways to get through, around or over it?
Yeah parents fundamentally, just like anything parents have ever done for their kids, requires sticking at it. So you know it's not unusual for parents to bear the brunt of some bad moods and some difficulties and some experimentation that goes wrong at various times. From a parent point of view, I think the most important thing to say is when kids run into trouble in this period, they need two things – one is parents who are prepared to stick at it and then the other is good information about access to help because kids don't have either of those things themselves. Just remember, they've never had the experience before, they don't know what it's like to get help, to be able to deal with the situation, to get out the other side. So they need parents who stick at it and if need be can negotiate the health system to get them the help they need.
Thanks very much Ian.
Thanks for listening. For more information check out the School A to Z website at www.schoolatoz.com.au.
Ian Hickie has been the Brain & Mind Research Institute's (BRMI) executive director since 2003. Previously he headed the national depression initiative beyondblue.
In 2008 Ian was appointed to the Federal Health Minister's new National Advisory Council on Mental Health. In 2006 Ian received the Australian Honours Award of Member (AM) for his services to medicine in the development of key national mental health initiatives and general practice services. He is also a recipient of Research Australia's national advocacy award for his work in mental health.
Ian led the BMRI as a founding member of the National Youth Mental Health Foundation ‘headspace' in 2007 and was elected as a Fellow of the Academy of the Social Sciences in Australia. In 2006, the Australian Financial Review named him as one of the country's top 10 cultural influencers.
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