Explaining child disorders


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Childhood Depression

Childhood depression is a very real butset in stone. For example, a 12 year old boy
sometimes elusive illness that affects themay show signs of depression by aggressive
young today. We take a look at what itbehaviour and phusical complaints."For Dr
actually means and how unity and support inChan, "Depression before the age of six is
the family can help fight its hold over avery rare. In fact, I do not think that there
child.At the recently concluded Asia Pacificis general agreement that it exists. In a
Suicide Prevention Convention 2006, we learntyoung child, the common emotional condition
a few startling facts about children andis anxiety, not so much depression. From six
suicide. For example, in a worldwide survey,years onwards, I would agree with the given
7.3% to 38% of the children surveyeddescription."Children under stress, who
demonstrated suicide ideation, which is theexperience loss , or who have attention ,
idea of wanting to kill themselves. Inlearning , conduct or anxiety disorders are
Singapore, close to 4.7% of childrenat a higher risk for depression. Depression
entertain this morbid thought. While thealso tends to run in families.Lena's
figure may be alarming, there is no need toexperienceLena (not her real name) is a 17
panic as it is actually not uncommon to thinkyear-old student who recently suffered a
about suicide.Ask anyone in the street if herelapse and fell into depression once more.
had thought about suicide before and theLena has been troubled by depression since
answer will most probably be a `yes'.the age of 12. Once again, she has no
Thinking about something as serious asappetite for food, is feeling listless and
killing oneself and actually doing it are twoconfused, lost alot of weight and is
different matters. Out of all childhoodisolating herself from others.Lena's mother,
suicides, approximately 23.5% are associated49 year old clerical staff Sonia (not her
with mental illness such as depression,real name), recounts her daughter's
schizophrenia and others. Seeing the numbersexperience with depression, " It all started
and understanding that depression is one ofafter Lena's father passed away. At first ,
the key causes that drive our young tonothing seemed wrong. SHe was very sad but
suicide. It is time we understand a littleshe did not shed a tear at his funeral. It
more about this elusive illness calledwas a year after that she started to miss him
"Childhood Depression".The Definition ofbadly. This was compounded by being bullied
Childhood DepressionIn a 2004 articlein school and stressed by schoolwork. Always
published by the American Academy of Childa quiet child, Lena became even more
and Adolescent Psychiatry , childhoodwithdrawn. She had trouble sleeping, would
depression is defined as "an illness when thecry for no reason, refused to eat and talked
feelings of depression persist and interfereabout hurting herself."Seeing her daughter's
with a child or adolescent's ability tocondition, Sonia brought Lena to a Polyclinic
function."Feelings of depression arewhich referred them to a psychiatrist at a
represented in the forms of mood, physical,hospital. Lena was given antidepressants and
mental and behavioural changes in a child. Drstarted having regular therapy sessions with
Ken Ung, Senior Consultant Child, Adolescentpsychiatrists and counsellors. She tried to
& Adult Psychiatrist & Psychotherapist atfollow their advice of not thinking
Adam Road Hospital describes the signs ofnegatively, to focus on developing her
childhood depression as persistentinterests and to make a timetable for each
"irritability or loss of interest, loss ofday. Everyday was a struggle but she managed
appetite and weight, poor sleep , lethargy,to recover with time."She said she liked the
headache, stomach pain, loss ofcounselling sessions where she could talk to
concentration, preoccupation with self-harmsomeone about her feelings and problems." say
or suicide, refusal to go to school,Sonia of Lena's reaction to treatment.
increased temper tantrums and antisocial"Slowly, she got better to the point that she
behaviours such as smoking, drinking andwas more cheerful and could laugh and giggle
running away from home. Any combination oflike a normal young girl. She even enrolled
these changes that lasts for more than twoin yoga classes that helped her gained
weeks could spell a child falling intofitness and to relax."For Sonia, being
depression and warrants a closer look.Many ofsupportive of Lena through the down times and
the symtoms listed are actually applicable tobeing sensitive to her needs are her
both adults and children but there arepriorities. "I told her that her health is
telling differences. Age, in amore important than studies. When I'm at
non-categorical way, does make a differencework, I try to call her and talk to her
in the presentation of depressive behaviour.whenever I can. She will tell me things like,
"We don't tend to categorize (childhood" Mummy, I'm useless and I don't know what to
depression) in terms of age groups," says Drdo," and I will try to encourage her to look
Ung, " but we can generally say thaton the bright side, not to think too
adolescent depression tends to look more likemuch..etc.. I have to try to give her lots of
adult type depression , whereas, childhoodlove, my full support and
depression can be more `a typical' perhapsattention."TreatmentWhat most doctors agree
manifesting in bodily pains and behaviouron is that medication should not be used
changes. The closer the age of a child tounnecessarily on children and that when used,
adulthood - the more we can expect to see anit should be accompanied with the right
adult-type depression.Types of childhoodcounselling and therapy. " It's interesting
depressionThere is no clear categorization ofthat recent studies have not been able to
childhood depression. According to Dr Ung,prove that antidepressants work in children.
"Typing depression is notoriously difficultThis could be because children are not mini
and fashions come and go. We now tend to typeadults and what works for adults may not work
it according to severity i.e. mild, moderatefor kids," says Dr Ung.There is also little
and severe. Sometimes, we use the termresearch of how antidepressants work on
`reactive' depression to denote the type thatchildren and prescription drugs may increase
is due to a reaction to some stress (such asthe risk of self-harm for some vulnerable
the sudden passing of a loved one). Althoughones. However, Dr Ung adds, "To keep a
very rare in children, `psychotic' depressionperspective on things, the increase of
refers to the presence of psychotic symptoms,antidepressants prescriptions is small,
which are symptoms that show that the personprobably around 2% in affected children given
has lost touch with reality, i.e. hearinginactive medications (placebos) to about 4%
voices, believing irrational, bizarre orof those on active medication."Counselling,
incredible thoughts."Another childhoodit seems , plays the key role in helping
psychiatry expert, Dr Sharon Chan of Sharonchildren recover from depression. "A good
Chan Child Guidance Clinic, who has beencounsellor will try to get information from
practicing child psychiatry since 1988parents, child and school and will try his or
concurs, "I am not sure that there is such aher best to co-ordinate the counselling to
categorization (of childhood depression)..incorporate all these parties.
because the entity is still controversial, itCognitive-behavioural therapy is one of the
follows adult depression patterns (sic) -commonest forms of counselling techniques
chronic, single episode or recurrent,used nowadays - it seeks to change the
adjustment disorder, bipolar etc."Bipolarnegative thoughts of the child to more
disorder, also known as manic-depression, isrealistic and positive ones and also t help
a type of mood disorder marked by extremethe child make action/behavioural changes
changes in mood, energy levels and behaviour.that will help lift the mood," adds the
Symptoms can begin in early childhood butpsychiatrist.Cyber  Help
more typically emerge in adolescence or
adulthood. Children with bipolar disorderWith the computer-savvy generation of today,
usually alternate rapidly between extremelysome children or teens may choose to express
high moods (mania) and low moodstheir thoughts and feelings in cyber space.
(depression). These rapid mood shifts canis a community website launced in March to
produce irritability with periods of wellnessprovide information and counselling services
between episodes, or the young person mayfor depression. A `diary' services allows
feel both extremes at the same time. Parentsmembers to post daily updates on their mental
who have children with the disorder oftenand emotional experiences while a `letterbox'
describe them as unpredictable, alternatingservice provides them with an opportunity to
between aggressive or silly andask questions to a panel of experts. Most
withdrawn.Stages of childhoodimportantly, a service like this seeks to
depressionAccording to a Harvard Medicaleducate the public on the existence of
School Publication, " The picture changesdepression and encourage those who are
with age. Up to age three, the signs (ofdepressed to seek help. Following examples,
childhood depression) may include feedingdepressed children may be inspired by a
problems, tantrums, and lack of playfulnessstrong sense of community to step out of a
and emotional expressiveness. AT ages 3-5,possible state of isolation. Adults too, can
depressed children may be accident-prone andvisit to gather more information and advice
subject to phobias. Even before age 5, theybefore deciding how best to seek
may show signs of self-reproach byhelp.Understanding is Key."Sometimes,
apologizing unnecessarily for minor mistakesdepressed children are mistakenly labelled as
and transgressions like spilling food orlazy, stubborn or difficult," says Dr Chan.
forgetting to put clothes away. Children ofThis is largely due to a lack of knowledge
early school age (6-8) sometimes showand understanding on the adults' part.
depression with vague physical complaints andChildren, unlike adults are dependent on
aggressive behavior. They may cling to theirtheir families and guardians to identify
parents and avoid new people and challenges.their troubles and seek help.Dr Ung adds,"
At ages 9-12, some common symptoms are morbidOne common misconception is that the child is
thoughts and lying awake worrying aboutmad. This is totally not so. Another is that
schoolwork. By then, children have enoughthe child is `weak'. Some famous people who
intellectual capacity and socialare strong of character and have suffered
understanding to think about reasons fordepression include Abraham Lincoln. Another
their depression , and they may blamemisconception is that it is incurable or that
themselves for disappointing theirthe child is `bad'. Depression is a very
parents."When asked for his opinion on thistreatable condition and the change of
analysis, Dr Ung says, " I think that this isbehaviour from depression should not be
a good guide by and large. Nevertheless, thismistaken for `badness'.
is merely a guide and should not ne taken as



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