| Childhood depression is a very real but sometimes | | | | guide and should not ne taken as set in stone. For |
| elusive illness that affects the young today. We | | | | example, a 12 year old boy may show signs of |
| take a look at what it actually means and how | | | | depression by aggressive behaviour and phusical |
| unity and support in the family can help fight its | | | | complaints."For Dr Chan, "Depression before the |
| hold over a child.At the recently concluded Asia | | | | age of six is very rare. In fact, I do not think that |
| Pacific Suicide Prevention Convention 2006, we | | | | there is general agreement that it exists. In a |
| learnt a few startling facts about children and | | | | young child, the common emotional condition is |
| suicide. For example, in a worldwide survey, 7.3% | | | | anxiety, not so much depression. From six years |
| to 38% of the children surveyed demonstrated | | | | onwards, I would agree with the given |
| suicide ideation, which is the idea of wanting to kill | | | | description."Children under stress, who experience |
| themselves. In Singapore, close to 4.7% of | | | | loss , or who have attention , learning , conduct |
| children entertain this morbid thought. While the | | | | or anxiety disorders are at a higher risk for |
| figure may be alarming, there is no need to panic | | | | depression. Depression also tends to run in |
| as it is actually not uncommon to think about | | | | families.Lena's experienceLena (not her real name) |
| suicide.Ask anyone in the street if he had thought | | | | is a 17 year-old student who recently suffered a |
| about suicide before and the answer will most | | | | relapse and fell into depression once more. Lena |
| probably be a `yes'. Thinking about something as | | | | has been troubled by depression since the age of |
| serious as killing oneself and actually doing it are | | | | 12. Once again, she has no appetite for food, is |
| two different matters. Out of all childhood | | | | feeling listless and confused, lost alot of weight |
| suicides, approximately 23.5% are associated with | | | | and is isolating herself from others.Lena's mother, |
| mental illness such as depression, schizophrenia | | | | 49 year old clerical staff Sonia (not her real |
| and others. Seeing the numbers and understanding | | | | name), recounts her daughter's experience with |
| that depression is one of the key causes that | | | | depression, " It all started after Lena's father |
| drive our young to suicide. It is time we | | | | passed away. At first , nothing seemed wrong. |
| understand a little more about this elusive illness | | | | SHe was very sad but she did not shed a tear at |
| called "Childhood Depression".The Definition of | | | | his funeral. It was a year after that she started |
| Childhood DepressionIn a 2004 article published by | | | | to miss him badly. This was compounded by being |
| the American Academy of Child and Adolescent | | | | bullied in school and stressed by schoolwork. |
| Psychiatry , childhood depression is defined as "an | | | | Always a quiet child, Lena became even more |
| illness when the feelings of depression persist and | | | | withdrawn. She had trouble sleeping, would cry for |
| interfere with a child or adolescent's ability to | | | | no reason, refused to eat and talked about |
| function."Feelings of depression are represented in | | | | hurting herself."Seeing her daughter's condition, |
| the forms of mood, physical, mental and | | | | Sonia brought Lena to a Polyclinic which referred |
| behavioural changes in a child. Dr Ken Ung, Senior | | | | them to a psychiatrist at a hospital. Lena was |
| Consultant Child, Adolescent & Adult Psychiatrist | | | | given antidepressants and started having regular |
| & Psychotherapist at Adam Road Hospital | | | | therapy sessions with psychiatrists and |
| describes the signs of childhood depression as | | | | counsellors. She tried to follow their advice of not |
| persistent "irritability or loss of interest, loss of | | | | thinking negatively, to focus on developing her |
| appetite and weight, poor sleep , lethargy, | | | | interests and to make a timetable for each day. |
| headache, stomach pain, loss of concentration, | | | | Everyday was a struggle but she managed to |
| preoccupation with self-harm or suicide, refusal to | | | | recover with time."She said she liked the |
| go to school, increased temper tantrums and | | | | counselling sessions where she could talk to |
| antisocial behaviours such as smoking, drinking and | | | | someone about her feelings and problems." say |
| running away from home. Any combination of | | | | Sonia of Lena's reaction to treatment. "Slowly, she |
| these changes that lasts for more than two | | | | got better to the point that she was more |
| weeks could spell a child falling into depression and | | | | cheerful and could laugh and giggle like a normal |
| warrants a closer look.Many of the symtoms | | | | young girl. She even enrolled in yoga classes that |
| listed are actually applicable to both adults and | | | | helped her gained fitness and to relax."For Sonia, |
| children but there are telling differences. Age, in a | | | | being supportive of Lena through the down times |
| non-categorical way, does make a difference in | | | | and being sensitive to her needs are her priorities. |
| the presentation of depressive behaviour. "We | | | | "I told her that her health is more important than |
| don't tend to categorize (childhood depression) in | | | | studies. When I'm at work, I try to call her and |
| terms of age groups," says Dr Ung, " but we can | | | | talk to her whenever I can. She will tell me things |
| generally say that adolescent depression tends to | | | | like, " Mummy, I'm useless and I don't know what |
| look more like adult type depression , whereas, | | | | to do," and I will try to encourage her to look on |
| childhood depression can be more `a typical' | | | | the bright side, not to think too much..etc.. I have |
| perhaps manifesting in bodily pains and behaviour | | | | to try to give her lots of love, my full support |
| changes. The closer the age of a child to | | | | and attention."TreatmentWhat most doctors |
| adulthood - the more we can expect to see an | | | | agree on is that medication should not be used |
| adult-type depression.Types of childhood | | | | unnecessarily on children and that when used, it |
| depressionThere is no clear categorization of | | | | should be accompanied with the right counselling |
| childhood depression. According to Dr Ung, "Typing | | | | and therapy. " It's interesting that recent studies |
| depression is notoriously difficult and fashions | | | | have not been able to prove that antidepressants |
| come and go. We now tend to type it according | | | | work in children. This could be because children are |
| to severity i.e. mild, moderate and severe. | | | | not mini adults and what works for adults may |
| Sometimes, we use the term `reactive' | | | | not work for kids," says Dr Ung.There is also little |
| depression to denote the type that is due to a | | | | research of how antidepressants work on children |
| reaction to some stress (such as the sudden | | | | and prescription drugs may increase the risk of |
| passing of a loved one). Although very rare in | | | | self-harm for some vulnerable ones. However, Dr |
| children, `psychotic' depression refers to the | | | | Ung adds, "To keep a perspective on things, the |
| presence of psychotic symptoms, which are | | | | increase of antidepressants prescriptions is small, |
| symptoms that show that the person has lost | | | | probably around 2% in affected children given |
| touch with reality, i.e. hearing voices, believing | | | | inactive medications (placebos) to about 4% of |
| irrational, bizarre or incredible thoughts."Another | | | | those on active medication."Counselling, it seems , |
| childhood psychiatry expert, Dr Sharon Chan of | | | | plays the key role in helping children recover from |
| Sharon Chan Child Guidance Clinic, who has been | | | | depression. "A good counsellor will try to get |
| practicing child psychiatry since 1988 concurs, "I | | | | information from parents, child and school and will |
| am not sure that there is such a categorization | | | | try his or her best to co-ordinate the counselling |
| (of childhood depression).. because the entity is still | | | | to incorporate all these parties. |
| controversial, it follows adult depression patterns | | | | Cognitive-behavioural therapy is one of the |
| (sic) - chronic, single episode or recurrent, | | | | commonest forms of counselling techniques used |
| adjustment disorder, bipolar etc."Bipolar disorder, | | | | nowadays - it seeks to change the negative |
| also known as manic-depression, is a type of | | | | thoughts of the child to more realistic and positive |
| mood disorder marked by extreme changes in | | | | ones and also t help the child make action |
| mood, energy levels and behaviour. Symptoms | | | | behavioural changes that will help lift the mood," |
| can begin in early childhood but more typically | | | | adds the psychiatrist.Cyber Help |
| emerge in adolescence or adulthood. Children with | | | | With the computer-savvy generation of today, |
| bipolar disorder usually alternate rapidly between | | | | some children or teens may choose to express |
| extremely high moods (mania) and low moods | | | | their thoughts and feelings in cyber space. is a |
| (depression). These rapid mood shifts can produce | | | | community website launced in March to provide |
| irritability with periods of wellness between | | | | information and counselling services for depression. |
| episodes, or the young person may feel both | | | | A `diary' services allows members to post daily |
| extremes at the same time. Parents who have | | | | updates on their mental and emotional |
| children with the disorder often describe them as | | | | experiences while a `letterbox' service provides |
| unpredictable, alternating between aggressive or | | | | them with an opportunity to ask questions to a |
| silly and withdrawn.Stages of childhood | | | | panel of experts. Most importantly, a service like |
| depressionAccording to a Harvard Medical School | | | | this seeks to educate the public on the existence |
| Publication, " The picture changes with age. Up to | | | | of depression and encourage those who are |
| age three, the signs (of childhood depression) may | | | | depressed to seek help. Following examples, |
| include feeding problems, tantrums, and lack of | | | | depressed children may be inspired by a strong |
| playfulness and emotional expressiveness. AT | | | | sense of community to step out of a possible |
| ages 3-5, depressed children may be | | | | state of isolation. Adults too, can visit to gather |
| accident-prone and subject to phobias. Even | | | | more information and advice before deciding how |
| before age 5, they may show signs of | | | | best to seek help.Understanding is |
| self-reproach by apologizing unnecessarily for | | | | Key."Sometimes, depressed children are |
| minor mistakes and transgressions like spilling food | | | | mistakenly labelled as lazy, stubborn or difficult," |
| or forgetting to put clothes away. Children of | | | | says Dr Chan. This is largely due to a lack of |
| early school age (6-8) sometimes show | | | | knowledge and understanding on the adults' part. |
| depression with vague physical complaints and | | | | Children, unlike adults are dependent on their |
| aggressive behavior. They may cling to their | | | | families and guardians to identify their troubles and |
| parents and avoid new people and challenges. At | | | | seek help.Dr Ung adds," One common |
| ages 9-12, some common symptoms are morbid | | | | misconception is that the child is mad. This is |
| thoughts and lying awake worrying about | | | | totally not so. Another is that the child is `weak'. |
| schoolwork. By then, children have enough | | | | Some famous people who are strong of |
| intellectual capacity and social understanding to | | | | character and have suffered depression include |
| think about reasons for their depression , and | | | | Abraham Lincoln. Another misconception is that it |
| they may blame themselves for disappointing | | | | is incurable or that the child is `bad'. Depression is a |
| their parents."When asked for his opinion on this | | | | very treatable condition and the change of |
| analysis, Dr Ung says, " I think that this is a good | | | | behaviour from depression should not be |
| guide by and large. Nevertheless, this is merely a | | | | mistaken for `badness'. |