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SIX. SPECIAL POPULATIONS

Children and adolescents can suffer from depression and many other mental conditions once believed to afflict only adults.

Do children get depressed?

Anne's comment:

One of the first clues to our child's depression was profoundly irritable and unreasonable behavior. Despite therapy the depression worsened, and academic problems and the inability to concentrate became pronounced With aggressive treatment with a course of antidepressants and continued therapy, our child's mood stabilized, and academic performance returned to normal. The intervening months of waiting for the medication to take effect were the most challenging. We were very careful to remain positive and encouraging during the months the academic grades tumbled.

Children and adolescents can suffer from depression and many other mental conditions once believed to afflict only adults. The risk of untreated depression in children and adolescents is the same as that in adults, but social-emotional development, as well as academic progress, may fall behind because of the impairment in functioning. Some differences in criteria are used to diagnose depression in children, but, essentially, the presenting symptoms are the same as in adults. Children do not always exhibit depressed mood but may be irritable instead. Depression often manifests with behavioral problems rather than a withdrawal from others. Behavioral problems in children that may be associated with depression include fighting with peers, increased defiance toward adults, a decline in grades, disruptive behavior in school, or school avoidance.

It was once believed that children and adolescents rarely suffered from significant depression. Teenage years are often believed to be tumultuous by nature and a sufficient explanation for problems of moodiness, oppositional behavior, school troubles, and so forth.

Studies that looked into the past of depressed adults found that many adults first suffered from depression as adolescents. At any time 10% to 15% of children and adolescents suffer from some symptoms of depression. Because of the adverse effect on social and emotional development, it is very important to treat depression in these age groups. Depressed adolescents are at a higher risk for substance abuse and early sexual experimentation, school failure, running away, and legal problems. Suicide is the third leading cause of death in adolescents. The family is often in crisis when a child suffers from an emotional disorder, putting a strain on siblings and parents. Parents may have to take extra time off from work to address school problems and to tend to the emotional and behavioral issues. They may not be as available for siblings who might feel neglected. Failure to recognize depression in children and adolescents is fraught with significant risks for everyone in the family. Depression is a treatable illness in children and adolescents and should be taken very seriously.

The guidance counselor at school believes our teenage daughter is depressed. She spends a lot of time in her room. Is this normal teen behavior?

It is often believed that adolescence is characterized by turmoil and significant distress. In fact, most teenagers do not experience high levels of turmoil and undergo transitions into adulthood relatively smoothly. As adolescents begin to establish their own identities, they begin to pull back emotionally from their parents. They may isolate in their room more frequently and may refuse to spend time with their parents. As a result, many parents do not know how their teenager is coping with and processing events around them. When locked in their room, teenagers may appear to be acting as any normal teen would. Although many depressed adolescents present with behavioral difficulties that are obvious to their guardians, many teens suffer silently, without showing their feelings. Parents may not be aware that a problem exists. At school, an adolescent may talk openly with the guidance counselor or teacher, perhaps as a way of getting help without admitting to the parents there is a problem. Whenever there is a change in behavior, there should be consideration of emotional problems as a cause rather than strictly assuming that it is "hormonal" or typical for teenagers.

 
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