Psychiatric Disorders In Children And Teen-agers

Depressive Disorders

Some children suffer from major depressions, periods of depression that last for at least two-weeks, and that seem to have very little connection to actual events. Other youngsters have what is called a dysthymic disorder, in which their general mood tends to be low and depressed. In dysthymia, symptoms tend to be milder but nearly constant for at least a year.

During depressions, signs and symptoms include sadness, irritability and or volatile mood; appetite and sleep changes; diminished energy; low self-esteem; feelings of hopelessness; poor concentration and indecisiveness. These symptoms color a child's every experience, impression, and response. They see in their life only a grim, barren and pointless future.

Sometimes, a child's emotional disturbance combines both depressed and euphoric moods. This type of depression is known as "bipolar disorder," or manic depressive disorder. Bipolar disorder is characterized by episodes of mania, or exuberant highs as well as episodes of depression. In some children, their mood may swing from one extreme to the other; in other children, there is simultaneous mixture of both highs and lows. Mania can also be characterized by irritable mood.

During manic states, a child may have an inflated self-esteem. His speech becomes constant and rapid, and he may have difficulty focusing on one idea or subject at a time. A manic child becomes easily distracted, appears agitated and restless, and sleeps very little. Most alarming, he may engage in implusive activities that negatively affect their homes, school or social lives.

When the disorder is milder and chronic, the mood disturbance is called cyclothymic disorder. In cyclothymic disorder, numerous manic and depressive episodes occur over a period of time without marked social or academic impairment. In children younger than nine, sadness, mania and agitation are often intermixed. They may appear extremely moody and irritable. Older children show distinct signs of euphoria, elation, paranoia, and grandiose delusions, and as puberty begins, extremes of depression and manic excitement become more pronounced.

Children with bipolar illness may be extremely hard to tolerate. Hyperactive, silly and aggressive in their verbal communications, their speech may be littered with profanities and sexual innuendo. Delusions of grandeur -- believing one is Superman, for example -- can lead to dangerous behaviors, like running in front of cars or jumping off roofs. A manic child also paces. He or she may not eat or sleep. One moment, the child is ridiculing others, and the next, she is accusing others of making fun of her or conspiring against her. He or she may also start using alcohol or drugs.

It is likely that depression and manic-depressive illness arise out of a complex combination of factors. Almost certainly, there is a biochemical predisposition towards mood disorders. Mood disturbances tend to run in families, suggesting a genetic component.

The family environment may build upon these biological vulnerabilities. When parents, for example, suffer from emotional disturbances, which are left untreated, their ability to be consistently responsive and nurturing may be compromised. Because bipolar illness, for example, is episodic, an adult's ability to parent may be erratic and unpredictable. When a parent is depressed, she may be less responsive to her child, which in turn can precipitate depressive symptoms in the child.

Depression may reflect elements of unresolved grief, possibly in response to early real or imagined losses of nurturing figures. Depression may also indicate that children have learned to feel of helplessness rather than seek solutions for life's problems. Depressed thinking tends to be negative, hopeless, and self-defeating, which in itself re-enforces feelings of depression.

In some cases of childhood or adolescent depression, a youngster has experienced early life trauma or loss. Many depressed children have family lives that are consistently bleak, chaotic, neglectful or abusive.

Depression and bipolar illness generally interferes with a child's social or academic functioning. When a child is depressed, school performance deteriorates. She loses interest in extracurricular activities and withdraws. She may complain of headaches, stomachaches or other physical symptoms especially before entering a new situation. Phobias may develop.

Symptoms

Persistent lethargy and loss of interest in normal pleasurable experiences: food, friends, pets, sports, music and hobbies; a family or personal history of depression or suicide, self-mutilating or self-destructive behavior, alcohol or other drug use; tearful, withdrawn, listless, dull or agitated appearance; sleep changes; failure to achieve the expected weight gain for a child her age or a sudden drop in weight; change in personal habits; slow movements, monotonous voice; negative self-references: "I'm stupid," or "No one loves me," or "I'm bad."; statments about suicide or being better off dead.

What You Can Do

Gently, encourage her to engage in activities she enjoys and at which she excels. Whenever you recognize her accomplishments and admire her abilities, you help build up her self-esteem which will counteract feelings of depression. If possible, help her stay connected with her friends. Encourage her to exercise and play sports. Keeping a journal, and talking to friends are other ways of sorting out feelings that can threaten to envelop her. In all things, be encouraging but be careful not to push. If these measures are not helpful you should seek a professional evaluation for your child.

Treatment

Group therapy is an important modality for children and adolescents. In a supportive group of their peers, youngsters can develop social skills that in turn can lead to a greater sense of mastery and self-esteem.

Families who live with depressed or manic-depressed children might find help through Family therapy. Many times, they learn to modify certain behaviors that commonly exacerbate depression in children -- lack of generational boundaries, severe marital conflict, rigid or chaotic rules, projection of parental feelings onto a child, or neglectful or overly-involved relationships -- as well as ways of dealing with the problems wrought by a emotionally disturbed child. In addition, other depressed family members can be identified in family sessions.

When To Seek Treatment

If you suspect that your child may be ruminating about the meaninglessness of life and considering suicide, seek professional help immediately.

Depressive symptoms, particularly when they persist or seriously interfere with social and academic functioning, cannot be managed by a child and his family alone. Ask your child's physician for names of clinicians who could conduct a psychiatric evaluation if your child's depression continues.

Prognosis