Even if there is no single explanation for all behavioral disorders in children and adolescents: Behind aggression, just as behind other abnormalities or physical symptoms, depression can be hidden. The “Berlin Alliance Against Depression” points this out, especially in view of the sometimes simplistic discussion about violence in schools.
Depression in children often recognized late
Overall, the topic of depression in childhood and adolescence is sometimes criminally neglected. This also has to do with the fact that the manifestations are usually different from those in depressed adults and that both parents and doctors too rarely get the idea that the child could be suffering from depression. “The consequence is often a far too late expert treatment,” explained now Dr. Meryam Schouler-Ocak, head of the Berlin alliance. It was not so long ago that even experts assumed that depression could not exist in children. It is now clear that around two out of every 100 children of pre-school and primary school age suffer from depression. From puberty on, the frequency increases. Overall, the possibility of suffering depression throughout adolescence is between 9.4% and 18.5% (according to various figures in the literature).
Triggers of childhood depression
These can be – but do not have to be – early childhood experiences and, currently, death or separation in the family or from close caregivers. If parents are depressed, this can further affect the offspring. Experts now agree that both components of the personal environment and biological factors play a role in whether or not a person is susceptible to depression. Social factors such as social inequality, migration background and excessive performance requirements, as well as “arbitrariness” or neglect in upbringing, are also considered to exacerbate mental illness in children.
Depression in children – symptoms
Symptoms vary not only by age, but also greatly from case to case, so distinguishing them from “normal” sadness in children and especially during puberty can be difficult. Parents, teachers and doctors overlook depression far too often. False advice such as “pull yourself together” also contributes to depression not being treated. In addition, sufferers and their families are afraid of being labeled “crazy.” In children, the signs of depression are almost always atypical. Only in adolescence do they resemble those of adults. With younger children, it is especially important to observe their playing, eating and sleeping behavior. With older children, attention must also be paid to how they deal with performance demands. It is also particularly important to ask parents, teachers or kindergarten teachers. Ultimately, only specialists and psychotherapists can ensure DIAGNOSIS. Close cooperation with family physicians is therefore particularly important.
Treatment of depressed children and adolescents
Treatment of depressed children and adolescents initially consists of psychotherapy, which usually includes the family. Interventions in the living environment may also be indicated. Sometimes, additional administration of antidepressant medications is necessary, which must be precisely tailored to the patient’s age and type of depression. Even if special care is required in dealing with psychotropic drugs, especially in children and adolescents, they are better than their reputation. Here, “ideological bias” can do harm. Inpatient treatment of depressed children and adolescents in specialized clinics is necessary only in particularly severe cases.
Help from the environment
Caregivers, teachers, parents, and other adults in the immediate environment can help prevent delayed diagnosis and therapy by watching for behavioral changes such as a drop in performance, social withdrawal, constant irritability, frequent sadness, or even suicidal expressions. However, they should neither diagnose nor treat, but convey their impressions and offer help. Support options are also available for teachers.It is important for all those who have to deal with children and adolescents suffering from depression: to accept it, to convey that it is an illness just as much as physical disorders, to integrate it into lessons and social life without overtaxing it, to offer a space of protection without accepting disruptive behavior, to encourage small steps and to give positive feedback even in the case of small successes. In the case of very severe depression that is accompanied by thoughts and expressions of suicide, it is certainly appropriate to address the issue; however, this should not be done in a class setting, for example. This is because even if the problem is conveyed in a well-intentioned way, the consequences are difficult to assess, among other things because hardly any individual will ask in front of the other students if he or she is at risk. Imitations (Werther effect) cannot be ruled out either. It is more favorable to generally communicate what help is available for young people in a crisis.
Conclusion
Children and adolescents can also be depressed. The distinction between a normal upset and an illness must be made by specialists. Treatment has a very good chance of success. What’s more, the affected person’s environment can contribute a great deal to timely detection and recovery.
