CHILDHOOD DEPRESSION: 

GUIDELINES FOR PARENTS AND TEACHERS

DEFINITION: The essential feature is a change in mood or feeling
where a child becomes sad, blue, gloomy, and irritable. There are
many other symptoms or changes of behavior present in depression
including (1) a marked loss of interest or pleasure in most
activities; (2) increase or decrease in appetite with a weight gain
or loss; (3) sleeping too much or too little; (4) restlessness or
slow movements; (5) loss of energy and feeling tired; (6) feeling
worthless or inappropriately guilty; (7) difficulty concentrating
and thinking; and (8) often thinking about death or suicide
(Diagnostic and Statistical Manual, DSMIII-R, 1987).

DURATION AND SEVERITY - While many children experience the above
problems, the key in depression is that at least five of the above
symptoms are observed changes in behavior and present almost every day
for at least two weeks. The severity ranges from mild to severe
according to the number of problems and their duration (DSMIII-R).

INCIDENCE - It is estimated that 3% to 10% of children experience severe
to mild depression (McKnew, Catryn, & Yahres, 1983). Only since the
1960s has depression been recognized by professionals as a childhood
disorder.

GENERAL INTERVENTIONS
The treatment and management of childhood depression involves many
considerations and interventions. Depression especially requires
treating the "whole child" and beginning with the "least restrictive
alternative."

ASSESSMENT - Parents should first seek a thorough testing, which for
depression often involves consulting many child professionals including
the family's doctor, in addition to psychologists, psychiatrists, and
school personnel. Testing should not only indicate the degree of
depression but also all areas of development such as physical status and
intelligence in addition to past history or the determinants concerning
the development and maintenance of depression. Physical causes for
depression symptoms especially need to be ruled out.

PRESCRIPTIVE INTERVENTIONS - The selection of the many intervention
procedures applied to depression should depend on the child's individual
needs. The counseling and management approaches for depression include
behavioral, social skills, cognitive, familial, and multimodal
interventions (see enclosed specific interventions).

FAMILY THERAPY -This approach is often applied to depression where the
family is treated as a unit. For depression, counseling is directed at
reducing maladaptive interactions between the depressed child and other
family members which maintain depression symptoms in addition to scape-
goating and family expectations.

SPECIAL EDUCATION - Depressed youths may be eligible for placement in
"severe behavioral handicapped" programs at school. This is helpful
when school failure due to depression is encountered.




MEDICAL TREATMENT - Medications and even hospitalization are often used
by medical doctors to treat depression. However, these should be
provided when other less restrictive treatments are found to be
ineffective - such as counseling - or if life-threatening behavior is
encountered.

SPECIFIC SUGGESTIONS

ENCOURAGEMENT - Depressed children may have the "mistaken goal" that they
can find their place with others by "display of inadequacy." Encourage
them at those very times when they appear sad or hopeless to let them
know that you aren't giving up on them; thus, you do not let them achieve
their "mistaken goal."

CONFRONTATION - At times, telling the child he/she is wrong and eliciting
anger helps break depression. Encouragement should be used following
confrontations.

RULE OUT DRUGS AND ALCOHOL - Depressed youths may have a higher risk for
substance abuse, and symptoms may be due to substance abuse rather than
depression. Refer to the family physician and agencies specializing in
chemical abuse if this is suspected.

TEACH SELF-MONITORING - Have the child record activities in a notebook
and rate how he/she felt during each activity, using a 10-point scale (0
is the worst and 10 is the best you ever felt). Help the child correct
misinterpretations which may have caused negative feelings.

PROMOTE INVOLVEMENT - Schedule activities during the depressed child's
day at home and school to reduce passivity and increase interaction with
peers and adults.

PROMOTE INVOLVEMENT - Schedule activities during the depressed child's
day at home and school to reduce passivity and increase interaction with
peers and adults.

PROVIDE OPPORTUNITIES FOR REPEATED SUCCESS - Activities that are within
the child's capabilities and are likely to result in success or pleasure
should be arranged as part of the child's schedule.

PROVIDE SOCIAL SKILL TRAINING - A depressed child's social withdrawal
often results from an inability to elicit and secure positive
reinforcement from others as well as an inadequate repertoire of social
behavior. Teach the child positive social interaction skills.

TEACH PROBLEM-SOLVING SKILLS - Depressed children often lack social
competence to solve interpersonal problems. Exploring alternatives and
examining potential consequences are strategies that facilitate problem
resolution (see guidelines handout, Problem-Solving Techniques for
Discipline and Guidance.)

BIBLIOTHERAPY - Bibliotherapy involves the use of books to promote
adjustment of children. Books, articles, or stories carefully selected
that deal with the subjects of death, divorce, and so forth may be used
to reduce unrealistic perceptions in addition to promote positive coping
skills.


USE MUTUAL STORY TELLING - This is an excellent technique to provide
insight and instill hope for the depressed child. After the child tells
a story, the teacher or parent offers a slightly altered version
containing a resolution of some problem or a special message. Once both
stories are concluded, a lesson is offered for the stories.

EXPLORE ENVIRONMENTAL MODIFICATIONS - Change in schools, special
education resources, and reorganization of custody/visitation rights are
examples of adjustments which may help.

PARABLES, METAPHORS AND FABLES - These are alternative thinking devices
which may help convey a message or help the depressed child clarify
his/her feelings.

TEACH POSITIVE SELF-TALK - The use of positive covert speech and coping
statements mitigates the depressed child's diminished feelings of self-
esteem and reduces associated anxiety.

USE MODELING - Find appropriate model(s) for the depressed child.
Rearrange the seating to promote involvement with peer(s).

BREAK TASKS INTO SMALLER UNITS - Careful assignments which provide
frequent successful experiences increase self-esteem and are particularly
useful for dealing with the depressed child's lack of interest and
energy, especially for school-related tasks.

AGENDA SETTING - Involve the child in the scheduling of pleasurable
activities or daily routines to increase feelings of control and mastery
as well as increase the likelihood of success.

ARRANGE FOR THE DEPRESSED CHILD TO HELP OTHERS - Often doing something
special for others helps the helper feel better about himself-herself and
is incompatible with negative rumination or preoccupations.

CORRECT THINKING ERRORS - The depressed child often distorts reality by
thinking errors such as overgeneralizations ("I am always going to be a
loser.") and dichotomous thinking ("I failed the test so I must be
stupid.") Call attention to these when observed and provide alternative,
positive thinking (e.g., "Kites rise highest against the wind." - Winston
Churchill).

USE HUMOR - Humor is often effective to point out fallacies or thinking
errors of depressed children (e.g., "Even postage stamps become useless
when they get stuck on themselves").

POSITIVE SELF-RATINGS - Ask the child to write down positive attributes
about himself/herself. Use this list as targets about the child to be
pointed out for encouragement and reinforcement when observed at home or
school.

CATCH THE CHILD BEING HAPPY - Praise and approve positive behavior such
as self-confidence or humor and try to ignore depressed behavior as much
as possible.

USE DIARIES, DRAWINGS, PUPPETS, STORY-TELLING, AND FANTASY GAMES - These
techniques promote communication and understanding of the child's
feelings and thoughts.

SUICIDE TREATMENTS - Suicide thoughts and behavior frequently occur with
depression, and this life-threatening condition should be identified and
treated if present.

THE CLASSROOM TEACHER MAY ALSO BE OF ASSISTANCE BY:

1. Encouraging the student to attempt even partial assignments or par-
ticipate even on a minimal basis in class.

2. Providing opportunities for repeated success. Encourage activities
which are within the pupil's capabilities and are likely to result
in success or pleasure upon completion.

3. Stressing short-term goals and objectives. Offer rewards for
activities completed that require sustained effort and
concentration.

4. Specific classroom reinforcement schedules may be developed to
provide sustained praise and encouragement at selected times
throughout the day.

5. Making sure expectations do not exceed the child's capabilities.

6. When possible, decrease the amount of perceived stress.

7. Being aware that feelings of worthlessness, diminished ability to
concentrate, suicidal thoughts, loss of interest in usual activi-
ties, and changes in eating and sleeping patterns commonly accom-
pany depression. Do not expect the child to initiate social acti-
vities. Gently guide and suggest activities that may not be too
strenuous or overwhelming.

8. Being realistic in regard to what the child will be able to accomp-
lish in the traditional classroom. Depression requires professional
treatment. Both counseling and medication use need time to allev-
iate the depressive symptoms.

9. Severe depression may be related to suicidal behavior in certain
cases. Precautionary measures should be taken as the depression
begins to subside and the student gains more energy.

References
Clarizio, H. (1985). Cognitive-behavioral treatment of childhood
depression. Psychology in the Schools, 22, 308-322.
McKnew, D.H., Catryn, L., & Yahres, H. (1983). Why isn't Johnny crying?
New York: Norton. Venzke, R.C., Farnum, M. K., & Kremer, B.J. (1987).
Childhood depression. American Mental Health Counselors Association Journal,
1, 28-36.