Many of today's youth struggle with depression and anxiety. The symptoms can be difficult to recognize because of the ever-changing development stages children and adolescents experience. Children/adolescents may act out their feelings rather than verbalize them. It is easy for parents and teachers to misdiagnosed boredom, hostility, and reckless behavior as signs of ADD rather than consider the possibility of depression or anxiety.
Depression is different from normal emotional experiences of sadness, loss, or a passing mood. Depression persists and can significantly impact an individual's thinking, behavior, mood, and physical health. Depression in youth can take three forms: major depression, dysthymia, and bipolar disorder. Children and adolescents experience these differently than adults. School-age children tend to internalize environmental stresses in the form of self-esteem distortions or excessive guilt. Their inner turmoil is often expressed in terms of somatic complaints like headaches, stomachaches, or anxiety such as school phobia or separation difficulty and irritability.
What to look for:
- Cries easily and more often than other children
- Decreased interest in playing
- Somatic complaints, such as stomach ache
- Listless and moody
- Appears sad
- Talks about being bored
- Trouble/difficulty with schoolwork
- More irritable than usual
- Easily discouraged
- More distant with friends and family
- Talks about death
- Always tired
- Increased arguments with teachers and parents
- Engages in harmful behavior (cutting him/herself)
- Extreme sensitivity to rejection or failure
- Alcohol or substance abuse
- Quits favorite activities
- Refuses to do chores or homework
- Suicidal thoughts
- Increased irritability, anger, or hostility
- Reckless or out-of-control behavior
- Problems with relationships
Working with Children and Adolescents. What is the next step?
Step 1: Determine the time, intensity, and duration of symptoms from both the parent's and the children's perspectives. This requires meeting with (preferably) both parents without the child and then both parents with the child initially.
Step 2: Therapist and child will meet three or four times to establish a relationship and exploring events and feelings the child is experiencing.
Step 3: Treatment with teens and youth include play therapy, cognitive-behavioral therapy, and creative expression.
Play therapy is a non-confrontational approach to help children "act out" their feelings, thoughts, and behaviors. It gives the therapist a sneak peek into how the child is processing their environment.
Cognitive-Behavioral therapy is a solution-focused skill-building therapy. The focus is to help the teen recognize that depression and emotional health are related to thought patterns and beliefs they hold about themselves. According to the National Institute of Mental Health, CBT has the highest remission rate in most cases of depression and anxiety.
Creative Expression is used to help children and adolescents find ways to cope with life's stresses. Learning new coping strategies that are healthful will give children life-long tools for optimum mental health. Role plays, art, and writing are used as a vehicle for change.
Step 4: Working with parents to increase their awareness of depression/anxiety and teach coping strategies to help manage their own response to their children as well as helping their child continuously.
Please know that when working with teens, the process can be difficult. Teens may not want to come to counseling, they often complain that it's boring or dumb. It is not unusual for a child to complain about the therapist. It can take a few sessions to establish a connection. Be sure to talk with the therapist to see how things are going, sometimes a connection is not established with the therapist. It's okay, it's just time to find another one more suited to your child.