One could easily say that Nathan was born into the wrong family. Had he been raised in the family next door, things might have turned out differently. Nevertheless, I was faced with a teenager whose sadness was overwhelming. He was immobilized by a deep depression that was affecting his motivation to perform quality work at school and to connect appropriately with age-mates.
On the day that Nathan visited me for therapy, he was particularly disturbed. After being awakened on a school day by his alcoholic father, he was told that he was "worthless" because he was unable to fix the glitch in their computer system. Such derogatory comments were common-place and colored Nathan's relationship with his dad. Over time, he began to internalize and believe his father's voice - that he was an overweight, incompetent slacker. Obviously, there was no evidence to support his father’s erroneous, abusive, mean-spirited assessment of his son.
While many depressed kids have parents who are not a major factor in their child's disorder, it is not unusual for parents to play a role in creating toxic environments at home. A child may internalize the stress of parental feuding, drinking or abuse and act out in response by being overly-compliant or pushing back with anger toward authority figures.
Depression in children may be a metaphor for what is occurring within his/her family system. There may be a bio-chemical predisposition to depression within the child’s family. Adverse childhood experiences as a result of parental abuse, domestic violence, excessive drug and alcohol issues, marital and family conflict and neglect may play a role in generating depressive thinking and behavior in kids. A parent may engage their child in therapy (without adult participation) in hopes of relieving the effects of depression. In such cases, the parent avoids involvement, and places the burden on the child to get the problem resolved.
On the other hand, some children experience depression that is not related to or caused by family factors. Such causes may include:
• A continuous problem with teasing and bullying
• The breakup of significant friendships
• Grief associated with the loss of loved ones and pets
• Reactions to a new location and school
• Physical and hormonal changes occurring in adolescence
• Trauma due to major illnesses in children
• Rejection in activities, such as sports and clubs
• Failure to achieve academic success
Depression often goes under-diagnosed among children because of the covert nature of the symptoms. It is not usual for features of depression to be displayed through certain self-destructive and/or acting-out behaviors. Hopelessness and anger are at the core of childhood depression. Kids may feel stuck in situations they are unable to change or lack the capacity to push back against adults or peers who try to diminish their worth.
Typical characteristics of depression in children consist of energy depletion, anxiety, lack of motivation, feelings of shame, helplessness and anger. These depressive symptoms are often camouflaged through purposeful behaviors aimed to get the validation and nurturing of significant adults. In an effort to soothe their psychic pain, children and teenagers may self-medicate, act out against authority figures, and dabble in criminal behavior.
Parents need to be aware of the following signs that indicate a possible problem with childhood depression:
• Significant avoidance of family and friends – withdrawing to bedroom, excessive use of electronic gadgetry, obsession with violent video games, refusing overtures from friends for involvement in activities, shutting down emotionally, avoiding any family contact
• Signs of drug usage - dilated eyes, erratic behavior, mood swings, escalation of anger, drug paraphernalia, dramatic drop in school performance
• Self-harming behaviors - self-cutting, refusing to eat, neglecting personal hygiene
• Acting out toward authority figures - school detentions/suspensions, negative reports from school, calls from school personnel about behavior
• A lack of involvement with school - not involved in school clubs, sports, music/arts
• Outbursts of mood - anger, rage, bouts of crying
• Sexual promiscuity - obsessively preoccupied with a partner, finding condoms, sneaking out of house, changing wardrobe, finding birth control pills
• Poor eating habits - refusing to eat with family, reducing food portions, changing dietary habits, exclusively eating alone
In order for parents to recognize and act on the signs of depression within their family, they must become more conscious of the behavior patterns and needs of their children. There are multiple steps that parents can take to assure that the well-being of their children is addressed:
• Seek family counseling - recognize that a child's experience with depression may be a symptom of a larger family problem.
• Take your child's symptoms of depression seriously - recognize the ‘red flags’ and stay out of denial.
• Promote non-evaluative exploration - explore your children's needs and feelings without imposing your own will or advice-giving and lecturing.
• Encourage and support your child's positive efforts - the power of positive reinforcement shapes behavior.
• Stay involved - attend activities that your children participate in and maintain open communications.
• Major in the majors - don't focus on battles that aren't as important as others, such as hair color, school clothes and homework; rather, emphasize character traits that promote civility, motivation and a positive attitude.
• Reflect on your own childhood - were there times when you felt trapped, angry, helpless and sad? Who was there for you?
• Role-model positive, energetic, involved behavior.
• Set reasonable positive and negative consequences for behavior.
• Get your child involved in sharing household tasks.
• Stay out of self-blame – blaming yourself for your child's depressive mood and behavior will change nothing. Accept responsibility for providing your child and family support in times of need.
We live in a fast-paced complex world filled with multiple stressors. Invariably, at some point during our life most of us may experience a bout of depression. This is particularly true for the most vulnerable citizens - our youth. Children are trying to balance responsibilities at school, home and in the community. Likewise, physical growth and hormonal changes also affect our kid’s way of reacting to life stressors. If parents remain aware and involved, the impact of depression on our kids can be minimized and corrected.
Note: This case is a composite drawn from my practice as a psychotherapist. It has been altered to protect the individual’s right to confidentiality and privacy.
James P. Krehbiel, Ed.S., LPC, CCBT is an educator, writer, licensed professional counselor and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He specializes in treating anxiety and depression for adults and children. He served as a teacher and guidance counselor for 30 years and has taught graduate-level counselor education courses for Chapman University. In 2005, he self-published Stepping Out of the Bubble: Reflections on the Pilgrimage of Counseling Therapy (Booklocker.com). His latest book, Troubled Childhood, Triumphant Life: Healing from the Battle Scars of Youth (New Horizon Press) is about the impact of adverse childhood experiences on adult functioning. He can be reached through his website at www.scottsdaletherapy.net.
