Tag Archives: Can Preschoolers Be Depressed?

Is there something really wrong with a society with depressed preschoolers????

1 Jul

Here’s today’s COMMENT FROM AN OLD FART: Moi read this article from Science Daily, Brain Differences Seen in Depressed Preschoolers:

A key brain structure that regulates emotions works differently in preschoolers with depression compared with their healthy peers, according to new research at Washington University School of Medicine in St. Louis.

The differences, measured using functional magnetic resonance imaging (fMRI), provide the earliest evidence yet of changes in brain function in young children with depression. The researchers say the findings could lead to ways to identify and treat depressed children earlier in the course of the illness, potentially preventing problems later in life. http://www.sciencedaily.com/releases/2013/07/130701172022.htm

Really. We have depressed preschoolers? Should one have experienced more about life before developing a negative opinion of it?

The National Institute of Mental Health in the Depression in Children and Adolescents (Fact Sheet) estimates about “About 11 percent of adolescents have a depressive disorder by age 18.”

About 11 percent of adolescents have a depressive disorder by age 18 according to the National Comorbidity Survey-Adolescent Supplement (NCS-A). Girls are more likely than boys to experience depression. The risk for depression increases as a child gets older. According to the World Health Organization, major depressive disorder is the leading cause of disability among Americans age 15 to 44.

Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child who shows changes in behavior is just going through a temporary “phase” or is suffering from depression.

PDF

http://www.nimh.nih.gov/health/publications/depression-in-children-and-adolescents/index.shtml

Statistics for the numbers of preschoolers who exhibit depression are hard to come by, but researchers are beginning to study the issue.

Pamela Paul reports in the New York Times article, Can Preschoolers Be Depressed?

But generally speaking, preschool depression, unlike autism, O.D.D. and A.D.H.D., which have clear symptoms, is not a disorder that is readily apparent to the casual observer or even to the concerned parent. Depressed preschoolers are usually not morbidly, vegetatively depressed. Though they are frequently viewed as not doing particularly well socially or emotionally, teachers rarely grasp the depth of the problem. Sometimes the kids zone out in circle time, and it’s mistaken for A.D.H.D., “because they’re just staring,” explains Melissa Nishawala, the child psychiatrist at N.Y.U. “But inside, they’re worrying or thinking negative thoughts.” More often, they are simply overlooked. “These are often the good kids who tend to be timid and withdrawn,” says Sylvana Côté, a researcher at the University of Montreal who studies childhood mood and behavioral disorders. “It’s because they’re not the oppositional, aggressive children who disrupt everyone in class that their problems go undernoticed.”

Many researchers, particularly those with medical training, are eager to identify some kind of a “biologic marker” to make diagnosis scientifically conclusive. Recent studies have looked at the activity of cortisol, a hormone the body produces in response to stress. In preschoolers who have had a diagnosis of depression, as in depressed adults, cortisol levels escalate under stressful circumstances and then fail to recover with the same buoyancy as in typical children.

But in adults, cortisol reactivity can be an indication of anxiety. Other research has found that in young children, anxiety and depression are likewise intertwined. At Duke, Egger found that children who were depressed as preschoolers were more than four times as likely to have an anxiety disorder at school age. “Are these two distinct but strongly related syndromes?” asks Daniel Pine of the N.I.M.H. “Are they just slightly different-appearing clinical manifestations of the same underlying problem? Do the relationships vary at different ages? There are no definitive answers.”

Further complicating the picture is the extent to which depressed children have other ailments. In Egger’s epidemiological sample, three-fourths of depressed children had some additional disorder. In Luby’s study, about 40 percent also had A.D.H.D. or O.D.D., disruptive problems that tend to drown out signs of depression. Though it looks as if only the children with depression experience anhedonia, other symptoms like irritability and sadness are shared across several disorders. http://www.nytimes.com/2010/08/29/magazine/29preschool-t.html?pagewanted=all&_r=0

There is no one single cause of depression.

The American Academy of Child and Adolescent Psychiatry says this about the causes of depression:

Depression has no single cause. Both genetics and the environment play a role, and some children may be more likely to become depressed. Depression in children can be triggered by a medical illness, a stressful situation, or the loss of an important person. Children with behavior problems or anxiety also are more likely to get depressed. Sometimes, it can be hard to identify any triggering event. http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Depression_Resource_Center/FAQ.aspx

Moi would theorize that these preschoolers are picking up stressors form unhealthy family situations and an unhealthy society.

Everyone would probably have some thoughts about what makes a good society or a healthy society. Here are some thoughts from Professor Patrick W. Jordan about THE GOOD SOCIETY FRAMEWORK:

Relationships – the quality of people’s social, family and interpersonal relationships; the extent to which society is coherent and harmonious.

Economy – people’s degree of economic prosperity and spending power;the extent to which jobs are rewarding and offer potential for growth and development.

Environment and Infrastructure the pleasantness and sustainability of the natural environment; the degree to which the built environment is pleasant and functions well and extent to which the infrastructure is effective and efficient.

Health whether people have access to good healthcare and healthy food; whether work, home and public environments are generally safe.

Peace and Security whether crime is low and people feel safe in their homes and public areas; whether or not society is affected by war or terrorism.

Culture and Leisure whether there is a rich and rewarding culture, both high’ and popular’; whether there are opportunities to participate in rewarding leisure activities.

Spirituality, Religion and Philosophy whether there is access to religious and spiritual teachings and the opportunity to practice one’s religion of choice; whether there is access to philosophical teachings and ideas about how to live.

Education whether there is education that enables people to function effectively in society; whether the education is intellectually enriching.

Governance whether there is democracy, fairness and freedom of expression; whether justice is transparent and consistent, and whether society is governed with compassion and equality.                                                                            http://www.une.edu.au/faculties/professions/Resources/goodsocietyframework.pdf

Given Professor Jordan’s framework for a healthy society, one might ask how the U.S. is doing? Like the canaries in the mineshaft who die when overcome by poisonous gases, maybe the depressed preschoolers are telling us.

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American Academy of Neurology study: Doctors cautioned against using drugs to treat children

19 Mar

Moi wrote in More children now on antipsychotics drugs:

Duff Wilson chronicles one family’s harrowing ordeal as they sought first, an accurate diagnosis and then appropriate treatment for their child. In the New York Times article, Child’s Ordeal Shows the Risk of Psychosis Drugs For The Young Wilson reports about the Warren family. Judy Lightfoot has a very informative article at Crosscut, We’re Doing Experiments On Poor Children whose are prescribed antipsychotic drugs more often. Pamela Paul has a fascinating article in the New York Times about preschoolers and depression. In the article, Can Preschoolers Be Depressed? Paul does a great job of describing what depression looks like in small children and reporting about nascent research efforts by various universities.                                                                                   https://drwilda.com/2012/08/10/more-children-now-on-antipsychotics-drugs/

The American Academy of Neurology (AAN), the world’s largest professional association of neurologists, is releasing a position paper on how the practice of prescribing drugs to boost cognitive function, or memory and thinking abilities, in healthy children and teens is misguided.”

Genevra Pittman of Reuters writes in the article, Be cautious of mind-altering drugs for kids: doctors:

Focusing on stimulants typically used to treat attention deficit hyperactivity disorder, or ADHD, researchers said the number of diagnoses and prescriptions have risen dramatically over the past two decades.

Young people with the disorder clearly benefit from treatment, lead author Dr. William Graf emphasized, but the medicines are increasingly being used by healthy youth who believe they will enhance their concentration and performance in school.

According to the National Institute on Drug Abuse, 1.7 percent of eighth graders and 7.6 percent of 12th graders have used Adderall, a stimulant, for nonmedical reasons.

Some of those misused medicines are bought on the street or from peers with prescriptions; others may be obtained legally from doctors.

“What we’re saying is that because of the volume of drugs and the incredible increase… the possibility of overdiagnosis and overtreatment is clearly there,” said Graf, from Yale University in New Haven, Connecticut.

In their statement, published in the journal Neurology, he and his colleagues say doctors should not give prescriptions to teens who ask for medication to enhance concentration against their parents’ advice.

Prescribing attention- or mood-enhancing drugs to healthy kids and teens in general cannot be justified, for both legal and developmental reasons, Graf and his co-authors conclude.

http://www.reuters.com/article/2013/03/13/us-medications-kids-idUSBRE92C17H20130313

Here is the press release from the American Academy of Neurology:

FOR IMMEDIATE RELEASE, MARCH 13, 2013

AAN: Doctors Caution Against Prescribing Attention-Boosting Drugs for Healthy Kids

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MINNEAPOLIS – The American Academy of Neurology (AAN), the world’s largest professional association of neurologists, is releasing a position paper on how the practice of prescribing drugs to boost cognitive function, or memory and thinking abilities, in healthy children and teens is misguided. The statement is published in the March 13, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology.

This growing trend, in which teens use “study drugs” before tests and parents request ADHD drugs for kids who don’t meet the criteria for the disorder, has made headlines recently in the United States. The Academy has spent the past several years analyzing all of the available research and ethical issues to develop this official position paper.

Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and prevent the misuse of medication,” said author William Graf, MD, of Yale University in New Haven, Conn., and a member of the American Academy of Neurology. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.”

The statement provides evidence that points to dozens of ethical, legal, social and developmental reasons why prescribing mind-enhancing drugs, such as those for ADHD, for healthy people is viewed differently in children and adolescents than it would be in functional, independent adults with full decision-making capacities. The Academy has a separate position statement that addresses the use of neuroenhancements in adults.

The article notes many reasons against prescribing neuroenhancement including: the child’s best interest; the long-term health and safety of neuroenhancements, which has not been studied in children; kids and teens may lack complete decision-making capacities while their cognitive skills, emotional abilities and mature judgments are still developing; maintaining doctor-patient trust; and the risks of over-medication and dependency.

The physician should talk to the child about the request, as it may reflect other medical, social or psychological motivations such as anxiety, depression or insomnia. There are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits and exercise regimens,” said Graf.

The statement had no industry sponsors.

View the full statement at: http://neurology.org/lookup/doi/10.1212/WNL.0b013e318289703b. View the AAN’s full statement on neuroenhancements and adults at: http://www.neurology.org/content/early/2009/09/23/WNL.0b013e3181beecfe.full.pdf

The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy. For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

Parents must be advocates for their children. If the first medical opinion does not seem right, get a second or even a third opinion.

Related:

Schools have to deal with depressed and troubled children https://drwilda.wordpress.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

School psychologists are needed to treat troubled children https://drwilda.wordpress.com/2012/02/27/school-psychologists-are-needed-to-treat-troubled-children/

Battling teen addiction: ‘Recovery high schools’ https://drwilda.wordpress.com/2012/07/08/battling-teen-addiction-recovery-high-schools/

Where information leads to Hope. ©                 Dr. Wilda.com

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School psychologists are needed to treat troubled children

27 Feb

Pamela Paul has a fascinating article in the New York Times about preschoolers and depression. In the article, Can Preschoolers Be Depressed? Paul does a great job of describing what depression looks like in small children and reporting about nascent research efforts by various universities.     

How Common Is Depression In Children?  

According to Mary H. Sarafolean, PhD in the article, Depression In School Age Children and Adolescents

In general, depression affects a person’s physical,  cognitive, emotional/affective, and motivational well-being, no matter  their age. For example, a child with depression between the ages of 6 and 12 may exhibit fatigue, difficulty with schoolwork, apathy and/or a lack of motivation. An adolescent or teen may be oversleeping, socially isolated, acting out in
self-destructive ways and/or have a sense of hopelessness. (See table 1.)    

Prevalence and Risk Factors             

While only 2 percent of pre-teen school-age children and 3-5 percent of teenagers have clinical depression, it is the most common diagnosis of children in a clinical setting (40-50 percent of diagnoses). The lifetime risk  of depression in females is 10-25 percent and in males, 5-12 percent. Children and teens who are considered at high risk for depression disorders include:

* children referred to a mental health provider for school problems
* children with medical problems
* gay and lesbian adolescents
* rural vs. urban adolescents
* incarcerated adolescents
* pregnant adolescents
* children with a family history of depression    
     

If you or your child has one or more of the risk factors and your child is exhibiting symptoms of prolonged sadness, it might be wise to have your child evaluated for depression. Because many children exhibit symptoms of depression, schools are increasingly forced to deal with depressed children.

Mark Phillips, professor emeritus of secondary education at San Francisco State University wrote the article, School psychologists: Shortage amid increased need which discusses the need for psychological support in schools.

The adolescent suicide rate continues to rise, with each suicide a dramatic reminder that the lives of a significant number of adolescents are filled with anxiety and stress. Most schools have more than a handful of kids wrestling with significant emotional problems, and schools at all levels face an ongoing challenge related to school violence and bullying, both physical and emotional.

Yet in many schools there is inadequate professional psychological support for students.

Although statistics indicate that there is a significant variation from state to state (between 2005- and 2011 the ratio of students per school psychologist in New Mexico increased by 180%, while in the same period the ratio decreased in Utah by 34%), the overall ratio is 457:1. That is almost twice that recommended by the National Association of School Psychologists (NASP).

THE NASP noted a shortage of almost 9,000 school psychologists in 2010 and projected a cumulative shortage of close to 15,000 by 2020. Mental Health America estimates that only 1 in 5 children in need of mental health services actually receive the needed services. These gross statistics also omit the special need of under funded schools and the increased roles school psychologists are being asked to play.

This problem, for the most part, is not one of commitment or values. Most school leaders recognize the problem and want to effectively address it, but they report that most of the counseling support services they have are for testing and helping kids with special emotional and/or learning problems. Even this is inadequate, with the psychologist available only a day or two each week.

In the best-funded districts, there is more full-time psychological counseling available for students. Yet, even in these districts, principals indicate that they have more students who need help with stress management than the existing counseling services can provide.

The problems extend beyond inadequate support services. School advisories — when a group of students meet with a teacher for advisory help — are supposed to provide psychological support but rarely do. Most students I’ve spoken with perceive advisories as a time for academic help but not a place they can go to deal with personal problems. Few schools are able to offer the training that teachers need to be able to provide that kind of support. Even those schools that have sponsored a program like Challenge Day, which provides an opportunity for students to openly discuss their individual struggles, rarely have a sustained follow-up program in place.

A bill was introduced in Congress last November that would provide some alleviation of this problem in lower income areas. H.R. 3405 is the Increased Student Achievement Through Increased Student Support Act. It would provide grants to partnerships between schools and low- income local educational agencies to improve the ratio of school counselors, social workers, and psychologists. Although limited in focus, it is at least a start. The bill was sent to the House Committee on Education and the Workforce and has still not been acted on by the Committee.

Even with the psychological services that should be provided and often aren’t, schools can’t fully prevent suicides, acts of violence, bullying, or the daily stresses that weigh on kids shoulders. The malaise runs deeper and broader.

Still schools need more resources than they receive in order to provide more programs that actively identify and counsel those kids that need help. At the very least, they need to alleviate some of the stress these kids are experiencing and to help improve the quality of their daily lives.

http://www.washingtonpost.com/blogs/answer-sheet/post/school-psychologists-shortage-amid-increased-need/2012/02/26/gIQAU7psdR_blog.html

It is important to deal with the psychological needs of children because untreated depression can lead to suicide.

Why Do Teens Attempt Suicide? 

The American Academy of Adolescent Psychiatry has some excellent suicide resources 

Suicides among young people continue to be a serious problem. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds.

Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. For some teens, suicide may appear to be a solution to their problems and stress.  

Sometimes, people see suicide as an answer to their problems. All of us must stress that suicide is always the WRONG answer to what in all likelihood is a transitory situation.  

What are the Warning Signs of Suicide? 

According to Teen’s Health there are some suicide warning signs 

Warning Signs

There are often signs that someone may be thinking about or planning a suicide attempt. Here are some of them:

talking about suicide or death in general

talking about “going away”

referring to things they “won’t be needing,” and giving away possessions

talking about feeling hopeless or feeling guilty

pulling away from friends or family and losing the desire to go out

having no desire to take part in favorite things or activities

having trouble concentrating or thinking clearly

experiencing changes in eating or sleeping habits

engaging in self-destructive behavior (drinking alcohol, taking drugs, or cutting, for example) 

These are signs that indicate a person may be depressed. 

According to Jared Story.com the primary cause of suicide is depression. 

# 1 CAUSE OF SUICIDE:  UNTREATED DEPRESSION

It can be very hard to diagnose depression.  There are many different kinds of depression and not all people will have the same symptoms, or have them to the same degree.  Here are some symptoms to watch for and if they last more than a few weeks, a doctor or psychiatrist should be consulted. 

Persistent sad or “empty” mood

Feeling hopeless, helpless, worthless

pessimistic and or guilty

Substance abuse

Fatigued or loss of interest in ordinary activities

Disturbances in eating and sleeping patterns

Irritability, increased crying, anxiety and panic attacks, (Post Traumatic Stress Disorder)

Difficulty concentrating, remembering or making decisions

Thoughts of suicide; suicide plans or attempts

Persistent physical symptoms or pains that do not respond to treatment 

The site also lists events that might trigger depression in a person. 

A death of a family member or close friend – which could include a fellow student from school

An assault, car accident or painful physical event – which could include physical bullying

Mental, or emotional event – which could include non-physical bullying

Marriage breakup, or love lost suddenly – which could include “breaking up” with a girlfriend or boyfriend

Constant physical, mental, or emotional pain that goes on for a length of time – which includes constant bullying that is not intervened, resolved or stopped entirely

Major Financial setback – which includes a teenager who may have lost a job

Something “embarrassing” happens – as an example; getting kicked off a football team or a public insult by a teacher or popular student; bullying

Failing an important exam a school – not a normal trigger unless the exam was life changing and the individual is under a lot of stress

A best friend moves out of town – especially true for teenagers who are being bullied and have very few friends as it is 

If you notice these signs, the key is to get help for yourself or a friend. 

What Should You Do if You Know Someone Who Thinking About Suicide? 

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center has some excellent advice about suicide prevention If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.” That statement should be clarified to make it perfectly clear that appropriate medical care may include a second, third or more medical opinions if necessary.

Resources:

Teen’s Health’s Suicide

American Academy of Adolescent Psychiatry

Suicide Prevention Resource Center

Teen Depression

Jared Story.Com

CNN Report about suicide

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