1 Depression in children Dr.Ksh. Chourjit Singh Prof. of Pediatrics Regional Institute of Medical Sciences, Imphal National Chairperson, Growth & Development.

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Depression in children

Dr.Ksh. Chourjit SinghProf. of Pediatrics

Regional Institute of Medical Sciences, Imphal

National Chairperson, Growth & Development Chapter, IAPNational Executive Board Member

Advisor HIV/AIDS in Children Task Force, Manipur State.Past President, East Zone, IAP

President, NNF, Manipur State Branch

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Introduction

Depression in school-age children and adolescents remain a long-overlooked Health problemAs prevalent as in adultsCommon cold of mental illness – Clinical DepressionSpecially in childhood – is a major health problem

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Severity of Problem

5% children at any given time1% of Pre-school children 2% of school-age children 5% of adolescents are affected 25-50% of all children & adolescents in Psychiatric treatment are for depression & its related problems More common in boys than girls – 5:1 school-age childrenAdolescent girls than boys - 2:1

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Severity of Problem ….

Untreated Depression can be taken as important cause of suicide in

adolescents, even adults

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Why depression in young ?

A) Risk factors

Children referred to mental health providers for school problems

Children with medical problems

Asthma

Diabetes

Epilepsy

Many chronic childhood diseases

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Why depression in young ? …….

Law and order problems

Frequent bandh/ strikes

Frequent school closures

Ethnic group clashes

Insecure feelings

Conflict environment

Watching television a lot i.e. more than 6 hours a day

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Risk factors …..

Rural vrs Urban children

Sexually harassed children

Children with family history of depression

Genetically potential

What is happening in an individual child’s life

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B) Why depression runs in families

Genetics Even if a child never contacts with depressed parents,

child may also likely to be depressed

Marital difficulties Broken family/ marital problems Divorce plus depression in parents

Parenting problems Hard to be good parent when depressed Parenting problems whether from parents or from child

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C) Can experience depression at any age –

Presentation?

Shortly after birth & very youngFailure to thriveDisrupted attachments to othersDevelopmental delaysSocial withdrawalSeparation anxietySleeping and eating problems

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C) Chance of depression at any age…

Between 6-12 years of ageFatigueSadness Inability to feel pleasure Irritability & InsomniaLack of self esteemStomach ache and headache

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C) Chance of depression at any age…

HallucinationsAgitation & extreme fearsWeight changes  Difficulty with school workApathyLack of MotivationSocial withdrawal

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C) Chance of depression at any age…

AdolescentOver-sleepingSocially isolatedActing out in self destructive waysSense of hopelessnessDespairing thoughtsWeight changes

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Future of depressed school-age children

If untreated in time – affects the children

School performance and learning

Social interaction and development of normal peer relationships

Self-esteem and life skill acquisition

Parent-child relationship & sense of bonding

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Future of depressed school-age children….

Lack of trust – can lead to Substance abuseDisruptive behaviourViolence and AggressionLegal troubles and even suicide

 Depression thinking can become part of a

child’s developing personality, leaving long-term effects in place for the rest of

the child’s life.

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Behavioural changes – What?

Professional attention decreases

Classroom disruption

Expulsion from school

School failure

Injury to themselves or others

Symptoms ADHD

Truancy

Delinquency

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Stress in students leading to depression

Parental pressure to perform and to stand out among other children

If not come up to expectationsFrustrationPhysical stressAggressionUndesirable complexes

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Stress in students leading to depression…

Under-Performers

Negative traits

Shyness

Unfriendliness

Jealousy

World to loner

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Over-scheduling a student’s life

Non-availability of time for extra-curricular activities after schoolNo proper place for ventilation & breathing spaceUnwanted learning like music, painting or outstanding in sportsToo many crammed schedule & unmindful of the children’s choiceUnadjusted school systems and tremendous amount of homework – spending their evenings, weekends and vacations

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Over-scheduling a student’s life…

Loss of interest in studiesUnder-perform due to excess academic pressure

Students often carry enormous amount of anxiety and negative personal traits & massive attention problemsNon-effortless learningPhysio-Psychological transition of studentsMainly affected elementary to Junior High School

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Diagnostic Points

Transient depression or sadnessImpairment in child’s ability to functionTwo typesDysthymic disorderMajor depressions

Dysthymic disorder – less severe but lasts longerChronic depression/Irritability > 1 year

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Diagnostic Points ….

Onset about 7 years of age2-6 symptoms within 5 yearsLeads to major depression/ Double depressionUntreated Dysthymic disorder will experience Remission within 6 yearsPrevalence of depression increases with age – 5 percent of all teens

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What can be done

Diagnostic evaluation – success to treatmentAll disorders be discovered and addressed Medication Mood stabilisers Anti-anxiety Anti-depressants Stimulants

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What can be done…Individual therapy

Often beneficial for patients & specially help with issues

Family conflicts

Self-esteem

Relaxation strategies

Mood and anger control

Better communication

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School environment

Interaction

School Counsellor

Principal

Psychologist

Teachers and Parents

Psycho-educational treatment

Speech and occupational therapy

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School environment…

Counselling

Curriculum modification

Resource classes

Behavioural modification system

Self-contained classrooms

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Home/ Parental environment

Family and Home modification\

Homely life environment

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Family therapy

Defining Family members role and responsibility

Better communication & behavioural Reward systems

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Don’t overload your child with too many after-school activities and

responsibilities.

Let children learn to pace themselves.

Don’t enrol them in every class along and don’t expect them to be first in

everything.

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Thank you