How could your child develop such an illness? Many different factors, acting together, cause depression. The child’s complicated makeup, including genetic endowment, physical health and psychological style, all contribute. The child’s environment also plays a role. He or she interacts with – and over time is shaped by – you, siblings, friends, school and the community. The age and the timing of difficulties in the child’s life, and the caretaking environment provided at home, can help or hinder the child’s resilience.
Heredity plays a major role in the development of depressive disorders and bipolar disorders in children and adolescents. Of children with depression, 20 to 50 per cent have a family history of depression. The frequency is even higher for children with bipolar illness.
If one parent suffers from depression, your child is three times more likely to have a mood disorder than children whose parents are not depressed. If the parent’s depression started before thirty years of age, the chances are even higher. Parental depression can affect your child in other ways. The parent may be too tired to set limits, or may feel miserable and, as a result, be too strict when the child misbehaves on one occasion, and then guilty and too lenient the next time. This inconsistency can confuse the child.
A child’s temperament is consistent throughout development. Some children have traits that work in their favour to fend off depression, such as even sleep rhythms, an easygoing disposition, curiosity and persistence. Some are adaptable, and have the ability to organize their world and ‘right’ themselves when problems develop. But others have difficulty adapting to changes, so that each new stage of life is stressful and upsetting. With too many changes and too little support, they may develop depression or other psychiatric problems.
Family difficulties can contribute to the onset of depression. Lack of give-and-take between you and your child can cause trouble, and so can a parent-child relationship complicated by neglect and violence. Witnessing spousal violence and very angry verbal disputes within the family can also lead to depression in a child. Loss of a parent’s love through death, chronic illness or divorce can be very painful. Less serious but still difficult losses result from the death of a pet, the loss of a friend, a family move or the birth of a new sibling.
Disasters, both manufactured and natural – can shake the child’s faith in the world and in his or her own security. Ongoing threats of war and terrorism may create an atmosphere of fear and doubt that is fertile ground for depression. Children are exposed to violence from television shows, including the news, and this violence can cause a warped view of the world.
Bullying at school can also make the child’s life a nightmare and lead to depression. Often a child will suffer silently rather than let parents or teachers know how severe the bullying is, for fear of reprisals. Some young suicides have been victims of persistent bullying.
Some child psychiatrists feel that the incidence of depression in children may be increasing because they have fewer supports than in the past. Many parents have less time to spend with their children, and are reluctant to set limits and clear expectations of Behavior when they are home because they want what time they have together to be easy and fun.
Children who have a delay in language development, both in speaking clearly and in understanding or finding words, may have trouble making their needs known during the preschool years; the frustration may lead to tantrums and hitting. During school years, they may have difficulty learning, and may feel humiliated by not doing as well as their friends. If the problem is not recognized and dealt with, depression may develop as a result of their frustrations.
Children who are socially awkward find it hard to make friends. They may not be able to read nonverbal cues, so they can’t anticipate what other people are feeling and respond appropriately. (Reading social cues is an inborn skill, like language development.) Their social failure can lead to lowered self-esteem and possibly depression, if it is not dealt with. These children may be withdrawn, may not listen or cooperate with other children when playing, and may end up getting into trouble with schoolteachers and parents because of their uncooperative and unsociable Behavior.
Some children have a pessimistic thinking style that can lead to depression; they always see the glass as half empty and expect the worst to happen. They feel personally responsible for disasters and helpless to influence what happens. They tend to use expressions such as ‘Nothing I do is going to help’, or ‘Everything I do is wrong’.
Ten-year-old Paul and his mother came to a child guidance clinic because the school was concerned about his disruptive Behavior. He was defiant and had sworn at his teacher when she told him he had to stay in at recess. He had then left the school without permission. Instead of returning home, he had gone to a vacant construction site, and police officers in a passing patrol car had spotted him running along the high scaffolding; he would have had a dangerous fall if he had lost his balance.
Paul’s mother said that, up until a few months ago, Paul had been a funny, warm little boy who loved to cuddle. But then her father, who had lung cancer, had moved into their home so she could nurse him. Paul’s grandfather had died three months ago. Paul’s father wouldn’t come to the clinic because he said Paul was just a ‘bad seed’. He was living at home but had met another woman and was unsure he wanted to continue with the marriage. He and Paul spent little time together. Paul was angry about his father’s neglect, and would talk openly about not having any use for him.
Paul was tested to see if he was having academic problems. He tested in the superior range of ability to learn and had no signs of a learning disability. When he talked to the counsellor, he said he missed his grandfather because the latter had paid attention to him and had told good jokes. Paul said he didn’t like the other children at his school because they were ‘sissies’. He fought with his sister and complained that she was treated better than him. He seldom smiled or made eye contact and was not very talkative. He seemed tense and angry most of the time. He was restless and unfocused, even when playing.
Paul’s dangerous Behavior escalated, despite the counselling sessions. One week he reported that his father had beaten him, and the child and family team of the local social services was called, but the parents denied that the father had touched him. Paul was placed in a specialized treatment unit for six months, during which time his father was required to attend sessions. Paul also attended social skills groups during this time. When he did well he was praised, and when he misbehaved he was punished consistently. After a while, Paul and his father started to do things together, and both parents attended sessions to learn to deal with Paul differently.
Paul’s problem was hard to identify at first because he had depression overshadowed by a conduct disorder. The treatment he received in counselling and in the child and family consultation centre was appropriate for both disorders. His Behavior improved but he and his parents would have to remain in treatment to be sure Paul didn’t get into more serious trouble as he entered his teenage years.