Treatment

Youth: DEPRESSION I SELF HARM

Why Kids’ Depression

Goes Unnoticed o
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Parents miss signs of depression in their child far more than they realize. Even the most f G"}

well-meaning can shut down communication in ways that subvert their good intentions. :
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By Alison Escalante, M.D. S3

4 6 1Psychology Today I M arch/April 2020


N AN IDEAL world, parents
I would recognize the first
subtle signs of depression in
a child and take immediate
therapy, secure the help the child
needs. In reality, most children who
action—talk to a pediatrician, pursue
struggle with depression do so unno­
ticed by those closest to them.
Parents are not mind readers,
and many children—for a variety of
reasons—work to minimize or conceal
entirely their despair. But with depres­
sion and suicide on the rise in children,
the recognition of the disorder has be­
come a matter of urgency. According
to a recent survey, one in four children
in middle school or older knows a peer
with depression; one in 10 knows one
who has died by suicide.
In my clinical experience, while
a small subset of parents bring their
child in for help shortly after depres­
sion sets in, the vast majority wait far
longer. Typically, by the time a child
comes to see a pediatrician, like me, or
a mental health professional for help,
they’ve been experiencing significant
symptoms of anxiety and depression
for two or even three years.
In a recent poll, 90 percent of par­
ents rated themselves at least “some­
what confident” that they would see
the signs of depression in their child.
But “somewhat” may be the operative
word. In the same poll, conducted by
C.S. Mott Children’s Hospital in Ann
Arbor, Michigan, two-thirds of parents
revealed barriers that could keep them
from recognizing their child’s poor
mood. Forty percent said it is difficult
to distinguish depression from normal
childhood ups and downs, while 30
percent acknowledged that children
may excel at hiding their true feelings
from prying adults.
Treatment I DEPRESSION
Good parents want to do right by
their children. When a child is strug­
gling with a mental illness like depres­
sion, it’s up to parents to break down
communication barriers, make kids
feel safe in speaking up, and do what’s
needed to facilitate recovery.
A SILENT SADNESS
Parent-child communication can
be complicated under the best circum-
Often kids
really don’t
soundthe
alarm that
they’ve been
feeling down.
stances; depression makes it more so.
Often kids really don’t sound the alarm
that they’ve been feeling down. Many
kids and teens in my practice confide
how bad things are for them emotion­
ally, but they also reveal that they’ve
never told their parents. Or they tried
once and didn’t bother to try again.
Why not? Most often, it’s for one
of the following reasons:
• Parents don’t listen. Maybe the
parents are busy when the child tries
to confide, or they are online and don’t
pick up a cue to put down what they
are doing and tune in. Even though
parents tend to spend more time with
their kids than ever before, evidence
suggests that they are also more often
distracted.
• Parents try to fix them . When most
people have a problem, they want a
loved one to listen—not fix.
But most parents have been
solving their children’s prob­
lems and healing their boo-
boos since they were little.
With this dynamic firmly in
place, it’s perfectly routine
for parents to tell a child
how to feel or suggest “quick
fixes” that don’t address the
true roots of the problem.
• Parents tell children th at
their feelings are temporary.
Children can seem to change
from day to day and week to
week. Even when confronted
with persistent evidence of
a child’s low mood, many
parents continue to be con­
vinced that he is simply going
through a phase that won’t
last. “Don’t worry,” a well-
H meaning mom might say. “It
will pass.”
• Parents don’t check in
again. Kids can look fine from the
outside, so parents move on—often
fearing that following up will itself
trigger the depression they so desper­
ately want gone—the way a three-
year-old says yes every time she’s
asked if something hurts.
Parents may think that their child
is impressionable and will imagine
that he is anxious or depressed if the
March/April 2 0 2 0 I Psychology Today I 47
Treatment I D E P R i ; s s i () \

idea is planted in his mind. Sometimes, wait until children are teenagers; it’s help, and that you hope your children
parents have even gone so far as to developmentally appropriate to have will confide in you if they are ever feel­
suggest that I created the anxiety in conversations about “big feelings” like ing low.
the 10 minutes I spoke alone with their sadness, joy, and fury when they’re Use your doctors and introduce
child—rather than believing what in elementary school. Share daily the idea that visiting the doctor is for
their child is telling me about years of experiences that make you frustrated, more than just fevers and coughs.
suffering. excited, or tearful and explain that Pediatricians can help with big feel­
• Children o ften p ro tect th e ir par­ expressing emotions is an important ings, too. Explain that there are even
en ts.They may not want to burden part of being human. “talking doctors,” as I like to call
their parents with their down moods Make it a point, too, to demystify them, who “do” big feelings all day.
because they know their parents feel Finally, go beyond doc­
responsible for those moods and would tors to identify other trusted
be upset to hear about them. And adults that children can turn
sometimes they understand that reveal­ to if they’re struggling. Par­
ing the truth about their current mental ents can encourage their kids
state would have a “piling on” effect. I to talk with a trusted friend,
see this most often in families where an It’s okav w
relative, or teacher.
older sibling takes on a caretaking role Parents, too, can contact
for younger ones. Plus, with the rising
rates of children with special needs, it
to start talking school personnel and ask
them to reach out if anything
has become increasingly frequent for seems amiss. One key finding
kids to tell me that they deliberately put about “big of the M ott poll was that
their needs second because a sibling has “seven in 10 parents think
so many more.
feelings”when schools should screen all
students for depression; sixth
CULTIVATING CONVERSATION grade is the most preferred
Depression has many different kids are in age to begin depression
signs in different kids and isn’t always screening.”
easy to spot. Some kids appear sad.
They may withdraw from friends and
elementary One of the hallmarks of
depression is that it cuts in­
spend time alone. Others act out and dividuals off from meaning­
are irritable or angry rather than sad. school. ful connection with others.
It’s easy to see a kid as having “behav­ Above all, it’s important for
ioral problems” or “slacking off in parents to take notice when
school” when, in fact, they are strug­ they feel that the bond with
gling to survive depression. their child is receding for
The best way to know whether more than a week or two.
your child is depressed? By asking, and depression itself. If you yourself have I tell parents every day, whether
by setting up a relationship in which faced depression, or know someone about fevers or feelings, “I am here
a child feels comfortable confiding in who has, tell your child about your for when you are not sure.” Come see
parents if she’s ever struggling emo­ experiences. If you’ve gone through it your pediatrician. Why wait? Opening
tionally—with depression, anxiety, or personally, tell your kids about how up and clearing the air can only help.
anything else. the experience makes you able to
To build such an open, honest re­ understand. If you’ve watched a friend practices
Alison E scalan te, M .D .,
lationship, start by making it clear that or a relative suffer, share your feelings pediatrics in Naperville, Illinois, and is
it’s okay—indeed, welcome—to talk simply and explain that you wanted to a fellow o f the American Academy o f
about feelings big and small. Don’t help. Tell them that there are ways to Pediatrics.

4 8 1Psychology Today I M arch/April 2020

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