Dr. Barry Garfinkel, the former chief of child and adolescent psychiatry
at the University of Minnesota, has an interesting way of categorizing
the symptoms of the children he treats. He refers to them as "onion
symptoms" and "garlic symptoms." Onion symptoms are
behaviors that irritate other people. Garlic symptoms are things
that bother the child, giving him, in effect, a case of emotional
heartburn.
Parents routinely spot the onion symptoms in their children—things
like aggression or temper tantrums. They have much more difficulty
seeing the garlic symptoms, such as anxiety, withdrawal, and depression.
The most commonly overlooked problem—and the most commonly
missed diagnosis by professionals as well—is depression. It
is especially tragic in those relatively few instances in which
it leads to suicide, for it represents the antithesis of all that
we wish childhood to be. Depression is anger and frustration that
the child turns against himself. While a certain amount of depression
is a normal part of growing up, the limited skills that children
have for coping with stress can make their depressions acutely painful
and confusing.
Unlike depressed adults, who from the first are likely to tell
someone they feel sad, depressed children may mask the obvious symptoms
of their problem with behavior that, to many parents and teachers,
appears to contradict the diagnosis. Many teenagers who get into
trouble at school or with the law are actually depressed. So are
some children who appear hostile and aggressive. (I often describe
depressed teenagers as "prickly.") While adults notice
the behavior problems, they miss the inner turmoil.
Two of the most common signs of depression in an adolescent are
a general slowing down of his physical activity and a growing isolation
from friends. A depressed teenager may watch two or three hours
of television after coming home from school, and then go up to his
room and play computer games alone or listen to music for a few
hours.
Like depressed adults, teenagers may show marked changes in their
sleep patterns: difficulty falling asleep, waking up early, or sleeping
many more hours than usual. They may talk about feeling worthless
and hopeless. Girls, more than boys, are likely to overeat.
There may be less obvious signs of a problem with depression,
including behavior that, at first blush, appears to be mature and
constructive. For example, some teenagers whose grades at school
are dropping and who feel alienated will throw themselves into their
schoolwork. Such atypical dedication may be a sign that the child
is feeling hopeless about his situation.
The most serious consequence of depression is suicide. Although
only a small percentage of depressed adolescents commit suicide,
a very large proportion of teenagers who kill themselves are depressed
at the time. Teenagers are especially at risk for suicide if they're
both depressed and abusing alcohol. Any child who fits that pattern
should be referred for professional help immediately.
Everyone gets the blues at times. But clinical depression is very
different from simply feeling emotionally low. It's a disease that
requires treatment.
Few parents would hesitate to have their child evaluated and treated
by a specialist if they suspected that she suffered from, say diabetes.
Yet many parents and teachers are confused about and reluctant to
seek help for a child who's seriously depressed. They worry about
the social stigma of labeling a teenager as having an emotional
problem. They believe that, with time, the child will "snap
out of it."
Here are some rules of thumb for deciding whether you should have
your child evaluated by a child psychologist or psychiatrist:
-
Is the depression interfering with her performance
at school? If a teacher calls to express concern about a significant
change in your child's schoolwork or socializing, or if you
notice such changes yourself, you should consider having your
child evaluated.
-
If your child appears depressed for the first time
and the condition lasts more than two weeks, he may need treatment.
If the symptoms are mild and go away by themselves in a week
or so, you probably shouldn't be concerned.
-
If the problem has occurred before, or if there is
a history of depression in either side of your family, you should
pay closer attention to it, even if it doesn't last very long.
|
