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“Many of the children we see with depression also have developmental delays or conditions such as ADHD,” says Cindy Busby, LVN, a psychiatric clinical nurse at Texas Children’s Hospital. “We’ve seen a definite increase in the number of children diagnosed with depression, but it’s unclear if this is because we’ve become better at diagnosing other underlying behavioral or developmental problems.”
Busby acknowledges that diagnosing children with depression is far more challenging than diagnosing adults with the condition.
“You can’t just ask a child if they are feeling depressed,” Busby says. “A lot of times, children act withdrawn or exhibit behavior problems at school and these actions aren’t recognized as depression.”
And many young patients suffer from depression as a result of their parents divorcing or other family problems.
“When a child is brought to our facility, we begin the process by conducting a two-hour evaluation,” Busby says. “The first hour is spent with the child using a variety of play therapies, and the second is devoted to interviewing the parents.”
After the initial evaluation, staff members refer families to the Learning Support Center, another department within Texas Children’s Hospital, for family therapy and testing. “I think all pediatric psych departments prefer to treat children with a combination of therapy and medication,” Busby says. “We rarely start them on just antidepressants unless their depression is severe.”
Often, children’s depression is the result of having a sibling who is ill, or because they aren’t doing well or are being bullied at school. In these cases, short-term therapy or even working directly with the child’s school can produce significant results.
“We often find that children have an undiagnosed learning disability and are depressed because they are falling behind in school,” Busby says. “Once the problem is diagnosed, we can work with the school to see that they receive the appropriate resources.”
In cases of severe depression, the process can be longer and more intensive. “We try to educate our patients and their families that antidepressants aren’t a magical pill,” Busby says. “If a child is feeling suicidal, there are issues that need to be addressed in therapy, and pills alone aren’t a solution.”
Reacting to emergencies
In cases of severe depression, when children are threatening to harm themselves or others, the first intervention may well take place at an emergency psychiatric department.
In the past 15 years, Martin Garro, RN, a charge nurse in the emergency psychiatric unit at the Contra Costa Regional Medical Center in Martinez, Calif., has seen many children brought in by either their parents or the police.
“Unfortunately, we see more children each year,” Garro said. “And a lot of the cases can be attributed to inadequate parenting.”
Children brought into the emergency psychiatric unit stay for several hours until they are stabilized and released to their parent or guardian, or are transferred to an inpatient facility.
Garro has noted an increase in the number of children brought to the emergency psychiatric unit since Sept. 11 and incidents such as the Columbine High School shootings.
“School officials and the police have become hypersensitive,” Garro says. “When a student threatens to harm themselves or others, any threat is taken very seriously.”
As the father of two children, Garro empathizes with many of his unit’s young patients who continue to battle depression.
“So many of the children we see just want to be loved,” he says. “There’s no medication available that can replace the love of a parent.”
Linda Childers is a freelance writer.
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