Depression in Children and Youth

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How to spot it in your classroom—
and what you can do to help

by Dr. David Palframan

Until recently, depression seemed to be either a normal reaction to sad or tragic personal misfortune or a state of mind that made some people miserable for no apparent reason. Were these people weak-willed or deliberately seeking attention? The reputation of depression was pretty bad and definitely associated with guilt and loss. No one thought that children could develop depression, except as a reaction to bad news.

The feelings of children and teenagers appear to be a clear reflection of their environments. Child + ice-cream = grin. Fourteen-year-old girl + telephone + chatty friend = popularity and happiness. This view of children’s emotions is wishful thinking. From fussy babies to gloomy adolescents, it is clear that individual reaction to life’s circumstances is extremely varied. As with adults, some children worry more, feel loss more keenly, and move unthinkingly from anxiety to anger.

Our present knowledge of depression has made it clear that the brain is distinctly changed during depression. The chemicals that speed the transmission of impulses from one nerve cell to another are not functioning properly. Various sorts of “brainmapping” techniques reveal that serotonin and noradrenaline, two of the dozens of chemical neurotransmitters, or messengers, are deficient in the brains of depressed people. This evidence has caused depression to be reclassified both medically and in popular usage from a weak and unhappy personality to a disorder of the brain.

Is depression a disease, a disorder, or a condition of normal life? It’s a matter of how intense and prolonged the low mood is. It also depends on whether the low mood is accompanied by serious anxiety, intense anger, sleeplessness, or sleep that leaves you still tired. Think of depression as a condition into which people slide, where self-confidence is reduced and life seems much less pleasurable. Without pleasure, all that is left in life is the annoying worrisome and sad bits. Think of the tide going out: ripples of water recede, leaving damp rocks, slime and junk.

Recognizing a child’s depression at school can be the first step in alerting parents and beginning treatment. Symptoms in the classroom will vary, depending on the age of the child and his or her particular personality. Younger children tend to be more emotionally transparent. A child who weeps over minor troubles, or whose face is twisted in rage and frustration repeatedly, may have an underlying problem with low mood, irritability and poor frustration tolerance. The special challenges of school, with the relentless comparisons children make amongst themselves, will sometimes reveal emotional troubles that remain controlled or hidden at home.

Kindergarten and early elementary school teachers can usually note which children are painfully shy, unusually aggressive, or extremely sensitive to criticism. For instance, children who constantly erase their work or tear it up and start over should the slightest imperfection appear, may be struggling with high anxiety. Such children might never be able to feel satisfaction at their efforts. If parents know that an A instead of an A+ meant failure and misery for their children, they might visit the family doctor to seek an evaluation about depression. Similarly, children with a short temper, aggression at recess, and no friends might well be trying to cope with a low mood that is increasing their irritability, and reducing their ability to learn social rules.

In the middle years of school, grades three to seven, teachers can report sudden drops in academic performance or changes in behaviour. A formerly cheerful child who becomes sullen, uncooperative and sad-faced may be sliding quietly into misery, avoiding attention, and feeling that no one notices or cares. Sometimes these periods are explained by self-limited family problems such as heart attacks or parental separation. At its worst, severe anxiety can produce school avoidance with multiple health anxieties and frequent absenteeism.

Elementary school teachers need to be both tactful and supportive in bringing such observations to the attention of parents, presenting observations as a shared concern: “I can’t quite figure out why he’s sliding, but it has me worried. Do you have any ideas?” An alliance with parents is greatly preferred over a critical confrontation in which they feel they must protect their child. When parents seem blind to the concerns expressed by a teacher, the matter may need to be discussed with colleagues who could put the child in touch with other professional services available in the educational system. Guidance teachers, psychologists, and social workers may be available to help alert parents to their child’s problems.

Added to the burden of being depressed, children may feel that their schoolwork is sliding towards failure. Depression makes it difficult to concentrate, and the condition reduces any sense of achievement associated with a good effort at school. A child can be helped with these worries by setting a new perspective—regaining health comes first, and then it will be time to focus on school. While the child is being treated for depression, if parents are available to be with the child, doing some schoolwork at home might be a good way for them to monitor the child’s mood. Parents and teachers, having discussed the options with the child, could set up a reduced timetable. It is a delight to someone recovering from depression to realize that they can concentrate enough to read and do mathematics. The goal is not to race and catch up, but to test how well the brain is doing. Schools may not know all the details of the child’s problem, but a clear letter from a doctor stating that the illness prevents full attendance but allows for some work to proceed can both protect the child’s confidentiality and keep the door open for academic recovery.

During and after puberty, management of emotional disorders requires an additional appreciation for the growing independence of a young student. At 18, a suicidal student has considerable autonomy and can manage personal decisions about getting help. However, autonomy and confidentiality must not stand in the way of identifying a problem and its possible solutions, especially if the person’s judgment is reduced by both immaturity and a psychiatric problem. Tact and compromise may be needed to help bridge the gap between “Don’t you dare tell my parents!” and “Thank you so much for telling us.” With patience, most students can be convinced of the benefit of involving parents and doctors. Students can sometimes be reassured that parents won’t be told just yet, providing the student accepts some counselling. Once matters are moving ahead, it is easier for a student to save face with parents by saying that they have acted responsibly by seeking help and they are now in need of including their parents for practical reasons such as paying for a prescription or counselling.

When an adolescent continually shares painful information with a trusted teacher about suicidal feelings, problems with addiction, or any situation that is dangerous, there often arises a particularly intense dependency on the teacher. At this point, the situation will need to be shared with a health care professional. The student is in clear need of treatment. Nothing can be more painful to a teacher than a suicidal student who has extracted a promise that their secret be kept. Any use of emotional blackmail—“If you tell anyone, it will be a betrayal and I might do something awful”—should confirm that a painful combination of depression, anger, and dependency now qualifies such a student for emergency assistance.

Adapted from Young Misery: A child and family psychiatrist discusses child and youth depression—how to identify it, and how to cope (Creative Bound International, 2007) by David Palframan, M.D. F.R.C.P. A child and family psychiatrist for more than 30 years, Dr. Palframan is extensively involved in community psychiatry for the Children’s Hospital of Eastern Ontario. He collaborates widely with school boards, parent groups and child welfare organizations. For more information, please contact Creative Bound International. 1-800-287-8610 or by email at resources@creativebound.com