Child depression causes, diagnosis and treatment

During a long period of time the scientific community, for strict theoretical reasons, argued that child depression did not exist (coinciding with the little importance given to the mental health of children),. However, in the real world there were depressed children and some clinicians began to reveal themselves against orthodoxy that vetoed the possibility of their existence. This began to occur around the 40s in different fields of applied psychology, and studies related to Child depression, under the names of Akerson (1942); Spitz (1945); Bowlby (1951), among others.

1. Definition of child depression
2. Emotional criteria and symptoms
3. Why child depression occurs
4. Epidemiology of child depression
5. Influence of family and school in childhood depression
6. Child depression evaluation instruments
7. Child Depression Treatment

Definition of child depression

In the early sixties Harlow (1961) observes, in the separated monkeys of their mothers, exactly the same type of behaviors that Spitz and Bowlby had indicated in children in the children. The experimental nature of comparative psychology produced a special impact for this type of findings and began to take a little more serious the possibility of the existence of depression in children, since the monkeys seemed to be able to develop them.

But really The acceptance of the existence of child depression It was possible thanks to the rise of the cognitive paradigm of the sixties, which allowed the study of internalized processes. Already in 1975 children's depression (DI) was accepted by the National Institute of Mental Health, as a psychopathological concept and entity.

The childhood depression can be defined as a Affective situation of greater sadness In intensity and duration that occurs in a child. There is talk of greater depression, when the symptoms are greater than 2 weeks, and of distymic disorder, when these symptoms pass from one month.

The supporters of a specific child depression are located in two trends, namely: the evolutionists, who believe that child depression is transforming according to the evolutionary era of the child's life in which they are presented, therefore argue the existence of a di Evolutionary, and those who sustain the existence of child depression with their own symptomatology, not comparable to that of the adult, especially related to behavioral problems, hence the name of Di masked, since many professionals are wrong their diagnosis.

Emotional criteria and symptoms

Experts on the issue of child depression, through numerous investigations have come to accept the following Characteristic symptoms and criteria of child depression (from the 1997 neighborhood): sadness, irritability, anhedonia (loss of pleasure), easy crying, lack of sense of humor, feeling of not being loved, low self -esteem, social isolation, sleep changes, appetite changes and weight, hyperactivity, dysphoria and suicidal ideation.

This operational definition can be used as a diagnostic guide and has the advantage of representing a core of coincidence of a broad spectrum of the scientific community.

Why child depression occurs

There are several theoretical frameworks that try to explain the origin of child depression, so we have:

• Behavioral: Through the absence of reinforcements (Lazarus), deficiency of social skills and negative events that occurred in the child's life.
• Cognitive: The existence of negative judgments (Beck), experiences of failures, depressive models (bandura), learned helplessness (seligman), absence of control, negative powers.
• Psychodynamic: in relation to the loss of self-esteem (of the self-according to Freud), and the loss of the good object (Spiz).
• Biological: due to a neuroendocrine system dysfunction (cortisol levels increase and reduce growth hormone), a decrease in serotonin activity (cerebral neurotransmitter), and by effect of inheritance (case of depressive parents).

At present, a complex interaction of different factors of both biological and social factors that serve as the basis for the appearance of the different normal and pathological behaviors is admitted. It is necessary that there will be a certain personal, family and environmental vulnerability that combined gives rise to the appearance of unjustified behavior.

In the case of the DI, the elements that suppose a vulnerability are of a biological, personal, social and demographic nature. (Del Barrio, 1997).

Epidemiology of child depression

The percentages of DI detected among the child population is about 8-10%, According to numerous investigations.

Several studies indicate that female sex has systematically associated with the increase in the probability of developing depression, effectively symptomatology is higher in girls than in boys, especially in the ranges that exceed 12 years, before this age it is rare to find differences between the two sexes (from the neighborhood, 1997).

As for the social class, some authors point out that they are more frequently in the lower and middle class children that in the upper class.

Influence of family and school in childhood depression

The family is the most immediate environment of the child, His microcosm and in his care and attention is based on the possibility of survival of the human subject, but not only his physical survival, but personal since the child from 0 months to 3 years, develops all the basic elements with which he later You will build your future life: language, affections, habits, motivations.

The attachment with which the mother and the son imprint mutually is the vehicle of an adequate social and personal integration of the child. Usecure attachments have been linked to all kinds of behavior problems and also to depression, as well as a safe attachment is the ideal goal of prevention of childhood depression appearance. In addition maternal depression It appears clearly defined as one of the risk factor's associated with the trigger for depression in the child.

Later, good relationships with parents are also indispensable for the normal emotional development of the child. Again and again numerous experts have pointed out how bad relationships with parents are the specific source of very different children's problems, and it is also clear about depression.

In relation to the family it has also been studied The position that deals with the brothers. In many investigations the intermediate position appears as the most vulnerable to develop emotional disorders.

Parents should pay special attention to the construction of adequate Self -esteem and self -efficacy In the child, as well as encourage them the ability to face, and the proper management of frustration, all this constitutes the primary prevention of the DI.

As for school, we know that the early location of any learning deficiency in a child and its prompt solution is essential to achieve a normal and acceptable progress situation, thus eliminating the possibility of affective disorders that lead to the appearance of childhood depression.

Many authors have related DI to school performance, sometimes considering it as a cause and sometimes as a effect of depression. In fact, a depressed child can descend his execution at school, but he can also begin his depressive symptoms for an academic failure. From there lies the importance of a good evaluation and monitoring by the teacher to detect these changes in the student.

Child depression evaluation instruments

DI evaluation instruments They vary depending on the theoretical framework from which they derive and what they intend to measure. Thus, when you want to measure internalized behaviors, pencil and paper tests that can be: standardized interviews, inventories, scales, questionnaires, pictorial tests, and others are mainly used. When what is intended is to measure the manifest behavior is made observation of behaviors, registration of behaviors, and application of children's game.

The evaluation of the biological aspects of child depression is carried out with analysis and objective tests of the physical elements that have been related to it. Thus we have endocrine tests, such as the determination of cortisol levels and growth hormone. Tests such as the EEG electroencephalogram (especially during sleep) and the EMG electromyogram (related to the facial muscles involved in expressiveness).

When specialized literature is reviewed, it is defined with all evidence that the instruments of greater use in the evaluation of the DI are fundamentally two: the Child Depression Inventory CDI (Kovacs and Beck, 1977) and the Child Depression Scale CDS (Tisher and Lang , 1974). At present, the most used questionnaire is the modified M. 1992 Kovacs CDI.

By resorting to these evaluation instruments Some factors such as: The level of development of the child, its degree of intellectual maturity, its emotional lability and the internalized nature of depressed behavior, for all this it is convenient to pass the questionnaire twice.

The parents' interview arises as an important data collection instrument, both of the depressed child and the family. As well as the interview with classmates and classmates.

Child Depression Treatment

The treatment of child depression above all It must be individualized, adapted to each particular case and the phase of the development that the child is, based on: its cognitive functioning, its social maturation and its ability to maintain attention.

It must also Involve parents actively, and perform interventions towards the child's environment (family, social and school). The treatment is divided into acute phase treatment and maintenance phase. Acute phase treatment includes: psychological, pharmacological and combined.

Psychological therapies

• Cognitive-behavioral: it is based on the premise that the depressed patient has a distorted vision of himself, the world and the future. Such distortions contribute to their depression and can be identified and treated with this technique.
• Behavioral: It is based on the application of behavioral modification techniques, proper management of situations, etc.
• Psychodynamics.
• Interpersonal
• Familiar.
• Group and support.

Pharmacological treatment

It is based on the use of drugs such as:

• Tricyclic antidepressants, for which a basal EEG is required, and blood pressure measurements, heart rate and weight.
• Selective inhibitors of serotonin ISRS reuptip.
• Combined treatment, which includes drugs and psychological therapies, has proven to be the most appropriate today.

Likewise, maintenance phase treatment will depend on the patient's clinical status, Its intellectual functioning, your support system, the presence or not of environmental stressors and their response to treatment.

By way of conclusion, at present the existence of child depression is a commonly accepted fact by the specialized scientific community, so its study and treatment has gained great importance. Some have come to call depression as 21st century disease.

This article is merely informative, in psychology-online we have no power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

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