May 17, 2022
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen.
Depression can affect anyone, even children. Does your child seem unusually sad or withdrawn or unable to let things go? Sometimes it’s just a temporary situation and sometimes it’s not, but how do you know when you should seek additional help for your child, and what are the signs you might be seeing? Listen to today’s episode as we talk with CHC clinical experts, Dr. Patrice Crisostomo, clinical program manager and psychologist, and Annemarie Kelleghan, doctoral psychology intern as they share their insights and expertise with us on this important topic. Welcome Patty and Annemarie.
Dr. Patrice Crisostomo:
Thanks so much for having us Cindy. I’m Dr. Patty I’m a licensed clinical psychologist and a program manager in the division of clinical services at the Children’s Health Council. I’m so appreciative for your interest in this really important topic, and thanks for having me.
Annemarie Kelleghan, MA, MPH:
And I’m Annmarie Kelleghan, I’m a clinical psychology intern here at Children’s Health Council and at Stanford children’s, and I’ve been working with kids, teens and families to address mental health concerns for the past six years, and I’m so happy to be here.
Cindy Lopez:
Thank you both for being here today to share your time with us on this really important topic about children and depression and Patty, as we get started, can you talk a little bit about what depression is?
Dr. Patrice Crisostomo:
So depression is a serious medical condition. Um, it’s a mood disorder that can cause someone to feel sad or irritable or hopeless for no known reason or for a very long period of time and depression can affect people at any age, including children. I think many of us think of depression as more of an adolescent or adult problem, but absolutely depression can affect kids too.
Cindy Lopez:
So how common is childhood depression? Are lots of kids impacted by it?
Dr. Patrice Crisostomo:
Yeah, depression is one of the more common mental health disorders in kids and teens. Depression affects about 3% of children between the ages of 3 and 17 years old here in the United States and that equates to close to 2 million people.
Cindy Lopez:
We tend to think about depression I think as a challenge with adults or even with teens, but we don’t think about it I don’t think as a society very much in terms of children and depression. Annemarie would you comment on the causes of depression? Why do kids get depressed?
Annemarie Kelleghan, MA, MPH:
Yeah, I think this is a great question and something that has a lot of different answers, and when we think about depression in kids I like to think about the bio-psycho-social model, which is a really big word. And basically it means that there are biological, psychological, and social causes of depression. And having a combination of these can lead a kid to have depression. And so these would be things like biologically having genetic predisposition for depression. Psychologically and socially there can be a lot of factors such as stressors in everyday life. Kids have changes with schooling, peer problems, bullying, any changes in the family structure like a divorce, a separation, a new baby. These kinds of stressors can contribute to the development of a depressive disorder in children, as well as in adults, but today we’re really focused on our younger kids.
Cindy Lopez:
As you were just talking Annemarie, I was just thinking some of the stressors you mentioned like there could be changes in the family. If a child ends up impacted by those, is that depression that would last over time?
Annemarie Kelleghan, MA, MPH:
I think this is a great point to bring up because one of the messages that I really want families and other caregivers and supportive adults to hear is that depression is treatable, and sometimes these stressors can precipitate a depressive episode or can result in some of these depressive symptoms, and yet over time, we know that depression can be treated.
Cindy Lopez:
Mhmm…thank you. So, thinking about depression and at CHC we often see depression occurring with other kinds of things. Does it often occur with other diagnoses?
Annemarie Kelleghan, MA, MPH:
Yes. So depression often times can co-occur with other mental health conditions. So some research that came out in 2016 found that for children 3 to 17, so kind of a wider range of kids, about 3 and 4 kids who have depression also have anxiety, and then about 1 in 2 who have depression also have behavioral problems. And sometimes we see co-occurrence of mental health conditions more frequently as kids get older. However, it’s really important I think for us to be aware of this because there’s a lot of different ways that depression and other mental health conditions can manifest for a child.
Cindy Lopez:
So, my background is working in education, and working with kids with learning differences, we often saw depression along with those learning differences, like dyslexia, ADHD. It’s interesting because anxiety is different than depression, maybe you could just say a couple of words about that.
Dr. Patrice Crisostomo:
In children depression and anxiety really often do go hand in hand. Anxiety though is different from depression. Anxiety is a very common mental health condition as well, but it’s a condition that can cause feelings of fear or panic or worry about situations or experiences that are more common or every day, and sometimes depression or anxiety in children, because they’re considered internalizing disorders can get chalked up to being like growing pains or maybe explained by other things by adults who are interacting with a child.
Cindy Lopez:
So if you’re seeing depressive signs in your child, anxiety in your child, it could be occurring because of lots of things, but it could be learning differences, like, you know, they’re slow readers or their processing is slow. So they compare themselves to others, come up short, and they end up feeling anxious and depressed. So, I’m wondering what are the signs of depression, and how does it get diagnosed?
Dr. Patrice Crisostomo:
So, in terms of the signs of depression kids can feel sad or hopeless or show irritability or be short-tempered for weeks or even months at a time. It can also look like a child losing interest in activities that they used to find really enjoyable, like playing with friends or going to school. Sleeping and eating habits often change as well. So, you might notice a child eating or sleeping either more or less than usual, and as a result there may be more weight gain or weight loss. In addition, difficulty with paying attention or concentration, even in things that they like to do might be observed by the adults around someone who is experiencing depression. I would also add that sometimes youth who are experiencing depression may think or talk a lot about death. So this might show in conversation or even their drawings or their play activities, or some depressed youth have more specific thoughts about hurting or killing themselves.
Cindy Lopez:
Hmm. Yeah, when you say that, I’m sure that any of our listeners are thinking, oh my gosh, you know, this is serious, like what should I do? So what should they do if they’re seeing these signs? When do they seek help? And even educators, they might be seeing things in the classroom, like when do they speak up about it?
Annemarie Kelleghan, MA, MPH:
Dr. Patty just mentioned about thoughts of death or suicide, and I think that’s a situation when it’s really important to seek help, and so it’s less common in younger children. However, it’s really crucial to get help in those kinds of situations. I also tell parents that if parents are having an intuition or a gut feeling that something’s wrong, they should really follow that because parents know their kids best, and that’s a really good time to follow up. Also if we see changes in behavior as Dr. Patty mentioned are lasting for a few weeks to a month. If they can’t do as well in school or are having trouble with social relationships and things like that, those are times when we really want to get additional help. And I think sometimes parents will say, “well, I’m not sure” to Patty’s point earlier, right, like, is this just a phase? Are they, you know, just going through this growing pain, and if it’s something that’s lasting more than a few weeks, I think it’s important to get kind of some sort of support and sometimes that’s going to the teachers. Our teachers spend so much time with our kids. As you know Cindy, working with teachers and learning disorder populations, that teachers have a lot of insight about what’s going on for a child and teachers see lots of different kids. So they have a sense of what is typical and what might be more problematic. And so as a first step, if you’re unsure as a parent, it can be really helpful to just check in with the teacher and see if they’re also noticing a change in behavior, less engagement at school, not having as much fun during lunch and recess and things like that, and those can be times when it’s important to get medical attention and help if you’re noticing those concerns.
Cindy Lopez:
If you are wondering about suicide, we do have some other podcasts episodes where we talk about self-harm and teen suicide as well. So please reference those too if you’re interested in those topics.
Mike:
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Cindy Lopez:
So if I’m one of our listeners, and they’re thinking, “okay, I am concerned, what do I do now?”
Dr. Patrice Crisostomo:
So I think the first thing to do would be to reach out to your pediatrician because it would be really important to rule out any underlying medical conditions that may be impacting a youths physical health. So things like anemia or a concussion or diabetes or a seizure disorder, even like a vitamin D deficiency might explain some of the observations that a caregiver is having. So if somebody is seeming like more fatigued or just not very motivated or having difficulties with appetite or eating there may be a physical reason for this, but after ruling out any potential underlying medical condition, if the pediatrician after they do a screener for depression, they would likely encourage a parent to then I scheduled an appointment with a psychologist or another mental health professional so that a more formal assessment can be done. And typically when a family goes to meet with a mental health professional, the therapist or the provider will first start off with a structured interview meeting with the caregiver and then the child. They may also use screening measures to just look at how a parent or a child’s ratings of their feelings and behavior compared to the general population, and I think it’s always really important for the mental health provider too to get a sense of what is happening psycho-socially for this child. So like what’s school like for them? Who’s in their family? What do they like to do for fun? What are their overall strengths and what are challenges, and have there been any significant changes in their environment that might begin to explain why somebody is experiencing a shift or a change in their functioning.
Cindy Lopez:
So it seems like you know as a parent or caregiver if you’re seeing your child who’s depressed and you followed up with the pediatrician now you’re going to follow up with the mental health professional, like that seems like it could be anxious time for parents too. Just a reminder to our listeners, don’t forget about yourself and your own wellbeing because you’re going to need all that to really support your child.
Cindy Lopez:
So what should families expect with treatment?
Dr. Patrice Crisostomo:
So the really reassuring good news is that there are gold standard, well-researched effective treatments for youth depression. Treatment can include psychotherapy or talk therapy, and that often involves meetings with caregivers and family members and with parents’ permission discussions with a child’s teacher or school or other important adults in your child’s life like coaches. The gold standard treatment for depression is called cognitive behavioral therapy, also known as CBT, and broadly this intervention really examines the connection between one’s thoughts and their feelings and behaviors and how they might be contributing to how someone is doing and feeling, and CBT really focuses on helping kids to learn how to think more positively, and control, behaviors that might be contributing to depression. And what I love about CBT is that it is a very active treatment approach. This form of therapy gives children tools to cope with depression in healthier ways. I should say though, that therapy does take time, at least a few months at best, but even then family members must plan to attend sessions regularly. Typically sessions are scheduled weekly for about an hour, and there’s assigned practice and homework every week in between sessions. So it does require a lot of effort from the parents and the child, not just the person who is experiencing depression. So parents should expect to be involved in treatment and, you know, we as providers need to hear from parents about what life is like at home and at school we know that kids aren’t always the best quote unquote “reporters,” if you will, about the sort of thing, and I think it’s also helpful for kids to see that if their parents are involved, that the whole family’s in this together. No one wants to feel like they are different or stigmatized in any way or like the identified patient, but that everyone’s working together to learn and generalize skills.
Cindy Lopez:
Thinking about depression, and Annmarie referenced this earlier, will it ever go away or is it really about managing it?
Annemarie Kelleghan, MA, MPH:
So yes, depression can go away, and with effective treatment and as Patty mentioned earlier having heavy involvement of family and getting services and support to really address the underlying problems and to support the whole family, depression can go away. For some people, depression tends to be a more recurring long-term challenge. And the great thing about CBT and other psychotherapy support for depression is that using tools and skills to manage depression allows people to live a full life, even if depression comes and goes at times as well.
Dr. Patrice Crisostomo:
To what Annemarie said for some youth depression can come and go over time. And so when we think about this from a developmental, like lifespan perspective, it’s really important for early interventions to be provided as soon as possible because if left undiagnosed and not properly treated then depression can develop into other things as well. So it could be depression plus other ways that a child or an individual attempts to cope in more ineffective ways. So for example, experimentation with substances or different eating behaviors and you know, certainly not to scare parents, but you know, to also just impart that the mental health challenges can shift and change. And so you know, the goal for many of my colleagues and myself is to reduce suffering, right? So at any point in time, when an individual is experiencing pretty significant challenges to how they’re doing and how they’re feeling, if we can address that when kids are younger, when there’s more malleability in their beliefs, in their behaviors, and there’s the possibility for involvement of caregivers, I think the prognosis for youth is much better.
Annemarie Kelleghan, MA, MPH:
Right, I think you made a really good point, which is that the earlier the diagnosis is made and the more aware people are of the challenges, the better the outcomes.
Cindy Lopez:
What’s the best way that parents or caregivers can support their children with depression and perhaps even talking about strategies that they can use to help their child manage their depression as well?
Annemarie Kelleghan, MA, MPH:
I think this is one of the huge strengths that parents can bring because parents or teachers, other caregivers are with the child for the majority of the child’s time. As mental health professionals, we have very limited opportunities to work one-on-one with the child, and as the caregivers in a child’s life you are in a wonderful position to really support the kids that you are working with. And there’s a lot of different things that you can do. One is to really be there with the child and to listen to them. If they’re going to talk about what’s been challenging for them sometimes with younger kids, it’s harder to open up and to have those conversations. So even just spending more time with your kids and making space for them is really important.
We also know that helping kids identify the feelings and emotions they’re experiencing is a really key component of social wellbeing. And also, as Patty said, it’s a key component of CBT as well. And so being able to help your child recognize when they’re angry or mad or upset and helping label that of like, “oh gosh, it looks like you’re really frustrated right now, I wonder if you’re feeling sad that your homework isn’t going so well,” or “I wonder if you’re just really mad right now.” And so helping label for a child the feelings that they’re experiencing builds awareness and recognition of what’s going on, and it also gives parents a chance to model for their child how to respond to certain emotional situations. So parents can say, you know, when I’m really angry it’s helpful for me to listen to upbeat music, or when I’m feeling sad sometimes running around the block or doing some exercise is really helpful for me. So parents can start building those conversations of modeling, healthy coping, and healthy responses to these big emotions that we all experience at different times.
Dr. Patrice Crisostomo:
Other ways that caregivers can support their children with depression is to maintain predictability in terms of schedules and routines and as part of that maintaining a lifestyle that incorporates a focus on the physical body as well as one’s emotional health. So getting daily exercise, making sure that there are healthy meals and options for snacks, making sure that people are engaging in sleep routines, having a regular bedtime routine and protected time where you can relax together as a family and being careful around use of technology.
I think the most important thing that parents can do for their kids is to be there with their kids. And I think it’s so hard because parents are often times multitasking for very practical reasons, right? It’s challenging to be a parent, and to be a parent of a child with mental health challenges, but I think being with your kid, being present, not trying to do too many things at once, but to actually show up and listen and, ask them directly, “hey, how have you been feeling, anything going on? Can I help you?” And being very genuine and earnest about it. We all know that like when we’re multitasking, we’re not as effective as we can be in any of the tasks that we’re trying to do. So I think kids can really feel it and adults can too, but when we’ve got someone’s undivided focused attention it can be really powerful.
Cindy Lopez:
You both referenced spending time with them, and as a young child what better way to spend time with them than to play with them, and I think then conversation comes out to things like, “wow, you seem really mad when you did that,” or if you’re coloring together, like asking questions about what they’re doing. And as Annemarie said, “they may not have the vocabulary,” so you can give them some words and see if they confirm. As we wrap up, I’m just wondering if you have any final thoughts that you’d like to share with our listeners?
Annemarie Kelleghan, MA, MPH:
Yeah, I think for all kids, but especially for those who are struggling with depression and other mental health conditions, having a loving and supportive adult in a child’s life is the most important powerful intervention. And by listening to this podcast, I’m sure you are the loving and supportive and caring adult for a child or children, and you are not in this alone. There are so many people who are here to support you and your family or student through these challenges and there are community mental health organizations like CHC, and there are many strategies and interventions that can treat depression. And, sometimes it feels like it’s just the absolute worst in the moment, and I just want families and kids to hear that it won’t always be as hard as it is right now.
Dr. Patrice Crisostomo:
I want to just also echo that kids can be incredibly resilient, and with the support of a loving family and a system of care around them, we really believe that kids and teens can thrive, and absolutely help is available if people are open and willing to seek it.
Cindy Lopez:
CHC is here for you. If you’re wondering if your child is experiencing depression and you have questions, we do have free parent consultations. You can also reach out to make an appointment. You can reach us at 650-688-3625 or contact our care team at careteam@chconline.org. We’d be happy to talk with you and give you some direction about next steps. So to Patty and Annmarie, thank you so much for joining us today and sharing your expertise, your insights, and also to our listeners thank you for joining us, and we hope that you’ll listen in again, next week.
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