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    Depression: Children Not Immune

    Parents often mistake depression in children for moodiness.

    The Key: Diagnosis continued...

    Most parents first take their child to a pediatrician. Unfortunately, many pediatricians lack the specific training needed to correctly tell when a child is depressed or anxious.

    "I think there is a public health problem," Koplewicz says. "You have 16,000 child psychiatrists and 8,000 child psychologists, and 8 million children and teens who need help. We have to decide whether to train pediatricians and nurses and counselors in the diagnosis of this disorder so we can get this properly diagnosed."

    Koplewicz believes that the heart of the problem is that insurance companies are less willing to pay for mental health care than for physical health care.

    "As a nation we don't treat psychiatric illness as we do physical illness," he says. "There are not enough experts. We have to demand from insurance companies to get parity, and pediatricians must get sufficient time to see kids to make this decision. It is a matter of whether we get training so the diagnosis can be made. Learning all your diagnostic skills from the pharmaceutical representative is a problem."

    Children younger than 5 years old can get depressed. But their depression most often reflects the mental state of their primary caregiver -- usually their mother, Benoit says.

    "Very often, in that preschool group, the child's affective state is highly connected to the mother's state," she says. "I could give you many cases of that, where the mother is the primary agent of what is happening with the child. If anyone does not take a look and do an evaluation of the primary caregiver, I think they would be missing a tremendous amount."

    Treating Childhood Depression

    What happens when a child is treated for depression?

    "What a parent should expect is a discussion about the depression, a discussion about the various intervention methods one would consider from the least to the most aggressive, and a discussion about suicide or self-harm and what parents should be alert to," Benoit says.

    Treatment requires the involvement of the parents.

    "Parent must be given a lot of information about what the options are, and a sense that it is they, the parents, who choose how they would like treatment to start," Benoit says. "I tell people about medication, I talk about providing psychotherapeutic support, and what I might want to do first. I never do anything at that first session, unless the child is suicidal. I say, "I want you to think about it, then come back. As long as a child is not suicidal, we have some time to think and talk to the pediatrician."

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