Recognizing Childhood Depression and Anxiety
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
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."