- The Washington Times - Sunday, July 8, 2001

Judy remembers exactly when her son's life turned bad actually, "horrible" is the word she uses. It was several years ago, and her boy, then a fifth-grader at a Montgomery County public school, "just went off totally out of control," she says.

"His whole temperament changed. He would have major mood swings: Some days he would be way, way, way happy, and the next I would be called in to school because he had blasted his teacher," says Judy, which is a pseudonym. The single mother of five children asked to remain anonymous to protect her son.

"I knew he had really low self-esteem," Judy adds. It didn't help that three of her son's four siblings had been designated "gifted and talented" at school.

"It got to the point where his sisters were scared of him; he stole from me and from stores, punched a hole in the wall and set off a play rocket in the house while I was asleep, which set a fire," she says.

Judy says she finally became convinced that her son suffered from depression. Doctors confirmed her suspicion.

Her son is far from alone. In fact, according to the American Academy of Child and Adolescent Psychiatry (AACAP), about 5 percent of children and adolescents suffer from depression.

"That's approximately one child in every classroom," says Dr. David G. Fassler, a child and adolescent psychiatrist practicing in Burlington, Vt.

"When I was in med school, we were taught that kids didn't get depression. It has really only been in recent years that clinicians have started to learn about it."

What they have learned, say Dr. Fassler and other specialists in the disease, is that depression is a formidable challenge that can impact nearly all aspects of a child's life. Depression chisels at family relationships, sours the depressed child's ability to make and keep friends and dilutes positive school experiences.

Even so, according to the AACAP, only one in five children who suffer from serious emotional problems receives appropriate treatment.

"Children need to be treated," says Dr. Fassler, who also serves as chairman of the Council on Children, Adolescents and Their Families of the American Psychiatric Association and is author of "'Help Me, I'm Sad': Recognizing, Treating and Preventing Childhood and Adolescent Depression."

"The effects of not treating the condition are pretty significant … you never catch back up," he explains. "You sort of check out, socially and emotionally and academically. The problems build on themselves" and can lead to serious emotional consequences later in life and sometimes even suicide.

In fact, Judy says that during her son's ordeal, she began to fear that the 10-year-old child might be intent on taking his life. The discovery of a tent spike in his bed fueled her fears.

"He was begging for help," she says. "I hope other parents take the cue. He said, 'Mommy, about how to go about getting help. But he'll be all right now."

Identifying the problem

Specialists in depression say a behavioral deviation is the biggest clue that a child may be suffering from a depressive episode.

"You're definitely looking for a change," says Dr. Nora Galil, a child and adolescent psychiatrist at Children's National Medical Center in the District. "We are not just talking about being upset a little while over something but when a child is struggling for months."

Another mother, who agreed to tell her story under the guarantee of anonymity, says the sudden behavior change in her daughter, now 12, was obvious. A developmental pediatrician who treats children with special needs and psychiatric problems, this woman lives out West with her husband, who also is a physician, and their three adolescents.

She says that when her daughter was a fourth-grader, the girl experienced an avalanche of problems. A good student who always had loved going to school, she refused to attend. The normally organized youngster became very scattered, coming home each night with the wrong notebook or without proper homework instruction.

"It was like she couldn't think straight and keep it all together," her mother says. "It was like a cloud had descended on her."

A last straw came when the child began to develop irrational fears. For example, she became afraid of taking baths because she believed she might drown or be washed down the drain.

Her parents sought treatment perhaps sooner than many, the mother says, because both parents have the benefit of medical backgrounds. The girl was evaluated and prescribed anti-depressant medication.

"I couldn't let her go on that way," the mother says.

The child has been on medication for three years and has "done great," her mother says. "She is a straight-A student, a talented musician, has lots of friends."

Last summer, the family decided to give the girl a chance to fly solo: At her request, they discontinued the medication.

"It was very clear when she went back to school in September that she needed it. The organizational piece sort of came right back, and the moodiness, being gloomy instead of being a happy kid," her mother says.

"In adolescence, there is moodiness and oppositional stuff that is totally normal, so it was a little bit hard to know if it was just the normal 12-year-old but clearly was beneficial for her."

Penny Peterson, a member of the National Association of School Psychologists, is accustomed to seeing normal and not-so-normal behavior while carrying out her duties as a Montgomery County school psychologist. She works in one high school and three elementary schools, helping children and their families deal with psychological issues.

She advises that parents should come clean with teachers and other pertinent school personnel if their child is being treated for depression or another mental illness.

"The best lab in the world is going to be the person who sees them six hours a day," Ms. Peterson says.

"And what you don't want to do is have your kid set up as a liar or not having any friends," she says. "I'd ask the teacher, 'Is there any way you can help me help not do that? If you notice anything out of the ordinary, I would like to know so that I can share it with our doctors.' And sure, I think that sometimes the teachers' lounges do become universal sharing places, but the majority of teachers I know are respectful and professional people."

Don't wait to treat

Depression can strike children before they ever set foot on an elementary school campus.

"We see 2- and 3-year-olds fairly regularly," Dr. Fassler says. "We also see a lot of 5-, 6- and 7-year-olds, too. We are getting better and better at recognizing the signs in young kids, so more are getting the help they need. I think it's critical work with kids that age because if you can catch a problem like depression in a child that young, you have a good chance of getting them on track."

The good news, Dr. Fassler says, is that depression is considered very treatable with the help of medication, individual or family therapy and attention from the school environment. He also says even young children welcome intervention.

"If you're 5 and get depressed, you don't understand what's been going on," he says. "You don't know why. … Finally, someone brings you to a therapist. You will appreciate the opportunity to finally tell someone what's going on."

To the pediatrician mother of the 12-year-old girl who suffers from the illness, depression is a small evil.

"Of course I would much rather that she didn't have it," she says, "but then on the other hand, I look at some of the patients I treat who have such severe illnesses they can't function at all, and I consider it fortunate that this is something treatable and controllable. In the grand scheme of things, it could be a lot worse and believe me, I know what 'a lot worse' is."

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