- The Washington Times - Sunday, July 8, 2001

Early diagnosis and treatment are key to helping a child who suffers from depression, say professionals who treat the condition.

The clues can be easy to miss, though, because the behavior of depressed children and teen-agers may differ from the behavior of depressed adults.

"Some kids have signs of classic depression, like adults: They are sad, withdrawn, have decreased energy and appetite," says Dr. David G. Fassler, a child and adolescent psychiatrist practicing in Burlington, Vt. "But others go in an almost opposite direction: They get agitated and may be involved in fights at home or school. During adolescence, they may get into trouble with the law or start abusing drugs or alcohol."

Fluctuation in mood, demeanor and reaction is a warning bell, says Dr. Nora Galil, a child and adolescent psychiatrist at Children's National Medical Center in the District and a private practitioner in Chevy Chase.

"Some children tend to get withdrawn, be more sensitive, be less social maybe they're not really creating a problem. Children whose irritability and mood problems end up in acting out will come for help much more quickly than the child who is withdrawn and sad and spending a lot of time in their room," she says.

A child who used to play often with friends may spend most of the time alone and without interests, according to information offered by the American Academy of Child and Adolescent Psychiatry. People, places and activities that once were fun bring little pleasure to the depressed child.

Children and adolescents who are troublemakers at home or at school actually may be depressed but not know it. Because the child may not always seem sad, parents and teachers may not realize that misbehavior is a sign of depression.

"I tell parents to look for a couple of key things," Dr. Fassler says. "One, do the symptoms or behaviors represent a change? For example, an outgoing child suddenly doesn't want to talk to anyone, and the grades drop.

"Two, are the symptoms lasting? Not just a couple of days, but at least a few weeks."

He continues: "And three, is it interfering with the child's life?"

The AACAP has published a checklist of symptoms to help parents determine whether their child needs help. If one or more of these signs of depression persist, parents should contact a qualified professional, whether a psychiatrist, psychologist or social worker:

• Frequent sadness, tearfulness, crying.

• Hopelessness.

• Decreased interest in activities or inability to enjoy previously favorite activities.

• Persistent boredom, low energy.

• Social isolation, poor communication.

• Low self-esteem and guilt.

• Extreme sensitivity to rejection or failure.

• Increased irritability, anger or hostility.

• Difficulty with relationships.

• Frequent complaints of physical illnesses such as headaches and stomachaches.

• Frequent absences from school or poor performance in school.

• Poor concentration.

• A major change in eating or sleeping patterns.

• Talk of or efforts to run away from home.

• Thoughts or expressions of suicide or self-destructive behavior.

In addition, Dr. Galil warns, depression has a strong genetic component, and "in families where there is a lot of depression or alcoholism, parents should keep a good lookout. Depression can be episodic and can come from a number of things whether from something dreadful happening to the child or genetic predisposition but you have to take each child on an individual basis."

Once parents have decided to seek treatment for a child, Dr. Fassler suggests they begin by talking with the child's teacher and family doctor. Ask for a referral to a qualified mental-health professional who specializes in children.

Most important, he says, ensure that your child receives a comprehensive evaluation.

"These are not easy diagnoses to make," Dr. Fassler says. "You really need to be an advocate for your child and get to a mental-health professional who has the expertise to really evaluate your child and develop a good treatment plan. Don't go along with any plan without understanding how you will be involved and how you and the child's therapist will know if the therapy is helping."

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