First Chapter: Depression and Your Child by Deborah Serani

Title: Depression and Your Child: A Guide for Parents and Caregivers
Author: Deborah Serani
Publisher: Rowman and Littlefield
Pages: 232
Genre: Self-Help/Psychology, Parenting
Format: Hardback/Paperback/Kindle

Purchase at AMAZON

Seeing your child suffer in any way is a harrowing experience for any parent. Mental illness in children can be particularly draining due to the mystery surrounding it, and the issue of diagnosis at such a tender age. Depression and Your Child is an award-winning book that gives parents and caregivers a uniquely textured understanding of pediatric depression, its causes, its symptoms, and its treatments. Author Deborah Serani weaves her own personal experiences of being a depressed child along with her clinical experiences as a psychologist treating depressed children.

2013 Gold Medal Book of the Year Award – IndieFab (Psychology Category)

https://www.forewordreviews.com/reviews/depression-and-your-child/

2014 Silver Medal Book of the Year Award – Independent Publishing (Parenting Category)

http://www.independentpublisher.com/article.php?page=1791

First Chapter:

Understanding Child Development

As a young girl, I always felt this looming sense of sadness. I remember feeling tired and sullen a good deal of the time growing up. When I was in school, I was quiet and kept to myself, but these feelings didn’t get much better when I was at home. Like Eeyore, the glum little donkey from the Hundred Acre Wood, I was known as a sad-sack to friends and family[i].

Piecing together my interior life along with school reports, medical history and my parents’ recollections, it’s easy to see now that I was a depressed child. I was very sensitive, cried easily, was frequently tired and irritable, prone to headaches and stomach aches too. And then there were the feelings of insecurity that plagued me wherever I went. I never felt good enough or smart enough, strong or pretty enough – so I preferred being alone than spending time with friends. I also struggled concentrating at school, constantly having to work hard to catch up to what was going on in the classroom – like my focus was moving at a slower pace than everyone else’s.

My depressive illness didn’t accompany my life as a big, dark cloud shrouding me in blackness. It was a silent partner – hazily clipping the edges of the light, subtly pressing itself against me in ways that made me complacent. Back then, I didn’t know I was depressed. I just thought everyone felt and thought the kinds of things I did. And no one – teachers, health professionals, friends or family – took notice of my depression back then either. Partly because children weren’t thought to experience clinical depression. And to another extent, because my behavioral and emotional presentations weren’t extreme, raising flags that I was a kid that needed looking after. I was a good, quiet kid that didn’t get in trouble.                                          But as I got older, my depressive symptoms intensified, challenging me to work harder to shake the negative feelings and physical fatigue. By then, I learned to mask them well, presenting with a cheerful exterior publicly, while privately feeling sad. I’d force myself to keep social plans with friends, attended extra-help sessions after school to improve grades, and even joined sports teams as an antidote to my constant tiredness. Try as I might to fight the dimness of my mood and the distortions of my thoughts, I often ended up cancelling on friends, barely passed school subjects and quit every sports team before the season ended.

My negative and corrosive thinking made it hard for me to feel hopeful or happy, and soon I descended into a perilous despair. At age 19, my junior year of college, a staggering sadness seized, spiraling me into a hopeless frame of mind. Within weeks, I stopped studying, then stopped going to my classes all together. I remained in bed nearly all day, the depression siphoning out my soul, creating for me a featureless, numbing existence. Soon my judgment clouded and I lost my sense of thinking clearly. With each passing day, I struggled to keep away thoughts and urges to hurt myself. Unable to control these internal pressures, my emotional collapse lead to a plan to die by suicide with a loaded hand gun. Luckily, my self-destructive act was interrupted and I received immediate medical care.

Through the life-saving interventions, I came to learn that as a young girl I’d been living with Dysthymic Disorder and that it escalated into a Major Depressive Episode. Having both these disorders was called a double depression, and it wouldn’t be the last time that would challenge me. Some 15 years later, I found myself in dire straits again, but knowing what risk factors to look for helped save me from plummeting into what could have been another life threatening situation. I was a trained clinician and realized what was going on. I kept an eye on my mental state just after returning home with my healthy, newborn beautiful daughter, Rebecca. I started noticing how I was feeling weepy, anxious, and irritable. Thinking it might be the radical hormone changes known as baby blues, I gave myself some time before checking things out with the doctor. Within months, those symptoms worsened, with negative thoughts, despairing feelings and self-destructive ideas plaguing me once again. There was no hesitation in my mind that I was experiencing another depressive episode – this time it was with the onset of Postpartum. I began medication and resumed psychotherapy, and was feeling better in a matter of weeks.

I have no doubt that if my parents, teachers, coaches, friends and family knew what to look for back when I was a child, I would’ve been involved in treatment much earlier in my life. And I strongly believe that earlier intervention would’ve helped me avoid circling the drain and thinking of suicide. Better late than never, getting treatment in my late teens was life-saving and inspirational to me. So much so, that I became a student of psychology – and have been an expert psychologist diagnosing and treating depression in children and adults for over twenty years.

Born out of my personal experiences with depression has come my professional need to educate others about how to detect depression, how to treat it, and how to live well in spite of it.

Defining Normal

          Understanding the range of normal development can help determine if your child’s thoughts and behaviors warrant concern. First and foremost, is the idea of understanding what normal is. Many definitions exist, but in my opinion, none get the job done in a sentence.

There’s the intellectual definition: “Normal is conforming to a type, standard, or regular pattern” – Merriam Webster Dictionary.

A tongue in cheek definition: “Normal is nothing more than a cycle on a washing machine” – Whoopi Goldberg.

And the existential definition: “Nobody realizes that some people expend tremendous energy merely to be normal.” – Albert Camus.

Defining normal starts with understanding that each culture has a set of accepted customs, rituals, traditions and expectations that guides the population. These agreed-upon norms

may be the same from country to country; they may vary from place to place; or be entirely different from one part of the world to another. For example, a handshake as a greeting is welcomed in American, Canadian and European cultures, but in Asian cultures a bow is preferred. In South Africa, Turkey or Arabic countries, a firm handshake is considered rude, better is a soft, long one. Take the subject of arranged marriages and you’ll find that they are customary in Africa, South Asia and the Middle East, whereas a love marriage is more culturally accepted in American, Canadian and European countries. Another example, co-sleeping (sharing a bed with your children) is practiced the world over, save for America, Australia, Canada and Europe. You get the idea. Norms are part of the way we begin to measure what’s acceptable and what’s not in society.

The second aspect that helps define normal is the science of developmental milestones. Commonly defined as the physical, cognitive and social-emotional expectations for children from birth through adolescence, milestones are divided into four periods:

1. Infancy (birth to 3 years old)
2. Preschool years (4 to 6 years old)
3. Middle childhood years (6 to 13 years old)
4. Adolescence (13 to 20 years old)

Within each period are a series of expected skills and behaviors that determine a child’s growth. Accomplishing such tasks determines if development is on track or delayed. Children achieve these milestones, like smiling for the first time, rolling over, saying “Mama”, bouncing a ball, learning colors, separating fact from fiction, developing social peer bonds through a combination of genetics and psychosocial experiences. In each developmental period, children move through more evolved and complex milestones, each one building on the ones previously achieved. Knowing these milestones is important not only to help children achieve their optimal developmental potential, but to identify children at risk. It’s critical to note that meeting the developmental milestone is more valuable than the age it is achieved. For instance, some children may talk later than others. Some children master social independence before others. The key is the attainment of the milestone.

Third in the process of characterizing normal is your child’s temperament. Defined as an inborn behavioral reaction style, temperament is largely biologically based, is present from birth, and remains stable across one’s life cycle. The usefulness of understanding the kind of temperament your child possesses will help you realize the kinds of structure needed to meet life’s demands. Your child’s temperament will also affect your parenting style, which, in turn, will further shape your child’s behavior.

Getting an overall picture of how your child moves through each of these dimensions will lead to one of three temperament types as illustrated by researchers Thomas, Chess and Birch:

1. 1.     Easy – The child with an easy temperament is generally adaptable, approachable and mild-mannered. There is a predictability to her rhythms and moods, and she adapts easily to new situations. Expression of frustration is mild or medium in intensity, and can be readily soothed. Caregivers report easy temperament babies are a delight to raise. About 40% of children fall into this group.
2. 2.     Difficult – The child with a difficult temperament     is typically more challenging to soothe, frustrates easily, fusses often and is feisty. He may be hard to get to sleep for the night, eating and day to day activities often having a spirited rhythm. Mood can be disagreeable, with irritability, tantrums or outbursts occurring. Caregivers        report raising children with a difficult temperament is trying. Understanding, patience and consistency are needed to help your child, where a positive adjustment to life’s     demands can be learned. About 10% of children fall into this group.
3. 3.     Slow-to-Warm-Up – This child is generally shy, hesitant or slow-to-warm-up with others. Initial encounters often cause discomfort, but the child slowly adapts. Unlike the difficult child whose mood is easy to register, there’s a slower reactivity making subtleties harder to recognize patterns. This child tends to do better if not pressured by others, finding more success when she makes decisions and adjustments at her own pace. Caregivers report slow-to-warm-up children not demanding to raise, but requiring gentle encouragement. About 15% of children fall into this group.

It’s been shown that identifying temperament early in a child’s life can help stave off behavioral problems, anxiety, depression and help with self-regulation skills. Detecting the type of temperamental style can also clue parents in to the kinds of discipline and structure needed to help their child adapt to the world. More so than anything else, temperament has a strong association to health, life events, and overall well-being.

The fourth and final aspect that yardsticks normal are the unique experiences that frame and contour your child’s world. These singular moments will influence how he thinks, feels and behaves – and ultimately shape who he is as a person. What makes this final area so vital is that no two people have the same life story. Your child’s personal narrative has incomparable meaningful, so it needs to be celebrated, understood and valued in its own light.

So, What Is Abnormal?

When it comes to detecting mental disorders, there is a general consensus in most of the world regarding what is deemed typical or customary for children as well as for adults. Let’s start by defining abnormal, which literally means “away from the norm.” An abnormal heart rhythm, for example, will vary on an EKG from the anticipated electrical impulses seen in a healthy heart. A summer-like temperature in the middle of winter is considered abnormal because the weather pattern strays from seasonal expectations. With depression, extreme negative moods are not considered a normal experience for children and adults.

Mental health, an important component of well-being, is a level of functioning where a child can move through the daily demands of life, deal effectively with adversity, work productively, and benefit from social connections. Well-being is a concept that is consistently defined the same way across the world. Behaviors that stray from this state of well-being and cause impaired functioning are considered mental disorders -illnesses characterized by alterations in mood, thinking and conduct.

Mental illness, like any health issue, will have a range of intensity, activation and persistence. Disorders can be mild, moderate, severe or profound; can have an early onset (childhood) or a late onset (adulthood); can be episodic or recurrent, and fluctuate from situation to situation.                                                                                                                Now that the normal has been defined, let’s take a look at a case of mine that highlights why understanding temperament, cultural norms and developmental milestones are so vital.

CASE STUDY: DYLAN

 

          Dylan, aged 3 years 2 months, was referred by his preschool for evaluation. Concerns were raised regarding his preferences for solitary play over more socialized interactions, poor expressive language, difficulty transitioning from one activity to another and excessive crying.  Prior to Dylan’s appointment with me, a full physical examination with his pediatrician revealed him to be in good health, meeting all developmental milestones. A full speech and language evaluation placed him within normal limits for receptive language skills, but just below average for expressive language.

Dylan was a very quiet boy who was small in build. He had brown hair, freckled fair skin and deep set blue eyes that disappeared in the folds of his face when he smiled. At the first session, he couldn’t immediately separate from his mother who was sitting in the waiting room, and clung to her tightly as I tried to encourage him to join me. He finally agreed, though we had to leave the door to the waiting room open a tiny bit to make him comfortable.

Dylan averted making eye contact, and when he did, it was quick and then gone. His movements, though, were gentle and delicate – not the kind of rough and tumble of most boys his age. During playtime, he chose Lego’s, paints and played at the rice table, making “whooshing” sounds in whispers as he scooped up rice and funneled it to a toy dump truck. When I approached, Dylan didn’t refuse my company, but didn’t interact with me or join me in pretend play. When I made loud “vrooming” sounds, crashed my cars, used dialogue in my play or painted in big large strokes, Dylan bristled. His reactions seemed to say that what I was doing near him was too much. Yet despite the fact that he spoke in one word answers to my questions – “No,” “Yeah,” “Uh-huh,” he appeared to enjoy his play. I spent the rest of the session mirroring his play, and this parallel style of interaction allowed him to feel more comfortable. His gaze connected with mine more often and that’s when the smiles began. When a Lego tower he was building swayed, trying to hold its impossible height against gravity, he let out a little laugh. And when it fell to the ground, he clapped his hands in delight, turned to me and yelled, “Oh, no!”

That was our first real moment of connection. Dylan responded well to my limits and structure of the session. He cleaned up the toys without protest, and smiled quietly as we tried several times to snap one of the covers to the paints back on. When it finally did, I rolled my eyes which made him giggle. As the session ended, I asked him to invite his mother into the consultation room, and watched as he trotted out, grabbed her arm and said, “C’mon, Mommy.” I instructed Dylan to tell his mother what we did, and he sat on her lap and spoke in short sentences, with little physical movement. His mother held his gaze and appeared invested in his every word. The interaction between Dylan and his mother was sweet and tender, and it was obvious that she was attuned to Dylan’s needs for quiet.                                                             I saw Dylan two more times after that, and each session deepened our connection. He would talk more when asked questions, but didn’t spontaneously initiate dialogue on his own. His play style, however, broadened with more lively physical movement and animated verbalizations. My evaluation with Dylan’s parents revealed a concern over his shyness and preference for alone time, otherwise they reported he was an easy baby and toddler, sleeping and eating well – “a smart, happy boy – a joy to be around.” School consultation showed a different picture, with Dylan’s teachers worried that he was a depressed and anxious child.                                      “It’s like pulling teeth to get him to do anything,” his teacher said.                                                Dylan cried often at school, barely spoke when teachers would ask why he was upset, often refused to eat during snack time and didn’t like participating in group activities.                         Formal testing showed that Dylan was a boy with above-average intelligence. No difficulties were found with his moods, thoughts or other functional areas of his life, except for moderate impairment in behavior towards others and school/daycare. Dylan was clearly struggling, but not from depression or anxiety. He was an introverted child, whose needs were being met at home, but were being misunderstood at school. He was not depressed.

Recommendations from my evaluation included making sure Dylan’s parents and teachers understood introversion – and how it differed from shyness, depression or anxiety. Introverts require a certain amount of quietness in their life. Introverted children expend a lot of energy being with others, which can leave them feeling tired, setting them into melt-down mode, which can certainly look like depression. So it would be important for there to be a quiet zone for him – and other introverted children in school.  For Dylan, when there’s too much noise, too many demands, too many choices it causes distress. Parenting and Teaching that presents Dylan with one task at a time, giving him two choices between things and an area to be quiet and refuel will make a big difference for his well-being.                                                                    Understanding Dylan’s specific needs helped remove the sense of frustration his teacher experienced, and also helped Dylan feel more secure in who he was, what he wanted and what he needed in his day to day experiences. Understanding child development also helped Dylan’s parents embrace his introverted ways instead of being overly sensitive to them.                               Children are unique. In order to reach them, teach them and love them, adults need to recognize aspects of their biology, the textures of their personal experiences and their special needs. This is why it’s crucial for parents to understand child development.  When adults become familiar with expected behaviors, personality styles and predictable experiences, it helps foster a greater awareness of what is normal and what warrants concern.

 

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