Understanding Depression

“Over one-third of teens are likely to experience anywhere from mild to severe depression”. (CNMAT, n.d)

“[Sixty-five percent] of adoptees reported that they have been depressed at some point in their lives” (Flynn, Welch & Paget, 2004). We hear a lot about depression and see it depicted in the media, but what does this mood disorder look like in everyday life for children and youth in general, and children and youth who join their family through adoption? Why is this important for adoptive parents to know? Everyone feels sad every once in a while, although depression is more than a feeling of sadness; it is a medical condition just like diabetes or heart disease. Like these conditions, depression needs to be treated.

Depression impacts the way a person thinks, feels and functions. When trying to identify the factors that contribute to depression, it is important to consider their experiences with grief, loss, trauma and attachment, as well as their genetic predispositions. There are many things to consider if you suspect your child or youth may be suffering from depression. For a child or youth living in foster care, there could be various factors impacting their mental health. This section on depression will provide some tips, tools and techniques for families considering adopting a child or youth living with depression, as well as a history or diagnosis of depression.

Signs of Depression

The signs and symptoms of depression can vary greatly depending on your child or youth. Not every child/youth who is diagnosed with depression will have the same symptoms, and the symptoms your child exhibits may change over time. Therefore, if parents are aware, it would be easier for them to take action.

Symptoms of depression in children and youth

According to Children’s Mental Health Ontario (2016), some specific symptoms in children might include the following:

• Sad mood
• Anxiety (e.g., separation anxiety)
• Irritability and frustration, accompanied by tantrums and behavioural problems
• Apathy and disinterest
• Lack of cooperation
• Withdrawal from family and friends
• Physical complaints (e.g., headache and stomachache)
• Auditory “hallucinations”
• May include obvious and not so obvious behaviours

*This is not a comprehensive list

Also according to your children’s Mental Health of Ontario (2016), adolescents and youth have common symptoms including some of the following:

• Refusing to attend school or poor school performance
• Sleep and appetite disturbances
• Weight loss/gain
• Delusions
• Suicidal thoughts and feelings
• Suicide attempts
• Difficulty concentrating
• Feelings of worthlessness
• Negative feelings about self
• Disruptive behaviour
• Withdrawal

*This is not a comprehensive list

Older children and youth can still exhibit some of the same symptoms as younger children. However, older children and youth are more likely to verbalize their emotions. Many teenagers with depression may say things such as “Why do I bother?” or “I hate myself”. It is also common for a teenager living with depression to withdraw from their friends and family, spending increasing amounts of time alone. They might also start to become forgetful and begin missing homework deadlines or fail to complete tasks that they normally would have done. You many find them sleeping a lot more and feeling tired or lethargic throughout the day.

When to seek out services and support

Occasional feelings of sadness are completely natural and normal. However, many children in care have experienced traumatic early life events and may be having a difficult time working through these experiences at different ages and stages. This does not necessarily mean that they are depressed. However, if feelings of sadness persist for more than two weeks, or if you fear that your child or youth may be at risk, (i.e cause harm themselves or others), it may be time to seek help.

If you suspect that your child may suffer from depression, it is important to seek help from a professional (psychologist, psychiatrist or an adoption competent therapist). NOTE: Oftentimes you have to start out with a family doctor for a referral. Each type of depression has its own criteria and an approved mental health professional will help determine whether your child fits the criteria for a certain form of depression. If you are concerned there are immediate safety risks to your child or youth, do not hesitate to call 911 or your family doctor.  It takes a village to raise a child.

Types of Depression

It is important to be well-informed about depression and to seek out the services of a doctor or counselor for a diagnosis and treatment plan. Becoming informed about your child’s needs and experiences prepares parents to be able to access supports and better understand, communicate, and meet the needs of their child. There are several different types of depression that can occur during childhood and adolescence. Below is a description of just some types of depression (American Psychiatric Association, 2013).

Major Depressive Episode: A severe feeling of sadness that does not simply go away on its own. Depression can also have physical symptoms such as headaches, stomachaches and fatigue. These symptoms will be present for most of the day, every day or for at least two weeks.

Seasonal Affective Disorder: Seasonal Affective Disorder is a disorder that occurs during the late autumn and winter months, when there is less daylight. The low mood and depressive symptoms will be persistent during those months and they will subside once the spring and summer months begin.

Disruptive Mood Dysregulation Disorder: A form of depression that is diagnosed in children and youth between the ages of six and eighteen. A child or youth with DMDD will appear to be irritable most of the day and they will have outbursts or temper tantrums at least three times a week.  In order to be diagnosed with DMDD, these symptoms must be consistent for at least twelve months.

Depression Associated with Bipolar Disorder: Bipolar disorder is different from Major Depressive disorder, however they do share some common symptoms. Bipolar disorder is characterized by periods of euphoria (manic period) followed by periods of depression.

How is Depression Diagnosed?  

Possible contributors of depression

Many children in care have experienced grief and loss, and or trauma (i.e neglect or abuse pre-placement), in combination with the transition to a new home. These factors may contribute to depression. It is important for you to know your child’s history and how he/she has been impacted past and present. A question you can ask is if your child has previously received any counselling or support.

Other risk factors for depression include:

• Biological factors: These factors can include a family history of depression. Children with a family history of depression are more likely to develop this diagnosis. However, just because a child has a family history of depression does not automatically mean that they will develop this diagnosis.  Some other biological factors can include chemical imbalances in the brain and a reduction in the amount of neurotransmitters (Mood Disorder Society of Canada, 2013). Some adoptive parents may not have their child’s family history and would not know if they have a genetic risk to depression, if there is a genetic risk.  
• Psychological and Social Factors: Children and youth in care are approximately eight times more likely to be diagnosed with a mental illness (Fuller, Leon, Stoner 2015). Their history of trauma and abuse, as well as other factors such as bullying, poverty, neglect and even the stigma of being in foster care, puts them at a much greater risk for depression. However, these factors alone do not mean that your child will become depressed. If they do, research shows that children in care who have an adequate support network can recover. (Mood Disorder Society of Canada, 2013).

Supporting a child or youth with depression

“Help can make a difference for 80% of people who are affected [by depression], allowing them to get back to their regular activities” (CMHA, 2016).

There are various forms of treatment available to support your child or youth. There is not one specific technique to treat depression and treatment needs to be tailored to the needs of your child, youth and/or your family. Counselling and medication can both be successful in treating children with depression.

A psychiatrist may determine that your child would benefit from anti-depressant medication to help manage their symptoms.  Medication can take some time in order to take effect, it is important to be patient and to give the medication a chance to work while monitoring side effects.  If the side effects are not bearable or are worsening with time, you may want to talk to your child’s psychiatrist or doctors about changing the dose or brand of their medication.

Ongoing medical follow up is needed to ensure your child or youth is getting appropriate support from counsellors, doctors or both.

Parenting a Child or Youth with Depression

Tips and tools

• Education: Learn as much as you can about depression. This knowledge will help you to understand your child’s diagnosis and help you to become their best advocate.
• Practice self-care: While caring for your child or youth with depression it can become easy to forget your own needs. Making sure that you take time to look after yourself can help reduce stress in your household and help improve outcomes for your child.
• Get enough exercise: Physical activity can help reduce symptoms of depression. Try to find an activity that your child enjoys and encourage them to participate. Even something simple like going for a walk with your child may help reduce their symptoms of depression.
• Develop a routine: Sticking to a routine that works best for your child or youth can significantly help your child’s mental health. This is especially true when it comes to eating and sleeping. Having a healthy diet and getting an adequate amount of sleep can greatly improve your child or youth’s mental health.
• Communicate: Talking with your child or youth about their emotions can help them explore their feelings in a safe environment.
• Develop realistic goals and expectations: It is important to have realistic expectations of your child. There may be days when they are not capable of doing things that other children their age are doing. Learning what is realistic for your child and setting goals that are attainable is extremely important.
• Develop a support network: Throughout your adoption journey it can seem like you are completely alone, however, it is crucial for your own health, as well as the health of your child that you surround your family with supportive people who understand your story and will support during difficult times.
• Do your best to eliminate stress: Research has shown that children who are adopted into households with lower levels of stress and a strong support system are more likely to have a positive view of themselves, even if they have a genetic risk of developing depression (Barth, Brooks, Kim, Ji 2010). Learn what can trigger your child’s stress.

*This is not a comprehensive list

Helpful Links and Resources for Depression

Canadian Network for Mood and Anxiety Treatments-http://www.canmat.org/

Children’s Mental Health Ontario- www.kidsmentalhealth.ca

Keck, Gregory and Kupecky, Regina. (1995). Adopting the Hurt Child: Hope for Families with Special Needs Kids. Colorado: Pinon Press.

Keck, Gregory and Kupecky, Regina. (2002). Parenting the Hurt child: Helping Adoptive Families Heal and Grow. Colorado: Pinon Press

Mood Disorders Association of Ontario- http://www.mooddisorders.ca

Mood Disorders Society of Canada- https://mdsc.ca/

Permanency and Adoptive Support Services (PASS) contact: pass@adoptontario.ca

Teen Mental Health- http://teenmentalhealth.org/learn/mental-disorders/

Content References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Canadian Mental Health Association (2016) Retrieved from- http://www.cmha.ca/

Canadian Network for Mood and Anxiety Treatments (CNMAT) (n.d) Retrieved from- http://www.canmat.org/

Children’s Mental Health Ontario (2001)- www.kidsmentalhealth.ca

Flynn, C., Welch, W., and Paget, K. (2004). Field-Initiated Research on Successful Adolescent Adoptions: Final Report 2004. The Center for Child and Family Studies, College of Social Work, University of South Carolina.

Ji, J., Barth, Richard, Brooks, Devon, & Kim, H. (2010). Beyond preadoptive risk: The impact of   
          adoptive family environment on adopted youth’s psychosocial adjustment. American  
          Journal of Orthopsychiatry, 80(3), 432-442

Mood Disorders Association of Ontario (n.d) Retrieved from- http://www.mooddisorders.ca

Mood Disorders Society of Canada (2013) Retrieved from- https://mdsc.ca/

Stoner, M., Alision, Leon, C.S, & Fuller, K. A. (2015).  Predictors of reduction in symptoms of
          depression for children and adolescents in foster care. J Child Fam Stud, 24, 784-797