Wednesday, September 12, 2018

Sad, Mad, and Bad: What depression looks like in children

There are a limited number of mental health problems that are thought to affect kids. ADHD and Autism Spectrum Disorders are commonly diagnosed in childhood, while mood disorders are most common in teenagers and adults. However, this doesn't mean that children don't get depressed. Children experience depression differently from adults, and thus their symptoms can look very different. This can result in depression being underdiagnosed in kids, or not diagnosed until they are much older, despite early symptoms.

The most commonly known symptom of depression is depressed mood. In children, this can look more like irritability. They may have more outbursts, break down crying more often, or not get along as well with friends and family as they used to. The next most common symptom is anhedonia, which means less interest in pleasure. Kids may be less interested in seeing their friends or participating in favorite hobbies and activities. They might even come up with excuses or feign sickness so that they can stay home from a friend's birthday party or miss an outing. Adults often experience significant weight loss or gain, though this can be difficult to track in kids; instead, we need to look at where they are compared to their expected growth and weight gain. Kids are also more likely to have bodily symptoms, such as headaches and stomach aches, and may go to the nurse's office a lot with such concerns.

Of course, this is not to say that kids never experience adult depressive symptoms. Sleep problems are common with depression in adults and kids, as are feelings of guilt and trouble concentrating. However, kids are more likely to have trouble expressing these symptoms. They might not understand depression at all, or have the words to say what's going on for them. Even if they do, they might be afraid to express it. Depressed kids often withdraw from their families. If your kid avoids telling you about their day at school, they may be avoiding telling you about their difficult feelings, too.

Suicidality in depressed kids can be a tricky subject. Just because they're kids doesn't mean they don't get suicidal ideation, but not all talk of death indicates suicidality. This is especially true in elementary age kids, who may be just processing the idea of death or suicide, and who may be repeating things they've seen in the media or heard from friends. When kids talk about death, it's important to ask about the meaning of what they say and get a clear picture of what's going on for them before jumping to conclusions. The national suicide hotline (1-800-273-8255) has a youth division, and their website has many resources specific to many common causes of suicide in kids and teens, like bullying, gender/sexuality, abusive relationships, and more.

Many kids don't feel comfortable talking to the adults in their life. In some cases, it can be as simple as making sure they know you are a safe person to talk to. Talking about your feelings can help them feel more okay being open about theirs (even something as simple as "I'm frustrated that the waiter hasn't taken our order yet" or "I'm so tired from work"). Being more explicit about the okayness of difficult feelings might be necessary for some kids to safe talking about their difficult feelings. Just make sure you don't pressure your kids into talking to you. It's like one of those finger traps: pulling hard doesn't get them to open up as well as gentle nudges do.

If your kid won't talk to you, or you aren't sure you can help them on your own, therapy can be hugely beneficial. Not only can a therapist teach your kid about their emotions and how to deal with them, but they can also help you and your child open up to each other more. Cognitive Behavioral Therapy can teach a kid how their thoughts aren't always reliable (i.e. jumping to conclusions, minimizing strengths and maximizing problems, etc). Narrative Therapy can help kids explore who they are in relation to the world around them -- which can be important for kids nearing puberty. Gestalt Therapy can help kids process any bottled up feelings. Therapy can also help kids gain the communication skills necessary to talk through problems and difficult feelings with others. Many kids don't feel comfortable talking to the adults in their life, but are willing to talk to a therapist; often times the therapist is the only person in the kid's life who doesn't have expectations for them, and this makes them safe to talk to. A therapist isn't going to have a kid wash dishes or take a math test, and most kids understand that therapists are there to listen and help.

While childhood depression sometimes goes away, it can be hard to distinguish from lifelong depression in the moment. Untreated depression can make it hard for kids to learn, make friends, and thrive in their daily lives, and can thus affect their long term development. Symptoms of depression also often overlap with symptoms of other illnesses, mental and otherwise, so it is important to bring up any symptoms your child shows with their doctor. If handled effectively, childhood depression can often recede and leave no traces in adulthood.

Tuesday, March 20, 2018

Time vs Task: Bounds of attention

I once worked in a special needs class that consisted mostly of kids with Downs Syndrome and Autism Spectrum disorder. There were many patterns I noticed that ran through both groups, but at the end of the free period when we had to draw the students' attention back to classwork, one difference became clear: their attention spans.

Kids on the Autism Spectrum would drop what they were doing as soon as they were told that it was time for lecture. To these kids, making sure everything scheduled happened on time was important; if something came up and they had to skip math, they would be distressed -- even if they didn't really like math. In contrast, kids with Downs Syndrome wanted to finish what they were doing. If they were in the middle of a puzzle, they had to finish it. If they were watching a Youtube video, they couldn't hit pause until it was over. We'd have to keep track of their activities and anticipate when a good time to pull them away. If a kid was listening to music, we'd approach them five minutes before the end of the period and allow them one more song.

This is not meant to draw boundaries between diagnoses (not every person with one of these conditions will act like the kids in my class did), but it does illustrate two very different approaches to attention: time-bound and task-bound. Someone who prefers to stick to a schedule is more likely to have time-bound attention, finishing a task when it is time for the next task, even if the previous task isn't completely finished. Others may be more task-bound, preferring to finish one task before moving on to the next.

To apply this to yourself, imagine being a child reading your favorite book before bed. You are told that it is time to go to sleep, but you are in the middle of a chapter. How reluctant are you to put the book down? Regardless of how good the book is, are you willing to go to bed before the chapter is done?

Variable answers are expected here. A gripping mystery novel is going to treat your attention differently from a comic book, in the same way that activities you enjoy feel different from those you don't. A person's willingness to move on to the next task may depend on many things, including time spent or remaining in the task, time until you can return to the task, enjoyment, and rarity of the task. You may be more reluctant to leave a party if you are talking to a friend you haven't seen in months, or if you just started playing a particular game with them, even if your attention is typically more time-bound.

Stress can come up interpersonally when one person is time-bound and the other is task-bound. If two people are putting together a puzzle and it's time for dinner, one might want to pause to eat, while the other might want to finish the puzzle first. Similarly, if a person who is time-bound is waiting on someone task-bound, they may end up waiting longer than they expected, depending on what the task-bound person is doing. It is important not to act like one of these ways of viewing attention is "correct"; they both have strengths and flaws and places where they are more or less appropriate. Just as it may hurt to stop an important conversation before wrapping up because it's "time for lunch", it would be inappropriate to drag an appointment over time if one or both parties has another appointment right after.

Next time you find yourself in a battle between the task at hand and the next task, notice where your attention is drawn and why. Notice how fluid this is -- your willingness to be time-bound when you want to be task-bound, or vice versa. Your answers may differ each time you try this, or they may show consistent patterns in your behavior. And once you've noticed these patterns, you can better examine how that changes the shape of your life.