How do we know when it is emotionally abnormal for a two-year-old to cry, or a four-year-old to be fussy and argumentative? What exactly is childhood depression?
The signs and symptoms of depression in children are notoriously difficult to detect accurately (and to study) and are dependant on a multitude of other, usually external, factors. In a patient-information sheet produced by the Mayo Foundation for Medical Education and Research, the authors note that: 'Depression is more difficult to diagnose in children because many behaviours associated with depression can be normal behaviours in children. In evaluating a child for depression, a therapist considers the number, duration and severity of signs and symptoms.'
Fair enough, but the factsheet then goes on to list symptoms such as listlessness, irritability, crying easily, complaints of boredom, arguing with parents, a lack of interest in schoolwork and even 'looking sad' as signs of childhood depression.
What parents can put their hands on their heart and say their child has never experienced any of these states?
What emerges in the evidence is that a child's mental stability is highly dependent on that of its parents and surroundings. A recent study by researchers at Columbia University in New York City, for instance, reports that poor parenting may put children at a higher risk for anxiety and depression. The investigators interviewed nearly 600 parents and their children, and concluded that poor parental behaviours, such as verbal abuse, inconsistent rules, parental arguments in front of children and a lack of supervision can all increase the chances of childhood anxiety or depression (Arch Gen Psychiatry, 2001; 58: 231-6).
Many studies show that, if the mother is depressed, the child will be too (J Am Acad Child Adolesc Psychiatry, 2001; 40: 1367-74; Matern Child Health J, 2000; 4: 215-21). In one study, if the mother was depressed and smoked, the likelihood of her child having 'low social functioning' was nearly doubled (Ambul Pediatr, 2003; 3: 288-94).
There is, likewise, evidence that we are using drugs to make bigger problems, such as social inequality, go away. Data suggest that poor and black children are those most likely to be given mind-altering drugs (Arch Pediatr Adolesc Med, 1999; 153: 1039-45) rather than receive counselling.