Childhood depression going undiagnosed
Megan’s* son was in grade one when he began struggling at school and with behavioural problems.
“He wasn’t coping with the school work,” she said. “He was referred to a remedial school and he had to repeat the grade.” Although grade one was the only grade Megan’s son Luke* repeated, his behavioural problems persisted.
“In grade four I just became uneasy with his behaviour,” she said. “The teacher said I was probably putting too much pressure on him and I shouldn’t be so hard on him.”
“(He was) in grade seven when I was now convinced that there was something wrong,” she added. “At that time he was seeing the school’s psychologist”.
According to Megan, the school psychologist told her that Luke had a low IQ and diagnosed him with Attention deficit hyperactivity disorder (ADHD). Luke, then 13 years old, was put on medication for the ADHD.
Children, adults with depression alike stigmatised
Shortly after Luke’s ADHD diagnosis, Megan noticed his mood change.
“I saw my son go from a happy to a very sad child,” Megan said. Luke was eventually diagnosed with depression and put on anti-depressants. National figures on mental illnesses among children and adolescents are scarce, but a 2011 University of Cape Town study conducted among 3 370 South Africans found that about 13 percent had been diagnosed with a common mental disorder before the age of 18 years.
While anxiety was the most prevalent of these disorders, about four percent of participants had been diagnosed with either a depressive or substance-related disorder. Not only may childhood depression be more prevalent than we think but some research suggests there may be links between depression and ADHD.
According to SADAG Project Manager Naazia Ismail, many children suffering from depression go undiagnosed because it is difficult to diagnose – and because society does not expect children to be depressed.
“It is also difficult to diagnose in children because they are still developing,” Ismail said. “Childhood depression is still stigmatised like any other mental illness.”
Megan declined to be fully named for this article for fear it would reveal her son’s identity. Luke, now 20 years old, declined to be interviewed.
ADHD may be linked to childhood depression
According to SADAG, one out of every five school children may suffer from ADHD. Children with ADHD may have up to a four times higher risk of developing depressive disorders than their peers, according to a 1998 US research review. Study authors also cited that more research was needed into the area.
Educational psychologist Fathima Adam says the risk of depression among children with ADHD may stem from low self-esteem as these children are more likely to be reprimanded and fall behind in school.
“Eventually the child will start feeling lonely and bad about himself and then comes the depression and suicidal tendencies,” Adam said. “An ADHD child can also succumb to peer pressure such as substance abuse because they are desperate to feel good about themselves.”
She stressed that not every child with ADHD will become depressed and that managing ADHD well could reduce the likelihood of depression among children.
Long road to treatment
Within a year of Luke’s diagnosis, Megan was forced to admit him to Tara Hospital, which is one of the few mental health institutions in the country that can treat children and adolescents. “There are not enough psychiatric wards for children (so it is difficult to get access,” Ismail said. “Another factor is the cost of mental healthcare – it’s very expensive over and above mental health resources being very limited”.
She added that the public health system’s referral process can also delay children’s access to treatment as families must be referred from their local clinics to progressively more specialised facilities.
“The patient first has to be seen at a local clinic, then move to primary hospital and then if it is a serious case they transfer it to a tertiary facility,”Ismail explained.
Like adult depression, childhood depression is treated with anti-depressants but Adam stresses that treatment goes beyond drugs.
“ If the child has mild depression then we do not rush for medication,” she said. “We give them medication for two weeks then as a parent you need to observe if there is a change in behaviour and if not then we change the treatment or dosage”.
To this day, Luke continues to take medication for both ADHD and depression. He also sees a therapist periodically. – Health-e News Service.
An edited version of this story was published in The Mercury on the 22 October and The Star on the 23 October