Psychological Treatment for Depressed Students

Psychological Treatment for Depressed Students

Depression in school-age children may be one of the most overlooked and undertreated psychological disorders of childhood, presenting a serious mental health problem. Depression in children has become an important issue in research due to its many emotional forms, and its relationship to self-destructive behaviors. Depressive disorders are of particular importance to school psychologists, who are often placed in the best position to identify, refer, and treat depressed children. Procedures need to be developed to identify depression in students to avoid allowing those children struggling with depression to go undetected. Depression is one of the most treatable forms of disorders, with an 80-90% chance of improvement if individuals receive treatment (Dubuque, 1998). On the other hand, if untreated, serious cases of depression in childhood can be severe, long, and interfere with all aspects of development, relationships, school progress, and family life (Janzen, & Saklofske, 1991).

The existence of depression in school-age children was nearly unrecognized until the 1990s. In the past, depression was thought of as a problem that only adults struggled with, and if children did experience it, they experienced depression entirely differently than adults did. Psychologists of the psychoanalytic orientation felt that children were unable to become depressed because their superegos were inadequately developed (Fuller, 1992). More recently, Clarizio and Payette (1990) found that depressed school-age children and depressed adults share the same basic symptoms. Only a few minor differences between childhood and adult depression have been found, including the assumption that with childhood depression, the irritable mood may serve as a substitute for the depressed mood criterion (Waterman & Ryan, 1993).

Depression in students has become difficult to treat due to a lack of referrals for treatment, “parental denial, and insufficient symptom identification training” (Ramsey, 1994). In addition, recognizing and diagnosing childhood depression is not a simple task. According to Janzen and Saklofske (1991), depression can develop either suddenly, or over a long period, “it may be a brief or long term episode, and may be associated with other disorders such as anxiety”. The presence of a couple of symptoms of depression is not enough to provide a diagnosis. A group of symptoms that co-occur, and accumulate over time should be considered more serious. Depression is classified by severity, duration, and type according to the DSM-IV-TR, published by the American Psychological Association (2000).

According to Callahan and Panichelli-Mindel (1996), many School Psychologists are not required to diagnose affective disorders in students but do need to assess and develop interventions for them. The DSM IV appears to provide much help to School Psychologists to determine the symptoms that indicate a particular disorder and to relay that information to professionals outside of the school. According to Callahan and Panichelli-Mindel (1996), it may be difficult to provide a diagnosis when childrens’ symptoms do not easily fit any categories. Also, a child that does not fit into a diagnostic category may go without treatment when treatment is needed (Callahan & Panichelli-Mindel, 1996). The child’s diagnosis appears to be the most important aspect in planning the appropriate treatment or intervention. Thus, misdiagnosing a child could be harmful.

According to Fuller (1992), childhood depression may account for a variety of behaviors, for example, “conduct disorders, hyperactivity, enuresis, learning disability, and somatic complaints”. Fuller (1992) also reports that depression in children may coexist with “irritability, low self-esteem, and inability to concentrate”. Also, children may “internalize depression maladaptively”, perhaps expressing it through conduct disorders, hyperactivity, or attention deficit disorders (Fuller, 1992).

In a study by Fitts and Landau (1998), brief therapy is regarded as inappropriate for children with depression. Fitts and Landau (1998) suggest that these children need “longer-term therapy” that provides extensive emotional guidance and support to make a lasting improvement to the child’s quality of life. It is also suggested, based on research, that people who are “extremely self-critical” require long-term therapy (Fitts & Landeu, 1998). 

In conclusion, there are many treatment options available to school psychologists today. Cognitive behavior therapy appears to be the orientation most frequently endorsed by research on the treatment of depressed students. Materials can be used in therapy to actively engage students who are reluctant to comply with treatment. The materials available can present as a fun activity to students, and help the therapist gather information, and establish rapport. Stimulating activities are also suggested for use with symptom-specific interventions (Ramsey, 1994). It appears that the most troublesome aspect of the treatment of childhood depression is the fact that many children remain untreated, or misdiagnosed. Education and an increase in awareness of the signs of childhood depression can help reduce the number of children that are left untreated. Coincidentally, National Childhood Depression Day is May 4th. This event is symbolized by a green ribbon and is an event created by the National Mental Health Association to help spread awareness and education regarding the seriousness of childhood depression