“I am rather concerned as our 9 year old
daughter Amy, for no apparent reason, has been depressed and tearful for the
last few months. Her teacher has noticed this and our family. She has lost her
appetite for food, school and a social life and, for the first time in her
life, has had difficulty getting to sleep. Friends say a child this young can’t
be clinically depressed but I don’t agree. I have tried some homeopathic
remedies but that did not work. Nor did hypnotherapy. We have also tried a
dietician to see if healthier food would work. Someone suggested child
psychotherapy- but I am worried about something psychoanalytic and long-term. I
understand there is little proof it works”.
Mrs A.
Children’s moods, like adults’, can fluctuate
throughout the day. However, it is indeed a matter of concern when a child is
depressed for such a consistent period of time and in both the home and school
environment. Mrs A is correct in stating that children can be clinically
depressed. A small number of children - about 5 in every 100 - can experience
feelings of sadness and hopelessness that become so intense that they gradually
interfere with social, emotional and educational development. This is the point
where distress reaches the level of an emotional disorder. Could Amy be
reaching this point?
Whilst the combination of loss of appetite,
tearfulness, insomnia and lack of interest in school and social life can occur
occasionally in many children without any long-term consequences, for such
features to last is of concern. A professional clinical assessment is important
here. Professor Israel Kolvin, who carried out research on childhood depression
at the Nuffield Child Psychiatry Unit, Newcastle University, comments
“Depression in childhood is much commoner than previously thought and we have
much better assessment procedures now. So far, it appears that the kinds of
medical drug treatments which work so well in adulthood do not work with young
children. It is my opinion we have to move to psychological treatments such as
therapy that help the children to understand themselves.”
The research found that childhood depression
was often triggered by a bereavement or trauma in the family. Mrs A, however,
can see no apparent reason for Amy’s state. Amy’s depression does not appear to
be linked to arguments with school friends, particular school anxieties or loss
or change in the family. However, in the Newcastle research it is worth noting
that whilst parent and depressed child agreed over symptoms such as loss of
appetite, insomnia or tearfulness, parents often did not pick up the child’s
inner experience of failure, fear and low self-esteem. There are some matters a
child can tell a professional more easily than a parent. Whilst research shows
psychological methods such as individual therapy are particularly useful for
depression that does not help Mrs A’s ambivalence.
Mrs A has tried out quite a range of
treatments unsuccessfully. In fact she has tried almost every treatment except
a professional assessment from a GP, Child Psychiatrist, Child Psychotherapist
or Psychologist. Shopping around for alternative treatments is a complex
process. Some parents are sensible and shop around because they have failed to
find the right practitioner or treatment. When they do find a treatment they
feel confident in they stay with it and improvements often occur.
However, for some people, shopping around
becomes a way of avoiding the action that really matters. A small number of
individuals manage, with unerring accuracy, to seek out the least suitable
treatment in order to both mock the chance for real help and to defend
themselves against the fear of what is actually wrong. Why is Mrs A so worried
about child psychotherapy? “I think it would be important to look first at Mrs
A’s worries and anxieties about child psychotherapy in order to de-mystify it
for her and reassure her” said Dr Jill Hodges. “What are this mother’s
anxieties that make it so important for her to try out so many other treatments
rather than look more closely at the meaning of her child’s unhappiness.”
Such anxieties are common. Mrs Dilys Daws,
Chair of the Child Psychotherapy Trust comments, “A large number of the
referrals to child psychotherapy have already unsuccessfully tried other kinds
of treatment. About three quarters of children who receive treatment after a
careful assessment make a satisfactory improvement. The length of treatment is
dependent on the child’s need.”
Child psychotherapists are health service
professionals who have received an intensive 4-6 year postgraduate training and
are members of the Association of Child Psychotherapists. This registration
ensures public safety. For adults therapists, there is the UKCP and the BCP.
As far as research evaluation goes, Dr Jane
Milton of the APP has produced a booklet detailing all results to date. Despite
lengthy NHS waiting lists adult and child psychoanalytic psychotherapists try
to hold out the possibility for some longer 2- 3 year treatments.
Without an assessment it is not certain what
time-length Amy’s problem requires. It is hard to tell whether Mrs A’s fears
about therapy are her own or whether she is voicing Amy’s own worries at being
in emotional touch with problems. What is clear is that Mrs A has the capacity
to recognise her child’s distress and does not minimise it. Hopefully, when
this is linked to suitable treatment for Amy, relief will follow.