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September 1, 2001
Vol. 59
No. 1

The Shrink in the Classroom / Too Sad to Learn?

Educational Leadership is pleased to present a new column on child and adolescent psychosocial problems, such as inattention and anxiety, violence and aggression, suicide, eating disorders, and chronic illness. Steven C. Schlozman will discuss the problems that students face, the possible causes of those problems, and what educators can do to address these problems in the classroom. Send your questions and ideas for the column to <LINK URL="mailto:el@ascd.org">el@ascd.org</LINK>.

Teachers and administrators are increasingly asked to vigilantly watch for signs of depressed mood and sadness in their students. Children and adolescents who suffer from depression encounter more academic and social problems than their peers, often fail to progress and mature developmentally, and may experience a multitude of coexisting psychological problems, such as substance abuse and violent behavior.
Indeed, the stakes are high when we fail to notice depression, and often the first signs of mental health difficulties occur in the classroom. Teachers often feel unsure and bewildered as they try to understand how best to recognize and reach the depressed student. Depressed children and adolescents may be disruptive or withdrawn, and they may leave their teachers and peers with a profound sense of hopelessness. Identifying and taking action to help a potentially depressed student is essential for meeting the academic and social needs of the student and for maintaining the overall learning environment.

About Depression

Depression is a psychiatric disorder characterized by a persistently sad or sometimes irritable mood. Formal criteria for the disorder are listed in the American Psychiatric Association's Diagnostic and Statistical Manual, 4th edition, (DSM-IV). In making the diagnosis, clinicians often refer to neuro-vegetative symptoms, such as poor sleep, decreased interest, low energy, guilty feelings, and changes in appetite. In addition, depressed individuals may hold their bodies differently, sometimes barely moving and sometimes fidgeting excessively. Suicidal thoughts and behavior are the most alarming of these signs, although one need not be suicidal to be depressed. In general, an individual needs to experience a depressed mood as well as five neurovegetative symptoms to be considered clinically depressed. If anyone suffers severely from even one of the symptoms, however, a clinical treatment is often helpful. Obviously, suicidal tendencies in the absence of other symptoms are an emergency.
Recent studies suggest that 0.4–2.5 percent of children suffer from depression, while adolescent depression may approach 8 percent or more of the general population. Approximately 15–20 percent of adolescents will experience depression during their teen years. Because the psychological and emotional development of young people occurs rapidly, however, the picture of depression in young people can look different from that of adults with the same diagnosis, and can look different among children of different ages.
In general, depressed younger children voice more physical complaints than do their adolescent counterparts. These younger children might experience persistent headaches or stomach-aches that often are mistaken for signs of an illness other than a depressed mood. In addition, younger children will often exhibit increased separation anxiety, and their overall behavior may seem somewhat regressed. As children approach adolescence, those who suffer from depression start to resemble adults with the same illness. Adolescents are more likely to feel seriously suicidal and may complain more specifically of the neurovegetative symptoms listed above. In all age groups, an experienced adult should interview the child or adolescent. Research has shown that parents are often not aware of their children's feelings, and that children often do not directly share their feelings with parents or other adults.
The ratio of boys to girls with depression in younger years is one-to-one, but during adolescence, girls with depression outnumber boys by approximately two-to-one, and this ratio persists into adulthood. Although the reasons for these differences are not clear, researchers think that biological and cultural differences among different age groups and between boys and girls play roles in these demographic variations. In addition, many people who suffer from depression have a family history of some mood disorder. Although depression is not always inherited, studies have demonstrated a genetic influence.
Finally, a depressed mood may represent psychiatric and medical disorders other than clinical depression—for example, medical illnesses like thyroid disease or psychiatric conditions like manic-depressive illness, traumatic-stress disorders, and adjustment reactions to difficult life events, such as the death of a family member. Depressed mood is often a nonspecific aspect of many potential problems.

Treating Depression

Treatment for depression involves both therapy and medications. Many children with depression need talk therapy, in which the therapist helps the child understand and cope with his or her feelings. Family therapy and education are also helpful. Medications most commonly include antidepressants, especially serotonin reuptake inhibitors (SSRIs). These medications lack the side effects of earlier antidepressant medicines and include agents such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox), and citalopram (Celexa). Each of these is likely to be effective for depression, though many children might respond to one medicine and not to another due in part to specific qualities of each medicine. In addition to the serotonin reuptake inhibitors, other effective medicines include bupropian (Wellbutrin) and venlafaxine (Effexor). Other medicines also may be effective. A combination of talk therapy and medications is often the most useful treatment regimen.

Advice for Educators

Because children spend so much of their time in the classroom, school personnel may be the first to notice when a student begins to act depressed. Although many of these behaviors are nonspecific and do not necessarily indicate depression, teachers are likely to notice students who start to act sad or reserved. Students with depression may become withdrawn or irritable. They might walk more slowly or with rounded shoulders, or they might seem persistently anxious and overwhelmed. Older children will often fail to respond to anything, including obviously funny or disruptive moments in class. Of course, teachers should make allowances for the normal fluctuations in mood that characterize healthy development. The child whose behavioral changes persist and clearly interfere with his or her development deserves extra attention.
Teachers who are concerned that a student is depressed might first speak with the guidance counselor or school psychologist to discuss options for further investigation or referral. When classroom behavior is dangerous or journals or essays suggest suicidal or homicidal thoughts, teachers should make a referral through the school's proper channels.
In the classroom, teachers need to be aware that depressed students often feel as if they have little to contribute. Teachers should show confidence, respect, and faith in the student's abilities. The teacher might also ask questions in class for which there is no clearly correct answer. A depressed student may be more likely to participate when there is a minimal chance for embarrassment, though one needs to be careful not to increase the already mounting anxiety that depressed children and adolescents experience.
Encouraging the student to assist younger or less able students might also help. Developing a connection between the student and a trusted teacher or coach can be invaluable; studies have shown that adults who suffered from depression when they were younger often recall a specific teacher as central to their recovery. In addition, young people are often reluctant to discuss their feelings directly. They might instead identify with literary or historical figures and use them to explore their own feelings.
None of these techniques should substitute for treatment for a depressed student. Attempting to "treat" a depressed student in the classroom is not fair to the suffering student or to the rest of the class. Nevertheless, teachers occupy a unique position in their students' lives. By attending to problems such as depression and sadness educators provide lasting and significant benefits to their students.
End Notes

1 American Psychiatric Association. (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: Author.

Steven C. Schlozman has contributed to Educational Leadership.

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