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Wednesday, July 21, 1999The great burden some children bear
One of Dr. Tatyana Barankin's patients has been talking about how difficult it is to be happy. She wonders what meaning there is in life and says she feels so badly she would like to step in front of a car. The patient is nine years old.
Barankin is the director and founder of the Children at Risk clinic at the Clarke Institute of Psychiatry in Toronto, a facility for children who risk developing depression. The doctors at the clinic take children who have a depressed parent and assess the children's own risk for becoming depressed. If a child is already depressed, they try treatment. Otherwise, they set up a system for monitoring the child to see if depression occurs later.
The clinic is the only one of its kind in Canada, and there are very few in North America.
"It's a poorly resourced area. There is still very bad awareness of the problem," says Barankin. "But the awareness now is much better than it was 12 years ago [when she founded the clinic], when doctors would say, 'What are you doing with those kids?' . . . My colleagues used to say, 'Leave the poor children alone. The parents are damaged enough. Why do you want to do this to the kids?' "
Not every child with a depressed parent will become depressed, but the odds are certainly against them: If one parent is depressed, there is a 15-17% chance that the child will turn out to be depressed, too; if both parents are depressed, the risk to the child jumps to 45-50%. The genetic risk for depression is part of it, but there is also the fact that living with a depressed person can affect the child.
"You can imagine what it's like [for the child], whether it's the mother or the father, and they're sleeping in bed all day and not going to work and not doing the household chores and they are less available to the kid," says Dr. Marshall Korenblum, a child psychiatrist at the Hincks Institute in Toronto who treats depressed adolescents and also works in Barankin's clinic at the Clarke.
"I can think of a number of cases where the mom is depressed and is spending days and weeks in bed . . . The child is worried about the mother . . . The kid turns into the parent and the parent becomes the child. The kids are forced to grow up pretty fast."
The statistics show that 18% of children between the ages of four and 18 have some sort of mental disorder. By the end of adolescence, 8-10% of kids are diagnosed with clinical depression. It is less common in pre-adolescence, with only about 4% of children at about age 12 showing signs of an actual clinical depression, but that's because the signs of depression aren't usually manifested until adolescence. Children who have a depressive episode before puberty have a high risk of depression becoming a regular part of their lives.
That's why it is important to detect depression early.
"When I first arrived at the Clarke [five years ago], I went up to the mood disorders clinic for adults and asked how many of the adults that you see have children in this age range," says Dr. Lynn Oldershaw, a psychiatrist at the clinic. "They looked at me blankly, saying, 'We never asked if they had kids.'
"One thing we know that is highly predictive of problems in these kids is an attributional style where they tend to blame themselves for things like the parents' behaviour," says Oldershaw.
Often, these children don't understand that their parents are ill and that it has nothing to do with them. One of the first things the doctors do is try to explain the illness to the children, so they understand that none of it is their fault.
The children are given a diagnostic interview that is stretched over a few weeks. The doctors look at everything from how the child has reacted to recent events in their life to whether the child characterizes things in a negative or optimistic fashion. The doctors usually ask to see the child again in a year if there are no problems, in six months if there are some early signs of depression. If the child is already depressed, they put the child into therapy immediately.
The method of treatment varies: family talk-based therapy, individual therapy, cognitive therapy (where the child is taught how to think differently), phototherapy (using light) and, as a last resort, even drug therapy.
Barankin has been teaching an elective course to medical students at the University of Toronto that aims to make doctors more aware of the possibility of depression occurring in the children of depressed parents. Doctors from all over the country have passed through Barankin's course. She says paediatricians and family doctors are now detecting the signs of what has been an invisible problem for a long time and are passing these children on to the clinic at the Clarke.
"Most of these kids don't talk about this with anybody," says Oldershaw. "So it's good for them to realize that someone else experiences this and to work with group leaders who can challenge some of their maladaptive belief systems."
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