“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”.
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.