Children are suffering because not enough is understood about depression in the young, mental health experts say. But others contend too many kids are being labeled 'mentally ill' by mistake. : What We Don't Know

By SHARI ROAN

June 29, 1993 12 AM PT

TIMES HEALTH WRITER

He was a bright little boy, but he was different.

“Difficult,” say his parents.

When he was a toddler and still not sleeping through the night, his mother would take him to the pediatrician.

“I would say, ‘There must be something wrong. He must be teething. He must have an ear infection,’ ” recalls his mother, whom we’ll call Renee because the family does not wish to be identified. “But nothing was wrong.”

Still, there was something wrong with the child. And no one could put their finger on it--yet.

When he was 8 and went out on his own to purchase audiocassette tapes on reducing anxiety, his parents chuckled. He was something, this son of theirs.

“I never took him quite seriously enough. How could you?” asks Renee.

At 12, the boy had become irritable, quick to anger, impulsive. He was immature. His parents sought the help of a psychologist who called him “just a difficult little boy.”

School officials tested him. But he needed no special services, they concluded.

At 15, he had bouts of fatigue and “feeling down.” But he always seemed to bounce back.

Then, at 16, the boy began having severe panic attacks and hallucinations. He was hospitalized and eventually was diagnosed with bipolar depression or manic depression, in which bouts of depression alternate with feelings of mania or euphoria.

“It was a devastating thing to watch and go through,” says Renee. “But when it finally happened, it was the beginning of the final piece of the puzzle as to who he was.”

According to mental health experts, there are many more like this Westside youth.

Recent research suggests more American children may suffer from clinical depression than previously acknowledged. The numbers appear so high, in fact, that experts now believe that many depressed adults first became ill during adolescence.

The problem, they say, is that neither parents nor teachers nor many mental health professionals are good at spotting depression in young people, and too many ill children go undiagnosed or are not treated appropriately.

“We need to learn the signs and symptoms of depression early on,” says Dr. Steven Aletkin, a Long Island psychologist who believes teachers and guidance counselors should be taught to recognize depression. “We have an increase in teen suicide, drug and alcohol use. A lot of these situations can either be stopped or the frequency can be significantly reduced if we are more sensitive to the early signs of depression. Unfortunately, we often don’t intervene until a late stage, when a child is severely acting out or has attempted suicide.”

But some experts fear this increased awareness may backfire. They suggest that too many youths are being labeled “mentally ill” when they are merely reacting normally to the harsh social conditions in which they live.

“Psychiatric solutions have been oversold in this country,” argues Louise Armstrong, author of a new book, “And They Call It Help: The Psychiatric Policing of America’s Children,” which criticizes what she says is a tendency to diagnose normal children as mentally ill.

In her research, Armstrong said she found scores of families who were told their children needed psychiatric services but who later felt misguided. Armstrong is particularly critical of the psychiatric hospitalization of youths, which she says medical authorities too often recommend to hapless parents because hospitalizing kids is lucrative.

“We are told treatment can’t harm them. But the kids are robbed of confidence in who they are. They are told there is something wrong with them,” she says.

What’s wrong may have more to do with the violence, stress or poverty the child is growing up in, Armstrong says.

To be sure, better methods to diagnose and treat depression in young people are desperately needed, says Dr. Michael Strober, a psychiatry professor at the UCLA School of Medicine.

“There seems to be as great a tendency to over-diagnose as under-diagnose,” says Strober, who recently completed a study on whether youths referred to UCLA for depression were actually clinically depressed. “There needs to be a general raising of consciousness on this whole issue.”

No one knows how many American kids suffer from depression. According to the American Psychiatric Assn., the number is about 3 million to 6 million--almost evenly divided between the sexes until puberty, when girls experience a significant increase in the disorder. In a 1982 study of 3,000 children in Grades 3 through 9, 15% had symptoms of depression.

A more telling statistic may be the nation’s suicide rate. Suicide, which is most often linked to a mood disorder, has increased 200% among youths aged 10 to 24 since 1960.

Studies show that at least 25% of adults with bipolar depression had their first bout during adolescence, Strober says. Unipolar depression, which is more common, is thought to be slightly less likely to occur early in life. There is a link between a family history of depression and early onset of either disorder.

Other than a family history of mental illness, however, there has been much confusion about what signs, symptoms and risk factors are linked to depression in young people.

Renee says that even though her son was diagnosed several years after his symptoms first occurred, the family had tried hard during that time to figure out what was wrong.

“We overlooked nothing,” she says. “We avoided nothing. We were always trying to decide ‘What is the best thing for him?’ But detecting the depression was hard for me. I see a lot of teen-agers, and they are all a mess.”

Yet, she notes, her son’s problems “were more chronic. The issues never disappeared. We were always wondering.”

Angela Alvarez also had an inkling that something was wrong with her young son, Daniel. But she didn’t see the suicide attempt coming.

“He would always cry easily. He seemed to be hypersensitive. He was withdrawn,” says Alvarez, a single mother of three who lives in Los Angeles.

At age 7, Daniel jumped from the roof of the family’s apartment building. He landed on a patio just below the roof and was spared serious injury.

“I didn’t know he was anywhere near that bad,” says Alvarez, who is now president of a local support group called Parents’ Advocate Council and who has been honored for her work in assisting parents.

“I knew that he felt like he needed attention. I knew that he was very, very sad. But you go through this range of emotions before you can come to grips that ‘maybe my child does have this disability,’ ” she says.

There are major differences between “normal” kids who sometimes act like this and children who are depressed, Strober cautions.

“Clinical depression is persistent and incapacitating,” he said. “It is not only associated with a depressed mood but a whole complex of related behaviors, such as trouble concentrating, relationship problems and sleeping and appetite changes. It is pervasive and tearing in a way that the normal moodiness of adolescence is not.”

It is here, however, that critics of psychiatric treatment like Armstrong object, lambasting society’s tendency to label children depressed or mentally ill if they are the victims of social conditions such as violence, sexual abuse or dysfunctional families.

“Often there is no other reason (for the behavior) other than a circumstantial reason,” she says. “The definition of depression is too vague.”

Parents, however, should not dismiss a child’s persistent unhappiness, says Collette Dowling, author of the book “You Mean I Don’t Have to Feel This Way?” Dowling’s husband and daughter, Gabrielle, suffered from depression.

“People say it’s natural for adolescents to be unhappy. That is completely bogus,” she says. “It’s true they have a lot of stress and change to deal with, but they should not normally be feeling depressed. The problem is that we have not been educated to think about kids this age becoming depressed.”

By her early 20s, Gabrielle seemed different, recalls Dowling, who writes about her daughter’s depression in her book.

She was forgetful, unreliable and complained of physical ailments, such as flu, fatigue or stomachaches. Gabrielle continued to work but felt increasingly that she was plodding through life, surrounded by a curtain of gloom. It was a major effort to perform her job.

Eventually, depression was diagnosed. In retrospect, the signs had been there for a long time, says Dowling. She had been a somber, melancholy youth, unfulfilled by her many talents.

“Puberty is when the rate of depression jumps in women,” says Dowling, whose daughter was treated swiftly and effectively with antidepressants. “Research is just starting to look at the role of hormones in depression.”

While less is known about causes, it is clear that the consequences of untreated depression in children are staggering, says Dowling.

“Depression in children has worse effects than in adults because it interferes with development, both socially and emotionally,” she says.

When adults with bipolar depression were asked how the illness had affected them as teen-agers, they cited big losses: dropping out of school, later financial and marriage problems, substance abuse, suicide attempts and a history of minor crimes.

Generally, both antidepressants and psychological therapy help kids with depression, although a “standard of care” for depression in young people has yet to be established, Strober says. This fall, UCLA and five other medical centers will participate in a study examining two classes of antidepressants in teens--the first large-scale study of the effects of antidepressant drugs in adolescence looking at both short- and long-term effects.

The research is sorely needed. Errors in treatment are commonplace, says Strober. For example, youths are sometimes given counseling without needed antidepressants. Or antidepressants are given at too low doses. Too often, he says, the doctor or therapist will not try alternative treatments when the child does not improve.

But better medical care is only part of what’s needed for depressed youths. Many are also ill-treated by school, social services, child welfare and juvenile justice systems, say parents and mental health advocates.

Sharon’s, teen-age son, Elliott, was expelled from school for poor behavior--even though he had been diagnosed with clinical depression.

“The school said he was rebelling, that he was a behavior problem,” says the South Bay mother, who asked not to be further identified. Her “straight-A” son had become withdrawn, had dropped out of soccer and often wrote essays in school that rambled on for pages without punctuation.

“Initially, I felt, ‘Maybe they’re right. Maybe he is just rebelling.’ You never think of a mental health problem striking your family,” she says.

But Elliott was hospitalized for depression last year at age 13. He has improved with treatment, but his parents are still fighting the school system to get special education services for their son.

“We gave them the medical evidence, but they said he didn’t meet the standards for special education,” Sharon says. “The schools just don’t want to deal with it.”

Alvarez says this case is typical.

“We’re trying to work with the school system,” she says. “But they have been less than responsive. They don’t see this as a major issue for them.”

The needs of mentally ill kids are only now being addressed, acknowledges Barbara Huff, director of the National Federation of Families, a parent-operated advocacy group, based in Alexandria, Va., for children with mental disorders.

“This disability is 30 years behind advocacy efforts for children with mental retardation,” she says. “Our advocacy efforts are just beginning.”

Signs of Depression in Teens and Children

Parents should look for:

* Depressed mood (absence of joyfulness, chronic boredom or apathy)

* Irritability and anger that are persistent and unreasonable

* Lack of self-esteem; persistent feelings of worthlessness

* Disturbed sleeping patterns

* Changed eating habits

* Social withdrawal (abrupt or longstanding)

* Drug and/or alcohol abuse

* Talk of death or suicide

* Frequent complaints of physical illness, such as headaches or stomachaches