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Weller, Weller, and Fristad (1984) suggest four models of how depression
might be triggered in children. The first is the behavioral reinforcement model,
which suggests that inadequate or insufficient positive reinforcement leads to a
sense of powerlessness in the student. The learned helplessness model states
that depressed students create a perception of hopelessness because they see their
behavior as independent of reinforcement. The model of cognitive distortion
claims that depression comes from negative conceptualizations of the self, world,
and/or future. And finally, the life stress model states that depression is formed
when there are changes in the life of the child that necessitate adaptation. Ramsey
(1994) adds that depression can be brought about by embarrassment; social
setbacks; frustration; conflicts with authority, friends or loved ones; personal
failures; serious illness or death (p.258).
There is also a potential medical component to depression, based on the
chemicals in the brain. Arkowitz and Lilienfeld explain that a deficiency of certain
neurotransmitters (chemical messengers) at synapses, or tiny gaps, between
neurons interferes with the transmission of nerve impulses, causing or contributing
to depression. They point out that in modern day, the chemical serotonin
has
garnered the most interest, but there are actually many other chemicals that may
be playing a role. The effectiveness of antidepressants, which in most cases
increase the levels of serotonin, is often used as evidence for this notion of a
chemical imbalance being the root cause of depression. Akowitz and Lilienfeld,
however, argue that brain chemicals are just one component of depression and that
we need to integrate everything we know about depression in order to treat it. This
may explain why many psychiatric professionals and researchers, such as Maag and
need, stating that the rising number of students and families in need of mental
health services, coupled with the decline in mental health programs, place school
counselors in the difficult position of sometimes being the only accessible mental
health service provider" (p.284). Bauer (1987) argues that teachers are in a great
position to assist in identification of at risk students and to make referrals to
guidance counselors, and Abrams, et al. (2005) claim that school counselors are in a
situation to understand the needs of both the student and the family, and may have
knowledge of and access to resources in the community.
Interventions and Treatment
Before delving into what can be done at the school level, it must be noted
that one of the most helpful treatments of depression is medication. According to a
study by Epstein and Cullinan (1986), approximately 75% of depressed individuals
taking medication show improvement. This is not a treatment that would be carried
out by the school, but if necessary, the school can play a role in assisting in setting
students and families up with appropriate psychiatric care. It is also important to
note, as Bauer (1987) points out, that these medications do present side effects
that can be physically dangerous and/or academically challenging, such as fatigue,
dry mouth, nausea, cardiovascular irregularities, and seizures (p. 83). Given that
teachers spend large periods of time observing and working closely with students,
they need to be aware of students being medicated and keep a lookout for these
side effects.
On a systematic, or school-wide, level there are a number of approaches to
addressing depressed students. One such systematic approach is the ecological
approach, which is presented by Abrams, et al. (2005). The concept behind this
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approach is that a student has many different factors and influences impacting his
or her life and an understanding and appreciation for those factors can help in
addressing depression. The model identifies four systems with which any child
interacts. The mesosystem, or microsystem, is the one closest to the child and
includes family, school, peers, and neighborhood. Next, the exosystem focuses on
factors that are outside a childs microsystem but can affect it, such as government
cutbacks in services. The macrosystem is further removed and includes things like
culture, society, global events, etc. And finally, the chronosystem accounts for the
time in history in which the child lives (this may seem irrelevant, but given that until
recently depression was not believed to exist in children, the time in which a child is
born can play a role in his or her mental wellbeing).
The argument behind this system is that schools, and particularly school
counselors have access to the student, as well as various aspects of their
microsystem. According to this approach, the counselor would lead the process by
convening a team made up of those in a students life. That team would form
hypotheses through an investigation of the students systems as to what might be
negatively affecting a childs depression and also what possible sources of strength
and healing exist within his or her world (p. 286). Interventions would then be
created and implemented based on these findings.
The team would begin with the individual student, looking for potential issues
stemming from him and possible interventions to address those issues, and would
then move outward through the different systems. For example, starting from the
child, if the team sees that the child is not receiving ample opportunity to be active
in school, they might create an intervention that allows for more exercise, as that
releases endorphins and is an effective way to combat depression. Other
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interventions at the level of the child might include a change in nutritional intake,
sleep patterns, and counseling. The microsystem level might uncover issues such
as divorce and interventions might include teaching a child coping mechanisms or
encouraging him to leave the house if things get heated. Similarly, if a depressed
student is struggling in school, an intervention might include finding areas of
competence and allowing him opportunities to invest time in those areas. The
energy and positive feelings he experiences in those times may spill over into the
rest of his day. As Abrams, et al. (2005) write, success breeds success. It may be
very effective to build success into the students day by ensuring that academic
goals are achievableand by involving the student in the discussion of goal setting
(p.289).
Another approach that is applicable at a school-wide level is that of CognitiveBehavioral Interventions (CBI), which focuses on cognitions and behaviors. With
regards to cognition, interventions target a students thoughts and private speech
about himself/herself, the environment, and his/her future (Maag and Swearer,
2005, p.260). CBI also includes a behavioral component, which includes modeling,
role playing, and positive reinforcement.
Maag and Swearer (2005) offer four CBI techniques for countering
depression. The first is self-instruction training, which is a means of teaching
children positive self-talk as a means of helping them gain self-control over certain
elements of depression, such as countering negative self-statements with positive
ones (p.261). The concept is to teach students to use certain positive phrases
while carrying out tasks that help instruct them as to how to be successful in the
task.
The next technique is attribution retraining, which focuses on the fact that
depressed students often attribute failure to something internal and unchanging in
themselves, and success as something external and changing. This technique tries
to reverse that thinking. One way to do this is to have students make statements
that link failure to insufficient effort, i.e. something that is changeable and can be
affected by himself.
Another technique mentioned by Maag and Swearer is problem solving
training, which teaches students a variety of skills to use in order to resolve a
conflict or address an issue. The purpose of this technique is to help students who
are depressed develop alternative solutions to problems that may be otherwise
thought of as insurmountable and to change their locus of control orientation from
external to internal (p.262). This tactic shows students that they have control over
their situations, they can act and need not feel helpless.
Cognitive restructuring is a technique that focuses on identifying and
altering young peoples irrational beliefs and negative self-statements by training
them to dispute irrational thoughts through the use of logical analysis and abstract
thinking (p. 262). Maag and Swearer site two types of cognitive restructuring:
rational-emotive therapy (RET) and cognitive therapy. The premise of RET is that
most everyday problems come from irrational self-statements we tell ourselves
and we can counter that by teaching children to counteract irrational beliefs with
more positive and realistic statements (p.262). The primary way this is
accomplished is by having children exaggerate these irrational beliefs to show their
ridiculousness. In cognitive therapy, children are instructed to identify the negative
thoughts that may be leading to depression and to work on counteracting them.
One method for doing that is reality checking, in which the child forms a
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hypothesis based on the negative thought and tries to test it to determine if his
negative thought is accurate.
Aside from school-wide approaches, there may be things all adults in a
depressed childs life can do to create an environment for success. Teachers and
parents need to help children form positive self-concepts. Ramsey (1994) suggests
that adults capitalize on strengths and children should be encouraged to become
involved in group activities that utilize their skills and give them the opportunity to
feel accepted and succeed (p.260). In school and at home, we can give children
tasks that utilize their skills and strengths and set them up for success and positive
self-concepts. Ramsey suggests further that even the language we use can build
positive self-concepts and encourage positive thinking. For example, students who
are struggling with a task can be challenged to change their thinking from I cant
to I will try (p. 261). Furthermore, students suffering from depression need to be
given control over their tasks. One suggestion Ramsey offers it to ask a child to join
you in making a task list. Additionally, because depressed students often suffer from
anxiety, physical exercise, active relaxation procedures (such as yoga), or passive
relaxation techniques (such as imagery) help reduce and manage anxiety (p. 261).
Lastly, and maybe most importantly, depression often goes along with suicidal
feelings and thoughts. Ramsey stresses how important it is for students to be
provided with ample and always available opportunities to talk about troublesome
feelings and events without judgement. It is also crucial that a school have a crisis
intervention plan that details the process for handling emergencies immediately
(Abrams, 2005, 291).
The school is a central institution of a childs or adolescents life. Students
spend a large portion of their waking hours there, it is often the source of most of
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their social interactions, it is where they learn, play, and eat. Given this centrality
and the mission of a school to prepare their students for the world, identification
and treatment of student depression is a responsibility that schools cannot deny.
Schools cannot take the place of mental health professionals, but they have a
critical role to play in addressing this very important need and creating an
environment in which all their students can succeed.
References
Abrams, K., Theberge, S. K., & Karan, O. C. (2005). Children and adolescents
who are depressed: An ecological approach. Professional School Counseling, 8(3),
284-292.
APA Psychology Topics: Depression. (2000). Retrieved from
http://www.apa.org/topics/depress/.
Arkowitz, H., & Lilienfeld S. O. (2014, March 1). Is Depression Just Bad
Chemistry? Scientific American Mind, 25. Retrieved from
http://www.scientificamerican.com/article/is-depression-just-bad-chemistry.
Bauer, A. M. (1987). A teachers introduction to childhood depression. The
Clearing House, 61(2), 81-84.
Epstein, M.H., & Cullinan, D. (1986). Depression in children. Journal of School
Health, 56(1), 10-12.
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