June 29, 2004
A Teacher’s Guide to Understanding and Working with
Students with Depression
The position of depression as a disability is ambiguous. Though early definitions of emotional and behavioral disabilities included depression, more recent definitions seem to leave depression as a possible side effect of the primary emotional and behavioral disabilities (Gearheart 367). Our primary textbook lists depression and suicide under “Related Considerations” along with adolescence and Substance Abuse (413). Despite this apparent backpedaling, Gearheart, et al. states that “childhood and adolescent depression as a disorder differentiated from adult depression has only recently become a topic of study.”
What is clear is the need for recognition and dissemination of information about this very valid disability. As one student wrote, “Teachers are trained to handle students who lack discipline, the slow learners, the extremely bright, and even kids who have ADHD. What I’ve discovered, though, is that they aren’t prepared to teach the students suffering from depression” (Madison). This student went on to describe the kinds of teachers she had: those who ignored her and those who approached her on a too personal level.
I am very afraid that these two reactions remain the most popular ones for a disability that can and quite often does kill the students it affects. Of all the disabilities, it seems depression should be one of the most studied and most watched for. What follows is an early attempt to provide a resource for initiating this reintroduction (or introduction) of depression into the regular teacher’s awareness.
However, childhood and adolescent depression is less researched and has a relatively short history. Children were not considered capable of experiencing depression in the past, particularly in the wake of Freudian psychology, which does not consider them sophisticated enough (Nunley). In the 1970’s, childhood depression was viewed as “masked” by other disabilities, but others in more recent times have moved toward looking at it in terms of adult depression, which is probably unwise (Nunley). Nevertheless, looking at depression as equivalent in some degree to adult (or established) depression gives credibility and weight to depression in youth (children and adolescents).
A 2000 study determined that 2.5% of children and 8.3% of adolescents live with depression. This number has generally increased over the past three decades while adult numbers have not increased as much (Warwick 62; Cooper 47). This number also increases during adolescence, especially among girls. Of course, adolescence is not the most ideal time to become distracted or otherwise dysfunctional. The sapping of motivation involved in depression can seriously affect schooling, thereby putting the youth back in her studies and furthering the depressive cycle by suggesting the student’s academic worthlessness. Depression does effect academic performance. Lose (or never gain) a sense of direction or purpose, thereby affecting their adult lives as well.
Most youths with depression also exhibit other behavioral problems. Warwick reports that 75% also have anxiety disorder, 50% have oppositional disorder, 33% have a conduct disorder and 25% have substance abuse problems (63). Episodes of depression have a 70% chance of relapsing in five years (Warwick 68) and most childhood depressives also experience depression in adulthood. Studies over the past five years have only reinforced the position that depression in these age populations is significant and largely misunderstood.
Depression can be viewed either as a continuum or as discrete illnesses (Warwick 62). As a continuum, depression is a stage in reacting to stresses, occurring after anxiety and anger, generally (51). When depression interferes with function, it becomes a disorder. When it develops into a significantly dysfunctional or abnormal state, it is an illness. These are all merely terms, however, and the discussion emphasizes not only the frequency of depression but the possible clinical seriousness of it as well.
The following are the major divisions or kinds of depression. More specific information about each division can be found at the surgeon general’s website, www.surgeongeneral.gov or the National Institute of Mental Health website, www.nimh.nih.gov.
Dysthymia (Depressive Neurosis)
A lifelong, chronic and mild form of depression.
Useful as a neutral term that encompasses the many signs of a depressive state, thereby differentiating between an isolated “blues” period and a more serious, recurring depression that encompasses many related symptoms.
Major Depressive Order (Unipolar Depression)
Main category used by the American Psychiatric Association. Five of their nine primary characteristic symptoms must be present for at least two weeks, producing a functional impairment. Some consider this category to be too inclusive, resulting in the over-identification of severe, clinical depression.
Bipolar Depression (Psychotic Depression)
Severe depression alternates with mania. Bipolar depression can be hard to separate from ADHD. These children exhibit grandiose behaviors (believing they can do anything) and flight of ideas. They can also become hyper-sexualized. Onset of this depression is always marked by radical and odd changes in behavior.
“This term is sometimes used to describe those children where depression and conduct disorder seem to have equal importance” (Warwick 64). Such a blending of disabilities is one reason that depression is often considered as a complement to EBD.
Considered a more severe case of “mood swings,” but is usually not disabling.
Grief can develop into depression, but grief generally does not include feelings of worthlessness, and is therefore not a form of depression.
Suicidal thoughts are closely linked to depression because of the shared feelings of hopelessness and uselessness, but there are number of young people who consider and commit suicide who were not observably depressed, so it is an important condition in its own right. Suicide is closely linked with “family dysfunction, behavioral problems and psychosocial stressors such as poverty” (Warwick 117), as well as with gifted students (Gearheart 414). Nevertheless, depressed students should be watched carefully for signs of suicidal thoughts. A relatively recent report from the National Institute of Mental Health reported that 2,000 adolescents (15-19) who were depressed in one particular year committed suicide while 2,330 depressed adolescents (10-14) committed suicide (“USA” 4). Sudden happiness in depressed students can be evidence of a decision to commit suicide. Methods for preventing suicide can also be effective methods for preventing depression, but careful thought should always be exercised.
Children can become depressed around the age of seven or eight (Warwick 49). As stated above, depression is most likely to occur during the adolescent years. While the symptoms and warning signs of youth depression are generally similar to adult symptoms, some symptoms are more likely to be easily noted in youth. The following is a fairly complete list, but psychologists tend to place the most emphasis on the first item in the list.
(Warwick 62; Cooper 98; Gearheart 413)
It is very important to determine that these symptoms last a significant amount of time or recur systematically and are not the side effect of other emotional or behavioral difficulties or a temporary low in the child’s life.
Youth who exhibit the above symptoms as well as the common student in the classroom can benefit from the following preventative measures.
If preventative measures do not work (this should not be considered a failure) and a teacher suspects a student is in a depressed state, that teachers should follow the protocol of her school or district. This protocol will probably follow the general protocol of all exceptionalities. The parents should be informally contacted once the teacher has enough recorded behavior to demonstrate her worry. This proof may include the results of a test, but most tests will probably be administered after the child’s official paperwork has begun.
Tests and scales exist to gauge depression in youths including the Children’s Depression Scale (CDS), the Children’s Depression Inventory (or the Beck Depression Inventory), and the Hopelessness Scale for Children (Cooper 98). Tests particularly geared for teachers include the Connors Teacher Rating Scale (which will gauge anxiety) and the Rutter (B2) Rating Scale. Though none of these tests should be used as a definitive diagnosis, they can help a concerned adult, such as a teacher, to keep records and substantiate concerns. There are a number of other tests that professionals can administer and even tests that parents can take, such as the Connors Parent Symptom Questionnaire (Cooper 99). A positive result from any of these testing tools should result in a more thorough examination by a professional who can make the diagnosis.
Order of protocol (counselor, teacher, mental health professional or doctor)
Teachers can also use sociometry (determination of how children view each other socially) to pinpoint students who may be in danger of developing or already experiencing a depressive state. A common technique is asking students to pick which students they’d like to work with, which they would not. Any practice of sociometry must be used carefully, however, because of the possible damaging effects the information can have on the children (Cooper 100).
After enlisting the parents, a discussion with the school counselor or another professional will determine need and an IEP may be begun. Regardless of the results of the testing, a teacher’s continued observations are very helpful in shaping the student’s IEP.
Although studies have shown that youths are able to resolve their own causes of depression spontaneously, methods of intervention are important.
One method is to remove the cause of the depression, assuming that the depressed state is a result of an event of specific loss. Stark recommends asking:
Being sure to point out the positives in a youth’s life, or simply being a positive for that child, can have remarkably positive results. Teachers should never falsely praise, but should be sure to provide frequent praise and implied worth. Discussing the student’s work with future aspects in mind – “This is a really good summary of this book. Do you think you can help me make a collection of summaries to use next year?” – can provide a sense of purpose and worth for a student who believes they are not capable of anything.
Closely related is cognitive therapy, which teaches the youth to actively reverse negative thought patterns. If the family is the cause of the youth’s depressive behavior, family therapy may be beneficial. Also related is the pointed teaching of social skills to lessen any isolation that could be creating or perpetuating a sense of depression (Gearheart 414). Generally, the term psychotherapy covers these methods and others like them. They seem to result in relatively few relapses, but studies are not very prevalent (NAMI).
Another, more popular method involves administering anti-depressant drugs, though there have not been enough studies centered on young adults to be certain of the benefits of administering drugs to that age group. Drugs are often used as the back-up to other kinds of treatment.
Intervention should always be taken when a student shows signs of depression and talks of suicide. Such intervention would include increased monitoring of the youth and calling in a professional to make a risk assessment. No threat of suicide should ever be taken lightly.
So what can teachers do to accommodate students who are depressed? A few key ideas follow.
Another important question, and one that occurs most frequently among teachers is what a teacher should do and act with these students. The following recommendations come from experienced teachers and students recovering from depression.
No teacher should ever feel that they are the only person who can help the depressed child. The teacher should make sure the student gains a wide range of adults and other students to help them cope including specialists, friends and parents. In the end, none of these measures may prove effective; a student may remain in a highly depressed state or may even successfully commit suicide. But the teacher must keep trying and, most importantly – continue care about each student. Hopefully, more information and new methods of treating and working with depression will be discovered. Until then, it is largely up to teachers to let no student fall go unnoticed – a tall order, but an important one. This disability can become a matter of life or death.
Andrews, Jeffrey A., Eric R. Wright, Harold E. Kooreman, Wanda K. Mohr and Lisa A. Russell.
“The Dawn Project: A Model for Responding to the Needs of Children with Emotional and Behavioral Challenges and Their Families.” Community Mental Health Journal, 39:1 (2003), 63-74.
Carnes, Joyce. “Suicide: A Teacher’s Experience.” Teacher Talk, 3:2 (1996). CAFS.
<http://education.indiana.edu/cas/tt/c3i2/depteacher.html> Accessed June 27, 2004.
“Child and Adolescent Bipolar Disorder.” NAMI. <www.nami.org> Accessed June 27, 2004.
“Childhood Depression and Implications for the Classroom.” Brooks Educational Newsletter.
(2002). <www.pbrookes.com/email/archive/january02/January02ED3.htm> Accessed June 27, 2004.
*Cooper, Paul. Understanding and Supporting Chidren with Emotional and Behavioral
Difficulties. London: Jessica Kingsley Publishers, 1999.
“Depression and Suicide in Children and Adolescents.” Mental Health: A Report of the Surgeon
General. (1999?) <www.surgeongeneral.gov/library/mentalhealth/chapter3/sec5.html> Accessed June 27, 2004.
Freden, Lars. Psychosocial Aspects of Depression. New York: John Wiley & Sons, 1982.
Gearheart, Bill R., Mel W. Weishahn and Carol J. Gearheart. The Exceptional Student in the
Regular Classroom. 6th ed. Upper Saddle River, New Jersey: Prentice Hall, 1996.
Joan, Polly. Preventing Teenage Suicide. New York: Human Sciences Press, Inc., 1986.
Kumpulainen, K., E. Rasanen, I. Henttonen, K. Puura, I. Milanen, J. Piha, T. Tamminen, and F.
Almqvist. “Psychiatric Disorders, Performance Level at School and Special Education at Early Elementary School Age.” European Child & Adolescent Psychiatry, 8:Suppl. 4 (1999), IV/48-IV/54.
Madison, Alexandra. “Depression in School: A Student’s Trial.” Teacher Talk. CAFS. 3:2
(1996). <http://education.indiana.edu/cas/tt/v3i2/depress.html> Accessed June 27, 2004.
Nunley, Kathie F. “The Relationship of Self-Esteem and Depression in Adolescence.” (2001).
<www.help4teachers.com/depression.htm> Accessed June 27, 2004.
Osher, David, Gale Morrison and Wanda Bailey. “Exploring the Relationship Between Student
Mobility and Dropout Among Students with Emotional and Behavioral Disorders.” The Journal of Negro Education, 72:1 (2003), 79-96.
Robbins, Paul R. Understanding Depression. Jefferson, North Carolina: McFarland &
Company, Inc., 1993.
“USA WEEKEND’s Teaching About Teens and Self-Image Classroom Guide.” USA Weekend,
Warwick, Ian, Peter Aggleton and Jane Hurry. Young People and Mental Health. New York:
John Wiley and Sons, Ltd., 2000.
Watt, Toni Terling. “Are Small Schools and Private Schools Better for Adolescents’ Emotional
Adjustment?” Sociology of Education, 76:4 (2003), 344-367.