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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


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.

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