Adolescent Depression: The Under Acknowledged Disease

Adolescent Depression: The Under Acknowledged Disease

        Depression is a disease that afflicts the human psyche in such a way

that the afflicted tends to act and react abnormally toward others and

themselves.  Therefore it comes to no surprise to discover that

adolescent depression is strongly linked to teen suicide.  Adolescent

suicide is now responsible for more deaths in youths aged 15 to 19 than

cardiovascular disease or cancer (Blackman, 1995).  Despite this

increased suicide rate, depression in this age group is greatly

underdiagnosed and leads to serious difficulties in school, work and

personal adjustment which may often continue into adulthood.  How

prevalent are mood disorders in children and when should an adolescent

with changes in mood be considered clinically depressed?

        Brown (1996) has said the reason why depression is often over looked in

children and adolescents is because "children are not always able to

express how they feel."  Sometimes the symptoms of mood disorders take

on different forms in children than in adults.  Adolescence is a time of

emotional turmoil, mood swings, gloomy thoughts, and heightened

sensitivity.  It is a time of rebellion and experimentation.  Blackman

(1996) observed that the "challenge is to identify depressive

symptomatology which may be superimposed on the backdrop of a more

transient, but expected, developmental storm."  Therefore, diagnosis

should not lay only in the physician's hands but be associated with

parents, teachers and anyone who interacts with the patient on a daily

basis. Unlike adult depression, symptoms of youth depression are often

masked.  Instead of expressing sadness, teenagers may express boredom

and irritability, or may choose to engage in risky behaviors (Oster &

Montgomery, 1996).  Mood disorders are often accompanied by other

psychological problems such as anxiety (Oster & Montgomery, 1996),

eating disorders (Lasko et al., 1996), hyperactivity (Blackman, 1995),

substance abuse (Blackman, 1995; Brown, 1996; Lasko et al., 1996) and

suicide (Blackman, 1995; Brown, 1996; Lasko et al., 1996; Oster &

Montgomery, 1996) all of which can hide depressive symptoms.

        The signs of clinical depression include marked changes in mood and

associated behaviors that range from sadness, withdrawal, and decreased

energy to intense feelings of hopelessness and suicidal thoughts. 

Depression is often described as an exaggeration of the duration and

intensity of "normal" mood changes (Brown 1996).  Key indicators of

adolescent depression include a drastic change in eating and sleeping

patterns, significant loss of interest in previous activity interests

(Blackman, 1995; Oster & Montgomery, 1996), constant boredom (Blackman,

1995), disruptive behavior, peer problems, increased irritability and

aggression (Brown, 1996).  Blackman (1995) proposed that "formal

psychologic testing may be helpful in complicated presentations that do

not lend themselves easily to diagnosis."  For many teens, symptoms of

depression are directly related to low self esteem stemming from

increased emphasis on peer popularity.  For other teens, depression

arises from poor family relations which could include decreased family

support and perceived rejection by parents (Lasko et al., 1996).  Oster

& Montgomery (1996) stated that "when parents are struggling over

marital or career problems, or are ill themselves, teens may feel the

tension and try to distract their parents."  This "distraction" could

include increased disruptive behavior, self-inflicted isolation and even

verbal threats of suicide.  So how can the physician determine when a

patient should be diagnosed as depressed or suicidal?  Brown (1996)

suggested the best way to diagnose is to "screen out the vulnerable

groups of children and adolescents for the risk factors of suicide and

then refer them for treatment."  Some of these "risk factors" include

verbal signs of suicide within the last three months, prior attempts at

suicide, indication of severe mood problems, or excessive alcohol and

substance abuse.

Many physicians tend to think of depression as an illness of adulthood. 

In fact, Brown (1996) stated that "it was only in the 1980's that mood

disorders in children were included in the category of diagnosed

psychiatric illnesses."  In actuality, 7-14% of children will experience

an episode of major depression before the age of 15.  An average of

20-30% of adult bipolar patients report having their first episode

before the age of 20.  In a sampling of 100,000 adolescents, two to

three thousand will have mood disorders out of which 8-10 will commit

suicide (Brown, 1996).  Blackman (1995) remarked that the suicide rate

for adolescents has increased more than 200% over the last decade. 

Brown (1996) added that an estimated 2,000 teenagers per year commit

suicide in the United States, making it the leading cause of death after

accidents and homicide.  Blackman (1995) stated that it is not uncommon

for young people to be preoccupied with issues of mortality and to

contemplate the effect their death would have on close family and

friends.  

        Once it has been determined that the adolescent has the disease of

depression, what can be done about it?  Blackman (1995) has suggested

two main avenues to treatment: "psychotherapy and medication."  The

majority of the cases of adolescent depression are mild and can be dealt

with through several psychotherapy sessions with intense listening,

advice and encouragement.  Comorbidity is not unusual in teenagers, and

possible pathology, including anxiety, obsessive-compulsive disorder,

learning disability or attention deficit hyperactive disorder, should be

searched for and treated, if present (Blackman, 1995).  For the more

severe cases of depression, especially those with constant symptoms,

medication may be necessary and without pharmaceutical treatment,

depressive conditions could escalate and become fatal.  Brown (1996)

added that regardless of the type of treatment chosen, "it is important

for children suffering from mood disorders to receive prompt treatment

because early onset places children at a greater risk for multiple

episodes of depression throughout their life span."

        Until recently, adolescent depression has been largely ignored by

health professionals but now several means of diagnosis and treatment

exist.  Although most teenagers can successfully climb the mountain of

emotional and psychological obstacles that lie in their paths, there are

some who find themselves overwhelmed and full of stress.  How can

parents and friends help out these troubled teens?  And what can these

teens do about their constant and intense sad moods?  With the help of

teachers, school counselors, mental health professionals, parents, and

other caring adults, the severity of a teen's depression can not only be

accurately evaluated, but plans can be made to improve his or her

well-being and ability to fully engage life.

References

        Blackman, M. (1995, May).  You asked about... adolescent depression. 

The Canadian   Journal of CME [Internet].  Available HTTP: 

http://www.mentalhealth.com/mag1/p51-dp01.html.

        Brown, A.  (1996, Winter).  Mood disorders in children and

adolescents.  NARSAD Research Newsletter [Internet].  Available HTTP: 

http://www.mhsource.com/advocacy/narsad/childmood.html.

        Lasko, D.S., et al.  (1996).  Adolescent depressed mood and parental

unhappiness.  Adolescence, 31 (121), 49-57.

        Oster, G. D., & Montgomery, S. S.  (1996).  Moody or depressed:  The

masks of teenage depression.  Self  Help & Psychology [Internet]. 

Available HTTP: 

http://www.cybertowers.com/selfhelp/articles/cf/moodepre.html.

Adolescence and Delinquency

Adolescence and Delinquency

I couldn't begin to cover all the possible reasons that may cause an 

adolescent to become a "juvenile delinquent."  During my research, I found 

that the term juvenile delinquency is defined a number of ways.  Mosby's 

Medical Nursing, and Allied Health Dictionary summed up juvenile delinquency 

best with this definition;  "resistant antisocial, illegal, or criminal 

behavior by children or adolescents to the degree that it cannot be 

controlled or corrected by the parents, endangers others in the community, 

and becomes the concern of a law enforcement agency"(1994). 

I found that most theories about what causes delinquency in children and 

adolescents originate with families and parenting.  Many statistics and 

studies have been conducted comparing the number of youths that had chosen a 

delinquent life style, with single parent households, or parents who were 

drug and alcohol dependant.  It is my belief that three out of four parenting 

styles that we have studied in our text, when taken to extremes, can be just 

as damaging to an adolescent as a parent suffering from drug or alcohol 

addiction.  Parents who exhibit an indifferent parenting style send the worst 

possible message to their children.  "When permissiveness is accompanied by 

high hostility, the child feels free to give rein to his most destructive 

impulses"(Craig, 1996, p.316).  And where exactly in the question of 

causation does nature Vs nurture fit in.  What about the child who seemingly 

has balanced, consistent authoritative parents, and still chooses a 

delinquent lifestyle. 

I'm going to address some of these issues in the pages to follow, beginning 

with an external factor that may influence some of our younger children; TV.

    The impact of television violence has been debated since TV first arrived 

in America.  According to a study highlighted in US News and World Report, 

the more violent TV programs children watch, the more likely they are to 

commit violent crimes.  "The greatest impact is on pre-adolescent children 

who do not yet have the capacity to gauge what is real and what is not" 

(Zuckerman, Aug. 2,1993).  The theory states, that combined with a lack of 

parenting by "plugging" children into the TV, these children later in life 

will be conditioned to violence, regarding it as exciting, charismatic, and 

effective.  Opponents of this theory argue the "solution to the problem of 

television violence may be to reinforce the traditional institutions of 

church, family and neighborhood, which provide the moral armor against bad 

influences from other sectors of society" (Bender @ Leone, 1997,p.57). These 

advocates sort of differentiate between good and bad violence on TV.  One 

example is the popular television show Law and Order, which is divided into 

two sections.  In each episode is the depiction of a crime, followed by a 

trial of the accused.   

    Probably the most controversial focus of juvenile delinquency causation 

can be attributed to the breakdown of families, giving rise to a large number 

of single parent households.  According to Robert L. Maginnis, a link does 

exist between single parent families, juvenile delinquency and crime.  

"Children from single-parent families, he argues, are more likely to have 

behavior problems because they tend to lack economic security and adequate 

time with parents" (Maginnis, 1994).  "Children from single-parent families 

are two to three times more likely to have emotional and behavioral problems 

than are children in two parent families" (Bender, Leone, 1997 p.64).  This 

report goes on to say these children "are more likely to drop out of school, 

to get pregnant as teenagers, to abuse drugs, and to be in trouble with the 

law."  Bender and Leone cite a study from the Journal of Research in Crime 

and Delinquency that reports the most reliable indicator of violent crime in 

a community is the proportion of fatherless families.  Fathers typically 

offer economic stability, a role model for boys, greater household security, 

and reduced stress for mothers.  " When compared to children from two-parent 

families, children from single parent homes are more prone to crime:

    · They use drugs more heavily and commit more crimes  

      throughout their lives. 

    ·They are more likely to be gang members.

    ·They make up 70% of juvenile delinquents in state reform  

     institutions.

    ·They account for 75% of adolescent murders.

    ·They are 70% more likely to be expelled from school" (Bender @ Leone, 

p.64).  Bender and Leone go on to cite a 1991 research review published in 

the Journal of Marriage and Family saying, "growing up in a single-parent 

family is linked with increase levels of depression, stress, and aggresssion; 

a decrease in some indicators for physical health; higher incidence of 

needing the services of mental health professionals; and other emotional and 

behavioral problems."  

    Of coarse, with every theory of delinquency causation, there is a counter 

theory.  Kevin and Karen Wright contend in their Washington DC Brief on 

Delinquents and Crime, that "Not only is data contradictory and inconclusive, 

the authors contend that much of the research conducted during the 1950's and 

60's was flawed by bias against single mothers."  What a tangled web we 

weave.  I was a single parent for ten years.  I have no doubt that my sons 

are lacking in some ways from experiencing the fullness of a loving 

two-parent household. On the other hand, Faith and God were always part of my 

modeling, and possibly from his grace my sons were, and are "good boys."  

    Theories regarding causation of juvenile delinquency and violence cite 

biological factors ranging from inherited personality traits and genetic 

defects to biochemical imbalances and brain damage.  Some studies indicate 

that biological factors, including genetics, may predispose a child to commit 

violent crimes.  Scientists have recently been exploring the role of certain 

neurochemicals- particularly serotonin, a brain transmitter that regulates 

mood and emotion in triggering violence.  Another study claims to have found 

a "dramatic connection between lead poisoning, which can impair brain 

function, and juvenile crime" (Bender @ Leone, 1997 p.79).  Other biological 

factors claim undiscovered brain damage early in childhood development can 

increase the risk of juvenile delinquency or violence.  "Head injuries could 

damage a part of the brain that helps curb aggressive impulses, or general 

impairment of the brains abilities, making it harder for a child to 

comprehend societal rules, or to function well in school" (Bender @ Leone, 

1997. p. 79).  

    Environmental theories regarding juvenile delinquency generally support 

the idea that most violent behavior is learned behavior.  The top three 

detrimental influences include violent and permissive families, unstable 

neighborhoods, and delinquent peer groups.  I noticed that single parent 

families weren't at the top of the environmental list.  All of these 

influences supposedly teach children delinquent behavior.  Theories about 

learned violence often go back to family situations when the child is very 

young, often citing spanking as the first "no-no."

    Another possible cause of juvenile delinquency is a lack of moral 

guidance.  The general foundation for this theory is, in my opinion, 

tragically credible.  Authors Bender and Leone describe moral poverty in this 

quotation:

        "Moral poverty is the poverty of being without 

          loving, capable, responsible adults who teach

          you right from wrong.  It is the poverty of 

          being without parents and other authorities 

          who habituate you to feel joy at others' joy,

          pain at others' pain, happiness when you do 

          right, remorse when you do wrong.   It is the

          poverty of growing up in the virtual absence

          of people who teach morality by their own 

          everyday example and insist that you follow suit."

This quotation, unfortunately says it all.  In extreme moral poverty, a child 

may grow up surrounded by deviant, delinquent, and criminal adults.  It gets 

worse.  They may also be in abusive and violent settings.  This moral vacancy 

is said to create children who live for the present moment, and have no 

concept of the future, nor do they have feelings of remorse or 

awareness of consequences.  When you add to this equation the fact that guns 

are more available to our children now, than ever before, the result is 

meaningless random violence.  According to the Journal of American Medicine 

Association dated June third, 1998, "Access to firearms and other weapons has 

been cited as an important factor contributing to the rise of violence- 

related injuries among adolescents" (JAMA, 1998, p.167).  Young children are 

accounting for more violent crime than ever before.  This kind of violence 

makes me very afraid for my wife and children.  I have seen and talked with 

morally vacant children at my job at the Oregon Health Sciences University.  

My hart sinks to my stomach at times.  

    There are probably many possible causes of delinquency that I haven't 

mentioned in this paper.  It is my belief that parents my unknowingly push 

their children toward delinquency by simply using poor parenting styles.  I 

believe, as the text, the most damaging parenting model is when parents show 

no interest in their role as a parent, and combine this with a 

low level of affection.  This indifferent parenting style offers absolutely 

no guidance to an adolescent, leaving plenty of room for those environmental 

factors to take over.  A clearly more 

effective parenting style models the authoritative style highlighted in our 

text.  Children brought up under this framework have a much better chance of 

avoiding the pit falls of delinquency.  There has also been legislation 

introduced to use public funds to empower religious institutions to act as 

safe havens for at risk children.

    Many deterrents have been tried to reduce the effects of juvenile 

delinquency.  More youths are being tried as adults in certain cases, and 

curfews are being enforced now more than ever.  Law enforcement agiencies 

aggressivly enforce truency laws, and most officers I talk to are very 

intollerent of the slightest sign of disrespect when approaching suspect 

youths.  Child and family counseling techniques have changed to fit more 

complex and extreme situations.  The fact is that we live in an imperfect 

world, and final solutions to this problem will probably not be found by men, 

but by God.