Depression in Children and Adolescents

One important study has shown that at any one time, as many as 20 children in 100 (one in five) may be suffering from significant symptoms of depression.1 This may seem an alarmingly high figure, but when you realize many of these children manifest their depression in some sort of "masked" form, it's not that difficult to accept.

   For many children, their depressions are temporary and don't require any special treatment. They are caused by normal losses every child has to come to terms with. Children lose pets who run into the road and get killed; friends move away; relatives die; sometimes they can't get what they want. Those are all losses children have to get through, but because they haven't yet developed the skills for coping with significant losses, they invariably go into some form of depression.

   Childhood depressions can also be very serious, not only because of the intensity of the depressions, but also because children are almost totally incapable of responding to their environment and making the appropriate adjustments to loss.

   Perhaps the most important point to make about childhood depression is that it's in those early stages of development that the patterns for later depressions are laid. The way a child comes to terms with frustration and learns how to handle loss sets the stage for how depressions are handled later in life, particularly in the

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neurotic and reactive depressions.

   If you sense your child is depressed, please don't hesitate to get help. Between your support and that of a caring professional, your child can emerge a stronger, healthier person.

WHAT IS CHILDHOOD DEPRESSION?

   Reaching consensus on an adequate definition of childhood depression is a real problem. Some researchers will only classify as a depression a mood disorder that is totally incapacitating. On the other hand, I believe depression embraces the full range from a normal experience of sadness all the way through to a major depression. It's not always easy to draw a line between what's normal and what is clinically a problem. For a child, however, it probably doesn't make any difference. Depression is depression. And when a child is sad, what's important is that he or she learns how to deal with that sadness in a healthy manner.

WHAT ARE THE SYMPTOMS OF CHILDHOOD DEPRESSION?

   While adults show their depression clearly as an intense sadness, a tendency to cry a lot, loss of energy, and social withdrawal, children don't always show theirs so straightforwardly. Here are some of the ways a child manifests depression:

   An appetite disorder called anorexia nervosa, which involves a rejection of food

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and an avoidance of eating, is frequently a symptom of depression in older girls.

   One factor in childhood depression that's different from adult depression is the increased sensitivity children have in relating to their peers. They are very concerned about how they're seen by friends, and any rejection they perceive causes or aggravates depression.

   The features of adult depression that are normally absent in childhood included dread of the future and inability to respond quickly to external change or distractions. Unlike adults, children do respond when you take them somewhere for a treat or change their environment. They have not yet learned the neurotic tendencies of adults, who see any change in environment simply as a temporary distraction.

   We need to be alert to the hidden symptoms of childhood depression. These include extreme forms of anxiety, nail biting, hair pulling or twirling, muscle tics, irritability, temper tantrums, sulkiness or moodiness, excessive negativity, self-mutilation, and deliberate destructive behavior. They can all mask a significant childhood depression.

WHAT ARE THE CAUSES OF CHILDHOOD DEPRESSION?

   There are many causes for childhood depression, but as with adult depression, they all reduce to one essential theme: the experience of loss. Let's look at one example.

   Reggie is only 11, but he behaves as if he's much older. He has seen quite a bit of life. Ever since he can remember, his parents have argued and fought. They separated many times. Sometimes his mother left home and took him with her to a hotel room for several weeks. At other times his father left home, leaving Reggie alone with his mother. On one occasion, he took Reggie with him.

   Because of this topsy-turvy home life, Reggie learned early to fend for himself. He tried not to show too much pain, and whenever the conflict between his parents became too intense, he would retreat to his bedroom or take a long walk until the conflict had subsided. As a result, Reggie became a very lonely person. He didn't like to be around his friends, at least the few he had, because they asked him all sorts of embarrassing questions about his family life.

   Slowly the tension began to get to Reggie. He discovered that if he just retreated into himself, he could anesthetize his feelings. By the time he became 11, he was adept at switching off and not paying much attention to the bickering

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between his parents that sometimes erupted into physical violence. He lost interest in games, seldom went out other than to go to school, and even neglected the television set. The only activity he allowed himself was to listen to the stereo in his room with headphones on. This helped to shut out the world and to numb his feelings.

   What's wrong with Reggie? Clearly, he is depressed. In fact, by the time his mother realized something was wrong and sought help, Reggie had already developed an intense clinical depression. He had become so "slowed down" that his mother thought there was something physically wrong with him. "He has absolutely no energy," she complained to me. "He just lies around all the time and says he's too tired to do anything."

   Reggie had also lost interest in other activities, including his hobbies and the games he liked to play. He had begun to make threats about taking his life or wishing he were dead. A dark, gloomy mood had come over him, and his mother was frightened.

   It's not hard to understand what depression is all about when you observe its development in a young boy like Reggie. Caught up in a conflicted and insecure world, threatened by losses all around him, Reggie's mind was doing precisely what it had been designed to do: protect him from the pain in his life. At 11 years of age, he hardly had the skills to survive by himself, and the fear of being abandoned by his parents was so intolerable that the only thing his mind could do was to anesthetize those feelings.

   So gradually a depression had come over him. No actual loss had taken place, but he was surrounded by the threatened losses of his home, of one of his parents, of moving to another part of the country as his mother kept discussing, and of disruption to his whole life. What is a young child supposed to do when surrounded by such threats? The best protection the mind can devise is depression.

   As we fall into depression, and "fall" is a good description, we become lethargic, lose interest in normal activities, withdraw from people and our social environment, and then begin to wish we could escape this life. For Reggie, this depression, so early in his life, could easily become a lifelong pattern. In the future, whenever he is confronted by intense conflict or threatened losses, he will know what to do, because he has learned it so well as a child. This is perhaps the strongest argument for parents to get help for their children who are depressed. They need to learn healthier ways of coping with life's problems.

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   On the other hand, biological depressions are not as common in children as they are in adolescents or adults. As a child approaches puberty, however, important hormonal changes may affect mood and produce temporary depressions. By and large, however, younger children are not being pushed and pulled by their hormones. They are being tugged at by life itself and the experience of losses.

   By far the most serious cause of childhood depression is the divorce or separation of parents; it's particularly damaging to a child approaching puberty. The divorce represents many losses, including the separation of the family, loss of one parent, and perhaps a change in environment with a loss of friends. There are also many threatened losses as the child anxiously tries to anticipate the future.

HOW DO FEELINGS OF FAILURE RELATE TO CHILDHOOD DEPRESSION?

   Any experience of failure by a child can be the cause of depression because of the loss it represents. Not coping well at school, repeated failure, or an inability to perform at the same level as other children may seriously harm a child's self-image and self-esteem.

   Parents who communicate extremely high standards to their children and the expectation that those standards be met may also be fostering a state of profound loss. Children who cannot live up to their parents' standards or who constantly feel rejected by parents because they're not "making it" may experience significant losses.

   This is one of the reasons competition can be damaging to many children. Highly successful children thrive on competition. They win all the awards and get all the prizes, and that works wonders for their self-image and self-esteem. The problem is that only one person wins, and everyone else feels like a loser. I wish we had a system in our culture that would help every child to have a sense of being a winner, at least part of the time.

   This is one reason I strongly advise parents to seek out activities for their children that naturally complement the children's talents. A child who isn't physically strong should not be pushed into a sport that requires great physical strength. An activity that naturally matches the child's abilities should be encouraged instead. This is also true in the academic realm. Some children are extremely gifted when it comes to using their hands, as in crafts, but may not be adept at mastering concepts out of books. Parents should value these other forms

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of intelligence and balance their expectations. I'll have more to say about this when I discuss the impact of depression on self-esteem at the end of this chapter.

IN PREPARING CHILDREN TO COPE WITH LIFE, IS IT A GOOD IDEA TO PUT THEM IN SITUATIONS WHERE THEY WILL FAIL SO THEY'LL LEARN TO HANDLE FAILURE?

   I don't believe so. We don't teach children to swim by throwing them into a swimming pool. Having a sound value system is far more important in coping with failure than the experience of failing. In fact, people who experience a lot of failure don't cope with defeat better than others; they cope less well and easily become depressed.

HOW CAN I BEST HELP MY CHILDREN COPE WITH DEPRESSION?

   The most important thing is to open up communication. You must allow them the freedom to talk about their feelings of sadness. Don't be afraid to hear what they have to say. This can bring to light some significant factors in their environment that may be contributing to their depression, such as rejection or punishment by their peers, or difficulties at school. When you know what's causing the depression, you're in a better position to help.

   One time a parent came to see me because her child was depressed and didn't want to go to school. The mother was blaming herself, thinking the problem was something she had done. I asked if she had talked to her daughter about it. No, she hadn't, because she thought that if she brought the matter into the open, it might aggravate her daughter's depression.

   I encouraged her to talk to her daughter. The result was the discovery that her daughter was having trouble with another child in a physical education class. It had nothing to do with the mother. The girls exercised in shorts, and this girl was making fun of her legs. As soon as we identified the cause of the depression, the mother knew what to do. She talked to the school counselor, her daughter changed physical education classes, and the depression lifted.

   You should also teach your children sound values. Early in life, they need to learn not to give too much worth to material things. That helps to minimize the growth of an exaggerated sense of loss over them.

   It's important, too, that you build your children's self-respect and self-esteem. Help them to discover their strengths. Some children grow up believing they're no good

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at anything simply because their parents failed to encourage experimentation with a wide variety of interests. Encourage your kids to find something they can do well so that they can feel a sense of mastery and accomplishment about it.

   Furthermore, teach your children how to delay gratification. By this I mean they should be taught that all their needs cannot be met immediately. Some rewards must wait. There's a tendency in our culture to expect to have our needs satisfied instantly. That sets us up for a lot of frustration and depression, because life just doesn't work that way. We must all learn to wait for life's prizes. After all, we don't get paid every minute as we work. We have to wait. Our gratification must be delayed.

   Let me illustrate how I did this with my own children. In her earliest years, my youngest daughter tended to be impulsive in wanting her needs met. She'd ask me to do something for her or would want some money. I would respond gently, "Yes, as soon as I'm finished with what I'm doing, I'll get it for you." Initially she would have a little temper tantrum. I would patiently respond with, "As soon as I'm ready, I'll get it for you." I would wait a few minutes, then stop what I was doing and do as I had promised.

   Soon she came to realize that I always kept my word, so she learned how to wait. But make sure you do follow through with what you've promised or you'll only create more frustration.

   If you can introduce a bit of delay whenever it's reasonable and then follow through on what you've promised, you can help your children become more patient. Believe me, in later years that will help them to avoid a lot of depression.

   Finally, reinforce as strongly as you possibly can God's love toward your child. The deep realization that one is loved and cared for by God can transcend feelings of depression and self-hate. Parents are imperfect, and there is no way we can command the same respect or create the same memory of perfect love in our children as God can. Most children can grasp the perfection of God's love and the unchanging nature of His caring. Teach your child about God, therefore, and point him or her to the experience of strength God can give. That will help your child to weather the present storm and to face the pressures of life in the future.

   Because God loves us, He never forsakes us, even though many of our friends might. He stands with us, and when we reach the rock bottom of despair, we discover the solid Rock who rises to the surface to sustain us. You may not be able to take away all the feelings of uselessness, but you can certainly help your child feel secure in the knowledge of God's love.

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HOW CAN I TEACH MY CHILDREN TO GRIEVE THEIR LOSSES?

   When we teach our children how to grieve their losses, they recover from them more quickly. We can begin in kindergarten to show them how losses are inevitable and what we should do about them. I vividly remember my grandmother helping me to grieve over the loss of a pet bird. It was a canary of a deep yellow hue. My grandmother kept it on the front porch because it had such a beautiful song. Every time I visited her, I fed the bird and cleaned its cage. It became a special pet to me.

   During one school vacation, while I was visiting, my grandfather got up early one morning to discover that the bird was dead in its cage. He tried to sneak it out so I wouldn't see it, but my grandmother stopped him. "Children must learn how to grieve also," she scolded. Then she promptly sat me down to explain that animals don't live as long as people and that for all of them, a time comes when they have to die. This is true for people also, she reminded me. We need to be brave, accept such losses, and get on with our lives.

   She suggested I find a shoe box, line it with an old cloth, and make a coffin for the bird. Later that day, she said, "We'll have a little funeral service. This is our way of saying good-bye, and you'll feel better because of it."

   She was absolutely right. At first I felt so overwhelmed by the death of that little bird that I wasn't sure I wanted to be a part of any funeral. By the time I had dug a little grave, said a prayer, and covered up the box with dirt, however, I began to feel relief and could accept the loss as something natural. Life would move on.

   This is true of many of life's experiences. Not only do friends and loved ones, as well as pets, die, but childhood also passes away, children marry and leave home, friends abandon us, and eventually we grow old and decline in health. These losses are all inevitable, and the sooner we learn to detach ourselves from them, the sooner we will recover.

HOW COMMON IS ADOLESCENT DEPRESSION?

   In contrast to the debate over whether depression exists in childhood, there has been little doubt about adolescent depression. We've known for a long time that adolescence is a period of extreme emotional discomfort; most of us have been through it ourselves.

   While we have no clear statistics on the incidence of depression in adolescence, a study conducted in the Oregon Depression Project discovered that

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whereas at any one time about 3 percent of adolescents were significantly depressed, there was a one in five chance of any child becoming depressed during the period of adolescence. The risk for girls was about twice that of boys and treatment was highly recommended for 93 percent of those considered to be depressed.

   With the growing frequency of adolescent suicide, many experts now believe it is far more common than in adulthood. In my opinion, at least one out of every two children will experience significant depression sometime during the adolescent period. At any one time, probably one out of five adolescents could be considered clinically depressed.

   A significant finding of the Oregon Depression Project was that 43 percent of the teenagers diagnosed as depressed also had other mental disorders over their lifetime. Depression existed together with physical diseases, and when it occurred with another mental disorder, it was more likely to follow than precede that disorder.

    Depressed teens were likely to be female and come from a one-parent family or not live with their natural parents. Grade at school, average size of household, number of siblings, and occupation of the head of the household made no difference. They were likely to have experienced stressful events with in the recent past; to be pessimistic, turned inward, and have a negative body image and low self-esteem; to be emotionally dependent on others; to be self-conscious; and to report less social support than others. This means that for many of them, the only social support they could point to was their own family.

WHAT ARE THE SYMPTOMS OF ADOLESCENT DEPRESSION?

   Because adolescence is a period of emotional upheaval anyway, depression may be hard to recognize. Feelings of sadness, loneliness, anxiety, and hopelessness that are normally associated with depression may also be seen in the normal stresses of growing up. Some adolescents who are depressed act out their distress, becoming inappropriately angry or aggressive, running away, or becoming delinquent. Such behaviors can easily be dismissed as "typical adolescent storminess," and their significance in pointing to the presence of a serious depression is overlooked. Any of these signs, therefore, should be examined closely in case they indicate depression.1

   In determining whether an adolescent is depressed, we have to look at what changes have taken place. The following questions may help to clarify the state of the adolescent mind:

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   If your answer is yes to any of these questions, it my indicate you need to get some help for your teenager. In addition, if your youngster feels unable to cope, demoralized, friendless, or is possibly suicidal, it's almost certain that he or she is depressed.

   One of the complicating factors of adolescence is that bipolar disorder (also called manic-depressive illness) often emerges. This is a more serious form of depression, although it is perhaps the more easily treated. It is manifested by periods of impulsiveness, irritability, loss of control, and sometimes bizarre behavior when the teenager is unable to sleep and engages in a lot of meaningless but manic behavior. This is not just the normal ups and downs of adolescence. Rather, it is going from a period of intense hyperactivity, which may last for many months, into severe depression, and back again to normal. Such a disorder needs immediate professional treatment.

DOES ADOLESCENT DEPRESSION IN THIS COUNTRY DIFFER FROM THAT IN OTHER CULTURES?

   In many cultures, adolescence is a period of significant mood disruption. Some cultures minimize these reactive depressions because they have much clearer "rituals of transition" from childhood to adulthood. In our culture, an adolescent must not only weather the storm of biological change, as in all cultures, but also the social and cultural storms of transition. Therefore, depression is much more of a problem here than in more tribal cultures. Adolescence is probably the most difficult stage of life for any person in the Western world to negotiate. Most adults remember the pain of their adolescence vividly and with much regret.

   It's common for adolescents to feel they're going crazy. No one understands them, so they must be the ones out of step with the world. Considerable emotional

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distress is the norm rather than the exception, and it comes at a time of life when they're extremely vulnerable to stress. They have adult bodies but still only children's minds. Because of improvements in health and living conditions, we grow up faster these days physically, and we are almost fully developed and capable of being parents before we have the mental ability to take care of ourselves. The result is that there are many reasons for depression in adolescence, just as there are many causes for loss.

   Alicia is typical of many adolescents. Once a happy child and a good student, she became depressed when she turned 14. She grew withdrawn, listless, and disinterested in school and her friends, except for one close friend she had known since she was a young child. She lost all her energy and enthusiasm. This was so noticeable because she had been energetic and enthusiastic about life. She developed a pervasive sadness that discouraged friendships with others and, except for her one close friend, became isolated.

   She gradually began to skip classes. Then, to avoid her mother's nagging, she started staying away from home until late in the evening. When she finally returned home, she feigned extreme tiredness and ran up to her bedroom, dropped on the bed, and pretended she was asleep. Alicia's mother became increasingly upset at her behavior.

   Alicia's father was an alcoholic, so he hadn't paid much attention to what was going on. Often he came home late, drunk, and that left Alicia's mother to be the sole parenting figure in the home. Because she felt hopelessly inadequate, she consulted with her pastor, who, after a brief period of consulting, convinced her Alicia was suffering from a significant depression. He referred Alicia's mother to a psychiatrist, who finally admitted Alicia to an adolescent treatment program in the local hospital.

   With some coercion from the psychiatrist, the father joined Alicia and her mother in family therapy, and the healing process began. However, healing would not have been completed without the help of some important medication.

   It was clear to the psychiatrist that Alicia was suffering from a biological form of depression that was being aggravated by the unsatisfactory home conditions. Typical of many adolescent depressions is this interaction between biological and psychological or environmental factors. The one plays off the other. The biological deficiency reduces an adolescent's ability to cope with his or her home, school life, and peer conflicts, so a significant reactive depression becomes superimposed upon hormonal or other biological changes. Treatment is only effective if both

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factors are addressed.

   Fortunately for Alicia, she was in competent hands, and recovery was rapid. I regret to say I have encountered many adolescents who are depressed and have not found the same level of professional competence, so their misery has been prolonged unnecessarily for years.

HOW CAN I GET HELP FOR MY CHILD OR TEENAGER?

   The first step in getting help is, of course, to get your child to acknowledge the depression. That isn't always easy. You may want to talk it over with your spouse, a close friend, or your pastor before you confront your child. Alternatively, take your child to your family physician, and have him or her explain the problem.

   How you proceed after that depends on the age of the child. Young children are usually quite compliant. Taking them to a professional for help, provided you prepare the way adequately and don't intensify their anxiety, should not be a problem. Many psychologists and psychiatrists specialize in childhood disorders. They know how to talk to a child and how to make the experience pleasant. If you don't feel comfortable with the first professional you consult, move to someone else.

   Specific treatments include various forms of play therapy, family therapy, and the use of antidepressants or other medications in the event that there is some biological complication.

WHAT SHOULD I DO IF MY CHILD REFUSES HELP?

   The older the child, the more difficult it may be to get appropriate help. A depressed 10- or 12-year-old may be quite resistant to going to see a professional, and you certainly cannot expect a child of that age to go alone. Make sure you or your spouse accompanies the child to provide a comforting source of reference.

   Because the risk of suicide increases the older the child becomes and is particularly hazardous in the adolescent years, it's imperative that a depressed adolescent be seen by a mental health professional as soon as possible. A teenager may resist treatment, so it may be necessary for you, as a parent, to "get tough" or use some form of coercion.

   In this regard, teenagers are extremely astute, even uncanny, in their ability to know if parents feel guilty or ambivalent about getting help for them. They can sense your indecisiveness, so you should, as parents, make up your minds what it is you want to do and then communicate an absolute sense of togetherness when it comes to telling your teenager you want him or her to get help.

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   Sometimes it's wise for parents to seek help for themselves before they approach their depressed child. If the youngster is destructive of self or others, it is essential that you don't delay. But if you can have an appointment yourself ahead of your child, you might find it easier to communicate firmness.

MY DAUGHTER IS SO DEPRESSED THAT I'M AFRAID SHE'S GOING TO COMMIT SUICIDE. WHAT SHOULD I DO?

   Many parents are left with severe guilt problems after their child has attempted or been successful in suicide. I've worked with several such parents, and I can assure you that those feelings cannot be dealt with easily. It is far better to get help, even if it's not absolutely necessary, than afterward to regret not having taken any action. You'll have a lot less guilt and pain to deal with if you've acted prematurely than if you have not acted at all.

   If your teenager resists treatment, discuss this first with the mental health professional. He or she will advise you on how to get tough, particularly if the teenager is using alcohol or drugs and is getting into trouble. "Getting tough" doesn't mean physically or verbally abusing your child. It does mean not being intimidated by any threats of running away. You present a united and unmovable front — and force the child into treatment.

   Getting tough also means seeing to it that your teenager follows through on treatment. If this becomes a problem, your treatment specialist may request that the child be hospitalized. This is particularly necessary if there is any threat to life. Your youngster may be better off in a psychiatric hospital, a drug rehabilitation program, or a residential treatment center, where the most intense forms of treatment can be provided.

   Remember that a depressive disorder is not a passing bad mood but an illness that should and can be treated. This is not the time to be caught up with doubts or to allow inexperienced friends to give you advice that may sound spiritual but could be devastating if things go wrong. Adolescent depression is a serious disorder with serious consequences. Don't hesitate to get appropriate help. God will honor your actions and He completely understands why you need to act with speed and firmness.

HOW DOES SELF-ESTEEM RELATE TO ADOLESCENT DEPRESSION?

   All forms of depression at all ages have a serious effect on self-esteem. Since the impact is greatest in childhood and adolescence, I want to discuss the topic briefly in this chapter.

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   Repeated depressions have a demoralizing effect. Each time one is depressed, one's sense of well-being, self-confidence, and self-image gradually erodes. After a little while and many depressions, this erosion becomes permanent, and the person comes to feel worthless.

   I recall treating an adolescent over several years who suffered from frequent depressions. After the first bout, when he was only 14, he felt quite negative about himself. He also felt uncertain about whether he could cope with his life adequately. After that brief bout of depression, his confidence gradually came back, and within a period of three months, his feelings about himself had returned to normal.

   Six months later, however, he went into another depression. We started the antidepressant medication immediately, but it was almost a month before the depression began to lift. By then he had become even more demoralized than the first time, and it took at least six months after his recovery before he began to feel confident and not too unsure of himself again.

   One year later, a third depression hit, and this time he was so deeply affected that even though the depression itself lifted quickly, he continued to be in a state of intense self-depreciation. This required many months of ongoing psychotherapy to help him restore his diminished self-esteem.

   What this illustrates is how depression affects self-esteem, not just during the depression, but afterward as well. It also emphasizes the importance of getting treatment for a child's or adolescent's depression as soon as possible. Untreated depression can be a major cause of low self-esteem later in life.

   Depression undermines our sense of worth and distorts our self-image, which are the basis for self-esteem. While I don't like the term self-esteem because it can be so easily misunderstood as a form of self-adoration, no other term adequately captures the concept. We all have an attitude toward ourselves, a self-image or self-concept that is the "picture" we carry around in our mind's eye of who and what we are. We then place a value on this self-image, either positive or negative, which is what we call self-esteem.

   I don't believe we should have "high" or "low" self-esteem, but simply that our esteem should be free of self-hate or self-rejection. "Low" self-esteem is a contradiction in terms. It really means self-hate, not esteem. The appropriate attitude toward oneself as a Christian should be self-transparency. We shouldn't be too concerned about how we feel toward ourselves, except that we should not be excessively self-rejecting or self-hating. Self-acceptance is the key to a healthy self-esteem,

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not self-adoration. If we've been accepted in Christ, we ought to value ourselves just as He does.

   Frequent depressions cause self-doubt and self-depreciation. We develop a sense of being without worth, and that lies at the root of almost all personal, moral and spiritual problems. Our actions are consistent with how we see and feel about ourselves, so it's important that those feelings be realistic. A child who is frequently depressed will grow up with a profound feeling of self-hate, which in turn will affect his or her life, marriage, present, and future. It also affects how we relate to God in later life. People with a lot of self-rejection find it difficult to really believe God has accepted them.

   It's common, therefore, for people with low self-esteem to not only feel worthless, but also insecure. They feel rejected, as if they don't deserve friends. They're easily humiliated, which causes more depression that they use as a way of escaping from life. They become convinced that nobody likes them, and it is then easy to retreat into fantasy or to blame others for how they feel. This is one of the reasons adolescence is a period in which aimlessness, negativism, and finally drugs, alcoholism, suicide, and other self-defeating behaviors set in. In a sense, those behaviors become alternative ways of dealing with depression.

HOW CAN I HELP MY CHILDREN SURVIVE DEPRESSION WITHOUT DAMAGING THEIR SELF-ESTEEM?

   There are essentially two strategies to follow. The first is a strategy of prevention, and the second is a strategy of recovery.

   If you build your child's self-esteem on a solid footing of self-acceptance, you can prevent or minimize a loss of self-esteem in the event that a depression should strike. Children brought up in an atmosphere of acceptance, love, praise for legitimate achievements, and affirmation, and who have a strong feeling of possessing a "place of belonging" with relatives, friends, and peers, never really suffer from self-hate. Such children are "inoculated" against depression's devastating effects on self-esteem.

   On the other hand, children who are frequently criticized, rejected, misunderstood, or labeled as stupid, clumsy, fat, or bad will always feel left out. Whenever they experience depression, the first part of the self that will be attacked is the esteem. Depression only convinces them that they are bad, inadequate, and failures. It reinforces the self-hate so easily triggered during times of depression. These children begin to think there is something wrong with them. They're not as

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important as others. They don't really belong. They are disappointments or even misfits and have nothing to offer. Such children often end up with the attitude "I wish I were dead."

   Prevention is, therefore, best achieved by building your child's sense of worth and by doing it honestly, recognizing we all fall short of God's standards and that there's a sense in which we are all unworthy before God. However, God has loved us enough to die for us, and that means we do have value in His sight.

   On the one hand, we need to teach our children where they stand in their relationship to God and their need of His salvation. But that doesn't mean we have to teach them they're unworthy or totally undeserving of His affection. It is not our task to reject and punish our children for their sinfulness. God will speak to their consciences. Our job is to teach them how to respect themselves, despite their sinfulness, so they can come to know God fully and receive His forgiveness. This is a tightrope we walk as parents, but unless we get it right, we won't give our children the skills and self-attitudes they need to weather the storms of depression. Parents should not be short on praise, only on criticism. We need to modify our expectations so our children can have a sense of accomplishment. They need to feel free to express themselves and to believe their parents take them seriously. No parent should demand performance from a child that cannot reasonably be met. That only reinforces a sense of failure and self-rejection. Through acceptance, affection, and approval, parents can build a secure and adequate self-image upon which a healthy sense of self can develop.

   This sense of personal worth becomes even more precious when children feel accepted by God and receive the gift of Christ's dying on their behalf. They then enjoy that deep and abiding sense of forgiveness and assurance that God is helping them to grow into more complete human beings.

HOW CAN I HELP MY CHILD RECOVER HIS SELF-ESTEEM?

   Prevention is only the first strategy. The second is one of helping a child recover from low self-esteem. Even if we build a solid base of prevention, there are times when we must help a child rebuild lost esteem. Some depressions are so severe that no matter how solid a shield children have built for themselves in terms of their self-image, their depression will undermine their self-esteem. They doubt God, they doubt themselves, and they quickly move to a place of self-hate.

   Recovery is best achieved by the same steps as prevention. We seek to reinforce feelings of acceptance, approval, and validation. We take our children

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back to the cross, where they can claim forgiveness for any sins that have been affecting them. Then, having claimed this forgiveness, they can move forward (see Philippians 3:13).

   Try to help your depressed child to not live in the past but to look to the future; to not wallow in failure but to rise up in hope. By helping your child accept that there are reasons for the depression, you can minimize self-rejection or self-blame. The more children understand about the nature of their depression, the more they will be able to contain its negative effects.

   Keep affirming the potential of your child. It can be very helpful to give a letter to your child during times of depression, expressing your affirmation and love in written form. Such a letter can become a prized possession. I know one adult who received such a letter from his parents when he was in a deep depression as an adolescent, and he keeps the letter in his Bible as a constant reminder that he is deeply loved. Whenever he feels depressed, he reminds himself of the depth of his parents' love. That's especially precious to him, because both his parents have now gone to be with the Lord.

   It can also be helpful to show children how to focus outwardly and not be so preoccupied with their inner feelings. In other words, try to help children to focus less on themselves and more on others. Suggest projects that can serve others, such as writing a letter to some elderly relative or, if they're old enough, volunteering at a charitable organization or simply visiting some elderly person in their neighborhood. It's amazing how this helps to restore a child's (or anyone's, for that matter) sense of value. Serving others is always rewarded by feeling better about yourself.

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1. Archibald D. Hart, Counseling the Depressed (Word, 1987), p. 150

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