NASP CQ 35-3 - Depression

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NASP Communiqué, Vol. 35, #3
November 2006

Depression: Helping Students in the Classroom

By Thomas Huberty, PhD, NCSP Indiana University

Michael is a 14-year-old boy in the eighth grade from an intact, professional family. He has a 16-year-old brother and a 10-year-old sister who do very well in school and demonstrate no problems. Michael is considered to be very bright, as shown by past grades and achievement test scores. Over the past few months, however, teachers have reported that Michael will not complete his homework or may complete it and not turn it in. He has a history of inconsistent performance over the past 2–3 years, which seems to have worsened these past few months. In the classroom he sits in the back, does not participate, doodles on his papers, and shows little interest in the activities. He is not disruptive or attention seeking and seems to want to avoid interacting with others. When asked why he is not doing his work, he says that, "I don’t know," "I don’t care," "It’s not important," or "No one cares, anyway." Other students view him as "odd" and a "geek," and report that they do not want to be around him. Over time, he becomes more socially isolated. Now, he has only one or two friends who are not part of the social mainstream. He does show occasional irritability or anger when pushed, but he is not aggressive or overtly noncompliant. Most of the teachers describe him as "lazy" and "unmotivated" and show little interest in trying to help him.

Background

Michael’s story is based on a real student and reflects characteristics of some children who are depressed. These behaviors are not unique to depression, and some students with depression may have some different characteristics. Teachers often have depressed students in their classrooms, and they have difflculty recognizing them or knowing what to do to increase performance. These students often are seen as lazy and they do not respond to typical methods of discipline, including suspensions, penalties, or encouragements. Most depressed children are not being deliberately deflant and uncooperative, but cannot muster the personal resources to perform as well as they are able. They may think in non-productive ways, such as, "I did poorly on a test because I am a stupid person," rather than, "I did poorly because I did not study hard enough" or in all-or-none, "I am terrible at everything," rather than, "I am good at some things and not as good at other things." Working with depressed children and adolescents requires that educators know about depression, its characteristics and effects on school performance, and what can be done to help these students in the classroom.

Depression in the classroom. Depression is a term we are hearing more often regarding children and adolescents. For many years, it was believed that young people could not experience depression, but we now know that they can and do become depressed, sometimes to a serious level. With sufflcient information, teachers can detect depression and are in a good position to identify it and seek help for the student. In the classroom, depressed students may appear unmotivated and uncaring about their work when, in fact, they are unable to function to their level of ability. Often, they have difflculty with sustaining attention, effort, performance, and social relationships. Coaxing, cajoling, punishment, and reinforcement typically have little effect on behavior and achievement.

Left untreated, depression can lead to continued academic and social problems, substance abuse, social alienation, risk-taking behavior, and suicidal thinking and behavior, perhaps into adulthood. Although students with depression may need counseling and therapy, teachers, school psychologists, counselors, and administrators in collaboration with parents can do much to help them in the classroom by knowing what to look for and learning how to be helpful.

Prevalence. Depression is one of the most common, but unrecognized, conditions of childhood and adolescence, and often is mistaken as a motivation or behavior problem. It is estimated that 8–10% of students experience depression serious enough to require intervention, and up to 20% of all adults may have a depressive disorder at some time in their lives. Adolescent girls and women are twice as likely to develop depression as are adolescent boys and men. However, there is no difference in frequency of depression between pre-adolescent girls and boys. A teacher in a middle school or high school may have as many as 3 students in a class of 30 who have mild to serious depression, with most of them likely to be girls.

Symptoms of Depression

Depression is not the same as the occasional adolescent mood swings or feelings of frustration and anger that accompany daily hassles, such as arguments with friends or complaints about school. Those events usually do not last long and do not affect social and school performance. Depression, on the other hand, is a constant mood of feeling down, blue, sad, or down in the dumps that impairs the ability to function. Moreover, the student does not seem to be able to do much to change the mood and does not respond to suggestions to snap out of it.

No two people with depression show it in the same way. Different circumstances and problems cause or contribute to it. However, there are some behaviors that may be signs of depression:

Depressed mood for more than 2 weeks
Loss of interest or pleasure in almost all activities
Irritability or anger
Changes in appetite or weight (weight loss not due to dieting or exercise)
Sleeping too much or too little (sometimes, people seek help for sleeping problems that turn out to be signs of depression)
Decreased energy or physical activity; even small tasks seem overwhelming and require too much effort (e.g., students may complete homework at a level less than they can do and/or may not turn in completed work)
Feelings of worthlessness, guilt, and low self-esteem
Difflculty thinking, concentrating, or remembering
Difflculty getting necessary things done, such as homework
Difflculty making decisions, often unable to make relatively minor decisions
Negative thoughts about self, the world, or the future
Repeated thoughts of suicide, including planning or attempting
Tired and listless
Feeling blah and seeming to have no feelings at all (i.e., feeling empty)
Reports "Not caring about anything"
Increased or decreased appetite
Interpret minor day-to-day events as personal failures or defects
Blaming self for things that are not his or her fault
Statements that others would be better off if he or she were dead
Believes that he or she is ugly and unattractive
Decreased personal hygiene and self-care efforts
Excessive crying or weepiness over relatively small things

Not all depressed people will show all of these signs or to the same degree. If you see several of them in a student, however, they may indicate depression.

Depression and Suicide

A frequent concern about depression is the increased risk of suicide. A small proportion of depressed students show serious thoughts of planning or attempting it. Although depressed youth are at higher risk for thinking about suicide, the vast majority do not attempt it. Most people considering suicide give several indications of their plans, but others may not pick up on them. Some attempters do not show obvious signs of depression, making detection difflcult. Predicting suicide is challenging because of its relatively low frequency and the lack of an accurate proflle of potential attempters. Thoughts of suicide occur more often when the person begins to feel that nothing will help to improve the situation. Feelings of hopelessness that things will never change and the pain will not end may lead to an increased risk of suicide. Behavioral signs of suicidal planning may include giving away personal or prized possessions, making statements like, "I won’t be around," visiting friends and family not seen in a while, taking care of personal matters (e.g., repaying debts, completing unflnished tasks), and talking about how he or she will like to be remembered.

Causes of Depression

The causes of depression are complex. Some people have a greater likelihood of developing depression, such as those who have first-degree relatives with depression (e.g., parent), living in highly stressful and demanding environments, or suffer traumatic events (e.g., loss of a loved one). Depression may be a long-term condition that has persisted over several weeks, months, or years or it may be of recent onset, such as in trauma. Long-term depression is more difficult to treat and most often requires professional help. Recent or sudden onset depression may subside more quickly, but may require professional help to show the best improvement. Most experts agree that depression is associated with changes in the chemistry of some neurotransmitters in the brain, and this can be chronic.

Some evidence indicates that children who believe that others do not view them as competent are more likely to develop depression. This view has particular salience in schools. That is, if teachers and peers view a student as not being academically or socially capable, there may be a greater risk of development of depression. Similarly, because schools can be stressful places for children who are not successful, they can be at increased risk for depression. Many children who have not been successful at school relate feelings of sadness and depression because they do not do well or fit in.

Depression is associated with other conditions seen in children and youth. For example, approximately 50% of children with depression also have problems with anxiety. Some of the same symptoms are shown in anxiety and depression, which makes it difficult to identify the primary problem. Perhaps surprisingly, depression co-occurs with Attention Deficit Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder, and substance abuse problems at levels ranging from 17 to 79% of cases. Therefore, many students who have acting out problems also may be depressed, requiring intervention for both affective and behavior problems. As depression worsens in children and youth, there is an increased likelihood of developing some of these behaviors.

Interventions

Depression is complex, particularly when it co-exists with other emotional and behavioral problems. Often, there are family problems, making a difficult situation even more challenging. The good news is that, with proper intervention, most children and youth can overcome depression and lead happy and productive lives. In some cases professional therapy and medications may be needed, which may be beyond the purview of the school. Although a student might need some direct counseling or therapy, there are many things that teachers and others can do to help the depressed student. Some suggestions include:

Develop a relationship. Approach the depressed student and try to develop a working and collaborative relationship. Do not be afraid to talk with the student. Many times, depressed students are seeking someone who cares about them, although it might not seem that way. Above all, don’t give up on them. Use positive approaches. Do not use punishment, sarcasm, disparagement, punishment, or other negative techniques. They are not effective and likely will only further reinforce feelings of incompetence and low self-esteem, which may deepen the depression.

Remember that these students are not choosing to be depressed. They want to feel better and to do well just as you want them to do well. When depressed, they lack the personal resources to do their best work. As an analogy, we would not expect someone with a reading disability to read at grade level. Punitive approaches are not recommended in these cases and, instead, it is best to give extra help or support. The student with depression needs to receive extra support and caring, as well, not criticism, punishment, or indifference. Consider ways to give the extra support and attention they need, while recognizing that the student may be doing the best he or she can do at the time.

Consider making adjustments or accommodations in assignments or tasks. This approach does not mean that expectations are lowered or that the student with depression should be given unearned grades. However, give more time, break assignments into smaller pieces, offer extra help in setting up schedules or study habits, or pair the student with others who express an interest in helping. Accommodations like these are provided often for students with learning disabilities. There is no reason that the student with depression cannot receive similar considerations.

Provide opportunities for success. To the extent possible, arrange experiences so that the student can be successful and be recognized for successes. Schedule pleasant activities and provide opportunities for successful leadership. It is very important that depressed students feel accepted as a part of the school and that teachers believe in their competence.

Seek help from support personnel. Consult with your school psychologist, counselor, or social worker to get suggestions of what to do for specific students. Each case is different and requires individual planning.

Summary

School personnel can have significant, positive impacts on improving the academic, social, and emotional development of children with depression without being professional therapists. Learning about depression and implementing methods to help can make the difference between a student’s success or continuing down a path of underachievement.

Resources

Koplewicz, H. S. (2002). More than moody: Recognizing and treating adolescent depression. New York: Putnam. ISBN: 039914918X.

Merrell, K. (2001). Helping students overcome depression and anxiety: A practical guide. New York: Guilford. ISBN: 1572306173.

Websites

American Psychological Association — www.apa.org

Depression and Bipolar Support Alliance — www.dbsalliance.org

National Association of School Psychologists — www.nasponline.org

Thomas Huberty, PhD, NCSP, is Professor and Director of the School Psychology Program at Indiana University. Reprinted from Helping Children at Home and School II: Handouts for Families and Educators (NASP, 2004).

NASP Communiqué, Vol. 35, #3 November 2006