Presentation delivered to the West Side Health Authority. This presentation was attended by program developers, teachers, principals, and directors of local community organizations.

1. Depression in children: Behavioral
manifestations and intervention
David A. Songco, M.A., Psy.D.
New Insights, LLC
Milwaukee, WI
(c) 2014 New Insights, LLC

2. Depression

4. Introduction
• Prevalence of depression increases with age.
• Mood disorders among preschool-age children
are extremely rare
• Among pre-pubertal school-age children in the
community, the prevalence is approximately 1
percent. Similar rates of depression in in terms
of gender
• The rate of depression in adolescent females is
double the rate it is in adolescent males.

5. Depression: What is it?
• Major Depressive Episode (2 Week
Period)
• Depressed Mood most of the day, nearly every day, as indicated by
either subjective report of other observations.
• Markedly diminished interest or pleasure in all, or almost all activities
• Significant weight loss when not dieting or weight gain, or
decrease/increase in appetite nearly every day
• Insomnia or hypersomnia nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt
• Diminished ability to think or concentrate or indecisiveness
• Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan

6. Depression in ChildrenDepression in Children
How is it Different?How is it Different?

7. Signs and Symptoms
• Depression in children typically manifests
itself differently than in adults
• The core features of Major Depressive
Disorder are highly similar in children,
adolescents, and adults, however
developmental factors influence its clinical
presentation.

8. Depression in Children
• Children and adolescents with depression often
display:
• Irritability
• Withdrawal from family and peers
• Deterioration in academic investment
• Social isolation

9. Recognizing depression
• Persistent themes in play and fantasy will
often reflect mood
• School phobia and excessive clinging to
parents may also be symptoms
• Poor academic performance
• Substance abuse
• Antisocial behavior
• sexual promiscuitY

10. Examples

11. Distinguishing between depression and
other BX Disorders
• In depression, behavioral disturbances will subside when the
mood disorder is treated. In conduct disorder and
oppositional defiant disorder, the behavioral disturbances are
likely more pervasive and embedded in the root of the
problem rather than a symptom of it.
• In depression, children and adolescents will often be able to
recognize feelings of sadness, depressed mood, irritability,
etc. when probed. Whereas, when dealing with strictly
behavioral issues, these depressive symptoms will likely not
be present.
• Conduct disorder and Depression are often present in the
individual concurrently. It is thought that the likely connection
is related to shared risk factors rather than a causal relation.

12. Behavioral disorders
Conduct Disorder, Oppositional Defiant Disorder
and Attention Deficit/Hyperactivity Disorder can
occur among children who later experience
depression.

13. Depression and Abuse
• Most young children with major depressive
disorder have histories of abuse or neglect.
• As professionals working with children, we
are mandated reporters.
• Responsibilities
• Find as many details as possible
• Make the DCFS Phone Call
• 1-800- 25-ABUSE

14. Suicide and DepressionSuicide and Depression

15. Suicide
• Suicide is the 3rd leading cause of death among adolescents in the US.
• Reports indicate that half of suicidal individuals express suicidal intentions
to a friend or a relative within 24 hours before enacting suicidal behavior.
• More than 12,000 children and adolescents are hospitalized in the US each
year due to suicidal threats or behavior.
• Completed suicide occurs about 5 times more often in adolescent boys
than in girls
• The rate of suicide attempts is at least 3 times higher among adolescent
girls than boys.

16. A point to remember
It is always OKAY to Ask about it!It is always OKAY to Ask about it!

17. Aggression

18. Working with aggression
• The nature of the population we work with is
very prone to acts of aggression.
• It is important to recognize the difference
horseplay, play fighting, and expressed
aggression.
• Aggression may be verbal and physical.
• It is difficult to work with an individual who is
currently in an aggressive state.

19. De-Escalation Model
• Physical Presentation
• Content of Speech
• Listening Tools
• Clarification
• Negotiation
• Positive Affirmation

20. Communication as
De-Escalation
De-Escalation
• Undivided Attention
• Be Nonjudgemental
• Focus on Feelings
• Allow for Silence
• Clarify Message

21. Program Development
Model
• Social-Cognitive Information processing
(SCIP) perspective of Aggression
• Decision Making Model - 4 steps
• Evaluate Environmental Cues
• Search memory for a script to guide
behavior
• Evaluate the generated script
• Behave according to the script

22. SCIP
• See Handout
• Right Column: Methods that can be used
to train the social-cognitive information-
processing components of each step
• Middle Column: Steps of the SCIP Model
• Left Column: Underlying processes
contributing to each step.

24. SCIP Application• Cognitive Mediation Training
• Trained to evaluate consequences of their
behavior
• 8 Steps
• Is there a problem
• Stop and think
• Why is there a conflict
• What do I want
• Think of Solutions
• Look at Consequences
• Choose what to do and do it
• Evaluate the Results

25. Services from New Insights,
LLC
• Psychological AssessmentPsychological Assessment
• Psychological Testing (Coming Soon)Psychological Testing (Coming Soon)
• Individual TherapyIndividual Therapy
• Couples CounselingCouples Counseling
• Group TherapyGroup Therapy
• Family SessionsFamily Sessions
• Workshops and Community PresentationsWorkshops and Community Presentations

26. Contact Us
• Dr. David Songco
• dsongco@newinsightsllc.com
• 414 - 604 - 6413

27. References
• American Psychological Association. Diagnostic and Statistical Manual of
Mental Disorders, 4th Ed. (2000).
• Boxer, P & Dubow, E. (2002). A social-cognitive information-processing
model for school-based aggression reduction and prevention programs:
Issues for research and practice. Applied & Preventative Psychology. 10: 177-
192
• Cowin et al. (2003). De-Escalating aggression and violence in the mental
health setting. International Journal of Mental Health Nursing. 12: 64-73.
• Sadock, J & Sadock, V (2007). Synopsis of Psychiatry. Philadelphia, PA:
Lippincott Williams & Wilkins.