Psychological Treatment for Depressed Students

Depression in school-age children may be one of the most overlooked and undertreated psychological disorders of childhood, presenting a serious mental health problem. Depression in children has become an important issue in research due to its many emotional forms, and its relationship to self-destructive behaviors. Depressive disorders are of particular importance to school psychologists, who are often placed in the best position to identify, refer, and treat depressed children. Procedures need to be developed to identify depression in students to avoid allowing those children struggling with depression to go undetected. Depression is one of the most treatable forms of disorders, with an 80-90% chance of improvement if individuals receive treatment (Dubuque, 1998). On the other hand, if untreated, serious cases of depression in childhood can be severe, long, and interfere with all aspects of development, relationships, school progress, and family life (Janzen, & Saklofske, 1991).

The existence of depression in school-age children was nearly unrecognized until the 1990’s. In the past,

Shure (1995) suggests that cognitive behavioral therapy teaches children how to think for themselves rather than think for the children. Shure (1995) recommends a cognitive approach to treatment named “Interpersonal Cognitive Problem Solving”, that is appropriate for children of various ages and IQ levels. Shure (1995) suggests that lesson based games can be applied as early as preschool. The games are designed to help children get in touch with their feelings, as well as the feelings of others (Shure, 1995). According to Shure, ICPS can help children learn to generate or apply more than one solution for a problem, learn to create dialogues to express their feelings, and increase coping skills (Shure, 1995). Family intervention also appears to be beneficial in order to address parental self-blame. Education of the child as well as the family enhances both understanding, and compliance with treatment (Sung & Kirchner, 2000).

When treating students for depression, it is not uncommon to encounter students that engage in self-destructive behaviors. Ramsey (1994) notes that when treating this population, it is a good idea to have the student review everything that has taken place in the child’s life within the past few days in order to become aware of any threats, hints, or self-destructive intentions. If a child suggests any intentions to harm himself or herself, it should be considered as “a cry for help”, and not just attention seeking behavior (Ramsey, 1994). The therapist should provide an environment that the child will view as non-judgmental (Ramsey, 1994). Some incidents that contribute to suicidal thoughts include: “losses of loved ones or pets, feelings of failure; and extreme shame or grief” (Ramsey, 1994). Of course, therapists always need to determine if the child has a plan, how well thought out it is, and if they have the means to carry out the plan. Based on this information, a counselor or therapist should be able to determine if the child is in need of referral to crisis services. The parents need to be notified of any suicidal risk and education regarding feelings of guilt, warning signs, and panic (Ramsey, 1994). These children need special attention because often young children do not understand that death is “irreversible” (Ramsey, 1994).

According to Callahan and Panichelli-Mindel (1996), many School Psychologists are not required to diagnose affective disorders in students, but do need to assess and develop interventions for them. The DSM IV appears to provide much help to School Psychologists to determine the symptoms that indicate a particular disorder, and to relay that information to professionals outside of the school. According to Callahan and Panichelli-Mindel (1996), it may be difficult to provide a diagnosis when childrens’ symptoms do not easily fit any categories. Also, a child that does not clearly fit into a diagnostic category may go without treatment when treatment is needed (Callahan & Panichelli-Mindel, 1996). The child’s diagnosis appears to be the most important aspect in planning the appropriate treatment or intervention. Thus, misdiagnosing a child could be harmful.

A student’s poor self concept is sometimes formed when children feel that they do not measure up favorably to other siblings or parental expectations (Ramsey, 1994). To help children develop more positive self concepts, children can benefit from being engaged in group activities or tasks at home or school that are consistent with their skills and provide a chance to feel successful (Ramsey, 1994). Parents can also benefit from instruction, role-play, and parenting groups to help learn to understand, and communicate with children who struggle with low self-esteem (Ramsey, 1994). In order to gain a sense of how the child feels and thinks, Ramsey (1994) recommends engaging the child in play therapy, drawings, incomplete sentences, or fantasy games. By asking a child with a poor self-concept how t

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