Special Report: The crushing years

NST: Children fall down, and scrape their knees. They get tired and cranky, and often they cry. But depressed? It happens, and stress makes it a possibility that parents should consider, writes ANITA ANANDARAJAH.
Dr Toh believes stress causes depression.

RANI used to smile when her 10-year-old son Rakesh put his palms together, as if praying, whenever he passed the altar room. But then he started doing it whenever he passed a broom, and the rice cooker in the kitchen.
The first doctor they saw ran some tests, then said he was normal. She went to the University of Malaya Medical Centre for a second opinion, and discovered he was suffering from depression.
It’s an uncommon disorder in children but not any less serious whenever it strikes.
Loosely defined, it is a prolonged low mood.
Children get depressed for many reasons, said Dr Toh Chin Lee. It has always been present but few parents or doctors recognise it, said the Kuala Lumpur Hospital child and adolescent psychiatrist.
In 1996, a Health Ministry survey found that 13 per cent of children aged between five and 15 have mental health problems. The survey, the second National Health and Morbidity Survey, also found 8.7 per cent of this age group were predisposed to depression.
Four years later, it made mental health the theme of a campaign to promote healthy lifestyles. Primary school pupils were one of its target groups taught to recognise stress.
Dr Toh believes stress causes depression in children.
"Most handle it successfully. But stress piled upon stress can be difficult to cope with. Some families may not recognise the child's needs."
A marriage break-up can cause undue stress, for instance. So can being bullied, or becoming a victim of verbal abuse.
Children may feel sidelined by a sibling, scared of fierce teachers, or struggle to meet parents’ expectations.
Children need stability, routine and predictability in life, he said.
How can parents tell if their a child is suffering from depression?
It was Rani’s training as a nurse which helped her notice Rakesh’s behaviour, shortly after he began tuition classes.
"He was frightened of his tuition master who would beat other children. I thought the discipline would help my son learn better," she said.
Attending psychiatrist Dr Aili Hanim Hashim saw Rakesh’s family environment as the predisposing factor. "There is little nurturing of the child in the family."
Aside from depression, Rakesh was diagnosed as suffering from obsessive compulsive disorder.
"His tic has been there for many years. The problem was exacerbated with the strict tuition master," Dr Aili explained.
Now 16, Rakesh is responding well to therapy and anti-depressants, and his tic subsided after six years.
At the UMMC’s child and adolescent psychiatric unit where he was treated, the youngest patient diagnosed with clinical depression is 14 years old.
The unit gets 10 new cases a week, excluding referrals from other units in the hospital.
Changes in behaviour should tip off parents and teachers, said child psychiatrist Dr Subash Kumar Pillai, also with UMMC.
This is important because struggling continually with negative thoughts and a poor self image will lead to an inability to cope with problems, he said.
The problem is, too often, bad behaviour is thought of as just being naughty.
"Children can be treated. Bad behaviour is just a symptom."
Parents need to look deeper into what the child may be going through.
"If previously he enjoyed going to school but suddenly refuses to go, it could be a sign that something is bothering him.
"Look out for somatic symptoms like frequent stomach aches, headaches and fever. Older schoolchildren may come up with cleverer complaints as their brains are better developed compared to pre-schoolers."
Can children get over it, like they get past teasing? Dr Subash points to genetics.
"If a parent has depression, and the child gets it at a young age, it may take a longer time to get better," he explained.
"The earlier it is caught the sooner we can offer better treatment and medication."

Sadly, a psychiatrist or psychologist is often the last person consulted. Parents are desperate to avoid the stigma of the psychiatric unit — the "gila" ward.
That has led many of them to alternatives offered by non-government organisations such as the Agape Counselling Centre.
Housed in shoplot off Old Klang Road in Kuala Lumpur, the centre has incentives that draw children naturally: toys. In its two playrooms, there are hundreds of dolls, action figures and puppets which children use to express their emotions.
The centre keeps a low profile, and visits are by appointment only. Yet its phone rings off the hook, and 235 clients walked through its doors last year.
Roughly one in seven were found to be suffering from depression.
"Cost is also a factor for our clients. They find consultation fees at private hospitals too expensive," said Lisa Sum, the director of the play therapy department.
The play method adopted at Agape was successful in drawing little Tien out.
His mother was deeply worried, for the once happy-go-lucky boy was bossing her about, acting like the man of the house when he was just 10 years old.
After three sessions, he revealed he was missing his father.
"Tien was drawing a picture of a car on the white board when he blurted out that he had dreamt that he was in the car with his father," said his counsellor.
After some gentle probing, he blurted that his father died of cancer. Father and son had been very close.
By the seventh session, Tien reverted to his old self. His counsellor said: "It was as if he had let go."

*Names have been changed to protect the privacy of those interviewed.