THOUGHTS ON CHILDHOOD, ADOLESCENT, AND ELDERLY PATIENT ILLNESSES
Within many of our lifetimes, the assumption was that what we call "dementia" today was simply a natural consequence of aging. Explanations such as "hardening of the arteries," "senility," and "old age" prevailed. A fairly broad and significant range of cognitive deterioration, unless very severe or bizarre, was considered to fall within the normal aging processes. As with most assumptions, this made sense intuitively -- after all, we eventually develop problems and degradation with many bodily functions . Why would the mind be any different?
However, we are discovering that many medical problems are not the natural result of aging. Often, they are symptoms of diseases that we may develop or may become more common over time. We now believe that the "natural" course of cognitive change is much less severe than first assumed. The primary natural change seems to be impairment of our ability to "multi-task." That is, our ability to juggle simultaneously multiple mental demands deteriorates slightly over time. These demands include sensory inputs such as noises (the radio, horns honking, being asked a question, the chatter of others talking), visual stimulation (cars changing into our lane, someone running by, flashing lights, etc.), tactile stimulation (e.g, a tap on the shoulder, pain, change in temperature), or a change in how the environment smells even. These sensory inputs may become more annoying, distracting, or overwhelming. At the same time, tasks that involve more cognitive work and "concentration" require more isolation from other distractions such as the sensory inputs described above. Think of driving under icy or perilous conditions -- when younger we may need to turn the radio down a bit to focus, but as we age, we do not want any radio, noises, reading lights, or passengers moving while we are trying to direct our attention to the many cues that allow us to drive under those situations.
Today, the symptoms of more significant brain dysfunction are lumped together under the broad term "dementia." This is discussed more in the dementia section of this site. Once we understand that large changes in mental function are from diseases, we can better understand how some people retain a high level of functioning into their later years. People fortunate enough to avoid these diseases are able to balance their checkbooks, pay their bills, make sure they take their medicines, and generally care (or obtain care) for themselves into their 90's!
As to children and adolescents, we very frequently dismissed depression and anxiety problems as a natural consequence of growing up and the "chemical changes" of adolescence. Like assumptions we made about cognitive problems and aging, this explanation seemed to make perfect sense. After all, our bodies were changing, the importance of our appearance became more important, we began separating from our parents, and we became much more interested in romantic -- often highly charged -- relationships.
However, we now know that anxiety and mood problems caused by the diseases addressed on this site are not natural or inevitable consequences of the trials and tribulations of childhood and adolescence. That is not to say personality, maturation, and life circumstances do not contribute to the problem. However, it seems that Clinical Depression, Bipolar Disorder, and Anxiety problems often first present during childhood and teenage years independent of these factors. This is true in the same way dementia is not caused by age; instead it is more likely to arise at that age. Other diseases such as Schizophrenia tend to first present in our early twenties when it is much more difficult to attribute a period of maturation or life circumstances to explain it. The point is we must be careful not to overlook treatable problems because of misinterpretation of distress to stages of physical maturation or typical life stressors of a given age group. Rather, we must consider both together -- and this is much easier to do with the help of someone to help disentangle these elements.
Fortunately, if we remain vigilant for typical symptoms of depression, mania, drug use, anxiety, eating disorders or the like in our children, we can catch the disease before it destroys lives -- sometimes violently. With regard to mood disorders -- particularly depression -- as parents and caregivers we should keep a lookout for periods of time when during the same period, our children seem to persistently "sulk," regularly speak negatively of themselves, stay in their room for long periods of time, groom and dress less carefully, show disruptions in their established sleep routine, and/or lose interest in things they used to like or love. Loss of interest may manifest itself in quitting a club, giving up on a sport or activity, and/or reducing interactions family or friends. Other signs may include our child forgetting or overlooking things more commonly, losing pep or vigor, complaining of tiredness, excessive sleeping, more irritability, indifference to maladaptive behaviors and their consequences, and a noticeable drop in school performance and grades.
It is imperative that we ask our children about these things -- remember they likely know very little about depression and how it is different from just being sad, disappointed, or "bummed out." Furthermore their life experience is often too limited to understand when thoughts and feelings are not just a normal part of life or inevitabilities. If you are worried that your child might hurt him or herself (or someone else), do not be afraid to ask. Although we may be afraid that this question may "plant a seed" to act on these thoughts, evidence suggests otherwise. It is likely that your child will feel relieved to discuss this and appreciate your interest and care in the changes in his/her life.
If your level of concern has arisen to this level, then you should consider offering help from someone with whom your child can discuss his/her problems -- particularly if they do not seem comfortable discussing it with you. If you are worried, do not accept "I don't want to talk about it" for an answer. It is also important to not dismiss the speech or behavior to "acting out," or "attention seeking" behavior. These are not mutually exclusive motivations. Children acting out and seeking attention do still kill themselves, despite the fact the behavior may appear and even be manipulative.
If your child does express thoughts of killing him or herself (or someone else), it is time to seek help immediately and you may well need to watch your child constantly/at all times (including bathroom breaks and the like) until help is obtained. It is probably wisest to take your child directly to the nearest emergency department for immediate evaluation and a safety plan. As an alternative, seek a same-day mental health appointment for a risk evaluation and plan. Until such an evaluation takes place, keep your child under constant watch. When you seek outside help, your child may be angry and object that you "betrayed" his/her confidence, but remember judgment is increasingly impaired as an individual becomes more depressed. We know there is a significant increase in the risk of violent and possibly deadly behavior when people begin discussing impulses or thoughts of hurting themselves or others -- regardless of age.
We must trust our instincts with our loved ones -- particularly those most vulnerable such as children or the elderly. If you are worried, then you are very likely right to do so. Children and adolescents guard and value their independence and privacy and may reject your inquiries defiantly. When we are helping elderly individuals such as our parents, they often mistake or characterize our interventions as meddling, disrespect for the parent/child relationship, or trying to control them with ulterior motives. As mentioned before, it is important to recall that at times of psychiatric crisis, the afflicted person is in a state of impaired judgment and they often try to reject our help - using anger, guilt, or minimization. We tend to defer to their wishes at these times, and during normal circumstances, that is generally the right course. However, at these times, you are likely in the best and perhaps only position to consider the situation thoughtfully, rationally, and in what is most likely to be the best interest of the individual in distress.