By: Caitlynn Iddings, MD
Let me explain why kids may be more depressed and anxious than we realize and the science behind why this may be. There is a specific area of the brain known as the "Pre-Frontal Cortex" (PFC). This is the area of the brain that is responsible for multiple functions. It is the "football coach" or the "orchestra conductor" part of the brain. The most typical psychological term for functions carried out by the prefrontal cortex area is "executive function." Executive function relates to the ability to differentiate among conflicting thoughts, determine good and bad, better and best, same and different. It is responsible for recognizing future consequences of current activities, working toward a defined goal, predicting outcomes, knowing expectation based on actions, and social “control.” It allows the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes.
Back before we better understood brain anatomy, doctors often would take the "clinically insane" person and do something called a frontal lobe lobotomy where they would scramble the forebrain or prefrontal cortex to make patients "more controllable." Sometimes lobotomy would leave a patient docile and childlike, with significant inability to care for themselves but often this would leave patients with a variety of issues including difficulty sleeping, apathy for previously enjoyed activities, significant personality changes, inability to sustain focus or commit things to long term memory, and increased reckless behaviors such as impulsive gambling, eating, thrill seeking, etc. In depression not only is there under activation of the PFC across all age groups, but its volume has been found to be reduced as well in persons who are more prone to depression. A depressed person with an underactive prefrontal cortex of reduced volume is not going to demonstrate the rational problem-solving abilities of someone without such deficits—this causes the brain to have a reduced capacity to support resilience.
- fussiness and irritability, startling and crying more easily, more difficult to console
- difficulty falling asleep and waking up more during the night
- Feeding issues such as reflux, constipation, loose stools, or frequent complaints of belly pain
- Increase separation anxiety, being more clingy, hesitant to explore and play
- hitting, biting, and more frequent or intense tantrums
- bedwetting or frequent accidents when they have previously been potty-trained
- constantly looking for words or affirmation or urgently expressing needs while seeming unsatisfied when needs are met
- And conflict and aggression or themes of illness or death during imaginative play time
As we grow older our prefrontal cortex continues to mature, but there are plenty of studies that suggest the PFC does not reach full maturity until close to age 25 (especially in males!). Therefore, it doesn't matter how smart your middle school or teenager is or how high of a score they manage to get on their ACT or MAP testing. Good judgement is just NOT something they can easily excel in, at least not YET. Studies show that as adults we tend to think or activate the prefrontal cortex, or the "rational part" of the brain and teenagers process more information with the amygdala or the "emotional part" of the brain. In adults the connections between these parts are well established but in teens those connections are still being made, and not always at the same rate for each child. Therefore, when we ask a teenager "What on earth were you thinking!?!?" we are often met with blank stares because it isn't as much about what they were THINKING as what they were FEELING at the time. They intrinsically lack a brake pedal when it comes the being able to stop and think though long-term consequences of their actions. They are hopelessly "near sighted" beings.
- mood changes that are not characteristic for your child including excessive anger or rage, irritability, increased conflicts or fights with family or friends
- changes in behavior, such as stepping back from personal relationships. If your ordinarily outgoing teen shows little interest in texting or video chatting with their friends, for example, this might be cause for concern.
- a loss of interest in activities previously enjoyed. Did your music-loving child suddenly stop wanting to practice guitar, for example? Did your All-Star basketball athlete suddenly quit and refuse to go to practice or see their friend?
- A hard time falling or staying asleep, or starting to sleep ALL the time
- Changes in weight or eating patterns, such as "never being hungry" or constantly overeating
- problems with memory, thinking, or concentration.
- less interest in schoolwork and drop in academic effort
- changes in appearance, such as lack of basic personal hygiene (within reason, a lot of teens are not dressing to the 9s for their virtual zoom classroom meetings)
- increase in risky or reckless behaviors such as drug or alcohol use, sneaking out at night
- thoughts about death or suicide or talking about the world being better without them in it.
Lastly, it is time to destigmatize mental health issues as well. As a parent if you are open about the importance of mental health and supportive of your child it will make all of the difference in their ability to approach you or someone they know to ask for help. If a child has a sore throat and fever and gets brought to the doctor and diagnosed with strep throat, they would get medicine to treat the symptoms and also help clear the infection because it is understood that untreated strep throat can be potentially deadly or have life-long consequences. If a child is severely depressed or anxious it should also be encouraged to bring them in to get them therapy or possibly medication that they need to prevent potential deadly or life-long consequences.
All kids need to learn how to cope with challenging things. One of the best possible gifts a parent or care giver can give to a child is to allow them to learn coping skills. These are things all people have to learn eventually to be capable and productive members of society. I always say it is better to learn these skills when you are 10 years old and have fewer responsibilities than when you are 20 or 30 or 40 years old. It’s about equipping kids to be resilient and giving them the mechanism to excel even when their prefrontal cortex has not quite caught up yet. COVID has taken so much from us as a society. It is time to start regaining ground and getting kids the help they truly need to come out of the other side of this pandemic with less trauma and less baggage. But no one can do that alone, it takes a team, and we have a pretty spectacular team of people waiting to give kids the tools they need. Give us a call to schedule an appointment so we can help!
· https://childmind.org/article/signs-of-depression-during-coronavirus-crisis/
· https://www.psychiatrictimes.com/view/new-findings-children-mental-health-covid-19
· Duan L, Shao X, Wang Y, et al. An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. J Affect Disord. 2020;275:112-118.
· Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 [published online ahead of print, 2020 Jun 3]. J Am Acad Child Adolesc Psychiatry. 2020;S0890-8567(20)30337-3.
· https://www.neuroscientificallychallenged.com/blog/2014/5/16/know-your-brain-prefrontal-cortex