CHILDREN / Too sad, much too young: One child in four has a mental health problem, but how can a parent tell depression from unruly behaviour? Angela Neustatter reports

THE first time 12-year-old Mark told his mother how scared he was that there might be a nuclear war, she comforted him and assumed it was 'just the kind of anxious phase children go through'. But over the following weeks his fears seemed to grow and grow; he would wake, terrified, in the night; he would ring her during the day from school; he would come home in floods of tears and leave in the morning in the same state. 'Then one day I collected him from school and he put his head in his hands and said 'I want to kill myself',' his mother Georgina recalls.

She felt helpless, not understanding why this despair had taken Mark over. She tried to remember when it had started. One possibility occurred to her: her son's anxiety had set in very soon after she told him that she was planning to visit a friend in Spain for a week, while her partner who had lived with them for several years, would care for him.

'Mark never mentioned being worried or upset by this,' she recalls. 'But I can see now that he became clinically depressed. He had no interest in anything: there would be occasional bursts of high spirits, and then he would talk about not knowing how to go on. After about six weeks I decided I should go to my GP.'

Childhood depression is far more common than many people realise, says Professor Ian Goodyear, of the Child and Adolescent Psychiatry Department at Cambridge University. He believes that three school-age children in 100 are suffering from a serious depressive disorder and that 10 more of that 100 are likely to have suffered depression in the previous 12 months. A report published by the Mental Health Foundation last year showed one in four children under 16 had mental health problems, including severe depression, which make a normal upbringing impossible.

What's more, the problem seems to be getting worse. Figures published by the Department of Health this year show that the number of children and teenagers suffering from serious mental illnesses and admitted to psychiatric hospitals has increased by 25 per cent over five years and that 111 youngsters in the 10-19 age group committed suicide in 1992.

Mark's GP was understanding and sympathetic. He said he could refer him for psychiatric help, but Georgina, who felt a terrible failure (as many parents do when faced with the idea that their child may be suffering from a mental illness), preferred to wait and see. It was when she decided to cancel her trip abroad that Mark started to get better.

'From the day I told him I wasn't going,' she says, 'things improved. The tearful calls came less and less often, he wasn't depressed all the time and he began going out swimming, racing around with his friends again. Most of all he stopped talking about wanting to kill himself. This happened over a year ago and he has been fine since. I still don't know why my going off for a week was so traumatic, but someone at a child guidance clinic told me boys at puberty quite often get anxious about being separated from their mothers, and clearly it was upsetting for Mark.'

Childhood depression can lift by itself but it should not be left too long, say Dr Andrew Slaby and Lili Frank Garfinkel, authors of a new book on teenage suicide No one Saw My Pain, published this month by W W Norton at pounds 17.50. If a state of hopelessness has lasted more than two weeks and includes at least five of the symptoms (see box), help should be sought. Professor Goodyear warns: 'Depression can be a downward spiral. We know it usually takes eight months for depression in children to be recognised, and the average length of recovery then is nine months; this means 17 months suffering in all. You are looking at an illness which can be three to five years in duration and even when it lifts there is a 60 per cent chance of a relapse. Getting the right kind of help is important.' He believes therapy may help. About a quarter of severely depressed children also benefit from medication.

Suzanne is sure that if she and Martin had got early help for his daughter Julie, who was three when they married, the child's life and their marriage might have been a lot happier. Suzanne describes the pattern of an 'illness which we didn't recognise partly because there was nothing straightforward about it'.

Between five and 12, Julie was withdrawn, sucked her thumb and soiled herself. She then contracted glandular fever and put on several stone, which she never lost. She stopped going to school, functioned at a minimal level and spent a great deal of time lying around and eating excessively. This was followed by stealing, and as Julie reached her mid-teens she began using drugs.

Parents sometimes dismiss their child's depression simply as bad behaviour. It is very hard for them to admit that their son or daughter is suffering from mental illness, says Peter Wilson, director of Young Minds, The National Association for Child and Family Mental Health. 'Children become depressed after significant disappointments and changes in their lives, as well as tensions and losses in their families. Sadness is a normal response to loss or an unhappy event. But depression is much more set and persistent and doesn't find relief or change with changing circumstances.'

The symptoms depressed children and teenagers show are confusingly broad-ranging and do not always tie in with our ideas of what depression is. Many children cannot talk directly about how they feel and instead express themselves in the way they behave. A child who is withdrawn, loses a sense of pleasure or interest in life, does not concentrate, eats irregularly, talks of feeling hopeless and has suicidal thoughts may be more easily identified as depressed. Less easy to diagnose is a child who is out of control, anti-social, gets into trouble at school, takes risks with his or her safety and is destructive.

Even babies and toddlers become depressed. The symptoms range from listlessness to grizzling and clinging. They are often unable to accept comfort or consolation and may refuse to eat. Children may also mess themselves, have broken sleep and nightmares, be unable to make or keep friends. Headaches and stomach aches are common physical symptoms masking depression.

Alerting GPs to childhood depression was one of the aims of last year's Defeat Depression campaign, organised by the Royal College of Psychiatrists and Royal College of General Practitioners. According to June McKerrow, director of the Mental Health Foundation, two million children attending GP surgeries have some form of severe psychological and emotional problem, but only 2 per cent are identified there. Doctors, once they have made sure there is not a medical problem, need to ask children how they feel inside. Parents too can ask a troubled child if they 'have bad feelings' because children are often able to respond to the question when put like that.

Looking back, Suzanne can see the succession of psychological body- blows which hit the child; she and Julie's natural mother had new babies at the same time; Julie's elder sister was consistently unkind to her; her beloved grandmother died and nobody helped her through the grief; and, Suzanne admits, striving to make her marriage work and, in due course, to bring up her own two children well, she was frequently impatient with Julie.

It was only when Julie, at the age of 14, stole a substantial amount of money to buy drugs that Suzanne and Martin went with her to family therapy. It was here that some of the problems were looked at. 'Some

reconciliation grew out of it,' says

Suzanne, 'but we should have done it years earlier.'

If a child seems depressed it is important to look at what is going on in his or her life, whether family upheavals and tensions may be having a negative effect. Child psychotherapist Trudy Klauber explains that children are like blotting paper, soaking up family troubles - marriage difficulties, money worries, unemployment or illness - and if these problems are kept secret, that can be even more distressing. They may also react if they are under a lot of pressure to meet parents' ambitions, or if they see too little of their parents. Another common trigger for depression is bullying at school.

One solution is psychotherapy. With a therapist children can talk and act out their feelings, often using play to do so. Changing the circumstances which may be upsetting children can also help cure their depression, while stopping to consider whether a child is being supported through such things as a new nanny or school, different custody arrangements or losing a friend - changes that can feel momentous and upsetting - may prevent it occurring.

Above all, says Klauber, we should remember that normal life includes bad times and that children need to be helped to cope with these. She adds: 'We are not saying to parents that depression is a life-long disaster, but that childhood depression which becomes chronic may be reactivated throughout life. The child who is helped through a depression and feels cared about may gain strength from the experience.'-

Handling depression

WARNING SIGNS

Symptoms that may indicate childhood depression include: being withdrawn, loss of pleasure and concentration, talk of feeling hopeless or suicidal, irregular eating, insomnia or broken sleep, anti-social behaviour, inability to make friends, risk-taking. For babies and toddlers the symptoms are listlessness, clinging, grizzling and refusing their food.

WHERE TO GO FOR HELP

Young Minds: The National Association for Child and Family Mental Health, 22 Boston Place, London NW1 6ER (071-724 7262). They will put you in touch with local services and, if you enclose an SAE, will send their leaflet Children and Young People Get Depressed Too. The Child Psychotherapy Trust, 21 Maresfield Gardens, London NW3 5SH.