Arizona Republic
May 20, 2004


By Janie Magruder

Katie Michelle Walton was born scared.

She startled easily, despite being part of a noisy household that
included a 2-year-old, and kept her tiny hands balled into tight fists
for the first nine months of life. She fussed and fidgeted until
someone picked her up, so much so that her family nicknamed her "Hold-
Me-Katie." As a toddler, she locked her arms around her mother's neck
in a demonstration of separation anxiety.

"I look back at pictures of her, and I can see the sadness in her
face," said Sherri Walton, Katie's mother. "She probably was

Babies depressed? Preschoolers mentally ill? For some, childhood is
anything but a happy-go-lucky, carefree time.

Depression is showing up earlier in children, according to the
National Institute of Mental Health. It reports that as many as 2.5
percent of children up to age 12 and 8.3 percent of adolescents ages
13-21 suffer from depression, an illness of the brain.

Babies can begin to experience depression at about 4 months, according
to the Zero to Three Foundation, a Washington, D.C.-based non-profit
organization that promotes the healthy development of infants and
toddlers. Even 1-month-olds can sense and be affected by anger or
depression in their parents. The symptoms, in babies who are "too
quiet" or in 2-year-olds who seem really "terrible," may not be
recognized by parents and may be passed off by pediatricians as normal

"When little kids are depressed, they tend to look very sassy," said
Marlo Archer, a Phoenix psychologist. "They're irritable, there's an
increase in temper tantrums, there are nightmares every night and
they're in your bed. It all looks very naughty, and in the past we
just didn't give that any credence. We missed it."

Screening statistics

In an effort to do a better job, the Arizona Psychological Association
earlier this month sponsored a free depression screening day of
children and adolescents. Two-thirds of the 27 youths seen were found
to be depressed, and eight of those, including one child, had suicidal

"We had several people come in who were in acute need of services;
that is, teens that had been cutting on themselves and kids who were
severely depressed," Archer said. "We were able to hook them up with
services and start them on the road to recovery."

But that doesn't happen often enough, according to a 2001 report of
the Surgeon General's Conference on Children's Mental Health. Less
than 20 percent of the estimated 14 million American children and
adolescents with mental illness receive treatment, the report stated.

When ignored, depression and other mental health disorders can lead to
school failure, family conflicts, drug abuse, violence and even

"This can shape a kid's childhood," said Chris Lebovitz, a Scottsdale
psychologist and chairman of the children's issues committee of the
Arizona Psychological Association. "They can become known as
troublemakers or bad kids, moody, difficult, because they're not
getting treatment. It's like someone with asthma or diabetes not
getting treatment."

Eric Benjamin, a Phoenix child psychiatrist, said the youngest child
he's seen with depression was just 18 months old. Carried into
Benjamin's office by her foster mother, the girl was curled into a
fetal position, unable to make eye contact and with a flat look on her
face. She had a strong family history of mood disorders, as most
depressed kids do.

"Childhood depression is rare," said Benjamin, director of psychiatry
at Phoenix Children's Hospital, estimating it at less than 1 percent
of his practice. "However, other disorders can make children feel
depressed or unhappy, dysfunctional, sad, and make them say things
about themselves like, 'I hate myself' or threaten suicide."

Disorders on rise

Benjamin is seeing such disorders more often. Bipolar disorder;
attention deficit hyperactivity disorder; extraordinary fears of being
away from their parents, making friends or going to school; selective
mutism, in which a child is unable to speak in certain social
settings; and other disorders can push a child into a black hole.

Katie Walton, now 13, has a family history of mental illness. Bipolar
disorder, ADHD, attention deficit disorder and depression run in her
family. Her sister, Jordan, 15, has Tourette syndrome, a neurological
disorder, as well as obsessive-compulsive disorder and ADHD. Her
mother, Sherri, 45, suffered from postpartum depression nine years ago
after the birth of Katie's sister, Kendall, who recently was diagnosed
with OCD.

"It's hard to admit you can't handle everything that's going on," said
Paradise Valley resident Sherri Walton, who takes medication for
depression. "People need to realize this is not a weakness, it's not a
pick-yourself-up-by-the-bootstraps, get-over-it thing. The brain is an
organ, like your heart and kidneys, and it can be ill, like your heart
and kidneys. The difference is, when your brain is ill, it affects
your thinking and behavior."

Evaluation, treatment

Depression in young children can be difficult to diagnose because they
can't or won't verbalize their feelings. Family history is important,
but some experts believe depression also can be caused by environment
- divorce, death, violence or substance abuse -- not just biology.

"What Mom or Dad are doing may be so toxic that the child starts
acting up to call attention to what's going on," Archer said.

Parents of a child with persistent signs of depression -- loss of
interest in favorite activities, fatigue, spending more time alone,
feeling hopeless, excessive crying -- or who suspect something's not
quite right with their children's behavior should talk with their
pediatrician. They also should consider finding a child psychologist
or psychiatrist for evaluation and treatment, and insist on careful
follow-up and monitoring.

In second grade, Katie Walton was diagnosed with ADHD and OCD. Her
grades were poor, she had problems with friends, and she cried easily,
even at not being able to watch her favorite television show. Her
parents took her to see Benjamin, who linked her family history and
"closed-off" demeanor and diagnosed depression. She has since been on

"It has lifted that dark cloud that surrounded her forever," Sherri
Walton said. "I can't describe how it feels to watch your child
finally be able to be successful, to be happy."

Katie, a pretty blond teen with hazel eyes who loves animals, dancing
and science, is reluctant to talk about her progress, saying only that
she feels better, is happier and likes school more. Her sister,
Kendall, says Katie still needs time alone, something Sherri Walton
says is a coping mechanism to help her manage the highs and lows.

Says Kendall, "She doesn't like a lot of people coming into her room.
I'll want to do something with her, and she says, 'No, don't bother
me, don't come in," and an hour or two later, she'll come out with
some crazy idea."

Antidepressants or not

Sherri Walton is a proponent of the careful use of antidepressants in
children and, as a board member of the Mental Health Association of
Arizona, has testified before the Arizona Legislature and at a Food
and Drug Administration advisory panel on their benefits.

"When you're down there in this black hole, you can't talk your way
out of it, and you have to lift that black cloud first," she said.
"One of the symptoms of depression is the inability to process
information, forgetfulness, and that makes it very difficult to work
through a problem."

Recently, concerns have been raised that antidepressants may induce
suicidal behavior and be ineffective in the treatment of depression in
youths, and the National Institute of Mental Health is researching
their potential value and risks. The American Academy of Child and
Adolescent Psychiatry encourages the use of psychotherapy first in
children with mild to moderate depression, then careful monitoring of
children for whom medication is deemed necessary.

Used appropriately, Benjamin said, antidepressants can make a big

"The kid who never raised his hand in class, and now he starts
talking, or the kid who wasn't going to school, and now he loves it."

Reach the reporter at (602) 444-8998.

Copyright 2004,