YOUR SPECIAL CHILD
Depression and Disability
What parents and caregivers
need to know
BY ERICA RIMLINGER
According to the
Journal of Pediatrics,
3.2 percent of children
between the ages of
3 and 17 have
been diagnosed
with depression.

Is having a disability a risk
factor for depression?
Not all disabilities are the same and we
can’t generalize the risks of mental health
comorbidities. There are not many studies
specifically investigating the mental health
of individuals with intellectual disabilities
beyond prevalence reporting. We are see-
ing more studies coming out on autism,
but we lack the lifelong trajectory data on
individuals with mental health problems.

The National Institute of Mental Health
estimated in 2017 that approximately 19
percent of all adults over 18 in the U.S. live
with mental illness. They do not separate
disability from that number.

42 Washington FAMILY MARCH 2020
Are children with autism at greater
risk for depression? There have
been conflicting studies on this.

Yes, the results are conflicting because it
depends on the population’s language and
cognitive function. It reflects the difference
between those who are able to communicate
their depressive symptoms and the ones who
are unable to do so. Research is less inclusive
of the lower functioning individuals with
regards to mental health.

How can parents tell the
difference between the
expected mood changes of
childhood/teenage years
and a mood disorder?
We need to keep a closer eye on our adoles-
cents with disabilities as the symptomatology
might be subtle. Parents are the best advocates
for their children. They are the first to notice
a difference in mood or behavior. When that
happens, it is a priority to consult with their
primary care doctor to rule out any condition
that can be addressed that might affect behav-
ior. We often see ear or urinary infections that
present with behavioral changes. We should
never assume a situation is behavioral or
primary to the disability.

If there is a concern that seems more
severe or there is no identifiable physical
cause, the time to take action is as soon as
possible. We should not let the stigma of
a psychiatric evaluation get in the way of
seeking mental health support.

What experience or qualifications
should a parent seek in a
mental health practitioner
if their child has autism?
It depends on what you are trying to
address. It should be a psychologist who
uses evidence-based treatments that have
been studied in autism or in the specific
difficulties that are the target for treatment
ISTOCK/GETTY IMAGES PLUS/NADEZHDA1906
D epression in all children, with or
without a disability, remains preve-
lant. According to a study published
in the March 2019 issue of the Journal of
Pediatrics, 3.2 percent of children between
the ages of 3 and 17 have been diagnosed
with depression.

Adolescents with disabilities, particularly
those with autism, have a higher risk for
depression, multiple studies have found.

However, those studies vary widely on
how much higher this risk may be. Further
complicating matters, developmental dis-
abilities and autism spectrum disorders can
mask the signs and symptoms of depres-
sion—or at least the ability to report one’s
symptoms. This makes making it more
difficult to detect depression or anxiety
in a child, not just for researchers, but for
parents and families as well.

Washington FAMILY spoke with Dr.

Carmen López-Arvizu, medical director of the
Kennedy Krieger Institute’s psychiatric mental
health program, about this issue. López-Arvizu
treats individuals with psychiatric illness in
the context of developmental disabilities and
is also a faculty member in the department of
psychiatry at Johns Hopkins Hospital.




YOUR SPECIAL CHILD
such as anxiety, depression or poor social
skills. If the patient is not verbal and the
goal is to address challenging behaviors,
you will need a behavioral psychologist.

If you don’t know where to start, seeing a
neurologist, a developmental pediatrician
or a child psychiatrist who has experience
in treating individuals with autism can be
helpful, as they can guide you on the more
specific treatment approaches indicated for
the presenting problem.

Is there a difference in the
way depression is diagnosed
in kids with disabilities?
The criteria are the same. The difference is in
how to ask the questions that represent the
symptoms. It takes experience and tact to
do a full review of symptoms. Diagnosis and
treatment of mental health conditions in per-
sons with developmental disabilities can be
challenging and has to be adapted to the indi-
vidual. Limitations in their ability to self-report
symptoms of mental distress may mean
that healthcare needs can go unrecognized
and unmet. Healthcare professionals report
feeling unqualified and uncomfortable caring
for patients with disabilities. Disability edu- examples are the lack of adequate social
cation should be part of cultural competency interactions and feelings of exclusion and
accessibility to the world in general.

requirements in medical education.

Literature has shown individuals with cere-
Is there a difference in treatment? bral palsy and comorbid neurodevelopmental
Psychopharmacological treatment is similar. disorders have a higher risk of mental health
Much more difficult is to find clinicians who disorders. However, a diagnosis of CP or
are educated or willing to learn about this another developmental disability alone brings
population. We notice this more when psy- a higher risk for inadequate access to health
chotherapy is indicated. Trained clinicians care and health screenings, trauma from abuse,
who understand disabilities, either physical neglect or intrusive therapeutic procedures,
—for example, spina bifida or cerebral poverty related to unemployment and under-
palsy—or cognitive, like intellectual impair- employment and social isolation stemming
ment or autism, are very rare. At Kennedy from communication difficulties, transporta-
Krieger Institute, we are lucky to have them, tion barriers and limited social opportunities.

but families report this is a barrier to obtain All these factors can be treatable and modi-
fiable to avoid their contribution to primary
treatment or even an initial evaluation.

depression or anxiety.

We still have much to do. We know that
Are there preventative steps
community support, standards of living
parents of kids with disabilities
and working conditions and opportunities,
can take to forestall depression?
Yes, to a degree. We know social environ- as well as political and economic factors,
ments are increasingly being recognized affect access to care for identification and
as contributors to poor mental and physi- treatment of mental illness.

However, one determinant of positive out-
cal health. Environmental contributors are
highly relevant to the health of persons with come is family involvement and advocacy.

developmental disabilities. Well-identified They can make all the difference. ■
Parenting isn’t easy, but there
are strategies that can help.

Find support and resources
at familytreemd.org/flip
or our 24-hour Parenting
HelpLine at 800-243-7337.

WashingtonFAMILY.com 43