Depression: The Hidden Problem Among Students with Exceptionalities

In fact, several months prior to his death, School Aid Pam Clouthier noted Armijo was constantly depressed and nervous. But despite these observations, the school perceived his aggressive behavior merely as a threat to others rather than as a threat to himself. Could this happen in your school? Yes.

Suicide is the third leading cause of death among people ages 15 to 24 in the United States, according to the National Center for Health Statistics and the second leading cause in Canada, according to the Canada's Minister of National Health and Welfare in Canada. In the U.S., school-based studies indicate that across the board 2-4 percent of school-aged children (4-12 years old) and 4-8 percent of adolescents (12-18 years old) suffer from depression, according to Steve Forness, professor of psychiatry and bio behavioral science at the University of California, Los Angeles. Due to the limited statistics available, it is unclear how many children with exceptionalities commit suicide or suffer from depression, but it is generally accepted that "the prevalence of depression and potential suicide is higher among children with exceptionalities than among the general school population," according to

Eleanor Guetzloe, professor of special education at the University of South Florida in St. Petersburg. While studies of the prevalence of depression in exceptional youth are limited, Forness estimates that between 30 and 40 percent of students in ED classes and 10-20 percent of students in LD classes suffer from depression.

The reasons for the high prevalence of depression in students with exceptionalities are clear. For students with disabilities, the stigma of being labeled with a disability or disorder can depress a child, Guetzloe said. Additionally, a number of biological factors related to the root of disabilities such as traumatic births, serotonin deficiencies, and other psychiatric disorders support a genetic predisposition for depression

Students with gifts and talents get depressed too. Their tendencies to be perfectionists, overly harsh on themselves, and idealistic, set them up for "failure" and frustration, leading them to feel depressed, according to James Webb, founder and co-director of Supporting the Emotional Needs of the Gifted. With the intense feelings they usually internalize, a "B" on their report card could mean the end of the world. And Webb argues that students with gifts and talents often suffer from existential depression in which the youth confronts basic issues of existence-death, freedom, isolation, and meaninglessness-issues with such enigmatic and empty answers too frustrating for a 16-18 year old to face.

Why This Population is Overlooked
Even though it is clear students with exceptionalities face unique challenges that make them more prone to depression, a number of factors prevent educators from detecting depression. Many students who exhibit aggressive behavior are identified as having a conduct or behavior disorder, when, in fact, their aggressive behavior may signify they are depressed. "People don't get beyond the aggression to realize that the reason for the aggression may be depression," said Beverley-Holden-Johns, supervisor of the LD/BD/SBD program at the Four Rivers Cooperative in Jacksonville, Ill.

Students living in urban areas who exhibit aggressive behavior are "definitely overlooked, because they are perceived to be expressing "plain old acting out aggressive behavior," added Brenda Townsend, associate professor of special education at the University of South Florida in Tampa.

"We think they can control it and are just acting that way," Townsend said. "It's so hard to discern the root of aggression. They come to school angry. When you talk to them, their self-esteems are low [and] they have fatalistic, defeatist outlooks on life." Or, depression can also be misdiagnosed as attention deficit disorder.

"We're better at identifying ADHD than internal depressive disorders," Forness said. In addition, culturally based behaviors of students from diverse backgrounds are often misinterpreted and, as a result, educators may fail to detect depression in their students. Many of the same cultural misinterpretations that land diverse students in special education classes in the first place apply to oversights of depressed students according to Townsend. "In some cultures, it's a stigma to have a psychological problem," Townsend said.

For students for whom therapy is a stigma, feelings of depression may be more internalized, leaving many students untreated, according to Townsend. Even if families know something is wrong, their cultural beliefs prevent them from seeking any kind of psychiatric help for their child.

Students with gifts and talents also fall through the cracks and are left to deal alone with their depression. These students tend to be excellent problem-solvers, which enables them to cover up their symptoms of depression in order to fit into mainstream society. "They are smart enough to know they are not liked if they overtly show depression," Webb said.

Students with gifts and talents also have few people to whom they can relate. Many teachers, counselors, and mental health professionals do not understand the characteristics of gifted children, including the intensity of their feelings. And partly because of this, many people do not think children with gifts and talents have reason to be depressed and therefore need no special attention. This leads them to "minimize the student's cry for help," Webb said.

"Teachers and school counselors with little training [about gifted students] may want to say to them 'just buckle down and get with it,'" Webb explained.

In addition, large class sizes make it difficult for any teacher to notice children with exceptionalities suffering quietly, said Dixie Jordan, coordinator of parent services for children with emotional disorders at the Parent Advocacy Coalition for Educational Rights. And today's busy schedules make it too easy to forget to listen to the students.

Detection and Referral
The first step in helping children with exceptionalities overcome their depression is to understand the symptoms. No matter what symptoms a student exhibits, a change in behavior signifies a problem. In a school setting, a child who shows an unexplained change in school performance, such as one who normally gets good grades suddenly does not, quits a job, withdraws from extracurricular activities and hobbies, has unreasonable fears, looks tired, engages in reckless behavior, or withdraws from friends and other social contacts may be depressed, according to Guetzloe. Additionally, expressions of hopelessness and low self-esteem such as "I'm not a good student" and "No one cares about me" should send out warning flags.

Understanding the symptoms requires understanding the student. Johns encourages teachers to "talk, talk, talk"-the only way to understand what is going on with a student is to open the lines of communication.

"Grab 'em by the front of their shirt, so to speak, and get them to talk," Guetzloe said. "The first time will give you a stomach ache, but thereafter it gets easier."

When talking to students from cultural backgrounds that look down on professional psychiatric treatment, teachers may need to enlist the support of someone of the same gender and/or cultural background with whom the student and his or her family can identify and trust, Townsend recommended.

"You don't want to violate any cultural norms, but you don't want to let cultural norms stand in the way of treatment," she said. "Know the values and beliefs of your student population."

When Depression Turns Fatal
When expressions of hopelessness turn into expressions of or obsessions with death such as "I'd rather be dead" or "I'd like to live with Grandma [who has passed away]," teachers must take immediate action in order to thwart a potential suicide, according to Guetzloe.

Additionally, tell-tale signs that suicide may be lurking around the corner are evident when children or youth give away their stuff, isolate themselves from their peer group, and refer to death, according to Jaeger.

And "a child whose mood has changed from very gloomy to very upbeat may have made up his mind to kill himself," Guetzloe said. She recommends quick detection and referral of any child showing signs of depression to a school psychiatrist or mental health professional for professional assessment.

Schools should provide a central person in the school-a school psychiatrist, counselor, or principal-with whom teachers can discuss at-risk students. Teachers also need to share information throughout the school and with this central designee who would then know all the issues surrounding each at-risk student; therefore, providing them with better assessments and treatments.

Additionally, schools may want to consider conducting staff development sessions for general educators and special educators about therapy in the classroom, including psycho educational strategies to correct the student's negative self-thought and in-school support groups for kids to express rage, Townsend said.

Communicating with Parents
Families must be involved in detecting and treating depression in their children. Addressing the parents is best done with a team approach with the teacher(s) and school counselor/psychiatrist, according to Johns. The team should try to learn if the family is seeing the same problems at home. But Guetzloe warns that the teacher and counselor should only inform parents of behavioral observations such as "one of the teachers has reported to me because your child has written an essay about death," leaving the diagnosis of depression to a mental health professional.

For more information on depression and students with exceptionalities, read Depression and Suicide: Special Education Students at Risk, $11.40/$8.00. To order, call CEC toll-free at 888/232-7733 and ask for book #P356.

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