Identifying Depression in Students with Mental Retardation

Article excerpt

The belief that people with mental retardation are always happy, carefree, and content is a misconception. In reality, students with mental retardation are at risk for the same types of psychological disorders as are students without cognitive deficits (Crews, Bonaventura, & Rowe, 1994; Johnson, Handen, Lubetsky, & Sacco, 1995; Sovner & Hurley, 1983).

Many researchers have actually found a higher rate of depressive disorders in people with mental retardation (e.g., Borthwick-Duffy & Eyman, 1990; Menolascino, 1990; Reiss, 1990). Teachers should be aware of this increased risk for depression so that they can appropriately refer their students for diagnosis and treatment. In this article, we present suggestions for detecting and treating childhood depression.

Prevalence and Symptoms of Depression

Although little research has investigated the precise prevalence of depression in children with mental retardation, special education teachers will likely encounter students with depression. Several studies have suggested that these children exhibit symptoms of sadness, loneliness, and worry at a much higher rate than do their peers without disabilities (e.g., Matson & Frame, 1986; Reiss, 1985). These studies estimated that as many as 10% of children with mental retardation suffer from depression, in contrast to the lower prevalence rate of 1% - 5 % in children without mental retardation (Cantwell, 1990).

Clinical depression is usually determined by a psychologist or psychiatrist, who uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) to make the diagnosis. To be formally diagnosed as "depressed," a child must experience five different clinical signs of depression over a 2-week period. The primary symptom is that the student exhibits either an overall depressed mood or a loss of interest in daily activities (also called anhedonia). Some students may express this depressed mood in the form of persistent irritability, rather than by sadness or withdrawal.

The remaining four symptoms are expressed as changes in a student's usual functioning. These changes may be expressed as either an increase or decrease in any of the following areas: (a) appetite or weight; (b) sleep habits; (c) activity level; (d) energy level; (e) feelings of worthlessness or guilt; (f) difficulty thinking, concentrating, or making decisions; or (g) recurrent thoughts of death or suicidal ideations, plans, or attempts (see Figure 1).

Causes of Depression

Students may experience depression as a result of a negative life event, such as the loss of a parent, stresses at home, or adjustment to a new environment. This type of reactive depression is normal and is not a cause for concern unless the depressive symptoms linger and significantly interfere with a student's typical level of functioning. In other cases, there may not be a clear precursor for the depression, yet the student consistently is in a depressed mood. It is when this mood persists over a 2-week period that a teacher should observe the child for other signs of depression.

Students with mild mental retardation seem to be at risk for depression because they often can perceive that their peers without disabilities are able to accomplish tasks that they themselves cannot (Eaton & Menolascino, 1982). They may also be aware, via negative peer experiences, that they are different and viewed negatively by society. These observations can then lead to a higher risk for depression and low self-esteem. Conversely, people with severe mental retardation are not as likely to be diagnosed with depression as those with mild retardation, but this may be because of their limited ability to verbally express feelings of sadness or hopelessness, rather than an actual decreased risk for depression (Chariot, Doucette, & Mezzacappa, 1993; Pawlarcyzk & Beckwith, 1987). …