{"id":12335,"date":"2018-06-06T02:41:37","date_gmt":"2018-06-06T02:41:37","guid":{"rendered":"http:\/\/www.lifeandnews.com\/articles\/?p=12335"},"modified":"2018-06-07T02:45:41","modified_gmt":"2018-06-07T02:45:41","slug":"teenage-depression-if-a-parent-doesnt-get-treatment-for-a-child-is-that-abuse","status":"publish","type":"post","link":"https:\/\/www.lifeandnews.com\/articles\/teenage-depression-if-a-parent-doesnt-get-treatment-for-a-child-is-that-abuse\/","title":{"rendered":"Teenage depression: If a parent doesn&#8217;t get treatment for a child, is that abuse?"},"content":{"rendered":"<p><span><a href=\"https:\/\/theconversation.com\/profiles\/michael-shapiro-464956\">Michael Shapiro<\/a>, <em><a href=\"http:\/\/theconversation.com\/institutions\/university-of-florida-1392\">University of Florida<\/a><\/em><\/span><\/p>\n<p>Hospital visits for kids in the U.S. who have contemplated or thought about <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2018\/05\/16\/611407972\/hospitals-see-growing-numbers-of-kids-and-teens-at-risk-for-suicide\">suicide<\/a> have risen sharply. <\/p>\n<p>As a child and adolescent psychiatrist, I am not surprised. For years, I ran a child psychiatric hospital, where we treat kids after they attempt suicide. Usually, by the time I diagnose a teenager with depression, it is almost too late. Almost. It\u2019s estimated that one in five teens will have depression, but two-thirds of them will <a href=\"https:\/\/www.today.com\/health\/all-teens-should-be-screened-depression-new-guidelines-urge-t123889\">go undiagnosed<\/a>. <\/p>\n<p>Lack of screening for depression is one part of the  problem in children\u2019s mental health, and efforts are underway to <a href=\"https:\/\/www.sciencenewsforstudents.org\/article\/finding-and-helping-teens-whom-sadness-disease\">improve screening and detection<\/a> for depression. Access to care is another problem, as there is a <a href=\"https:\/\/www.psychologytoday.com\/us\/blog\/political-minds\/201706\/the-child-psychiatrist-will-not-see-you-now\">severe shortage of child psychiatrists in our country<\/a>. Parents may also not see symptoms of a mental health problem or not be aware of how severe the problem is, due to lack of knowledge or understanding of depression in children. <\/p>\n<p>These are several barriers to treatment, which are unfortunate. However, one barrier that is rarely addressed is when parents ignore obvious signs of depression or just don\u2019t want help. Studies have noted that between <a href=\"https:\/\/link.springer.com\/article\/10.1007%2Fs00787-016-0930-6\">12-26 percent of parents<\/a> reported not wanting or needing help, or being unwilling to seek help for a child\u2019s depression.<\/p>\n<p>I <a href=\"https:\/\/www.jaacap.org\/article\/S0890-8567(18)30156-4\/fulltext\">authored a paper<\/a>, published May 31, in which I ask: Would it be considered child abuse for a parent to not get medical help for their depressed teen?<\/p>\n<h2>A serious illness, often experienced in loneliness<\/h2>\n<figure class=\"align-center \">\n            <img alt=\"\" src=\"https:\/\/images.theconversation.com\/files\/220501\/original\/file-20180525-51121-1l484yo.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\"><figcaption>\n              <span class=\"caption\">Teens often experience depression far longer than their parents realize.<\/span><br \/>\n              <span class=\"attribution\"><a class=\"source\" href=\"https:\/\/www.shutterstock.com\/image-photo\/portrait-serious-teenage-boy-on-dark-744084832?src=QtKmUW7Ip7LV2nkxN_p36w-1-36\">polya_olya\/Shutterstock.com<\/a><\/span><br \/>\n            <\/figcaption><\/figure>\n<p>In my experience, teens experience depression for much longer than their parents are aware. There are several reasons for this, including the stigma of mental illness, and teens not being forthcoming because they blame themselves for feeling depressed and don\u2019t want to upset their parents.<\/p>\n<p>In fact, <a href=\"https:\/\/www.verywellmind.com\/is-it-my-fault-that-im-depressed-1066597\">feeling like things are your fault<\/a> is one of the symptoms of depression. We are lucky if a teen tells their parent they are feeling depressed or a parent sees warning signs and brings their child for an evaluation, because the depression is likely far more severe than the parent realizes. Sometimes, we\u2019re not as lucky. <\/p>\n<p>In my experience, many children who attempt suicide never have been evaluated or treated for depression before. After a child attempts suicide and a parent starts to understand and learn about depression, most parents are willing to do anything to help their child. But in some cases, this doesn\u2019t happen. <\/p>\n<p>This is incredibly hurtful to teens who ask for treatment and the message they get is their suffering is not important enough to treat.<\/p>\n<h2>Depression is the deadliest disease of childhood<\/h2>\n<figure>\n            <iframe loading=\"lazy\" width=\"440\" height=\"260\" src=\"https:\/\/www.youtube.com\/embed\/XuHO_r328FU?wmode=transparent&amp;start=0\" frameborder=\"0\" allowfullscreen><\/iframe><figcaption><span class=\"caption\">Dr. Michael Shapiro discusses teenage depression, a major cause of teenage suicide.<\/span><\/figcaption><\/figure>\n<p>Depression and its worst risk, suicide, are serious and common problems in children and teens. Suicide is the <a href=\"https:\/\/www.prb.org\/suicide-replaces-homicide-second-leading-cause-death-among-us-teens\">second leading cause of death<\/a> in U.S. teens, resulting in more deaths than from cancer or any other disease or illness. <\/p>\n<p>In addition to deaths by suicide, <a href=\"https:\/\/www.psychcongress.com\/article\/over-time-untreated-depression-changes-brain\">depression can cause progressively worsening brain changes<\/a>, according to new research. And yet, even after a trained mental health professional diagnoses a child with depression, some parents refuse treatment. This can occur despite these teens wanting and asking for treatment. <\/p>\n<p>Some do not want their children to take antidepressants. Antidepressants carry the FDA black-box label warning on thoughts of suicide in young people. But the consensus in the field is that <a href=\"https:\/\/www.jaacap.org\/article\/S0890-8567(09)62053-0\/pdf\">benefits outweigh risks<\/a> with careful monitoring. Also, a recent study reported the clinical trials used to form the FDA black-box warning excluded patients who were already at <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29097612\">\u201csignificant risk of suicide,\u201d<\/a> which means this risk-benefit analysis was formed without patients who were the most depressed and at the most risk. Evidence-based psychotherapy also treats depression, but some families don\u2019t commit the time or resources to ensure their children have frequent appointments.<\/p>\n<p>In most states, teens under 18 <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4008301\/\">require a parent\u2019s permission<\/a> to receive treatment for depression. There are some exceptions, but in most cases, a child cannot get treatment on their own.<\/p>\n<h2>Mental health can be neglected<\/h2>\n<p>One possible way to overcome this is to view a deliberate lack of providing treatment for depression as a form of child abuse. The term \u201c<a href=\"http:\/\/www.aappublications.org\/content\/28\/12\/18\">medical neglect<\/a>\u201d refers to a child being harmed due to a lack of medical care.<\/p>\n<p>In the criteria outlined by the <a href=\"http:\/\/pediatrics.aappublications.org\/content\/120\/6\/1385\">American Academy of Pediatrics<\/a>, medical neglect occurs when parents understand the medical advice given, the recommended treatment would have significant benefit for the child\u2019s health and be accessible by the family, and the parent or caregiver still denies or refuses treatment or access to care. Another way for neglect to occur is to ignore obvious signs of illness. <\/p>\n<figure class=\"align-center \">\n            <img alt=\"\" src=\"https:\/\/images.theconversation.com\/files\/220503\/original\/file-20180525-88002-1jpazaa.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip\"><figcaption>\n              <span class=\"caption\">Capsules of Prozac, a commonly prescribed antidepressant. The FDA gives its strongest warning for antidepressants used to treat children.<\/span><br \/>\n              <span class=\"attribution\"><a class=\"source\" href=\"https:\/\/www.shutterstock.com\/image-photo\/close-detail-foil-packet-green-white-755216179?src=n4n5A4Bowaz74WE_7Q0xvg-1-66\">callumrc\/Shutterstock.com<\/a><\/span><br \/>\n            <\/figcaption><\/figure>\n<p>While these criteria are usually applied to chronic physical illnesses like HIV or asthma, it appears to be rarely applied to <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26931563\">mental illnesses<\/a>. If I told you that a teenager was hospitalized multiple times due to a chronic life-threatening illness, and that teenager\u2019s parent refused to bring the child for doctor\u2019s appointments or allow them to take medication for the illness, what would you think should be done? <\/p>\n<p>My guess is if the illness was HIV, diabetes or asthma, the answer would be to ensure the child is allowed to take their medication and attend doctor\u2019s appointments. But that was not the answer I got with one teen with depression and multiple suicide attempts. <\/p>\n<p>The <a href=\"https:\/\/www.flsenate.gov\/Laws\/Statutes\/2012\/Chapter394\/All\">law in Florida<\/a>, where I teach and practice, is that only when children reach age 18 years can they consent to treating their own depression with medication or with ongoing therapy. I was told this teen would have to \u201cwait\u201d until he or she reached 18 to get treatment since the parent was refusing. <\/p>\n<p>Depression is hard to diagnose because it is not always obvious. Parents may not believe in an illness they don\u2019t see. <\/p>\n<p>The Practice Parameter for Treating Depression by the American Academy of Child and Adolescent Psychiatry (AACAP) acknowledges that families \u201cmay not wish to participate in psychotherapy or <a href=\"https:\/\/www.jaacap.org\/article\/S0890-8567(09)62053-0\/fulltext\">may object to taking any medications<\/a>.\u201d However, if these are the two evidence-based treatments being recommended and they are available, what are our options for ensuring these children receive appropriate care? Once a professional does make the diagnosis, and if severe enough, why are we allowed to let it go untreated?<\/p>\n<p>When we \u2013 children, parents and physicians \u2013 view depression like other illnesses, more people will be helped. We as physicians should be working to prevent neglect from occurring by talking to parents about depression and treatment, providing education and addressing their concerns. <\/p>\n<p><img loading=\"lazy\" src=\"https:\/\/counter.theconversation.com\/content\/95353\/count.gif?distributor=republish-lightbox-basic\" alt=\"The Conversation\" width=\"1\" height=\"1\" \/>Parents need to be educated that some illnesses still exist and cause suffering even if they can\u2019t always see it. Parents should also know we physicians are not blaming them for their child\u2019s illness, but they are responsible for getting their child appropriate treatment. If they don\u2019t, I believe that is neglect.<\/p>\n<p><span><a href=\"https:\/\/theconversation.com\/profiles\/michael-shapiro-464956\">Michael Shapiro<\/a>, Associate Professor, Psychiatry, <em><a href=\"http:\/\/theconversation.com\/institutions\/university-of-florida-1392\">University of Florida<\/a><\/em><\/span><\/p>\n<p>This article was originally published on <a href=\"http:\/\/theconversation.com\">The Conversation<\/a>. Read the <a href=\"https:\/\/theconversation.com\/teenage-depression-if-a-parent-doesnt-get-treatment-for-a-child-is-that-abuse-95353\">original article<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Michael Shapiro, University of Florida Hospital visits for kids in the U.S. who have contemplated or thought about suicide have risen sharply. As a child and adolescent psychiatrist, I am not surprised. For years, I ran a child psychiatric hospital, where we treat kids after they attempt suicide. Usually, by the time I diagnose a [&hellip;]<\/p>\n","protected":false},"author":44,"featured_media":12336,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[42],"tags":[1788,200,266,4604,1929],"_links":{"self":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/12335"}],"collection":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/comments?post=12335"}],"version-history":[{"count":1,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/12335\/revisions"}],"predecessor-version":[{"id":12337,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/12335\/revisions\/12337"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media\/12336"}],"wp:attachment":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media?parent=12335"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/categories?post=12335"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/tags?post=12335"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}