Identifying Depression: In Students with Mental Retardation

Τ •^lie belief that people with mental retardation are always happy, care­ free, and content is a misconcep­ tion. 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 sug­ gestions for detecting and treating child­ hood 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 chil dren with mental retardation suffer from depression, in contrast to the lower preva lence rate of 1 % -5 % in children without mental retardation (Cantwell, 1990).
Clinical depression is usually deter mined by a psychologist or psychiatrist,

Laura M. Stough
Lynn Baker who uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edi tion (DSM-IV; American Psychiatric As sociation, 1994) to make the diagnosis. To be formally diagnosed as "depressed," a child must experience five different clin ical signs of depression over a 2-week pe riod. The primary symptom is that the student exhibits either an overall de pressed 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 ex pressed as changes in a student's usual functioning. These changes may be ex pressed 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 think ing, concentrating, or making decisions; or (g) recurrent thoughts of death or sui cidal 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 ad justment to a new environment. This type of reactive depression is normal and is not a cause for concern unless the de-

B e h a v i o r a l M a r k e r s
It is most common for a person who is depressed to exhibit an overall mood of sadness. Children with mental retarda tion, however, may express their sadness through withdrawing and decreasing their social interactions with their peers.
Alternatively, they may change the way in which they interact with their peers, becoming irritable or even aggressive to ward them. Also, teachers should pay at tention when students exhibit new, inappropriate behavior, such as non compliance or distractibility. In some cases, students may even begin to express their depression through self-injurious be havior. Although behavioral markers such as these may stand out, they may also be quite subtle: A depressed student may simply not seem to take pleasure in ac tivities that he or she previously enjoyed.
As m a n y as 10% of (hlldren w i t h m e n t a l r e t a r d a

n«alment of Depression in Children wHh Mental Retardcrtion
The Individuals with Disabilities Educa tion Act (IDEA) not only ensures the right to free and appropriate educational ser vices, but also to related services, such as psychological assessment and coun seling. Many times the school district has programs or staff that can help a student diagnosed as depressed. Once the student has been assessed, the teacher can work closely with the school psychologist or counselor to provide supportive therapy for the student.

Students w i t h mild m e n t a l r e t a r d a t i o n s e e m t o be at risk for d e p r e s s i o n because t h e y o f t e n <an perceive that their peers w i t h o u t disabilities a r e able t o accomplish tasks that t h e y t h e m s e l v e s cannot.
The teacher can also discuss with the family any additional support needs that they might have as these needs may con tribute to the stress that the student is ex periencing. Loss of employment, death of a family member, or economic hard ships can all affect the student's level of depression. Teachers should be aware of changes in their students' home envi ronments to help determine if a student is depressed-as opposed to, for exam ple, simply being oppositional. These support needs often occur across settings, for example, at family outings or at recre ational activities (see Figure 2 ) .
Examining the settings in which a stu dent functions on a regular basis can help pinpoint obstacles or difficulties that the student is experiencing in these areas, for example, appropriately talking to peers at the community pool. Knowledge of these difficulties thus can help the teacher tar get instructional objectives for the stu dent in the classroom, such as learning social skills training.   In addition, the mental health provider should always be apprised of the stu dent's current medication intake and medical history.

Final Ihougiils
Intellectual functioning does not seem to offset depression; in fact, those with mild mental retardation seem to be at an even greater risk for depression. We say, "seem to be," because of the paucity of recent re search in this important area. In addition, Family tborapyt The f a m i l y meets with α psychologist or counselor who mod e r a t e s while problems and solutions are generated by the family members. Family interactions, perceptions, and roles are the areas of focus and change. SUIIs tralaloft Building social skills allows the student to engage in social sit uations while he or she receives modeling and coaching from α therapist or teacher. These social situations allow the student to practice skills in particu lar deficit areas. PsycbodraMat Guided by α psychologist or counselor, the student acts out themes or roles that represent areas of concern and unresolved conflict. The drama provides emotional release and insight into these areas of concern. Art t i M T o p y : A nonverbal therapy, usually directed by α psychologist, coun selor, or art therapist, art therapy uses art as the milieu in which emotions and thoughts can be e x p r e s s e d froely.
Masic tborapyt A nonverbal therapy, usually d i r e c t e d by α psychologist, coun selor, or music therapist, music therapy uses music to help students express and r e l e a s e emotions.
H o y tborapyt A psychologist or counselor works with the student as he or she plays with toys or other materials that permit expression of conflict issues. Nychopharmacologyi This type of therapy uses prescription drugs to treat medical problems associated with mental disorders.