CHILDHOOD
DEPRESSION
Summary
When
neurological brain lesions are not evident, or where not found out by current
means of investigation, although highly possible as it happens in some forms of
mental retardation, and when visual or auditory deficits have been excluded, as
well as difficulties in social-cultural integration, learning difficulties in
childhood must be supposed to be caused by some form of childhood depression.
Nowadays depression is
known to impair cognitive mechanisms such as attention, concentration, memory,
thought mobility and so on, and by this way it can decrease learning skills.
Only the understanding
of these variables can allow remedial intervention less likely to be temporary
or incomplete.
Key words: Learning
difficulties; school age; childhood depression; somatic causes; psychological
causes.
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As for children
with school learning difficulties and our argument, we have to exclude subjects with burden learning
troubles when their brain is evidently damaged as for mental deficiency (MD) in
cerebral palsied, in epileptics, or in carriers of chromosomal or genetic
anomalies, without any remedial.
The same we have to say for
found out or highly suggested lesions following a pathological history and a
current severe, intellectual and social deficit such as in isolated mental
deficiency, which, by definition, always presupposes a previous lesion, even if we are unable to
detect it.
So, when we find learning
disabilities that manifest themselves in children lacking any brain lesion, who
attend obligatory school, we are facing what in past we preferred to term
it as "false mental
deficiency" (FMD) [1].
In fact, what appeared was only an individual poor answer, apparent
and/or temporary, to the tools of intellectual evaluation, by considering the
evaluation of the school learning as an intelligence test with long times of
application.
While in the MD there is
the brain damage that inhibits the development of intellectual abilities, in the FMD, according
to this optics, the brain development is normal, but it does not work well, in
certain contexts, because bad running of
altered, but not destroyed, structures [2].
Currently, the evolution of
knowledge in this field has brought to a widening idea of FMD, being this last
even present in subjects with MD.
Causes of learning disabilities in the obligatory
school.
By searching possible causes of the learning disability, we shall start
from the common final datum. When
learning disability appears, nearly always it
is present even a secondary psychological
depression. In its turn, it more contributes to impair the necessary cognitive mechanisms (
attention, concentration, memory,
thought motility, the use of
second or third degree integrating mechanisms, etc.), already ill-working following the primary cause.
The secondary depression
comes from the acquired awareness of own learning difficulty, and, throughout
this way, it increases a cognitive
situation already impaired.
Anyhow, this share is the
easier to treat with simple support (like encouragement, pointing up the successes rather than the
errors; If possible and in needs, a more efficacious method of studying may be
proposed), with noticeable results both
in pure FMD and in FMD added to MD [3].
In the MD, which originates from brain damage
by definition, any IQ improvement cannot
come from decreasing of the coexistent share of FMD [2].
If instead we are want to investigate the FMD
primary causes, it is custom distinguish them as extrinsic and intrinsic
factors.
Extrinsic factors:
a - culture linked factors.
I am referable to a certain
reduction of intellectual performances given by subjects
belonging to another cultural contest. Every individual assimilates the culture
of his/her origin group and consequently, if
the child has to adapt to a new cultural context, he/she can meet some
difficulties in adapting him/herself to new schemes.
b - economic and family factors. They
are: long absences of the parents; the need
mother's working (for which the children are, for part of the day, left
to themselves); the disagreement among the parents; educational errors before
the school age; requested or excessive
expectations by the parents, as for the scholastic success of the child; to be
the last born in a large family [2].
c - factors
linked to school structures and
dynamics. They can act either trough
somatic pathways (with an increase of the physical fatigue) and through
psychological-relational pathways ( for disturbed relationship with the teacher
or with the classmates). I shall stay on
only the list of them: Distance from the school, class with many pupils,
insufficient or unsuitable classrooms, a double or triple sharing of the same
classroom, class made up of different age groups, quick turning of the teachers of the same class, disturbed personality of the
teacher, isolation among the peers' group, etc. [10].
All the extrinsic factors,
at least took a for a, have to be considered more properly as concurrent /
co-operating causes, able to express
their negative influence on a frail child [4].
Intrinsic factors:
d - physical conditions:
Sensory troubles, and of the language, motor deficits, convulsive fits,
long-time use of anticonvulsant drugs that inhibit learning abilities,
weakening illnesses, poor diet [9].
Moreover all the states of not optimality
happened in pre- peri- and neonatal age,
which apparently did not resulted in some immediate troubles. Only then they
showed to have impaired brain functional
areas recruited for systematic school learning
[9].
To these events we
have to add many other postnatal ones,
among which cranial traumas and
followings of meningitis or encephalitis, both overcome without any residual objective neurological
troubles. The same we can say for
whooping cough, and long therapies with antibiotics, whose depressant
effects on the brain cannot be ignored further on.
In after all,
we are dealing with causes able to produce a childhood depression of
somatic origin. From a psychic point of view, besides learning troubles, it can manifest
itself with emotional inhibition or the so-called temper reactivity [9].
In this field we have also
to remember:
- or, finally, a simple delay in intellectual
maturation. The child develops slowly and shows a delay when compared with age peers.
The depression as an unifying moment.
We do not intend
as depression only the mood decreasing, which, mainly in the infancy, can even
be lacking.
Excluding the secondary
psychological depression, from acquired awareness of own school difficulties,
we however have to remember these four
facts:
- the cognitive
trouble seems joining only the 2/3 of
manifest childhood depressions;
- the same can be the only evident symptom of a
remote or recent childhood somatic
depression;
Besides being this
psychological component of primary origin ( a case where the
diagnosis is exact ), it can even be only concomitant with a somatic cause.
Finally it can be only a secondary reactive component, due to
the awareness of own learning disabilities. The last one can be found even in
mentally retarded Ss where it elicits its own share of reduced intellectual
performances.
Conclusions.
Learning disabilities in a
child without any evident or presupposed neurological trouble, and without
sensory troubles can have their explanation on a neural dysfunction on a
depressive base, in a wider sense.
This dysfunction can hinder
the cognitive mechanisms that permit learning. To know all the possible somatic
or psychological causes, either in the past or in recent time, either primary
or secondary, often present together in a varius number, forces to an accurate
anamnestic investigation, and ponts up the way for a more targeted and complete
intervention.
References.
[1] Cocchi R., Tornati A.: Alcuni rilievi sul concetto e sul
fenomeno di pseudoinsufficienza mentale. Rass. Studi Psichiat. 1975, 64:
546-556.
[2] Cocchi R.: La pseudoinsufficienza mentale. In: Strutture e dinamiche
neuropsicopatologiche in eta` evolutiva. Montefeltro, Urbino 1985.
[4]
Cocchi R.: Il disadattamento scolastico. In: Strutture e dinamiche
neuropsicopatologiche in eta` evolutiva. Montefeltro, Urbino 1985.
[6] Cocchi R.: Prime esperienze sull'uso
di una associazione a bassī dosaggio di amitriptilina + perfenazina nella
terapia del disadattamento scolastico. Rass. Studi Psichiat. 1974, 63: 862-870.
[9] Cocchi R.: Le depressioni infantili. In: Strutture e dinamichå
neuropsicopatologiche in eta` evolutiva. Montefeltro, Urbino 1985.
[10] Cocchi R., Tornati A., Cocchi Cercolani P.: Depressione e
disadattamento nella scuola dell'obbligo. Tentativo di analisi intedisciplinare.
Note Riv. Psichiat. 1973, 66: 321-360.
Paper presented
during the IX World Congress of the IASSMD. Brisbane / Broadbench, 1992.
Printed on It. J. Intellect. Impair. 1992, 5: 137-142.
Author's
address : dr Renato COCCHI, via via Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Mental
retardation
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