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‘Explosive’ child may be suffering from depression

SHARE ‘Explosive’ child may be suffering from depression

Question: I am deeply concerned that my 5-year-old son has a mental disorder. He does not seem to be happy.

He is oppositional regarding almost every aspect of life — eating, bathing, going to school. He also has "fits" that are more appropriate for a 2-year-old. The smallest things set him off: He flies into an uncontrollable rage that almost always includes hitting someone and screaming. This is followed by immense sadness and remorse.

It saddens me to see a child so unhappy. Even in DisneyWorld, he refused to go on the rides and have fun.

Our other child is being adversely affected. Often we have to leave places because of the fits, and my other child is deprived of having fun.

Any insight would be helpful. —No Name, New Orleans

Answer: You are right to be concerned about your child's distress and to seek help for him.

"The Boston Children's Hospital Guide to Your Child's Health and Development" (Perseus, 2000) describes some symptoms of depression — including deep sadness that has persisted, not eating, not bathing or not going to school — which might be one way of understanding your child's unhappiness.

Another possibility is that your son may be hypersensitive and easily overwhelmed by too many sights and sounds. For children like this, the world can be a frightening place.

A child who is easily overwhelmed by stimulation that other children seem to handle more readily may feel "different" and may retreat into depressed or resistant behavior.

Having learned to avoid situations that are too painful for him, he may turn inward and refuse to eat, sleep, dress or participate. These refusals may represent his attempts to control input from his environment, though other causes are certainly possible.

It is a hopeful sign that your child feels remorseful about his outbursts. This means he has developed a conscience, which can help motivate him to work with you on his problems.

Consider that your other child's "good" behavior may be making him feel worse. He may feel destined to remain the "bad child" he may feel he has become.

Planning a few separate outings with each child may help. Try not to compare the two. Instead, help them to understand and accept their differences.

The child who is struggling will need to know that you recognize his sadness as well as his strengths — no matter how remote they may seem right now. Help him to feel good about his desire to master his symptoms. Watch for successful moments — even fleeting ones — and offer praise.

If he's hypersensitive, respect his need for situations less stimulating than DisneyWorld. Let him know you understand and want to help.

Since depression and other problems can start early, it's not too soon to seek an evaluation by a child psychologist or psychiatrist. It will be important to understand the cause of the tantrums. In the meantime, you may find that the approach outlined in Ross Greene's book "The Explosive Child" (HarperCollins, 1998) helps cut down on these.

Question: Our 2-year-old grandson cries every time he has to leave us. He has a great time with us, but when it is time to go home, he gets very upset.

When my husband and I watched him overnight, we returned him to his house, thinking it would be easier to say good-bye there. That didn't work either.

Is there anything we can do to smooth the departures? —No Name, via e-mail

Answer: You sound like wonderful grandparents, and you must be proud that your grandson cares so much about being with you. You may even wonder why he would prefer to stay with you rather than return home.

But his meltdown behavior should not necessarily be given that much significance — and his parents are likely to feel rejected by it unless you reassure them about it. This is typical behavior for a 2-year-old when it's time for any type of transition. Whether he wants to change or not, a transition can throw a toddler into turmoil.

"Do I want to go or not go?" He will be so hungry to make his own decision, but he'll know he can't. Watch his face. He'll look at you and then at his parents. He may turn red and then lie down and scream with what looks like pain. But it will be the inner pain of a 2-year-old who is trying to make up his own mind — and not be dominated by adult decisions.

You can help by preparing him for each transition — though you may not be able to avoid the meltdown.

After it's over, hug him to say, "It's so hard being 2! I love you, and I'll miss you, too. But we'll have lots more times together."

As you reassure him, he'll sense that his leaving is painful for you, too, and you can suffer together. He'll know how much you care. Just be sure to let his parents know that his behavior is not a rejection of them.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 609 Greenwich St., 6th Floor, New York, NY 10014-3610. Questions may also be sent by e-mail to: nytsyn-families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider. Distributed by New York Times Syndicate