Psychology

The paper presents a theoretical and practical analysis of an interview with a care worker at language school. Language impairments in children after traumatic brain injury (TBI) are the central point of analysis. The principles and findings presented by the interviewee are positioned from an interactionist perspective, which shows language as the product of both biological and social development. The interviewee makes emphasis on the collaboration and communication between children and between them and older language professionals, turning communication and articulation in a form of challenge, which children have to meet in order to develop and maintain friendly ties with their peers.

    The loss of effective communication skills and the development of language impairments in children with traumatic brain injury (TBI) are not rare. Since the middle of the 20th century, the importance of language impairments in children following brain injury has been relatively low. On the one hand, researchers in neurology and language studies lacked a clear definition and a single integrated idea of how TBI in children and subsequent brain injury are linked. On the other hand, professionals in neurology also lacked a systemic methodology necessary to help children with brain injury restore their language function. In the current state of research, speech and language impairments and TBI in children are closely interlinked. Given the impact which language impairments in children with brain injury produce on the quality of their lives, numerous professional organizations were created to address the loss of communicative abilities in these groups of small patients. Despite the lack of a single theory or methodological approach, these organizations have proved to be en effective element on childrens way to full recovery and as a result, better quality of life.

    I CAN is an international organization based in UK and created to deal with children with various types of language impairments, including those that follow severe TBI ( Can, 2009). The organization was able to create a number of special schools for children with language impairments and has already achieved considerable success in treating even the most complicated language disorders in those, who had to experience the tragic consequences of brain injury. Mrs. Sheila Shanks, a care worker at Meath School kindly agreed to shed the light on the way language impairments are being treated in practice, as well as the ways language pathologists and teachers choose in their daily interactions with children following TBI.

    Mrs. Shankss official job title is that of a care worker, but her responsibilities and obligations usually stretch beyond what is required by her position. One reason for this is that she is bound to work with children, whose needs and behaviors change on a daily basis. Another reason is in that to be a care worker means to be responsive to everything that occurs in the working environment, to which Mrs. Shanks belongs as such her position requires increasing flexibility and openness. To be a child care worker at Meath School implies the need for Mrs. Shanks to help children as they arrive to the center, to help them find their tutor, and to organize their daily activities and schedules, but often Mrs. Shanks is directly involved in different learning and playing activities and thus becomes the direct participant of the major treatment process in children with language impairments. Having spent 5 years as a care worker at Meath School, Mrs. Shanks also occupied other positions with I CAN, beginning from a volunteer, through nursing, teaching and up to care work. With her Masters in Special Education she is likely to become one of the most experienced language therapists in the organization, but she is very satisfied with her present job.

    Mrs. Shanks cannot conceal her excitement when describing her present job. She is pleased to have a chance to work with children between 4 and 11 years and old and to help them restore their cognitive and language abilities. Her obligations require that she cares for children who come to Meath School during the day  from meeting them and helping them to find their class up to developing activities and schedules for children with language impairments and helping them with their home tasks. Her typical day begins at 8 a.m. A day of a typical care worker at Meath School starts with attending a regular meeting of the school staff, discussing previous achievements, daily plans, and problems. The number of language groups during the day may vary from 2 to 6, depending on the particular day of the week (during weekends, the number of children brought to school is usually higher compared to week days). Between groups, Mrs. Shanks participates in various team projects or works to develop various communication activities for children. She may deal with individual patients, who require her attention and help when working on their individual tasks. Mrs. Shankss day usually ends between 6 and 7 p.m., and a meeting with parents often becomes a logical end to her long work day.

    The children with whom Mrs. Shanks works have various types of language impairments, but the prevailing majority is caused by TBI, which is particularly painful and problematic in smaller patients. Expressive language disorder, articulation disorder, fluency disorders, and even dysphagia often become the objects of the increasing professional concern. According to Karunanayaka et al (2007), language problems in children following TBI may underlie observed problems in academic performance, social competence, and peer integration. Previous investigations have documented deficits in expressive and receptive language skills, naming ability, and written language (p. 356). Very often, children with TBI experience difficulties when trying to utter complex sentences or to transform or synthesize information (Karunanayaka et al, 2007), but Mrs. Shanks asserts that children with expressive language disorder are the most frequent attendants of Meath school. As a result, language professionals at I CAN have experience and knowledge necessary to deal with this type of language impairment in children but they do not lose the grip of control over other, possibly more complex and more dangerous language disorders.

It should be noted, that with the knowledge and experience about language disorders she currently possesses, Mrs. Shanks cannot but recognize the overtly diffuse nature of brain injuries in children and their impact on their cognitive functioning. Recently, Mrs. Shanks has become interested in the development of dysarthria as a form of speech disturbance in children following TBI. Although dysarthria is usually referred to a group of orthopedic disturbances in children, there is a direct link between it and TBI. Mrs. Shanks is confident that cognitive failures alone cannot explain the difficulties, which children after TBI experience while speaking. In this context, Mrs. Shanks supports the findings of Loh, Goozee and Murdoch (2005) who tie tongue and lip movement to the problems with brain functioning in children. Moreover, she views language development in children as the product of both biological and social processes, which positions her as the supporter of the interactionist perspective in language and learning. She is confident that only through continuous interaction with peers and professionals can children overcome their language difficulties. Mrs. Shanks has her own complicated vision of language impairments in children after TBI, and the activities and team initiatives which she develops are expected to cover both social elements of language impairments and the physiological (physical) difficulties, which children may experience because of their brain trauma.

    Needless to say, language impairments in children with whom Mrs. Shanks works or meets while fulfilling her job obligations impact the quality of their learning. On the one hand, they are not always able to express their thoughts and to form logical sentences on the other hand, because of their language disorder children often lose attention and fail to concentrate on the process of acquiring and processing new knowledge. Mrs. Shanks knows that the current state of research does recognize the link between the loss of attention and language impairments that follow TBI in children, but throughout her work she was also able to observe this link in practice. That attention is the critical element of successful learning is not a secret, but for Mrs. Shanks, the link between learning, attention, and language impairments forms a kind of a vicious circle while language impairments negatively impact attention in children and result in the loss of concentration, this loss of concentration and attention deficits slows down the progress in dealing with language impairments among children after TBI. This is exactly what Finneran, Francis and Leonard (2009) state in their research and this is also what has already become a reality for Mrs. Shanks. That is why cooperation with other language professionals, as well as the emphasis on the continuous communication and collaboration between children are the key to success in different groups of children coming to Meath School.

    As a care worker, Mrs. Shanks often possesses information about children, which may not be available, accessible, or known to other language professionals at school while occupational and language therapists deal with children during their lessons, a care giver is involved in broader interactions with children and their parents and can thus discover and identify language problems that may go unnoticed in the process of training. For this reason, Mrs. Shanks is often involved in creating reports about children and their progress in dealing with language impairments, especially expressive language disorder and aphasia. When asked about the contribution, which language professionals and care workers can do for children who experience language difficulties after TBI, Mrs. Shanks says that their school and their organization in general are critical for improving the quality of life in such children. Traditional schools fail to address specific needs of children with language disorders, while Meath School and its professionals provide a balance of support and challenge that encourages pupils to make progress in all areas of the curriculum (I CAN, 2009). For example, TBI in children is often associated with the loss of consciousness, and the duration of unconsciousness results in different degrees of axonal injury and cerebral concussion  health conditions that make treatment of language disorders in such children even more problematic (Murdoch, 1990). More importantly, Meath School provides conditions necessary to develop close friendly ties between children with similar language problems  as a result, they become open to each other and develop better language skills. The need for children to express themselves to their peers often becomes a form of a challenge, which they cannot meet unless they are able to articulate their thoughts and memories. As a result, speech therapists, occupational therapists, physical therapists, care workers and teachers altogether create an environment, which makes it possible to address these complications and to enhance the pace of learning in children after TBI  the processes which are difficult and even impossible at public schools.

    Mrs. Shanks is confident that continuous education and attention to research findings is the basic component of her professional success, and she recommends that other language professionals pay special attention to what researchers and scholars in neurological studies publish in professional journals. For example, with her emphasis and attention toward dysarthria, Mrs. Shanks became increasingly interested in how electropalatography may reduce the symptoms and signs of articulation impairments in children with post-traumatic brain injury (Morgan, Liegeois  Occomore, 2007). These scientific findings are further evaluated and adjusted to the practical environments, in which Mrs. Shanks cooperates with other professionals. Regular meetings with other professionals and continuous collaboration with related organizations all over the world often become the sources of interesting discoveries and findings, which specialists share and then use in their practical work. Certainly, Mrs. Shanks does not forget about the impact of culture on language impairments. She believes that language impairments in children after brain injury impact their ability to create macro and micro structures in language, but these structures also heavily depend on the culture-specific language patterns, which children and their parents and or caregivers use in daily environments. As a result, separating culture from language therapy is undesirable and even impossible, given the importance of language for childrens subsequent development and learning. However, the most important aspect of Mrs. Shankss professional success is the emphasis she makes on continuous communication between children in groups. In all her findings and discoveries, she intentionally or unintentionally reveals her respect of and commitment to the principles of collaborative learning, where children have an opportunity to communicate with each other and with older care workers and caregivers, thus acquiring more effective language skills and learning how to overcome their language difficulties in different situations.

    Interactionist perspectives in language development and acquisition show language as the product of both biological and social processes. As a result, interacting with peers and older care workers is critical in treating language impairments in children after TBI. Mrs. Shanks, a care worker from Meath School, is the direct support of the interactionist view of language in such children. She makes special emphasis on the need for children to interact with each other and with other adults. As a result, practical communication creates a form of challenge, which children are bound to meet in order to articulate their ideas and memories to other children. Although collaborative learning also poses some problems, and although not all parents can readily understand and accept the principles of shared knowledge and shared authority that are essential for collaborative language development, Meath School seems to have been able to overcome these difficulties through continuous communication with parents. I personally believe that the interactionist theory provides excellent opportunities for maintaining a reasonable balance of social, psychological, and biological factors of language development in children with language impairments following TBI.

According to O Neill (2005), governments define social conditions as social problems by spending money on them. (14). this has specifically been true when it comes to juvenile gang violence. However what has become clear over the course of several years is that gang violence is not a problem that you can simply throw money at and have it go away. There are specific ethical issues that must be addressed when attempting to help adolescents who are gang members to separate themselves from this negative lifestyle.

    The first ethical issue is that of integrity. As a specialist in juvenile gang violence you will need integrity, not only to avoid becoming involved with gang issues yourself, but, as a sign you can be trusted by the juveniles that you work with. Integrity will also be critical in terms of working hand in hand with the police and other social agencies that are helping to prevent juvenile gang violence because, it is often necessary for the psychological professional to act as an intermediary between law  enforcement and the client.

    A second ethical issue that will play a critical role is that of justice. While my main goal will be to help my clients escape the gang life, a secondary goal will be in preventing gang violence in order to provide justice to all of the families who have had their lives harmed by gangs, either because a family member is involved in gang violence, or because someone in the family has been harmed by gang violence.

    The third and perhaps, most important ethical principle that must guide by career is that of fidelity and responsibility. Fidelity is important because if I am not loyal to my clients and seek to serve their best interests, they will not learn to trust me, more than they trust their gang. Responsibility is also critical. As a counselor I have a responsibility to my clients, to protect them, to help them solve their problems and the help they develop the coping skills, and life skills that they will need in order to leave the gang, and to stop participating in gang violence. Each of these ethical principles will guide my choices throughout my career and help me to serve the interests of my clients to the best of my abilities.

Cognition and learning
     Cognition is the mental process of knowing something either through awareness, perception, reasoning, and judgment.  This is how somebody can claim to know something. Learning is closely linked with cognition. Learning can be said to be the process of acquiring new knowledge, skills, behaviors, values and understanding. (Brown et al, 1989).

    In psychology stroop effect is understood to be a demonstration of the reaction time of a particular task. This theory is named after its author John Ridley Stroop who first published it in English language 1935.

    According to the theory, it is easier to teach primary colors to schools children by naming the color  being learnt by  for example when teaching children color blue, it is important to write the word blue using the same color using a word printed in the same color. When a color is named using a different color for example when a word such as red is printed in color green learning the color take longer and is prone to mistakes than when it is named with the same color.( Brown et al, 1989)

    In the medical field the stroop effect have been found to be effective in testing selective attention so as to know whether a patient is suffering from brain damage or even detect brain diseases. This is done by asking the patient to name the color of an object painted a different color. For example a red cup but its name is printe3d in white. The patient is asked to name the color of the cup and also say the color of the letters used to print the name cup. The stroop effect has proved to be very effective in clinical functions.

    Similarly the stroop effect can also be used by policemen to test the attention of driver on the highways. This is can be done painting a card in a certain color and then writing the meaning of that color in traffic.  For example a red card written in green get ready to move. When a driver is asked to say the meaning of color red in traffic, it will take a longer time to process and those who have not mastered the meaning of traffic lights will be caught easily.

Descriptive and inferential statistics are the two most general types of statistics that are being used in researches and similar studies. Descriptive statistics are the type of statistics that provides the summaries of numeric data in an organized and straightforward manner (Levinson, 2002). Inferential statistics on the other hand, is the type of statistics that is uses a small set of data to come up with educated guess or inference about the larger set of data represented by the smaller data set (Levinson, 2002)

    Both statistics are often used in researches like criminal justice researchers, clinical researchers, and psychological and social researches. An example of application of descriptive statistics is on the computation of grades of students attending a particular class. Descriptive statistics may take the form of the average grade or the ranking of grades from the highest to the lowest, the total number of students with grades belonging to a particular range, or how often or frequent does a particular grade was incurred in the said class. So in its sense, descriptive statistics are used if you want to describe the characteristic of the population you are interested with.

    However, if you are to determine the future performance of the students in the said class, you are then deploying inferential statistics. Say if four out of five students will fair well in the midterm exam, then you can say that around eighty percent (80) of the students attending the said class will pass the final exam. Another example of inferential statistics is if you want to determine which of the boys and girls will perform well in the final exam.  Collecting a sample of boys and a sample of girls and determining the percentage of those passing in each gender will more or less give you an idea who will perform well and not during the final exam.

Human beings brain is indeed very powerful. A mindset of a person will always have a physical manifestation through its actions and behavior. So to speak, it is not what happens to a person but rather it is what heshe does with what happens to her. Therefore, a person invents hisher own life.

    Let us take the case of Mr. G, a married man working for a major corporation, who is presently seeking treatment due to his frustration and disappointment because he lost his promotion due to public speaking. He even thinks that the thought of public speaking makes him sick that he just wants to run away whenever he anticipates it. He even claims that he will be stuck in his current position forever. It is but apparent that Mr. G. is not happy with the recent happenings in his life. He is having a negative disposition in life.

This can be more explicitly understood with the Rational Emotive Behavior Therapy (REBT) founded by Albert Ellis. This was formerly named as Rational Therapy which was later changed to Rational Emotive Therapy before it has been coined to its current appellation. According to this theory, a person does not merely get affected by unfavorable and unfortunate adversities, but by how they create their views and perspective of life with their language, beliefs, philosophies about them and others.

REBT makes us of the A-B-C (adversity-belief-consequences) model of psychological disturbance as well as change. This means that it is not just about adversity that results to dysfunctional behavioral Consequences, but also what a person believes about the adversity.

Taking the REBT in the scenario that we have with Mr. G, it is evident that with his negative views with what he is going through, this results to a destructive emotional and behavioral consequence.
Also, REBT makes use of framework concepts that humans have both innate rational (constructive) and irrational (destructive) propensity and leanings. People manifest emotional difficulties, whether consciously or unconsciously, such as self-blame, self-pity, clinical anger, hurt, guilt, shame, depression, and anxiety. And this is what Mr. G is going through and experiencing in the scenario presented above.

    According to this theory, there will be no other way to get better and stay better but by persistent work and continuous practice of searching for ones own irrational beliefs and actively deter these beliefs.

With REBT, an intervention can be created to help people like Mr. G. as this is after all adapted as an educational process in which the therapist teaches the patient on how to identify destructive beliefs and forcefully clash those beliefs.  The therapist can focus much on the emphasis that a person always has a choice on how to minimize such feelings of negativity towards unfortunate events of ones life.

The first step should be noted that Mr. G has to acknowledge the problems, accepts the emotional responsibility and most importantly, has the willingness and determination to help his self. To be more specific, the intervention which can be arranged to help Mr. G, is one in which we have to seek professional help from psychotherapists to help demonstrate Mr. G with the unconditional other-acceptance. The therapist shall understand Mr. Gs concerns and point of view and heshe shall work not just as a mere therapist but rather as a facilitator, teacher, and most importantly encourager.  The therapist and Mr. G shall together work in a structured and active-directive manner, working on a set of target problems and a set of therapeutic goals shall be established as well.

Consequently, Mr. G. is expected to learn to take a broad view on the insights of the relevant situations which happened in his life. The therapist shall then examine possible underlying beliefs and more deep perspective and schemes which may account for a possible variety of problematic emotions and behavior.

    Also, it is important that Mr. G should have the best social support that he could get from his wife, family, and friends to help him get out of this situation. Activities which focus on quality time with his loved ones could evidently help him to realize that there is indeed more to life. This could help him minimize the instances of focusing on thinking about the negative things that he has in mind.

All the attempts made by a person(s) to control the behavior of another through improper utilization of power using bonds of relationship, trust, and dependency aimed at making the victim helpless are termed as abuse. Men are widely known to be abusive towards women and children. There are several reasons that may lead to a man becoming a perpetrator of violence. Biological and historical factors may make a person to be violent (Stong, 2007). Past experiences from violent surroundings, demographic characteristics such as poor education, age, and financial strains, psychological and personality disorders and substance abuse are all factors that may make a person to be abusive. Violent relationships either from a family or from friends also tends to create abusive characters. The community where a person is living may also make himher to be violent if the circumstances are not conducive. These may either be circumstances like lack of employment, existence of illegal arms or high population density.  Societal norms may also develop violent people. Some societies believe that a woman can never be the head of a family and that children are not supposed to have any say in their families (Better health, 2009).

Violent men
There are different types of abuse that men can exhibit either towards women or children. These are physical abuse which includes hitting, beating, punching, slapping, pulling hair, mutilation, burning, biting, use of weapons and murder. The other one is sexual abuse which ranges from unwanted touches to rape. Verbal abuse is another type of abuse where a person uses derogatory words, threats, insults, and shouts at the other person. Psychological abuse is the case where intimacy, sympathy and emotional care are withdrawn from a relationship. Financial abuse occurs when someones money is stolen, withheld, or some one is restricted from acquiring information about household financial matters (Better health, 2009). The other form of abuse is spiritual abuse, where either a persons religious beliefs are belittled or the person is completely restricted from attending a religious gathering. A man can show one of these forms of abuse all exhibit al of them. Abusive men are very difficult to detect and they tend to make a woman think that she is not up to the standard. They also tend to put all the blame for everything that goes wrong in their lives on women. Abused women often portray depression and low self esteem (Better health, 2009).

According to Alexander (2009), in the beginning all relationships are very intimate and turn out to be abusive as time goes by. There are various signs that can be detected from an abusive man. One of them is that, they have a character of telling women that they will change and often pretend how much they love and care order to make a woman stick with them. They are also known to make a lot of empty promises. These men tend to become jealous over all other relationships a woman may be having be it at the workplace, family friends, and other family members. They tend to continuously accuse their women on cheating with other men.  They always inquire of a womans where about in an accusatory way.  Better health, 2009), notes that an abusive man tends to take control of all household business. This man also tends to believe that he is always on the right track and if anything is done contrary to his will, he becomes verbally or physically abusive. An abusive man also tends to blame anything that he does and goes wrong on a woman. An abusive man manipulates the thinking of a woman making her believe that, its her fault that he is abusive. They also make a woman think that they cant help being abusive, leaving the woman with nothing but feeling sorry for him. Abusive men have uncontrollable mood swings that range from offensive to remorseful and caring after they have abused a woman. The actions of an offensive man never match with his words. He is ford of making and breaking promises. Abusive men have no respect for a woman. They regard all women as a punching object to cool their tempers on. Considering the history of an abusive man he has very many cases of abuse either directed to a woman or an animal (Alexander, 2009).

Reasons why men become abusive

Biological factors
The major hormone that determines the character of man is testosterone. This hormone is believed to be a major contributing factor to the violence portrayed by men. Abusive nature of men occurs as a result of power inequity between them, women and children. The body structure of men is very different from that of women and children. They are more masculine and therefore tend to exercise that power against women (Stong, 2007),

Personality
There are some men who are hostile due to their personality type. Harway, ONeil, and Biden, (1999), states that these men are aggressive in nature and very little can be done to change their character. Abuse of drugs tends to further aggravate the abusive nature of these types of men. The situation is made worse when a person who is naturally aggressive is subjected to violent relationships either as a child or as an adult. Men who abuse often have low self esteem and feel powerless and useless and they tend to abuse others in order to prove their worth.

Social factors
These are the environmental factors that may lead to a man becoming abusive. Family structure, stress and social learning are some of the social factors that make men to be abusive. Constant violence directed towards children by their parents children especially the boy child tend to create a very aggressive person. Men who are reared in societies where illegal weapons such as gun are readily available tend to become very abusive when they grow (Welch, 2009).

The society also puts a lot of pressure to people who are not employed by requiring them to do things just the same way a financially stable person would do. As a result, a person subjected to that kind of pressure becomes very violent. Traditionally, many laws encouraged the battering of wives. It was seen as a form of instilling respect and discipline to a woman. The society may also view an aggressive person as a champion and treat him as such (Harway, ONeil, and Biden, 1999).

Family stress
According to Better health, (2009), families that are prone to pressures of all forms subject their members to psychological stresses. Some of these pressures include lack of finances to cater for basic family needs, too many family members and yet few facilities, accumulation of debts, and cases where one or both of the parents is very abusive.  As a way of responding to stress members become very abusive.  Families that thrive in poverty are at a higher risk of experiencing violence than families that are financially stable. Lack of Finances hinders a man from living up to his dreams of a successful life. As a result of fears that he may loose his credibility he turns out to be violent in search of honor and respect. All the abusive forms employed by this man are aimed at expressing his masculinity (Harway, ONeil, and Biden, 1999).

Social learning
Transforming Communities, (2009), states that people acquire most knowledge from observing what others are doing and copying them. Imitating a person whose moral character is upright generates a very nice person, whereas imitating a hostile person generates a hostile creature. Transmission of violence occurs from one generation to another through observation. Boys who are reared in communities full of abuse will most likely copy the behavior and direct it towards women later in life. Men also learn to be violent from their families, especially their abusive fathers and other violent male models. Welch (2009), states that violent social networks ranging from violent programs on television, violent movies to articles portraying violence against women tend to create a violent being out of a man. Few interventions have been taken to minimize the chances of a man becoming violent. The society tends s to blame the violent acts of abusive men on substances like alcohol and abuse of other drugs. This tends to give abusive men courage as they also blame their abusive nature on substances. Women are also not willing to report violent cases to the authority they do not want to suffer from public humiliation. Women also think that they will not get proper attention from a male dominated authority. When an abusive man realizes this it encourages him to continue with the evil acts (Transforming Communities, 2009).

However much the society tries to point an accusing finger towards abusive men, the vice is still rampant. Women should take precautionally measures in order to protect themselves and their children from violent relationships. By observing the actions of a man a woman can detect whether he is abusive or not, as abusive men are ford of telling empty promises. On detecting that a man is abusive, a woman should take the necessary steps by either seeking guidance and counseling or leaving that man as it is very hard for an abusive man to change his character. Women should also report any case of abuse towards them as violence can never stop if the victims are reluctant to report. After an abusers partner has left the abuser may tend to be remorseful crying for forgiveness. Women should be warned that if anyone goes back to such a character she should be prepared for more abuse.

    Depression pertains to a mental health disorder that is mainly characterized by a general feeling of sadness that lasts for a prolonged duration of time (Henje Blom et al., 2010).  An individual with depression also shows a lack of interest in specific activities that he used to find pleasure in performing.  Depression is also physically manifested as a sudden gain or loss in total body weight.  In the United States alone, it has been estimated that there are at least 20 million individuals who are currently experiencing depression.  This mental health condition affects several aspects of an individuals life, including the performance at work or school, as well as the quality of interactions with his loved ones.  Depression has been strongly associated with death and suicide and thus there is a great need to address this mental health disorder.  Depression generally affects individuals from age 15 years old to late adulthood.  This wide age range thus requires thorough differential diagnosis of specific features that may be present in each age group.  This case study will focus on adolescent depression, including applications for facilitating improvement and management of the condition.

The condition and causes of adolescent depression
    Adolescent depression pertains to a mental health disorder that is developed during the teenage years of an individual.  The major features of adolescent depression include a general feeling of sadness, as well as a prolonged sense of discouragement.  An adolescent experiencing depression also feels that he is worthless and this is usually reflected in his loss of interest in specific activities that he used to cherish.

    The condition of depression may be regarded as a temporary reaction to difficult situations or stressful incidents.  It should be understood that these types of conditions vary and these mainly depend on the age range of the individual.  Stressful situations for adolescents are therefore different from that of adults and the elderly.  Among adolescents, a number of difficult situations may trigger the development of depression.  The normal physiological changes that occur during adolescence, such as the changes in the physical features of the body, may induce depression in an adolescent.  The development of breasts among female adolescents or the lowering of the pitch of male adolescents may be stressful to these young individuals.

    The adolescent stage is also physiologically linked to an increase in the production of the sex hormones, testosterone and estrogen.  Aside from the primary effect of production of sex-specific physical features among adolescents, these hormones can also affect the mental health condition of these individuals, thus resulting in the condition of depression.  The adolescent stage is also characterized by an urge to feel independent and thus conflicts usually ensue with the parents.  Such stressful condition may also trigger the development of depression among adolescents. 

There are also certain social situations that may impart difficulty to an adolescent, including the death of a loved one or a close friend.  Depression may also result from a breakup with ones girlfriend or boyfriend.  It is also possible that poor performance at school may also initiate the depressive disorder, as the young individual feels embarrassed over his failure in class.  It is also possible that depression occurs when an adolescent is bullied, harassed or abused (Nguyen et al., 2010).  A congenital condition or developmental delay in an adolescent can also influence the occurrence of depression.

Symptoms of adolescent depression
    The major effect of depression on an adolescent is a change in the way he sees himself, as well as how he lives his life at that particular stage.  One unique feature of depression during the adolescent stage is that the young individual sees everything else surrounding him with a negative association and that each item will bring in more difficulty to his current situation.  In addition, an adolescent with depression often finds himself agitated and easily irritated.  The depressed adolescent is also restless and thus finds it difficult to focus on a specific task at hand.

    An adolescent with depression also suffers from a major change in appetite.  It has been determined that adolescents with depression are more likely to loss appetite than to gain it, as compared to adult depression which can go either way (Henje Blom et al., 2010).  The eating disorder, anorexia nervosa, is therefore strongly associated with adolescent depression, as the extreme loss of weight may be due to a depression caused by any of the aforementioned social causes.

    A number of mental skills are also affected by adolescent depression.  It is common to find an adolescent with depression to find difficulty during decision-making activities, as he often is incapable of concentrating on specific topics.  There may also be episodes of memory loss in an adolescent with depression.  As this young individual is plagued with problems that seem to be irresolvable at any point in time, then the adolescent therefore feels mentally drained and physically fatigued.

    In certain cases of depression among adolescents, behavioral problems develop such as shoplifting and uncommon defiance to parents and teachers at school.  It is common to observe irresponsible actions in an adolescent who is depressed because he feels that he is trapped and is therefore struggling to save himself from more misery.  Other depressed adolescents would turn to drinking of alcoholic beverages as these drinks could numb their senses, unknowing that this effect is only temporary.  Once the effect of numbness due to the alcohol is lost, the depressed adolescent would initiate another bout of drinking, to revive that pain-free sensation.  The same principles are also employed with the use of illegal drugs.

    An adolescent suffering from depression usually avoids interacting with his family members and other close friends because he often feels less stressed out if he keeps to himself.  Unfortunately, family members usually treat such isolation as part of a tantrum that is a common characteristic of adolescents.  It is therefore important that family members are observant enough to identify the causative factor of a tantrum and a depressed state.  It is possible that certain adolescents find themselves in an advanced stage of depressed due to the misinterpretation by the parents of the adolescents tantrums.

    In extreme cases of depression in an adolescent, it is possible that this young individual would even consider committing suicide as a possible escape from all the suffering that he is experiencing.  It is unfortunate to find literature that describe that the incidence of suicide is highest among adolescents, as they find themselves alone in a cruel world.  It is thus important to determine possible treatments and approaches that would alleviate this mental health disorder and ultimately save lives. 

Diagnosis of depression among adolescents
    Diagnosing depression in an adolescent is usually harder than that in adults and the elderly, as it is a common occurrence for an adolescent to have mood swings during this developmental stage.  In addition, the mood swings usually last for hours or even days and thus it is important to differentiate a mood swing from the actual pathological depressed condition.  One confusing approach to diagnosing an adolescent with depression is to ask him directly if he is happy.  The common response of an adolescent, regardless of depression or mood swing, is that he is not happy and that everything around him seems to make his life difficult.  It is therefore more helpful if the physician would ask the adolescent about the symptoms that are associated with depression.

    In addition to the questions regarding the symptoms of depression, the physician also conducts tests that would facilitate in the diagnosis of this mental health condition.  It is important for the physician to rule out other medical disorders and thus a blood test may be requested to determine cell counts and other protein levels in the blood.  The blood test may also assist in determining the presence of alcohol or any other illegal drugs, which are substances that also generate a depressed condition in an individual.

    A psychiatric assessment should also be conducted to determine the frequency and extent of the symptoms of depression in the adolescent.  The co-occurrence of other mental health conditions, such as bipolar disorder and schizophrenia may also be detected during psychiatric examination of the adolescent (Miklowitz et al., 2010).  The physician will also ask the adolescent if he has ever entertained thoughts of suicide or actions that would physically hurt his self.  These questions are important because these will determine if the adolescent would be a threat to himself. 

    The assessment may also require the input of the parents and other family members of the adolescent, as well as his teachers at school.  These interviews will provide the physician of the regular activities and the underlying conditions that the adolescent is experiencing in the last few months or years.  The information collected from the interview will assist in the construction of the emotions that the adolescent may be expressing outside the clinical consult.  Once a diagnosis has been formally made, the physician is then required to design a treatment plan that would personally fit the adolescent patient.

Treatment of depression among adolescents
    There are currently a number of treatment regimens for adolescents who have been diagnosed with depression.  The choice of the actual therapeutic approach mainly depends on the condition of the adolescent, as well as his capacity to adhere to the suggested treatment plan of the physician.  In addition to the participation of the adolescent in the treatment regimen, the parents of the adolescent, as well as other sibling and family relatives, are also asked to engage in treatment.  It is important for the individuals in the immediate environment of the adolescent to be aware and to understand the condition of depression, in order to provide support and care to their loved one.

Pharmacologic treatment of depression among adolescents.  One of the most common treatment plans for individuals positively diagnosed with depression is to administer anti-depressant drugs.  There is currently a wide range of drugs that could be employed in the treatment of depression, yet the usual initial treatment of an adolescent involves a selective serotonin reuptake inhibitor (SSRI).  It should be understood that serotonin is a neurotransmitter that is released in the nerve endings of neurons.  This neurotransmitter is responsible in sending messages from one nerve cell to another and thus a change in the amount of this molecule may result in changes in the mental health condition of a patient.

    In the case of depression, it has been determined that the neurotransmitter serotonin is relatively high and is actually being maintained between the space between nerve endings.  The transmission of messages between nerve cells is thus inhibited and this often results in an imbalance in the mental health condition of an individual, which in turn generates a depressed condition.  The administration of a selective serotonin reuptake inhibitor thus prevents the return of serotonin to nerve endings, resulting in the progression of neurotransmission to the next nerve cell.  This inhibition of reuptake of serotonin therefore reinstates the normal physiological functioning of nerve cells and ultimately diminishes the symptoms of depression.

    Two major drugs that are classified as selective serotonin reuptake inhibitors are fluoxetine and escitalopram.  Fluoxetine, more commonly known by the drug brand ProzacTM, and escitalopram, of drug brand name LexaproTM, are the only drugs that have been approved by the Federal Drug Administration for the treatment of adolescents, between the age of 12 and 17 years old, who have been positively diagnosed with depression.  For children of age 8 years old and below, only fluoxetine has been approved for administration.

    One side effect of selective serotonin reuptake inhibitors and its analogues is that this drug could increase the likelihood to commit suicide.  The packaging of these drugs therefore carries a warning sign that states that such risk is associated with its intake.  Despite anecdotal reports on the increase in incidence of suicide among children and teenagers under this medication, there is still a need to establish a direct connection between the occurrence of suicide and the actual drug. 

    In order to prevent possible incidences of suicidal attempts among children and adolescents under selective serotonin reuptake inhibition medication, a number of guidelines have been established with its administration.  Firstly, the physician should make regular check-ups on the young patient to identify any side effects that may develop soon after the initiation of therapeutic intervention.  Another guideline is for parents to be observant of their child as soon as he starts taking the anti-depressant drug.  Specific side effects, including any changes in the behavior, as well as signs of nervousness should be immediately reported to the physician.  They should also be vigilant for signs of agitation or indications of irritability in their child.  In addition, if these changes worsen through the days, then the medication should be stopped immediately, despite the knowledge that his depression would eventually return.

Talk therapy as treatment for depression among adolescents.  The talk therapy approach for the treatment of adolescents who have been positively diagnosed with depression appears to be effective in this specific age range.  The most plausible explanation for the effectiveness of talk therapy among adolescents is that these young individuals are not often engaged in expressing their emotions and concerns to other people.  Such inhibition is strongly associated with this developmental age and therefore the mental health disorder of depression often results in the deterioration of the total well being of an adolescent.  Once a young individual has initiated talk therapeutics, he feels that there are other individuals who care for him and that he is not alone anymore.  In addition, the adolescent also learns during talk therapy that there are various methods on how to deal with his depression.  There are currently three major types of talk therapy.

    Cognitive-behavioral therapy is a type of talk treatment that educates individuals diagnosed with depression on how to fight negative ideas and emotions on a daily basis.  In the case of an adolescent with depression, cognitive-behavioral therapy allows the young individual to learn which external factors commonly trigger his development of symptoms of depression.  In addition, this type of therapy assists the adolescent in detecting factors that make his mental health condition worse.  Cognitive-behavioral therapy therefore equips the adolescent with skills that will allow him to solve his own problems.  It is expected that once the adolescent is cognizant of these external factors, he is now capable of handling difficult situations that have earlier influenced him to reach a depressed state.

    Another type of talk therapy is family therapy, which technically involves the participation of the members of the adolescents family.  In this setting, the adolescent and his loved ones, and possibly some teachers from his school, engage is a discussion of how they feel about the adolescent.  It should be understood that a psychiatrist or therapy counselor is always present during these sessions because he is responsible in regulating and directing the discussion.  This type of therapy is often suggested in cases where conflict within the family has been influential on the development of depression in the adolescent.  The principle behind family therapy is that a discussion will allow each member of the family to express his concerns, thoughts and ideas regarding the adolescent, all in a positive way that will help the adolescent in recovering from his depression.  These sessions are also aimed to make the adolescent feel that he is not alone and that there are people who care for him and are willing to support him through his journey to recovery.

    Psychotherapy is another form of talk therapy that assists a depressed adolescent in understanding specific issues that are observed to be causing him to remain in that mental health condition.  This approach mainly involves the adolescent and a psychiatrist, where this one-on-one correspondence allows the young individual to reflect on his emotions and his concerns in life.  The psychiatrist generally asks the adolescent a battery of questions that are designed to make the young person realize that there are solutions to each of his problems.  The aim of psychotherapy is to empower the adolescent with realizable principles that would guide him through his daily life.  The psychiatrist plays an instrumental role in guiding the adolescent in his personal assessment of his thoughts, as well as behavior.

    A support group is another form of talk therapy that involves a number of individuals who have been also diagnosed with depression.  In the case of the adolescent, it is possible that he participates in a group that is composed of individuals of his same age range.  This setting will allow the adolescent to feel that there are other adolescents who are struggling with the same mental health condition and therefore he should not feel alone.  If this setting is ineffective, the adolescent may also participant in a support group that has members of different ages.  It should be noted that the support group allows an individual to see the condition of depression through the eyes of different personalities.  The aim of engaging in a support group is for an individual to express his feelings and thoughts, as well as hear other individuals who have the same mental health disorder, in the hope of learning from such engagement.

Additional approaches for the treatment of depression among adolescents
    The symptoms of depression may vary from one individual to another, and thus it is important for the physician to recognize certain features that would need to be addressed during treatment.  One important feature that has to be recognized during the diagnosis of depression is the severity of the mental health condition.  Individuals with mild depression are generally easy to treat because this typically requires a low dose of anti-depressants.  On the other hand, individuals with severe depression need more extensive treatments because the risk of committing suicide is generally higher in these cases. 

In the case of an adolescent, the participation of the parents and teachers at school would be helpful in monitoring the condition of the young individual.  However, it is often recommended that adolescents with depression be hospitalized in a mental health institution, which specializes in monitoring such clinical cases.  In these healthcare institutions, highly trained healthcare professionals constantly monitor patients with regards to their activities.  The monitoring of an adolescent with depression may be more difficult in a home setting because the parents or siblings may not be present at all times.  If the depressed adolescent shows suicidal thoughts or may simply indicate plans of harming himself, then hospitalization may be the best option for the young individual.

Mental health institutions are equipped with personnel that engage is talk therapies.  These regular sessions, similar to the talk therapies previously described in this report, allows the adolescent to learn how to identify factors that influence him to develop his condition of depression.  Behavioral patterns are also taught, so that the adolescent may be empowered with actions that would prevent him from being affected by external stress stimuli.  Pharmacologic treatments are also administered to adolescents in mental health institutions, mainly to stabilize their condition.

An adolescent with depression should also be empowered with the knowledge, as well as skills, on how to deal with stressful events that he may encounter on a daily basis.  In addition, it will also be helpful for the adolescent to learn important things in his treatment.  Firstly, the adolescent should be educated on what medications he has been prescribed.  It will be helpful if the adolescent understands the effect of the actual drug he is taking and what are the possible side effects that might occur once he has started his medication.  The physician should also educate the adolescent on the effects of stopping his medication without physicians advice.  It would also be beneficial if the adolescent were taught of the importance of patient adherence, especially in terms of the prescribed treatment regimen for his diagnosed depression.  The adolescent should also understand that if he feels that his condition has worsened, he should inform his physician, as well as his parents, of this change so that the appropriate action could be immediately performed.

An adolescent with depression should also engage in exercise because this activity improves the circulation of blood in the body.  This improvement in circulation provides sufficient oxygen to the brain, which is the main organ that is affected by depression.  Exercise also serves as an activity that keeps the adolescent busy and far from concentrating on personal issues associated with depression.  The adolescent should also refrain from taking alcoholic beverages because these may interact with the anti-depressant drug that he is taking.  Illegal drugs and other narcotics should also be avoided, in order to prevent any adverse effects from the medication.

    Depression is a mental health disorder that is characterized by a general feeling of sadness and helplessness.  This disorder affects individuals of various ages and therefore it is important to consider the age of an individual during diagnosis.  Adolescent depression is generally more difficult to diagnose and to treat due to the inherent characteristics of this developmental stage.  A number of factors influence the development of depression in an adolescent, including social, physiological and hormonal factors.  It is important for a physician to carefully examine an adolescent during the diagnosis of depression, which is usually performed by asking questions regarding the symptoms of the condition.  An adolescent diagnosed with depression may be treated with pharmacologic drugs, as well as talk therapy.  The progress of the treated adolescent should be regularly monitored in order to determine the improvement of his condition.  Additional treatment measures may also be conducted in order to assist the adolescent in his recovery from depression.