When school grades lead to depression

I am now handling a sixth grade student from an exclusive boys’ school in Metro Manila. I learned that early this week, the class ranking of the graduating grade school class was announced. During his lower year, my patient had ranked second. This year, he had performed outstandingly and was expected to be the class valedictorian. When he heard the announcement in school that he was just the first honorable mention, he reacted initially with passivity, disbelief and numbness. At home, he manifested dysphoric mood, anxiety, anorexia and insomnia. The abrupt change from a vivacious and outspoken boy to a boy with school phobia and varied emotional symptoms made his parents so distraught they decided to seek professional help.

The boy’s emotional trauma was further aggravated when he learned of the alleged manipulation of his grades. So far, he has refused to go back to his school to attend the graduation practices. Anything that would remind him of his school would apparently trigger intense anxiety and flashbacks. In the past, even if he had fever, he would still insist on attending his classes. He has lost interest in even answering phone calls and text messages. He cannot eat nor sleep.

What happened to this student? It appears that the announcement that he was not the valedictorian nor the salutatorian was such a big shock to him, his self-esteem was shattered. This devastated him so much he experienced an initial subjective sense of numbness or absence of emotional responsiveness. It was as if he was in a daze. He would repeatedly experience flashbacks of his psychologically traumatic school experience described as a sense of reliving the experience or distress upon exposure to reminders of the traumatic school event. There was marked avoidance of stimuli that aroused recollections of his trauma in school. He also developed marked symptoms of anxiety, difficulty in sleeping and an exaggerated startle response. This psychological disturbance resulted in the impairment of his social and academic functioning.

Based on the above manifestations, I told the child’s mother that her son has an "Acute Traumatic Stress Disorder." This disturbance may last for a minimum of two days and a maximum of four weeks. This diagnosis is given since the child’s symptoms had occurred within four weeks of the traumatic event. If the duration of the child’s symptoms lasts more than a month, then a diagnosis of "Post-Traumatic Stress Disorder" will be given.

I advised the boy’s mother that when faced with such a problem, she needs to give her son her support and she should encourage him to discuss the situation. She should also teach her son a variety of coping mechanisms (for example, relaxation). Medication may be given if the anxiety has become severe. In children, especially those who find it hard to talk about their feelings, environmental manipulation (removing the child from the source of stress) is beneficial. I therefore advised the mother to make her son rest at home for a few days.

A child with Acute Traumatic Stress Disorder must be encouraged by his parents to talk about his trauma and his feelings. They should ask their son how he manages to get home and appear unaffected. They should point out to him that he somehow felt some relief when his family and peers gave him their emotional support. They should inform their son that these symptoms are not permanent, that these symptoms will disappear in time. Processing of this traumatic event in his school by talking about his experience and feelings will be most beneficial. Allowing him to have his close friends sleep over at his house is a good idea. The parents should also spend more time now with their son. I told the mother to try to emphasize to her son that what happened in school is now in the past and that perhaps, there are lessons to be learned from his experience and most of all, that life must go on and that it is time to move on and plan for his future.

I am optimistic that my patient’s recovery period will not be that long since he has a good emotional support system aside from the fact that he can translate his feelings into words and his coping styles are not maladaptive or inappropriate.

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Congratulations to my nephew, Leonard Michael Valero Halili who is graduating from college next week.