Depression can be seen in children of all ages--preschool-age through teenagers. Different symptoms occur depending on the child’s developmental stage. These symptoms may develop gradually or be observed somewhat suddenly.
A preschooler might be irritable or apathetic, and may also regress to earlier behaviors. A school-age child may complain more of frequent physical symptoms like headache or stomachache. He or she may also be more irritable, have crying spells, and show general unhappiness during usual activities. Teenagers can be highly sensitive to criticism and are much moodier and more irritable. They complain of being bored all the time or hopeless. (1)
These symptoms are different than what is seen in the depressed adult who can verbally discuss their persistent sad mood. Everyone can have a bad day, but the symptoms of depression occur most every day for weeks or more. Neither the child nor the adult who is depressed can “snap out of it." The numbers of children who struggle with depression are 0.3% of preschoolers, 2%-3% of school age children, and 6-8% of teens. (4), (5)
There are some risk factors for depression in children including stress, loss, and family history of depression in the parents or siblings. A child’s loss can be a break-up with a boyfriend/girlfriend, rejection by a friend, or loss of a parent through death or divorce. Other stressors include failure of some kind at school, having a chronic illness like diabetes, or experiencing abuse or neglect. Family chaos and a confrontation with law enforcement are also risk factors for pediatric depression.
Other conditions that are frequently seen with childhood depression include learning disabilities, anxiety disorders, substance abuse, and ADHD. Symptoms that might be indicators for pediatric depression are: (2), (3)
Constant irritability or agitation (MOST predominant symptom)
Sadness, tearfulness, and crying
Withdrawing from friends and family; not communicating
Declining school performance; missing a lot of school
Temper tantrums, more defiant behavior, shouting outbursts, more reckless behavior
Changes in appetite--too much or too little food intake
Changes in sleep--difficulty falling asleep, staying asleep, or too much sleep
Forgetfulness; inability to concentrate, being indecisive
Feeling worthless or hopeless; low self esteem; feeling guilty
Physical complaints--headache, stomachache, muscle aches
Extreme sensitivity to rejection or failure
Low enthusiasm, lack of motivation, boredom
Low energy and fatigue
Efforts to run away from home
Thoughts of death, self harm or suicide
Five or more of these symptoms seen for at least 2 or more weeks, most every day, would be a concern.
Are all children moody or needy at times? Yes, occasional irritability, sadness or brooding is normal. But, when the symptoms do not go away or interfere with the child’s life, treatment is usually necessary.
If you are concerned abut any of these symptoms in your child, take your concerns to your child’s health care provider for further evaluation. The earlier a diagnosis is made, the earlier the essential treatment can begin.
Treatment might include individual counseling for the child, play therapy for a younger child, or family therapy. Emphasis will be made on a healthy sleep pattern, good nutrition, a strong family support system, and exercise. Treatment is necessary as untreated depression can lead to school failure, drug/alcohol use, or suicide/self-harm. A family may consider a medication trial for the child if the symptoms are moderate to severe and are creating impairment in several areas of the child’s life such as school, home, or with friends. Even when your child begins to feel better, it is important to follow though with counseling and medication as directed. If treatment is discontinued too early, there could be a relapse of symptoms.
It is very difficult for a child to answer the question, “Why are you so sad?” However, parents can discuss the feelings their child has, provide unconditional love and support, and seek the professional help their child needs. Childhood depression is a treatable condition.
Reference List
(1) Rappaport , N. et al. “Treating Pediatric Depression in Primary Care”. (1996). Journal of Pediatrics. Vol 148, #5. 567-568.
(2) Psychiatric Central. Childhood Depression. http://psychycentral.com.
(3) Emslie, G. (1998). The Depressed Child. American Academy of Child & Psychiatric Psychiatry. “Facts for Families, #4”. http://www.aacap.org.
(4) Substance Abuse and Mental H earth Services Administration, Office of Applied Studies. May 11, 2009. The NSDUH Report: Major Depressive Episode and Treatment Among Adolescents. Rockville, MD.
(5) Costello, J. et al. “Is There an Epidemic of Child or Adolescent Depression?” Journal of Child Psychology/Psychiatry. (2006). Vol 47, # 12; 1263-1271.
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