Depression in Children in Childhood
Depression is a state of low mood
and aversion to activity. It may be a normal reaction to occurring
life events or circumstances, a symptom of a medical condition, a
side effect of drugs or medical treatments, or a symptom of
certain psychiatric syndromes, such as the mood disorders major
depressive disorder and dysthymia. Depression
in childhood and adolescence is
similar to adult major depressive disorder, although young
sufferers may exhibit increased irritability or aggressive and
self-destructive behavior, rather than the all-encompassing
sadness associated with adult forms of depression. Children who
are under stress, experience loss, or have attention, learning, and behavioral
Base rates and prevalence
About 8% of children and
adolescents suffer from depression. Research suggests that the
prevalence of young depression sufferers in Western cultures
ranges from 1.9% to 3.4% among primary school children and 3.2% to
8.9% among adolescents. Studies have also found that among
children diagnosed with a depressive episode, there is a 70% rate
of recurrence within five years. Furthermore, 50% of children with
depression will have a recurrence at least once during their
adulthood. While there is no gender difference in depression rates
up until age 15, after that age the rate among women doubles
compared to men. However, in terms of recurrence rates and symptom
severity, there is no gender difference. In an attempt to explain
these findings, one theory asserts that preadolescence
women, on average, have more risk factors for depression than men.
These risk factors then combine with the typical stresses and
challenges of adolescent development to trigger the onset of
depression.
Suicidal intent
Like their adult counterparts, children and
adolescent depression sufferers are at an increased risk of
attempting or committing suicide. Suicide is the third leading
cause of death among 15-19-year-olds. Adolescent males may be at
an even higher risk of suicidal behavior if they also present
with a conduct disorder. In the 1990s, the National Institute of
Mental Health (NIMH) found that up to 7% of adolescents who
develop major depressive disorder may commit suicide as young
adults. Such statistics demonstrate the importance of
interventions by family and friends, as well as the importance
of early diagnosis and treatment by medical staff, to prevent
suicide among depressed or at-risk youth. However, some data
showed the opposite conclusion. Most depression symptoms are
reported more frequently by females; such as sadness (reported
by 85.1% of women and 54.3% of men), and crying (approximately
63.4% of women and 42.9% of men). Women have a higher
probability to experience depression than men, with prevalences of 19.2% and 13.5% respectively.
Risk factor
In childhood, boys and girls appear to be at
equal risk for depressive disorders; during adolescence,
however, girls are twice as likely as boys to develop
depression. Before adolescence rates of depression are about the
same in girls and boys, it is not until between the ages of
11-13 that it begins to change. Young girls around this age,
physically, go through more changes than young boys which put them that a higher risk for depression and hormonal imbalance. The
gender gap in the depression between adolescent men and women is
mostly due to young women's lower levels of positive thinking,
need for approval, and self-focusing negative
conditions. Frequent exposure to victimization or bullying was
related to high risks of depression, ideation, and suicide
attempts compared to those not involved in bullying. Nicotine
dependence is also associated with depression, anxiety, and poor
dieting, mostly in young men. Although causal direction has not
been established, involvement in any sex or drug use is cause
for concern. Children who develop major depression are more
likely to have a family history of the disorder (often a parent
who experienced depression at an early age) than patients with
adolescent- or adult-onset depression. Adolescents with
depression are also likely to have a family history of
depression, though the correlation is not as high as it is for
children.
History
Professionals first became aware of child abuse in
the early 1980s, so some of the young people
identified with depressive disorders may have had a history of
sexual abuse, which was not disclosed. This raises the question of
what the outcome would have been for those young people if they had
disclosed the abuse and received appropriate therapeutic
interventions. It is well-known that childhood sexual abuse is a
significant factor in the history of some adults with depressive
syndromes.
In the past, attention deficit hyperactivity
disorder (ADHD) was not recognized, and hyperkinetic disorder was
only rarely diagnosed. Some young people, especially those with
comorbid conduct disorder and major depressive disorder, may have
had undiagnosed and untreated ADHD. Before the use of
psycho-stimulants, some young people may have been more vulnerable
to the development of depressive syndromes because of untreated
attentional and other behavioral problems which reduce their
self-esteem.
Although antidepressants were used by child and
adolescent psychiatrists to treat major depressive disorder, they
may not always have been used in young people with a comorbid
conduct disorder because of the risks of an overdose in such a
population. Tricyclic antidepressants were the predominant
antidepressants used at that time in this population. With the
advent of selective serotonin reuptake inhibitors (SSRIs), child
and adolescent psychiatrists probably began prescribing more
anti-depressants in the comorbid conduct disorder/major depressive
group because of the lower risk of serious harm in overdose. This
raises the possibility that more effective treatment of these
young people might also improve their outcomes in adult life.
Can Children Really Suffer From Depression?
Yes. Childhood depression is different from the
normal "blues" and everyday emotions that occur as a
child develops. Just because a child seems sad doesn't necessarily
mean he or she has significant depression. If the sadness becomes
persistent or interferes with normal social activities,
interests, schoolwork, or family life, it may indicate that he
or she has a depressive illness. Keep in mind that while depression
is a serious illness, it is also a treatable one.
How Can I Tell if My Child Is Depressed?
The symptoms of depression in children vary. It is
often undiagnosed and untreated because they are passed off as
normal emotional and psychological changes that occur during
growth. Early medical studies focused on "masked"
depression, where a child's depressed mood was evidenced by acting
out or angry behavior. While this does occur, particularly in
younger children, many children display sadness or low mood similar
to adults who are depressed. The primary symptoms of depression
revolve around sadness, a feeling of hopelessness, and mood
changes.
Signs and
symptoms of depression in children include:
-
Irritability or anger
-
Continuous feelings of sadness and hopelessness
-
Social withdrawal
-
Increased sensitivity to rejection
-
Changes in appetite -- either increased or decreased
-
Changes in sleep -- sleeplessness or excessive sleep
-
Vocal outbursts or crying
-
Difficulty concentrating
-
Fatigue and low energy
-
Physical complaints (such as stomachaches, and headaches) that don't respond to treatment
-
Reduced ability to function during events and activities at home or with friends, in school, in extracurricular activities, and in other hobbies or interests
-
Feelings of worthlessness or guilt
-
Impaired thinking or concentration
-
Thoughts of death or suicide
Not all children have all of these symptoms. In fact,
most will display different symptoms at different times and in
different settings. Although some children may continue to function
reasonably well in structured environments, most kids with
significant depression will suffer a noticeable change in social
activities, loss of interest in school and poor academic
performance, or a change in appearance. Children may also begin
using drugs or alcohol, especially if they are over age 12.
Although relatively rare in youths under 12, young
children do attempt suicide -- and may do so impulsively when they
are upset or angry. Girls are more likely to attempt suicide, but
boys are more likely to actually kill themselves when they make an
attempt. Children with a family history of violence, alcohol abuse,
or physical or sexual abuse are at greater risk for suicide, as are
those with depressive symptoms.
Which Children Get Depressed?
Up to 3% of children and 8% of adolescents in the
U.S. suffer from depression. Depression is significantly more
common in boys under age 10. But by age 16, girls have a greater
incidence of depression.
Bipolar disorder is more common in adolescents than
in younger children. Bipolar disorder in children can, however, be
more severe than in adolescents. It may also occur with, or be
hidden by, attention deficit hyperactivity disorder (ADHD),
obsessive-compulsive disorder (OCD), or conduct disorder (CD).
What Causes Depression in Children?
As in adults, depression in children can be caused by
any combination of factors that relate to physical health, life
events, family history, environment, genetic vulnerability, and
biochemical disturbance. Depression is not a passing mood, nor is
it a condition that will go away without proper treatment.
Can Depression in Children Be Prevented?
Children with a family history of depression are at
greater risk of experiencing depression themselves. Children who
have parents that suffer from depression tend to develop their
first episode of depression earlier than children whose parents do
not. Children from chaotic or conflicted families, or children and
teens who abuse substances like alcohol and drugs, are also at
greater risk of depression.
Depression in Children: Warning Signs
Parents should be particularly vigilant for signs
that may indicate that their child is at risk for suicide.
Warning signs of suicidal behavior in children
include:
-
Many depressive symptoms (changes in eating, sleeping, and activities)
-
Social isolation, including isolation from the family
-
Talk of suicide, hopelessness, or helplessness
-
Increased acting-out of undesirable behaviors (sexual/behavioral)
-
Increased risk-taking behaviors
-
Frequent accidents
-
Substance abuse
-
Focus on morbid and negative themes
-
Talk about death and dying
-
Increased crying or reduced emotional expression
-
Giving away possessions
How Is Depression Diagnosed in Children?
If the symptoms of depression in your child have
lasted for at least two weeks, you should schedule a visit with his
or her doctor to make sure there are no physical reasons for the
symptoms and to make sure that your child receives proper
treatment. A consultation with a mental health care professional
who specializes in children is also recommended. Keep in mind that
the pediatrician may ask to speak with your child alone.
A mental health evaluation should include interviews
with you (the parent or primary caregiver) and your child, and any
additional psychological testing that is necessary. Information
from teachers, friends, and classmates can be useful for showing
that these symptoms are consistent during your child's various
activities and are a marked change from previous behavior.
There are no specific tests -- medical or
psychological -- that can clearly show depression, but tools such
as questionnaires (for both the child and parents) combined with
personal information, can be very useful in helping diagnose
depression in children. Sometimes those therapy sessions and
questionnaires can uncover other concerns that contribute to depression such as ADHD, conduct disorder, and OCD.
Some pediatricians start using mental health
screens at a child's 11th-year well visit and each year after.
Depression in Children: Warning Signs
Parents should be particularly vigilant for signs
that may indicate that their child is at risk for suicide.
Continue Reading Below
Warning signs of suicidal behavior in children
include:
-
Many depressive symptoms (changes in eating, sleeping, and activities)
-
Social isolation, including isolation from the family
-
Talk of suicide, hopelessness, or helplessness
-
Increased acting-out of undesirable behaviors (sexual/behavioral)
-
Increased risk-taking behaviors
-
Frequent accidents
-
Substance abuse
-
Focus on morbid and negative themes
-
Talk about death and dying
-
Increased crying or reduced emotional expression
-
Giving away possessions
Although most people think of depression as an
adult illness, children and adolescents can develop depression as
well. Unfortunately, many children with depression go
untreated because adults don't recognize they're depressed.
It's important for parents, teachers, and other
adults to learn about childhood depression. When you understand the
symptoms of depression and the reasons children develop it, you can
intervene helpfully.
It's important for parents, teachers, and other adults to learn
about childhood depression. When you understand the symptoms of
depression and the reasons children develop it, you can intervene helpfully.
Sometimes adults assume kids shouldn't be depressed
since they don't have to worry about adult issues, like paying
bills or running a household.
But kids experience stress too. And even children
who live relatively stress-free lives may develop depression.
Children who are raised in good homes with loving
parents can become depressed.
Depression in Children Looks Different
While adults with depression tend to look sad,
children and teens with depression may look more irritable and
angry.
You might see changes in behavior
, such as
increased defiance or a decline in grades at school.
Your child might insist that he's fine or he may
deny that he's experiencing any problems. Many parents pass off
the irritability as a phase or they assume it's part of normal
development. But, irritability that lasts longer than two weeks
may be a sign of depression.
Some children with depression often have physical
complaints. They may report more stomachaches and headaches than
their peers.
Children May Resist Talking About Mental Health
Younger children often lack the language skills to
verbalize their mood. They may not be able to describe how
they're feeling or what they're experiencing.
Older children who have a better understanding of
what depression means may feel embarrassed or they may worry that
they're different.
It's usually best not to ask lots of questions.
Instead, keep a diary that tracks the changes in mood or behavior that you're seeing. Then, you'll have a clear record to show a
physician so you can address your concerns.
You Have Treatment Options
Sometimes parents fear that depression treatment
will involve heavy-duty medications. But, medication isn't always
needed to treat depression. Talk therapy may be another option.
Ultimately, it's up to the guardians to decide what
treatment options they want to employ. Parents and children need to educate themselves about treatment and the
potential risks and benefits of each option.
If you suspect your child is depressed, the
pediatrician's pediatricians start. Schedule an appointment
with the physician and talk about your concerns.
The pediatrician can rule out potential physical
health issues that may be contributing to the symptoms you are
seeing. If warranted, your child may be referred to a mental
health professional.
Depression Isn't a Sign of Weakness
Anyone can develop depression and it isn't a sign
of weakness. It also isn't your fault if your child is
depressed.
While stressful life events, like divorce, may
contribute to depression, it's only a small piece of the puzzle.
Many other factors, including genetics, also play a role.
You Can Be Proactive About Your Child's Mental Health
You can't always prevent depression in children.
But, you can take steps to proactively improve your child's
mental health, regardless of whether she has a mental health
issue.
Talk about how caring for her body also helps
her mind. Eating nutritious food, getting plenty of exercises, and
sleeping the recommended number of hours each night is good for
her mental health.
Help your child develop a rich social life without
over-scheduling her time. Assign responsibilities and reward her
for being responsible.
Teach her how to solve problems, manage her
emotions in healthy ways, and develop strategies that will help
her cope with failure and setbacks. Talk about your mental health
too and make staying healthy a priority in your family.
ADHD Overview
ADHD stands for attention deficit hyperactivity
disorder, a condition with symptoms such as inattentiveness,
impulsivity, and hyperactivity. The symptoms differ from person to
person. ADHD was formerly called ADD, or attention deficit
disorder. Both children and adults can have ADHD, but the symptoms
always begin in childhood. Adults with ADHD may have trouble
managing time, being organized, setting goals, and holding down a
job.
Types of ADHD
The combined type
is the most common, and your child has it if she doesn't pay
attention or is hyperactive and impulsive. In the
predominantly hyperactive/impulsive type, she's fidgety
and can't control her impulses. If she has the
predominantly inattentive type, she finds it hard to focus
but isn't overly active and usually doesn't disrupt the
classroom.
Counseling
It can help your
child learn to handle frustrations and build self-esteem. It
also teaches you some support strategies. One type of therapy,
called social skills training, shows him how to take turns and
share. Studies show that long-term treatment with a combo of
drugs and behavioral therapy works better than medication alone.
The Role of Routine
You can give your
child more structure at home if you lay out clear routines.
Post a daily schedule that reminds her of what she's supposed
to do throughout the day. This helps her stay on task. It
should include specific times to wake up, eat, play, do
homework and chores, and go to bed.
Your Child's Diet
Studies on diets have
mixed results, but some experts believe food that's good for the
brain could be helpful. Things that are high in protein, like
eggs, meat, beans, and nuts, may help your child concentrate
better. You may also want to replace simple carbs, like candy
and white bread, with complex ones, like pears and whole-grain
bread. Talk to your pediatrician before making any big changes
in what your child eats.
ADHD and Junk Food
While many kids
bounce off the walls after they eat junk food, there isn’t
any strong evidence that sugar is a cause of ADHD. The role of
food additives isn't certain, either. Some parents believe
preservatives and food colorings make symptoms worse, and the
American Academy of Pediatrics says it's reasonable to avoid
them.
ADHD and Television
The link between
sitting in front of the tube and ADHD isn't clear, but the
American Academy of Pediatrics suggests you limit your young
child's screen time. The group discourages TV viewing for kids
under 2 and suggests no more than 2 hours a day for older kids.
To help your child develop attention skills, encourage
activities like games, blocks, puzzles, and reading.
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