What Is Childhood Depression?
Although childhood
depression has probably affected many generations of children, it is only in the past two decades that this serious condition has been taken very seriously. Childhood depression is a condition that affects a young person's thoughts, feelings, behavior, and body. But it is more than sadness or "the blues." With childhood depression, there are more symptoms, the symptoms are more severe, and they last for a longer period of time.
Depression can happen at any point in a child's life, even when things seem to be going well. Children with depression may have a hard time dealing with everyday activities and responsibilities. The depression may affect the way kids behave at home and at school, how they interact with others, and how they feel about themselves. If left untreated,
depression in children can ultimately lead to school failure, alcohol or other drug use, and even suicide.
Depression in children (or adults for that matter) is not a personal weakness; it's a mental health problem. The good news, however, is that childhood depression is treatable, especially when it is diagnosed early.
Recent studies show that one out of every 33 children may have
depression at any given time. The rate of depression among adolescents is closer to that of depression in adults, and may be as high as one in eight. About one in five children will experience depression before adulthood.
Certain factors may increase the chances of developing childhood depression. For example, if one parent has depression, or the family has a history of depression, the child is at an increased risk of developing childhood depression. In addition, the risk of experiencing subsequent episodes is high, and there is an increased chance that the child will develop other mental health disorders, such as
anxiety disorder or attention deficit hyperactivity disorder (
ADHD) --
see Depression and ADHD in Children.
Types of Depression in Children
In this article, depression refers to clinical depression (also known as major depression or major depressive disorder). There are, however, several
types of depression that a person can experience starting in childhood or adolescence. Besides major depression, other types of depression include dysthymia and
bipolar disorder.
Dysthymia
Dysthymia is a less severe type of depression that can be long-lasting. It can keep a person from functioning well, feeling good, or experiencing joy. Dysthymia often starts during childhood or adolescence.
Bipolar Disorder
Bipolar disorder (also known as
manic-depression) is the least common type of depression. The disorder can occur anytime from childhood to old age. A person who is bipolar will have cycles of mood changes, alternating between mania (a severe high) and depression (a severe low). Mania affects thinking, judgment, and social behavior in ways that can cause embarrassment and problems.
Symptoms of Childhood Depression
Depression in children is more than just having the "blues" now and then; it is a persistent condition in which children may suffer from low self-esteem and have a hard time coping with everyday activities and responsibilities or getting along with others.
Possible symptoms of childhood
depression can include:
- A major change –– either an increase or a decrease -- in eating and/or sleeping patterns
- Frequent complaints of physical illnesses such as headaches and stomachaches
- Low energy
- Poor concentration
- Thoughts or expressions of death, suicide, or self-destructive behavior
- Difficulty making decisions
- Frequent sadness, tearfulness, or crying
- Empty or hopeless feelings
- Feelings of inadequacy, unworthiness, and guilt
- Extreme sensitivity to rejection or failure
- Increased irritability, anger, or hostility
- Clinging to a parent or worrying that the parent may die
- Signs of not caring about anything (seen in children younger than six)
- Persistent boredom
- Withdrawal from other children and adults
- Lack of communication with others
- Difficulty with relationships
- Pretending to be sick or refusing to go to school
- Poor performance in school
- Talk of, or efforts to, run away from home
- Substance abuse.
If you notice one or more of these possible
signs of depression or are worried that your child might be depressed, don't panic! Your child doesn't necessarily have depression just because he or she has some of these signs. But if your child does have depression, the good news is that depression is a treatable illness, and you can help your child get better.
You can help your child get the treatment he or she needs. If your child is showing
signs of depression or mania:
- Talk with your child about how he or she is feeling.
- Keep the lines of communication open between you and your child.
- Take note of the behaviors or other symptoms that worry you.
- Monitor how long the behaviors have been going on, how often they occur, and how severe they seem to be.
- Get help. Contact your family doctor, local mental health center, or county health offices for treatment options. You can also contact the Substance Abuse and Mental Health Services Administration's (SAMHSA's) National Mental Health Information Center at 1-800-789-2647.
Diagnosing Childhood Depression
In order to make a diagnosis of
depression in children, the healthcare provider will ask a number of questions and perform a complete physical exam. He or she will also evaluate the child's:
- Family situation
- Emotional maturity
- Ability to cope with illness and treatment
- Age and state of development
- Self-esteem and prior experience with illness.
Childhood
depression and adult depression are different illnesses due to the developmental issues that children face. Children experience depression differently, and they may show different symptoms. However, if your child is showing four or more of these symptoms explained above for longer than two weeks, he or she may be suffering from childhood depression.
Keep in mind that some of these signs can occur in response to normal developmental stages; therefore, it is important to determine whether they are related to depression or a developmental stage. For example, a child may be sad in response to trauma, and the sadness usually lasts a short time.
Depression Treatment in Children
If your healthcare provider diagnoses your child with
depression, there are many different treatment options available. Your child's treatment plan may include medications (
antidepressants) and/or psychotherapy. You should develop this plan with your healthcare provider and other members of your family, including your child; giving your child an active role in planning his or her treatment can be very important to his or her improvement and recovery.
The best thing that you can do for a child who may have depression is to help him or her get treated as soon as possible. Never wait to get help in the hope that the mood will pass. Depression is a serious illness, but it is treatable. The most effective form of treatment for childhood depression may include both talk therapy and medication. A mental health professional can review treatment options with you to ensure the best care for your child.
Prognosis for Childhood Depression
Most children and adolescents with depression experience a recurrence. Twenty to 40 percent of depressed children relapse within two years, and 70 percent will do so by adulthood.
The age of first onset of childhood depression appears to play a role in its course. Children who first become depressed before puberty are at risk of some form of mental disorder in adulthood, while teenagers who first become depressed after puberty are most likely to experience another episode of depression.
Helpful Suggestions for Parents Worried About Depression in Children
How to Tell if Your Child Is Depressed
As a parent, you want what is best for your child, and you want her to be happy. When she was really young, it was easy for you to take care of her. If she fell or scraped a knee, you made the pain disappear by putting on a bandage, wrapping your arms around her, and telling her, "Everything will be okay."
Now that she is getting a little older, a simple hug and a Band-Aid
® may not be enough to make her feel better. As your child begins to experience life's ups and downs in a more intense way, she may pull away or act out in a manner that leaves you confused, angry, or scared. Your child may seem to be in a permanent bad mood, sleeping too much or eating too little. These are signs that your child may be depressed. There are things that you can do to help your child, however -- and learning more about
depression is a great first step!
What to Say
Now more than ever, it is important that you have good communication with your child. When you approach him about any behavior changes or signs you've noticed, he may not want to talk about it. You can begin the conversation by reminding him that you are there for him and that you love him. Let your child know that he can trust you, that he has not done anything wrong, and that you want to know what is on his mind. The goal is to create a space where your child feels safe to share his feelings in an open and honest way.
Although there is no specific phrase or set of statements that can be suggested as "words that always work," there are some things that you should never say. If your child is coming home right after school and sleeping for a few hours, only to wake up for a little while, then go right back to bed, do not scold her for being lazy. If your child can't seem to focus at school and seems to be drifting away into a dream world at the dinner table, do not tell her to snap out of it. It may be frustrating for you to sit by and watch what seems like an easy thing to change or get over, but if your child is depressed she needs more than a push to get back the energy and drive she once had.
What to Do
After talking to your child, you also might want to talk to her teacher or friends and see how your child is acting at school and outside the home. Have they noticed a difference? If you or other important adults in your child's life suspect a problem with
depression, here are a few suggested actions to take:
- Take careful notes about the behaviors that concern you. Note how long the behaviors have been going on, how often they occur, and how severe they seem to be.
- Make an appointment with a mental health professional or your child's doctor for evaluation and diagnosis.
- Get accurate information from libraries, hotlines, or other sources.
- Ask questions about treatments and services.
- Talk to other families in your community.
- Find family network organizations.
Some children try to numb their feelings of depression with other destructive behaviors like smoking cigarettes, drinking alcohol, using marijuana or other illegal drugs, gambling, or over-eating. If an addiction to one of these substances or activities develops, it will be important to treat your child for both the addiction and the mental illness. Try to prevent that from happening by showing your child other ways to cope with his emotions and to "escape" in a way that is safe and fun.
If your doctor diagnoses your child's illness as depression, there are many different treatment options available. Your child's
depression treatment plan may include medical treatment and/or psychotherapy. You should develop this plan with your healthcare provider and other members of your family, including your child; giving your child an active role in planning his treatment can be very important to his improvement and recovery.
Suicide is as rare among children and adolescents who have no other mental disorders as it is among adults. The adolescent often believes that his or her disease is outside the realm of control, and is in the hands of God or some other force. Refusing treatment is not a way of attempting suicide, but comes from his or her belief that fate, luck, or God determines life and death.
Within the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34. Children are less prone to suicide before puberty due to immature reasoning capabilities that make planning and carrying out suicide difficult.
The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase in adolescent alcohol abuse. Chronic and acute illnesses are not major causes of suicide in the young. The suicide rate for male adolescents is four times as high as the rate for females. The suicide rate for white adolescents is about twice as great as the rate for African Americans and Hispanics.
Some suicide risk factors for the general population of children include:
- Biologic factors
- Predisposing life events
- Social factors
- Mental problems
- Contagion
- The availability of deadly weapons
- Motivating events.
Biologic Factors
Biologic
risk factors for depression can include a family history of mental problems such as
depression,
schizophrenia, alcoholism, drug dependence, and conduct disorders. Genetic predisposition to low levels of serotonin is associated with depression.
Predisposing Life Events
A few examples of life events that can predispose a child to
depression include an early family history of abuse by a parent; a negative life event such as the loss of a parent; childhood grief; and disturbed, hostile relationships in the family. Many other social problems and negative life events do not seem to cause suicidal behavior.
Social Factors
There are a number of social
risk factors for depression in children. One social risk factor is the very nature of adolescence itself, with its desire to experiment with drugs and alcohol. Conflict or confusion about sexual orientation can be another factor in adolescent suicide. Also, characteristics such as perfectionism, impulsiveness, inhibition, and isolation can all lead to thoughts of suicide.
Mental Problems
Ninety-five percent of young people who commit suicide have a mental disorder. These mental disorders usually include major depression,
schizophrenia, alcoholism, drug dependence, and conduct disorder. However, most children with mental problems do not commit suicide.
Contagion
"Contagion" is an expression that describes the phenomenon of young people identifying with others who have committed suicide. Some young people who are vulnerable may copy suicidal behavior. For example, friends of a cancer patient who has committed suicide could potentially be at a greater risk of committing suicide themselves -- and should be offered support and counseling.
The Availability of Deadly Weapons
A gun in the house can allow suicide to occur.
Motivating Events
The diagnosis of cancer can cause an at-risk person to attempt suicide. When a person attempts suicide, there are usually other motivating events present, such as a mental disorder, other life stresses, an upsetting event such as a failure in school, or a life-threatening disease such as cancer.
Suicide prevention must include individual evaluation; referral to the correct health professionals; treatment with medications; and both individual counseling and family therapy.
The age of first onset of depression appears to play a role in its course. Children who first become depressed before puberty are at risk of some form of mental disorder in adulthood, while teenagers who first become depressed after puberty are most likely to experience another episode of depression.
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