Signs of depression in children

Does your child seem unusually sad, irritable or quiet lately? Such changes in mood could be due to a temporary stress in life. But how do you know if it’s something more? According to the Centers for Disease Control and Prevention, the number of children with depression and anxiety has increased over time, and 3.2% of children between the ages of 3 and 17 have a current diagnosis of depression.

Types of depression and mood disorders in children

Children may experience different types of depression and mood disorders. A licensed mental health professional can provide a diagnosis based on your child's symptoms and recommend the best treatment.

The most common types of depression and mood disorders in children include:

• Major depressive disorder (MDD): Also called major depression, MDD is diagnosed when a child experiences severe or intense depression that lasts more than two weeks.
• Persistent depressive disorder (PDD): Also called dysthymia, a child with PDD experiences milder symptoms of depression, but the symptoms last for a longer time (more than one year in children, two years in adults).
• Adjustment disorder with depressed mood: This diagnosis describes depressed mood that develops within 3 months after an upsetting or stressful event, such as a death in the family or parental separation. Some adjustment difficulties are normal and expected in children; this diagnosis only is given if the difficulties are out of proportion to the triggering event and cause impairment in daily functioning.
• Seasonal affective disorder (SAD): SAD is a form of MDD with a seasonal pattern. Children with this form of depression tend to experience symptoms primarily when the hours of daylight are shorter, as occurs during the winter months in the northern hemisphere.
• Bipolar disorder: A diagnosis of bipolar disorder describes episodic periods of mania (persistently euphoric or irritable mood together with an increase in goal-directed behaviors, present most of the day, nearly every day for at least a week) alternating with episodic periods of depression. Bipolar disorder is rare in children. Sudden anger outbursts are not bipolar disorder.
• Disruptive mood dysregulation disorder (DMDD): DMDD is diagnosed when a child over age 6 displays a lasting and intense pattern of irritability, aggression, anger, severe tantrums and frequent outbursts. The child's mood is persistently irritable or angry most of the day, nearly every day, even between temper outbursts, and has been this way for over a year.

What are risk factors for childhood depression?

It's important for parents and caregivers to understand the risk factors for depression in children, which can include anxiety, family history of mental disorders, hormonal changes in puberty and life stressors.

"Chronic anxiety is one of the most common risk factors we see for depression in children," explains Alice Ann Holland, Ph.D., ABPP, Research Director of the Neuropsychology Service at Children's Health℠ and Assistant Professor at UT Southwestern. "This is anxiety that hasn't been properly diagnosed or treated for anywhere from months to years, which wears children down emotionally over time."

Risk factors for childhood depression can include life stressors such as:

• Changing to a new school
• Conflict in the home
• Dealing with bullying – in person or on social media
• Dealing with medical issues
• Parental separation or divorce
• Starting school

In addition to the above life stressors, adolescents and teens may also deal with the following situations that can trigger depression:

• Academic stress, especially related to college admissions
• Athletic performance pressure
• Dating relationships, including negative relationships and breakups
• Sleep deprivation

Is my child depressed?

Symptoms of depression can vary in children and are different from a temporary change in mood or sadness. If your child displays signs of depression lasting more than two weeks, or if symptoms seem to occur around the same time as certain stressors (such as tests) or at certain times of the week (such as Sunday evenings before the school week starts), anxiety or depression may be the cause.

Signs of depression in children

Signs of depression in children age 12 and younger may include the following:

• Decreased interest in favorite activities
• Difficulty initiating and/or maintaining social relationships
• Extreme sensitivity to rejection or failure
• Frequent absences from school and/or a sudden decline in grades
• Physical symptoms with no medical cause
• Frequent sadness, tearfulness or crying
• Hopelessness
• Low energy
• Low self-esteem
• Increased irritability
• Increased frequency or severity of tantrums (for younger children)
• Major change in eating and/or sleeping patterns
• Obsessive fears or worries about death
• Social isolation
• Talking about or attempting to run away from home
• Thoughts or expressions of suicide or self-harming behavior
• Trouble concentrating

Signs of depression in teens

Signs of depression in adolescents age 13 to 18 may include all of the above, plus:

• Increased interest in topics related to death
• Increased risk-taking behaviors
• Excessive or inappropriate feelings of guilt
• Feelings of worthlessness or self-hatred
• Substance use
• Short temper
• Trouble making decisions

Dr. Holland notes that two signs of depression are commonly missed in children. One of those signs is increased irritability. "People often associate depression with sadness, but children and adolescents may simply demonstrate increased irritability rather than overt signs of sadness like crying," she says. It's normal for children to be irritable at times – such as when they're overtired, stressed or not feeling well. But if your child has been unusually short-tempered or moody for weeks to months, this could be a sign of depression.

The other commonly missed sign of depression in children is somatic symptoms, meaning any health issues, such headaches or stomach aches, that do not have a physical cause. Again, it's normal for children to not feel well occasionally. However, "If the school nurse says your child is getting a stomachache every day during math class, that could be a red flag," says Dr. Holland.

How can I help my child with depression?

Medication can have an important role in the treatment of depression in children and teenagers, and it is especially indicated for cases of severe depression. "If a child is too depressed to engage in therapy, medication can kick-start engagement and get them to better engage with therapy and benefit from it," says Dr. Holland. However, parents may find it reassuring to know that medication is not always necessary when treating depression in children.

Studies have shown that in the majority of cases, therapy is as effective or more effective than medication alone when it comes to treating depression in children and adolescents. Cognitive Behavioral Therapy, or CBT, is one common type of therapy that research has shown to be effective for childhood depression treatment. For very young children or those with limited language skills, research indicates that play therapy is the preferred approach.

If you're concerned that your child may be experiencing symptoms of depression, consider the following steps to help:

• Start by talking with your child: On a regular basis, ask them about how they're doing in all aspects of their life. "Establish open communication with your child before you have any concerns, so that if concerns arise, they're comfortable talking to you about what's going on," says Dr. Holland. Still, if concerns do arise, don't assume your child will tell you if they're feeling depressed. Young children in particular have difficulty putting their feelings into words. Adolescents and teens may feel ashamed or embarrassed about acknowledging feelings of depression. With children of all ages, parents should convey their concern and ask questions in a loving, supportive way.
• Get other adults engaged: Speak with your child's teachers, coaches and anyone else who works with your child regularly. Ask them if they've noticed any changes in your child's mood or behavior. Request they keep an eye on your child and let you know about any out-of-the-ordinary behavior.
• Consult with a mental health professional: You can go alone to meet with a mental health professional – such as a school psychologist, counselor, therapist or psychiatrist – to discuss your concerns about your child. In speaking with you, this specialist may be able to help you discern if your child is dealing with chronic anxiety, coping with a temporary life stressor, exhibiting typical behavior for their age or is demonstrating symptoms of depression. This initial conversation should help guide your decision whether to have your child by evaluated by or pursue treatment (such as therapy or medication) with that specialist or be evaluated by another mental health professional (since not all mental health providers conduct evaluations).

Does my child need counseling?

To know when to seek counseling for your child, parents should look for noticeable changes in behavior, such as decreased interest in fun activities, social isolation or statements such as "I don't want to be alive anymore." A mental health professional can help your child process these feelings and provide an appropriate diagnosis.

If you are unsure if your child needs counseling for depression, speak to a physician about your child's symptoms. Teenagers in particular are at high risk for acting impulsively on feelings of depression and suicidal thoughts, so parents should seek professional help before those thoughts and feelings escalate.

Dr. Holland notes that teenagers may be resistant to counseling and therapy and recommends involving them in the process. Get their buy-in by asking them if they have a preference on a provider (e.g., male or female, young or old) and listen to their feedback. Encourage your child to be patient at the beginning of counseling, as it can take a few sessions to develop a therapeutic relationship. However, if after a few sessions it becomes clear that your child is not comfortable with that provider, you can look for a new therapist. Ask your child what he or she did and didn't like about that therapist, as this can guide your search for a new one.

Who can treat depression in children?

Different types of mental health professionals can help your child with symptoms of depression. Masters-level professionals licensed in the state of Texas include marriage and family therapists (LMFT), professional counselors (LPC) and social workers (LCSW). Doctoral-level mental health professionals include psychologists (Ph.D. or Psy.D.) and psychiatrists (M.D. or D.O.). These abbreviations after a provider's name will tell you what level of training they have.

Psychiatrists typically provide medication management rather than weekly therapy, although some offer both. It is important to know that research shows that medication alone is less effective than a combination of medication plus therapy. However, mild cases of depression may not require medication at all, only therapy/counseling. A licensed mental health provider can help determine the best treatment for your child.

Your child's safety is your number one priority

If your child or teen is engaging in behaviors that cause you concern for their immediate safety – such as discussing plans for suicide or other forms of self-harm – immediately take them to the nearest emergency room or call 911. Your child's safety is the top priority. "Better safe than sorry" should be your guiding philosophy in such situations.

Learn more about depression in children

Children's Health offers one of the most comprehensive specialty programs available for children and teens who need mental health services, staffed by experts with access to the latest research and treatments for depression and other mood disorders. Learn more about our Pediatric Psychiatry and Psychology services.

You can also access emotional care and support from the comfort of your home with Virtual Visit Behavioral Health. With a behavioral health care appointment, you can speak to a board-certified psychiatrist or licensed therapist using video technology. Learn more about Virtual Visit Behavioral Health.

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