Licensed Clinical Psychologist Photini Panayiotou, PhD
Transient sadness, irritability, or bad mood are parts of the typical emotional trajectory in children. However, when negative thoughts and emotions persist for a long time and affect a child’s ability to function normally in school, social or family life it may indicate that she or he has a depressive disorder. Childhood depression differs from the normal “blues” and everyday negative feelings that occur as a child develops, as they linger and cause significant distress or impairment in functioning.
Rates of childhood depression have been on the rise in the last decades. Studies1 estimate that 3.2% of children aged 3-17 years (approximately 1.9 million in the US) have diagnosed depression. The disorder is slightly more common in boys before the age of 13, but much more common in girls after the age of 132. In addition, the majority of children with depression also have at least one co-morbid psychological disorder, the most common being anxiety disorders (34%) and behavior disorders (40%)3.
It is often difficult for parents and other adults to identify when a child has depression. According to the Diagnostic and Statistical Manual of Mental Disorders4, the typical symptoms of childhood depression include the following:
- Depressed or irritable mood that doesn’t go away
- Not being interested in things and activities the child used to enjoy
- Decreased or increased weight or appetite
- Increased or decreased sleep
- Psychomotor agitation (fidgetiness) or retardation (slowed down speech/movements)
- Decreased energy, fatigue
- Feelings of worthlessness or excessive guilt
- Indecisiveness, or reduced concentration
- Recurrent thoughts of death or suicidal ideation (in older children and adolescents)
In addition to the above criteria, children and adolescents may also exhibit some of the following symptoms:
- Frequent vague, non-specific physical complaints
- Increased hostility, irritability or anger
- Frequent absences from school or poor performance in school
- Reckless behavior
There are a number of factors that can potentially increase the risk of depression in children. Difficult life events including family problems (e.g. parents separating, bereavement) difficulties in school, bullying, physical, emotional or sexual abuse, a family history of depression and other mental health problems can all trigger or exacerbate depressive symptomatology.
As with other illnesses, depression can improve with the right attention and care. Depressive symptoms often continue or worsen if they’re not properly identified and treated. If you think your child might be depressed:
Talk to your child about depression and emotions, and show care. Children might often overlook, hide, or deny how they feel. Listen to your child, offer your support, and show interest and care. Remind yourself that the difficult moods they are experiencing are part of depression, and not intentional. Avoid conflict and try to stay calm, patient and understanding. A positive parent-child relationship can help strengthen a child’s resilience against depressive symptoms.
Improve your child’s physical well-being. Make sure your child eats healthy and nutritious foods, gets at least 8-9 hours of sleep, and exercises on a daily basis. Establishing healthy lifestyle habits has a positive effect on mood.
Consult with your child’s doctor. The pediatrician will typically do a complete physical exam in order to check and potentially rule out any other health conditions that could cause depression-like symptoms. If the pediatrician diagnoses your child with depression, or a similar mood disorder, he or she may refer you to a mental health specialist for evaluation and treatment.
Contact a mental health professional. Symptoms of depression can improve with proper help. A child psychiatrist or a psychologist can assess your child’s symptoms and recommend a specialized treatment.
Ghandour, R.M., Sherman, L.J., Vladutiu, C.J., Ali, M.M., Lynch, S.E., Bitsko, R.H.,& Blumberg, S.J.(2019) Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics, 206, 256-267
Angold, A., Costello, E.J.,(eds)(2001). The epidemiology of depression in children and adolescents (2nd ed.) Cambridge: Cambridge University Press.
Angold, A., Costello, E.J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.