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Depression



Grouchiness, moodiness, reluctance to spend time with family are all typical phases that young people experience at some point during their childhood; however, sometimes these behaviors can indicate something more serious than "growing pains"--an illness such as depressive disorder.  Because normal behaviors vary during each developmental stage, it can be difficult to know the difference between "a phase" and something more serious.  According to the American Academy of Child and Adolescent Psychiatry, an estimated 2% of young children, and 4% to 8% of adolescents, suffer from depression. While depression definitely exists in some younger kids, it's much more common in teenagers.  We know that the years between 15 and 24 represent the most common time for the onset of a depressive disorder, and occurs twice as frequently in girls after puberty.  

The key is to know your child. If your usually quiet and well mannered 9 year old suddenyl begins behaving aggressively, or your boisterous teenager suddenly becomes silent and withdrawn, it may be time for an assessment from a professional.  Children are actually less likely than adults to admit they feel depressed. They may be unable to recognize the symptoms of the illness, or they may incorrectly conclude that what they are experiencing is something to be ashamed of. This makes it even more important for parents and other concerned adults to be watchful for the symptoms of depression in children and adolescents. 

What is depression? 
Depressive disorders in children and adolescents include disruptive mood dysregulation disorder (DMDD), major depressive disorder, and persistent depressive disorder. Bipolar disorder is a mood disorder not included in this category; due to the potential for overdiagnosis in children, children up to age 12 experiencing similar sypmtoms of persistent irritability and frequent episodes of behavioral dyscontrol will be treated as having DMDD.  Parents can help their child by recognizing the following symptoms of a depressive disorder:


Symptoms in children:
  • Excessive crying
  • Anger and aggression
  • Temper outbursts
Symptoms in adolescents:  
  • Irritability or anger
  • Continuous feelings of sadness/hopelessness
  • Social withdrawal
  • Increased sensitivity to rejection
  • Changes in appetite -- either increased or decreased
  • Changes in sleep (too much or too little)
  • Vocal outbursts or crying
  • Difficulty concentrating
  • Reduced interest in hobbies and extracurricular activities
  • Feelings of worthlessness or guilt
  • Conflict with authority 
  • Thoughts of death or suicide
What causes depression?
Studies show a combination of environmental factors, child temperament, biochemical distrubance, and genetics contribute to depressive disorders. Childhood risk factors include parental loss or separation or other significant disruptions in caregivers, co-existing diagnosis of ADHD or anxiety, and chronic irritability in infancy.  While not all children with depression have experienced adverse childhood experiencing, heritability of depression is approximately 40%.  Certain lneuro-transmitters and a number of brain regions have been implicated in depressive disorder as well.   

What is the typical approach to treating depression?
The first step to successful treatment is a comprehensive and thorough assessment
of functioning.  The assessment includes:
  • Review of current symptoms, concerns, duration and intensity
  • A thorough review of child development and past medical history
  • Review of family systems
  • Additional important family background information including history of mental health issues
Then the best course of treatment is decided together with the caregivers.  Parents and caregivers play a crucial role in treatment because family plays a crucial role in helping to reinforce learned coping skills, reduce triggers, and alter family dynamics that contribute to an imbalance of perceived security.  Treatment may include a combination of the following:
  • Play therapy to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.
  • Family therapy including play to explore and/or challenge existing family dynamics 
  • Traditional "talk therapy" to create a space of unconditional acceptance
  • Dialectical Behavioral therapy to learn the connection between mind and body 
  • Cognitive behavioral therapy to replace negative thought patterns
  • Psycho-education with family to learn causes, symptoms, and treatment of depression
  • Medication is discussed and referred as needed
 
 

When you bring your child to us for an intake assessment, we use evidence-based methods to gain perspective on the nature and intensity of your child's symptoms.

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