| Depression in Children - what is Depression in Children-treatments for Depression in Children. Bright Tots Information on child development |
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Depression in young children is a difficult topic for most parents to conceive or to accept.
Although children have always been vulnerable to a group of mental disorders, many children
suffering from undiagnosed depression have been labeled as being shy, distant, lazy, stubborn,
or disobedient. More recently, as awareness of emotional problems has increased, depressed
children have often been diagnosed with a temporary response to stress (adjustment disorder),
Attention Deficit Hyperactivity Disorder (ADHD), oppositional-defiant disorder, or some other
setback. While a number of children do have these other disorders, they often coexist with or
are misdiagnosed instead of depression.
Major depression is one of the mental, emotional, and behavior disorders that can begin during
childhood and adolescence. This type of depression affects the child's thoughts, feelings,
behavior, and body. Major depression in children and adolescents is serious; it is more than "the
blues." Depression can lead to school failure, alcohol or other drug use, and even suicide.
Although children have always been vulnerable to a group of mental disorders, many children
suffering from undiagnosed depression have been labeled as being shy, distant, lazy, stubborn,
or disobedient. More recently, as awareness of emotional problems has increased, depressed
children have often been diagnosed with a temporary response to stress (adjustment disorder),
Attention Deficit Hyperactivity Disorder (ADHD), oppositional-defiant disorder, or some other
setback. While a number of children do have these other disorders, they often coexist with or
are misdiagnosed instead of depression.
Major depression is one of the mental, emotional, and behavior disorders that can begin during
childhood and adolescence. This type of depression affects the child's thoughts, feelings,
behavior, and body. Major depression in children and adolescents is serious; it is more than "the
blues." Depression can lead to school failure, alcohol or other drug use, and even suicide.
| Depression in Children |
Depression is a serious mental health issue that can disturb even very young children.
Depressed children are generally lacking in energy and enthusiasm. They often become withdrawn and are unable to
concentrate or to enjoy life. If they are in school, they usually perform poorly. Sometimes they are irritable and unhappy or
even aggressive. If they are old enough to talk, they may refer to themselves as stupid and ugly, disliked, unloved and
incapable of being love, worthless, or even hopeless. They may be preoccupied with themes of death and dying, and,
occasionally, they may think or even attempt suicide.
Even small children may do impulsive, dangerous things intended to hurt or to kill themselves, although their ideas of death
are rather different from those of adults. The occurrence of depression is increasing in next generations and beginning at
earlier ages. Although adolescent and adult females are diagnosed with a depressive disorder twice as often as males, boys up
to age 12 are as likely to suffer from depression as girls.
Depressed children are generally lacking in energy and enthusiasm. They often become withdrawn and are unable to
concentrate or to enjoy life. If they are in school, they usually perform poorly. Sometimes they are irritable and unhappy or
even aggressive. If they are old enough to talk, they may refer to themselves as stupid and ugly, disliked, unloved and
incapable of being love, worthless, or even hopeless. They may be preoccupied with themes of death and dying, and,
occasionally, they may think or even attempt suicide.
Even small children may do impulsive, dangerous things intended to hurt or to kill themselves, although their ideas of death
are rather different from those of adults. The occurrence of depression is increasing in next generations and beginning at
earlier ages. Although adolescent and adult females are diagnosed with a depressive disorder twice as often as males, boys up
to age 12 are as likely to suffer from depression as girls.
Identifying the Signs
There are two primary types of depression: major depression which lasts at least two
weeks; and the milder but chronic dysthymic disorder (a mood disorder characterized
by mild depression), in which an enduring depressed mood seems to be connected to
the child's temperament or personality. Though dysthymic disorder is uncommon in
childhood, it may begin prior to adolescence. These children may go about their
activities as though absorbed in an unhappy daze, with only brief periods of improved
mood and outlook.
Major depressive disorder, the most severe and most disabling form of depression,
occurs in incidents that affect approximately 1% of preschool children and 2% of
pre-pubertal school-aged children at any given time. Moreover, approximately 2% of
children suffer from dysthymia. More than two thirds of children with dysthymia
develop major depression within 5 years.
Young children often do not talk about feeling depressed or down; therefore, puzzling,
nonspecific physical complaints (headaches, stomachaches, other pains and aches) can
be the first indications of severe depression in a school age child. Other young children
with depression may also be irritable; experience anxiety at separation from their parents; poor concentration and hesitation
or have exaggerated fears. Not all children who suffer with severe depression appear depressed, but instead may behave
irritable or moody, switching from extreme sadness to sudden anger.
Usually, there are other clues or signs that a child is depressed. He/she may lose interest or enjoyment in most activities. The
child may complain about being tired frequently or lack the energy to perform daily activities. He/she may sleep or eat too
little or too much. Children with depression may have trouble concentrating or making decisions, feelings of worthlessness,
anger, or guilt, may imply suicidal thoughts or pondering about death.
Signs of childhood depression:
• Regular sadness, weeping, crying; and/or hopelessness.
• Lack of interest in or failure to enjoy activities.
• Low energy; and poor concentration.
• Social separation, feeling of loneliness, and/or poor communication.
• Low self-esteem; guilt; extreme sensitivity to refusal or failure.
• Increased irritability, anger, or hostility; difficulty with relationships.
• Headaches and/or stomachaches.
• frequent school absences or poor performance
• A major change in eating and/or sleeping routine.
• Talk of or attempts of running away from home.
• Thoughts or expressions of suicide or self-inflicted behavior.
Causes of Depression in Children
Depression is a complicated condition. Likely rooted in a genetic and/or biochemical predisposition, depression also can be
linked to unresolved grief, possibly in response to early real or imagined losses of nurturing figures. Depression may also
reflect that the child has learned feelings of helplessness rather than feeling motivate and seek solutions for life's problems.
Some seriously depressed children have experienced early life or environmental stresses including childhood trauma, or the
death of a parent or other significant people. They may live in families where they regularly witness or are victims of parental
aggression, rejection, or target of strict punishment, or parents abusing one another. Such family pressures may contribute
to the development of a depressive mood disturbance in a child.
Depression also runs in families. Often one parent of a depressed child has suffered with depression. Thus, both genetic risk
and life experience can contribute to the child’s depression. Depression usually interferes with a child's social and academic
performance. When a child is seriously depressed, school achievement declines and he/she loses interest in school and peer
activities.
Sometimes the symptoms of restlessness, frustration, and decreased concentration may mislead parents or teachers into
thinking that a child has attention deficit disorder while, in fact, the child is depressed. It is not uncommon for children who
are evaluated for one condition to be diagnosed with the other disorder because the two different disorders can coexist.
Coexisting Disorders
More than half of depressed children also have at least one other psychological disorder, usually an anxiety disorder,
attention deficit, conduct or oppositional-defiant disorder, or eating disorder. Almost one third of children diagnosed with
Attention Deficit Hyperactivity Disorder and 20–30% of those who are initially diagnosed as depressed eventually turn out to
have bipolar disorder, which is characterized by extreme mood swings from unrealistic elation to severe depression.
Risk Factors
For children of a depressed parent, the risk of depression is much higher than average. From studies with identical and
fraternal twins as well as other siblings reared together and apart, it is estimated that 50% or more of the risk of childhood
depression is inherited. Children under stress, those who have experienced a loss, those who abuse substances (including
tobacco), those with chronic illnesses, and those who have attention, learning, or conduct disorders are at a higher risk for
depression.
Although we do not know all of the factors that cause a genetically susceptible child to develop a depressive disorder, it is
likely that major contributing factors include death or the divorce of parents; a child’s inability to adapt to impractical
demands or encouraged to live according to strict moral beliefs by parents; failure to establish solid emotional bonds in
infancy because of rejection or neglect; an excess of punishment and criticism with too little reward and praise; physical,
emotional, or sexual abuse; bullying; and traumas such as terrorism or natural disasters.
Recent studies points to many of the major symptoms of depression in adolescents and adults anhedonia (a psychological
condition characterized by an inability to experience pleasure from normally pleasurable activities), sadness and irritability,
low energy level, recent changes in energy level, low self-esteem, crying, hyperactivity that begins after age 2, and playing
or talking about themes involving death are also characteristic of depression in children. Difficulty experiencing joy when
exposed to the pleasurable aspects of daily life is especially typical of most depressed children. There are, however,
important age-related differences in the signs and symptoms of depression.
• From birth to age 3: Depression may be reflected in feeding problems, failure to thrive that has no identifiable physical
cause, tantrums, lack of playfulness, detached, and less expression of positive feelings in general.
• Age 3–5: May be accident-prone, subject to phobias and exaggerated fears, likely to exhibit delays or regression in
important developmental milestones such as toilet training, and prone to apologize excessively for minor mistakes and
problems such as spilling food or forgetting to put away toys.
• Age 6–8: Expresses vague physical complaints, aggressive behavior, clinging to parents, and avoidance of new people and
challenges.
• Age 9–12: Expresses morbid thoughts, extreme worry about school work, insomnia, and blaming themselves for
disappointing their parents and teachers.
A child that exhibits some or even all of these traits does not automatically mean the child has a depressive disorder. When
these signs and symptoms are present particularly if the symptoms are severe and/or persist regularly for a month or more, it
is important to have the child evaluated by a mental health professional who specializes in children, especially if the child has
other risk factors. Early diagnosis and treatment can shorten depressive episodes, help avoid future episodes, and prevent
potentially dangerous or unsuccessful results such as school failure, self-injury, or suicide.
Evaluation and Treatment
For children with mild depression, cognitive-behavioral therapy is usually the first step. Cognitive-behavioral therapy is a type
of psychotherapy that involves helping individuals develop coping skills that allow them to better handle upsetting situations
and teaches them how to change destructive or negative thoughts. Family members may be asked to participate in therapy
sessions. In cases concerning prolonged or severe depression, medication may be recommended to accompany the
psychotherapy. Rarely is medication prescribed for depressed children who are under age 5 or 6. Psychotherapy, however,
can be effective for preschool children. To help the youngest children, psychotherapy is directed at parents, the aim being to
teach them how to help their child. Children and adolescents rarely require hospitalization for depression.
Individual Psychotherapy Therapy offers support and compassion while encouraging discovery of the depressed feelings
and symptoms. Treatment may alternate between play and talk because a treatment goal is to help the child talk about her
feelings. If a specific circumstance or event that has precipitated the depression divorce, for example therapy gives the
child a chance to resolve some of his/her feelings and accept even a difficult reality.
For younger children or children who have trouble expressing through speech, play therapy can provide an opportunity to
communicate feelings and awareness. Through play, the depressed child is able to communicate or act out in play his/her
sense of loss, hopelessness, hostility or danger and ultimately deal with these painful emotions.
Cognitive Behavioral Therapy - Often effective in treating depression in older children, cognitive therapy focuses on the
unreasonable ideas and unclear feelings which are part of depression, such as a negative view of the self, the world, and the
future. Usually a depressed child feels guilt over failure, magnifies negative events, and minimizes positive events and
achievements. Cognitive therapy focuses on identifying and correcting negative thought patterns or misinterpretations and on
helping the child change her thinking.
Group Therapy - This approach in children aims to help them develop social skills that can lead to a greater sense of
knowledge and self esteem. Children may find it easier to express feelings in a supportive group environment. Support
groups for parents can help them manage specific problem behaviors, use positive reinforcement, communicate with
children in an age appropriate manner, and become better listeners for their child.
Family Therapy - Family therapy deals with problems that may deteriorate depression in children such as a lack of parental
boundaries (in which parents or caregivers treat their children as peers), severe marital conflict, strict or harsh rules, or
neglectful or overly involved parent child relationships. In addition, family sessions may help identify other depressed family
members and assist them in getting their own treatment.
Medication - Medications are sometimes used as part of a complete treatment approach with a depressed child. Research is
ongoing to clarify the role of medication and the reaction in the developing child. Some recent studies have shown
improvement with use of antidepressants. The more commonly prescribed antidepressants are fluoxetine (Prozac),
imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), and sertraline (Zoloft). Other antidepressants include
bupropion (Wellbutrin) and venlafaxine (Effexor). Before an older child begins taking a medication, specific target symptoms
should be identified in a discussion between the child, the parent, and the physician. Possible side effects and other
performances of the medication should also be fully discussed.
Hospitalization - A depressed child should always be evaluated for the risk of suicidal or self inflicting behavior. If a child is
restless with death by suicide or has a well-thought out plan, hospitalization may be needed. Otherwise, as long as the child
is able to function and his/her family is relatively supportive, intensive therapy can be done as outpatient sessions.
or have exaggerated fears. Not all children who suffer with severe depression appear depressed, but instead may behave
irritable or moody, switching from extreme sadness to sudden anger.
Usually, there are other clues or signs that a child is depressed. He/she may lose interest or enjoyment in most activities. The
child may complain about being tired frequently or lack the energy to perform daily activities. He/she may sleep or eat too
little or too much. Children with depression may have trouble concentrating or making decisions, feelings of worthlessness,
anger, or guilt, may imply suicidal thoughts or pondering about death.
Signs of childhood depression:
• Regular sadness, weeping, crying; and/or hopelessness.
• Lack of interest in or failure to enjoy activities.
• Low energy; and poor concentration.
• Social separation, feeling of loneliness, and/or poor communication.
• Low self-esteem; guilt; extreme sensitivity to refusal or failure.
• Increased irritability, anger, or hostility; difficulty with relationships.
• Headaches and/or stomachaches.
• frequent school absences or poor performance
• A major change in eating and/or sleeping routine.
• Talk of or attempts of running away from home.
• Thoughts or expressions of suicide or self-inflicted behavior.
Causes of Depression in Children
Depression is a complicated condition. Likely rooted in a genetic and/or biochemical predisposition, depression also can be
linked to unresolved grief, possibly in response to early real or imagined losses of nurturing figures. Depression may also
reflect that the child has learned feelings of helplessness rather than feeling motivate and seek solutions for life's problems.
Some seriously depressed children have experienced early life or environmental stresses including childhood trauma, or the
death of a parent or other significant people. They may live in families where they regularly witness or are victims of parental
aggression, rejection, or target of strict punishment, or parents abusing one another. Such family pressures may contribute
to the development of a depressive mood disturbance in a child.
Depression also runs in families. Often one parent of a depressed child has suffered with depression. Thus, both genetic risk
and life experience can contribute to the child’s depression. Depression usually interferes with a child's social and academic
performance. When a child is seriously depressed, school achievement declines and he/she loses interest in school and peer
activities.
Sometimes the symptoms of restlessness, frustration, and decreased concentration may mislead parents or teachers into
thinking that a child has attention deficit disorder while, in fact, the child is depressed. It is not uncommon for children who
are evaluated for one condition to be diagnosed with the other disorder because the two different disorders can coexist.
Coexisting Disorders
More than half of depressed children also have at least one other psychological disorder, usually an anxiety disorder,
attention deficit, conduct or oppositional-defiant disorder, or eating disorder. Almost one third of children diagnosed with
Attention Deficit Hyperactivity Disorder and 20–30% of those who are initially diagnosed as depressed eventually turn out to
have bipolar disorder, which is characterized by extreme mood swings from unrealistic elation to severe depression.
Risk Factors
For children of a depressed parent, the risk of depression is much higher than average. From studies with identical and
fraternal twins as well as other siblings reared together and apart, it is estimated that 50% or more of the risk of childhood
depression is inherited. Children under stress, those who have experienced a loss, those who abuse substances (including
tobacco), those with chronic illnesses, and those who have attention, learning, or conduct disorders are at a higher risk for
depression.
Although we do not know all of the factors that cause a genetically susceptible child to develop a depressive disorder, it is
likely that major contributing factors include death or the divorce of parents; a child’s inability to adapt to impractical
demands or encouraged to live according to strict moral beliefs by parents; failure to establish solid emotional bonds in
infancy because of rejection or neglect; an excess of punishment and criticism with too little reward and praise; physical,
emotional, or sexual abuse; bullying; and traumas such as terrorism or natural disasters.
Recent studies points to many of the major symptoms of depression in adolescents and adults anhedonia (a psychological
condition characterized by an inability to experience pleasure from normally pleasurable activities), sadness and irritability,
low energy level, recent changes in energy level, low self-esteem, crying, hyperactivity that begins after age 2, and playing
or talking about themes involving death are also characteristic of depression in children. Difficulty experiencing joy when
exposed to the pleasurable aspects of daily life is especially typical of most depressed children. There are, however,
important age-related differences in the signs and symptoms of depression.
• From birth to age 3: Depression may be reflected in feeding problems, failure to thrive that has no identifiable physical
cause, tantrums, lack of playfulness, detached, and less expression of positive feelings in general.
• Age 3–5: May be accident-prone, subject to phobias and exaggerated fears, likely to exhibit delays or regression in
important developmental milestones such as toilet training, and prone to apologize excessively for minor mistakes and
problems such as spilling food or forgetting to put away toys.
• Age 6–8: Expresses vague physical complaints, aggressive behavior, clinging to parents, and avoidance of new people and
challenges.
• Age 9–12: Expresses morbid thoughts, extreme worry about school work, insomnia, and blaming themselves for
disappointing their parents and teachers.
A child that exhibits some or even all of these traits does not automatically mean the child has a depressive disorder. When
these signs and symptoms are present particularly if the symptoms are severe and/or persist regularly for a month or more, it
is important to have the child evaluated by a mental health professional who specializes in children, especially if the child has
other risk factors. Early diagnosis and treatment can shorten depressive episodes, help avoid future episodes, and prevent
potentially dangerous or unsuccessful results such as school failure, self-injury, or suicide.
Evaluation and Treatment
For children with mild depression, cognitive-behavioral therapy is usually the first step. Cognitive-behavioral therapy is a type
of psychotherapy that involves helping individuals develop coping skills that allow them to better handle upsetting situations
and teaches them how to change destructive or negative thoughts. Family members may be asked to participate in therapy
sessions. In cases concerning prolonged or severe depression, medication may be recommended to accompany the
psychotherapy. Rarely is medication prescribed for depressed children who are under age 5 or 6. Psychotherapy, however,
can be effective for preschool children. To help the youngest children, psychotherapy is directed at parents, the aim being to
teach them how to help their child. Children and adolescents rarely require hospitalization for depression.
Individual Psychotherapy Therapy offers support and compassion while encouraging discovery of the depressed feelings
and symptoms. Treatment may alternate between play and talk because a treatment goal is to help the child talk about her
feelings. If a specific circumstance or event that has precipitated the depression divorce, for example therapy gives the
child a chance to resolve some of his/her feelings and accept even a difficult reality.
For younger children or children who have trouble expressing through speech, play therapy can provide an opportunity to
communicate feelings and awareness. Through play, the depressed child is able to communicate or act out in play his/her
sense of loss, hopelessness, hostility or danger and ultimately deal with these painful emotions.
Cognitive Behavioral Therapy - Often effective in treating depression in older children, cognitive therapy focuses on the
unreasonable ideas and unclear feelings which are part of depression, such as a negative view of the self, the world, and the
future. Usually a depressed child feels guilt over failure, magnifies negative events, and minimizes positive events and
achievements. Cognitive therapy focuses on identifying and correcting negative thought patterns or misinterpretations and on
helping the child change her thinking.
Group Therapy - This approach in children aims to help them develop social skills that can lead to a greater sense of
knowledge and self esteem. Children may find it easier to express feelings in a supportive group environment. Support
groups for parents can help them manage specific problem behaviors, use positive reinforcement, communicate with
children in an age appropriate manner, and become better listeners for their child.
Family Therapy - Family therapy deals with problems that may deteriorate depression in children such as a lack of parental
boundaries (in which parents or caregivers treat their children as peers), severe marital conflict, strict or harsh rules, or
neglectful or overly involved parent child relationships. In addition, family sessions may help identify other depressed family
members and assist them in getting their own treatment.
Medication - Medications are sometimes used as part of a complete treatment approach with a depressed child. Research is
ongoing to clarify the role of medication and the reaction in the developing child. Some recent studies have shown
improvement with use of antidepressants. The more commonly prescribed antidepressants are fluoxetine (Prozac),
imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), and sertraline (Zoloft). Other antidepressants include
bupropion (Wellbutrin) and venlafaxine (Effexor). Before an older child begins taking a medication, specific target symptoms
should be identified in a discussion between the child, the parent, and the physician. Possible side effects and other
performances of the medication should also be fully discussed.
Hospitalization - A depressed child should always be evaluated for the risk of suicidal or self inflicting behavior. If a child is
restless with death by suicide or has a well-thought out plan, hospitalization may be needed. Otherwise, as long as the child
is able to function and his/her family is relatively supportive, intensive therapy can be done as outpatient sessions.
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| ________________________________________________________________________________________________________________________ Copyright © 2004 Bright Tots® Inc. - Educational Toys & Resource Guide to Child Development - All rights reserved. ________________________________________________________________________________________________________________________ |
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