Childhood Depression is Challenge for kids and parents, but It Can be Effectively Managed
"Childhood and adolescent depression is a significant issue in this country," says Cleveland Clinic pediatric psychologist Vanessa Jensen, Psy.D. The problem can range from mild to severe, and at its worst, can increase a teen's risk of suicide.
The American Academy of Child & Adolescent Psychiatry (AACAP) estimates that about 5 percent of children and adolescents in the general population suffer from depression at any given time. The incidence of depression starts to climb between ages 7 and 10, Dr. Jensen says, but can occur as young as 2. It peaks in adolescence, from ages 14 to 16, at the same time becoming more common in girls.
What depression in kids looks like
"The 'blues' - or sadness - is a normal, transitional reaction to a serious event, such as a loss. For instance a breakup with a girlfriend or boyfriend, a best friend moving away, or a death," says Dr. Jensen. "Depression is more intense, more persistent, and impairs a child's ability to function in day-to-day life." She says that loss can precipitate depression. In such cases, a child doesn't "bounce back" emotionally after what would be considered a normal amount of time. Depression also can develop gradually without a precipitating event.
Depressed children may have difficult relationships with parents and siblings, may withdraw from friends or activities and feel overwhelming hopelessness. Teens may sleep more than normal or have sleep disturbances. While sleep requirements will vary, throughout childhood and adolescence, kids need approximately 9 to 12 hours per night. In addition to exceeding the normal number of hours of sleep per night, sleep disturbances include routinely waking up tired, needing to be roused from a deep sleep most mornings, difficulty falling asleep at night or having difficulty falling back to sleep in the middle of the night due to excessive worrying. Depressed kids also may eat too much, eat the wrong foods, or not eat enough.
Some depressed kids display a lack of motivation or "flatness." They have no energy. On the other hand, some depressed kids may be easily agitated and unable to focus. "If a kid is normally pretty easy going, but over a period of time or all of a sudden shifts to being very upset, irritable or angry in response to any request, these could be symptoms of depression," says Dr. Jensen.
The AACAP says signs of childhood depression include:
- frequent sadness, tearfulness, crying; hopelessness
- decreased interest in or inability to enjoy activities
- persistent boredom; low energy; poor concentration
- social isolation, poor communication
- low self-esteem; guilt; extreme sensitivity to rejection 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
- talk of or efforts to run away from home
- thoughts or expressions of suicide or self-destructive behavior.
Causes of depression vary
Depression may be the result of genes passed down from a parent, environmental circumstances, or a combination of both, says Dr. Jensen. Studies show that depression tends to run in families. One parent with a history of depression increases a child's chance of developing depression. If both parents have experienced depression, the child's chances are even greater.
Traumatic events in a child's life, such as abuse or poverty, may increase the risk of developing depression. Poor parenting skills can cause depression in children. Constantly sending negative messages - telling a child he or she is worthless, unattractive, stupid, or the like - increases a child's chance of developing depression.
When to seek professional help
Regardless of the cause, if a child shows signs of depression, getting professional help early is crucial. The pediatrician is a good place to start, says Dr. Jensen. A pediatrician can rule out a medical problem that can cause depression-like symptoms, such as stomachaches, headaches or lethargy. If depression is suspected, a pediatrician can recommend a child psychologist, psychiatrist or therapist. Dr. Jensen also recommends asking friends or family members for the names of mental health professionals. "Above all, you need to find someone you and your child are comfortable with and whom you trust."
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 involving prolonged or severe depression, medication may be recommended to complement the psychotherapy. Rarely is medication prescribed for depressed children who are under age 5 or 6. Psychotherapy, however, can be effective for pre-schoolers. To help the youngest children, psychotherapy is directed at parents, the objective being to teach them how to help their child. Children and adolescents rarely require hospitalization for depression.