Is My Child Depressed?

Podcast Transcript

Speaker 3: Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time.

In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, here's today's host.

Dr. Tatiana Falcone: Welcome back to Little Health. I'm today's host, Dr. Tatiana Falcone, a child adolescent psychiatrist, and the vice Chair of research for the pediatric behavioral health and neurosciences department at Cleveland Clinic Children's.

Depression isn't just a struggle. It can really impact children's and teens. Today as part of our season on behavioral health and psychiatry we'll discuss the specific warning signs to look out for and how to support your child. Our guest today is Dr. Jasdeep Sohi, the section Head of Child, Adolescent Psychiatry at Cleveland Clinic Children's. Welcome to Little Health, Dr. Sohi.

Dr. Jasdeep Sohi: Thank you, Dr. Falcone.

Dr. Tatiana Falcone: Yes. I think depression is probably as child psychiatrist, one of the most frequent consults that we have. So I think it's very important for parents to learn about how to recognize what are some of those common signs of depression in children's and teens.

Dr. Jasdeep Sohi: So I'm going to start with telling you like how common is depression in children, because that's important to know. So the prevalence of depression is about like 2% in young children and about four to 8% in adolescence.

So as we see that, you know, in children, the sex ratio is about the same, like both boys and girls. They struggle with about 2% of the children, both in boys and girls struggle with depression. And as they grow into adolescence, the ratio is one to two for male and female.

And it's important to know this is the official diagnosis. So the actual number is likely much higher than this. In children who are struggling with chronic illnesses like diabetes, epilepsy, chronic pain, and as none, the rate is even higher than this one.

And then it's important to remember that depression does not come alone. 60 to 90% of these kids are going to have another diagnosis, and about 50% have two or more diagnosis. So majority of these kids who are struggling with depression are going to have depression in adulthood. And 60% of them will try to commit suicide at some point of their time.

So talking about the symptoms and signs of depression. So as I said, like you know, the prevalence is higher than what we expect, so it's important to pay attention to the symptoms, and sometimes parents don't recognize it. So. If your child is feeling persistently sad for a long period of time, at least two weeks, even much longer than that, then we need to worry about it.

And sometimes these kids starts having problem focusing, so they start doing poorly at school. So that's a red sign. And then these kids, they show no motivation to go to school. They start skipping school and they're tired all the time.

Parents are yelling at them all the time. They're more irritable than usual, and their self-esteem goes down. They feel worthless. They feel hopeless and helpless, and eventually these are the kids who start having thoughts about hurting themselves or start having thoughts of death.

Dr. Tatiana Falcone: So if I'm a parent and I see that my kid is acting different, how do I know what's the difference between just having a bad day and real depression?

Dr. Jasdeep Sohi: Oh, that's a great question. So there are a lot of things that can affect your mood on daily basis. Like, you know, these kids go through different stress at school, they have a test going on, they're really worried about it, and then they had a fight with their friend and they're too tired, or the weather changes or their hormonal fluctuation, that can definitely affect their mood.

So it's important to know like what's the typical mood change and what's depression. So the one big thing is, of course the duration. So the typical mood changes are more like temporary. So these kids will have something happen at school that, that shift, they're mood from one moment to another. It doesn't last very long.

But in depression, these feelings are more persistent. The sadness, the loss of interest will last several, several weeks.

Dr. Tatiana Falcone: So very important point. So it sounds like the, the main difference is the two weeks? [Yes]. So if my kid is having depressive symptoms for one day, that doesn't really make criteria. But if they are having the symptoms and it's more than two weeks, then I should ask for help.

Dr. Jasdeep Sohi: Definitely. And you know, like sometimes when always in doubt, it's okay to inquire from your primary care physician and ask them these questions because we don't wanna miss anything. But at the same time, it's important to know the duration.

And then the intensity, these typical mood changes like that can happen because of the situational stress can range from like feeling happy, sad, irritable, but symptoms of depression are kind of more intense.

This is when the kid is feeling more hopeless. They start having these worthless feelings, they start having suicidal ideation. So those are the main symptoms to look for. And then, uh, also the impact on daily life, it's also very important. So if you have situational mood changes it does not affect your ability to function in your daily life.

Kids who are struggling with depression, these are the ones who will have changes in their work habits, their sleep. They're not eating that well. They start missing school. They don't enjoy spending time with family and friends.

Dr. Tatiana Falcone: So what are some risk factors that can put kids and teen at risk for depression?

Dr. Jasdeep Sohi: Actually, there are several. So it's like a combination of factors, like it comes from your genes, there are biological factors, there are environmental factors and their psychological factors.

So genetics it's plays a big role. Like, you know, if you have a parent or a family member struggling with depression, it kind of elevates your risk to about 40 to 60% of having depression.

So, which is a big one, you know, if you are concerned that your child might have depression and you also struggled with depression in the past, that's a red flag and the, then you should be more worried than others parents that who never struggled with depression.

And then studies have shown that parents who use drugs have any kind of substance use disorder it increases the risk of depression. And it's, although less common substance use can both be a cause and effect of depression, as we all know.

And then personal characteristics of the children like kids who struggle with low self-esteem, they get easily overwhelmed and by any kind of stress in their life. And also kids who are more pessimistic, it increases their risk. And of course, living in a stressful, abusive environment increases the risk of depression.

So kids who have any history of abuse, it can be physical, sexual, emotional, or any kind of neglect growing up. Loss of loved one is a big one. Parents going through divorce or separation can also cause a lot of stress and lead to depression.

And being a female increases your risk too. And also kids when they start hitting puberty, as we talked earlier, that adolescents have more risk of developing depression compared to younger children. And we discussed before that the chronic medical issues like asthma, epilepsy makes these kids stay in the hospital a lot and miss on so many things that their peers are doing and increases the risk of depression.

And also if you have a previous history of depression that kind of contribute to increased risk for subsequent episodes.

Dr. Tatiana Falcone: So you said abuse plays an important role. When we think about abuse, before we used to think mostly physical abuse, but we know that also emotional abuse plays a big role. Uh, talk to me a little bit about bullying and cyber bullying and how that can play a role in depression.

Dr. Jasdeep Sohi: So, you know, in the past, like past generation, they endorsed bullying only when they went to school. And these days the bullying doesn't stop even after coming back from school because of the things that they do on social media, especially the cyber bullying.

So, yes. Excessive use of media is like linked with depression, and we always see that, you know, if you are using the media, like media has both pros and cons, if you are using the media like in a selective way, not spending too much time on it. It can be a good platform for social connection.

But when you are excessively spending time on it, it's kind of, you're losing touch with reality. And there's so many studies which have shown recently that kids are spending more time on the media. Even parents are too, and there is lack of connection and cohesion between family and friends because you know, they see a different life on social media.

And sometimes these platforms open doors for like social comparisons. So they see a very unrealistic life on social media and start having these really unrealistic expectations. Fear of missing out is a big one, like fomo. Have you heard about it, Dr. Falcone? [Yeah.] Yeah. Kids talk about it in our appointments all the time. Even I hear it from my kids too. They see their friends participating in all these events and they feel like, oh my God, I'm missing out, out on it.

And all this leads to like low self-esteem. Then eventually these kids start experiencing symptoms of depression and anxiety. The other thing that I see with excessive social media use is especially these kids are not sleeping at night because they're spending time on the phone now and talking to their friends, so it is interfering with their sleeping pattern. They all have a poor sleep hygiene, which is again closely linked to depression.

Dr. Tatiana Falcone: If we think about, you know, kids that spend a lot of time at school, right? And you said that sometimes when they're depressed, they don't wanna go to school, right? And they start failing academically. So what are things that, from the school perspective, you think might be helpful for like teachers to know about depression?

Dr. Jasdeep Sohi: Sure. So schools play a big role because, you know, like eight hours of their day they're spending at school and you know, when they come home they're busy like doing other activities. So sometimes the teachers can pick on things that parents cannot pick as like a first time.

So, um, so schools are often like considered as like the first place where changes in behavior, their school performance, their social interactions can easily be picked by teachers. So there are definitely schools which follow these depression screening programs, which always help with like early intervention and treatment.

And it's important to educate teachers, like counselors, other staff members to recognize the signs of depression and know what to do once they recognize them, that how to advise these families to seek help.

So, uh, schools that promote students' mental health wellbeing, it has shown that they have improved classroom behavior. The students are more engaged in school setting and they have better peer relationship. And we know that all these factors are so connected for your academic success.

So I want to mention here that what we do at Cleveland Clinic for school mental health. So Cleveland Clinic right now has a very extensive program at Lakewood School District. So they're eventually extending it to Garfield Heights and other school district.

They provide a variety of services for schools like mental health assessments, virtual access clinic, transition bridge program, counseling and therapy along with psychiatric evaluation and treatment. They are also very focused on teaching school staff, like about how to identify depression and what they can do to help their

students and along with like participating in school to help children, um, to get a IEP or a 5 0 4 plan so that it can help ease out some of their stress.

Dr. Tatiana Falcone: That's very important Dr. Sohi. Can you tell the parents a little more? As a parent, right, what are some of the things that you can do kind of your rights to request these services?

So, if my kid is a really great student, but suddenly they don't wanna go to school, they're not doing good, and I know that they have depression, they, we are seeing a psychiatrist. How can I advocate for my kid with the schools?

Dr. Jasdeep Sohi: So, you know it, that that's a very good question and not a easy answer for that because you know, I can see it from both sides.

Even schools struggle a lot these days because of the budget cutting and not have able to do more for the kids. But at the same time, we know that the parents have a right to ask for more accommodation for their children when they're struggling with something.

So they should be reaching out to the school to ask them if there can be more help for their children, which can come in the form of like a 5 0 4 plan or an IEP.

In some cases, I see that like, you know, sometimes when these parents request something from school, they will just be brushed off. So in those cases, I always recommend them. They can write to start a paper trial, like write a letter to their principal and say that their kid is struggling and can they provide them more accommodation?

And if they're not able to provide those accommodation, can they refer them to a different school who can help these children? So there's several rights, but you know, we also have a legal department at. Cleveland Clinic that can also help advocate for these patients if they are struggling to find a way to get those kind of needs met at school.

Dr. Tatiana Falcone: Great. And that's such an important point for parents, because as a parent, sometimes you feel hopeless that your kid is struggling, that they used to be a great student and now they're not doing good. So using those resources like the 5 0 4 and the IEP can be great for accommodations and every parent has the right to use it.

And they are the ones who start the process. So yes, we are here to support them, but they are the ones that can even start the paper trail asking the school for help.

Okay, that's great. Now let's talk a little bit about the differences on how depression can look when you're thinking a young child versus a teenager, do they look different? And what are some of the things that you can see?

Dr. Jasdeep Sohi: Yes, definitely. We know that sometimes these young kids, they don't have ability to articulate their feelings, so it's hard to know like what they're struggling through. So in those cases, and in some cases like the symptoms of depression, like some of them like overlap with ADHD and anxiety. So it's hard to differentiate things.

So in younger children, we have to look for changes in their normal routine, like related to their activities. Like are they sleeping okay? Are they eating okay? Or there has been a big change in how they're playing or they're just isolating themself.

Sometimes these kids, like, you know, for anything, like even for anxiety along with depression, they present with more somatic complaints like my belly hurts. I'm having headaches. But it's like they're trying to get attention for somebody to understand that they're struggling with something.

And they, they definitely tend to show more irritability. Irritability is a very confusing symptoms like especially for young children. Like, you know, if they have ADHD, they show irritability. If they have anxiety or depression, they show irritability. It's like a more common symptom kind of blurs everything. Like, okay, where to fit it.

But seeing other things along with it. Like, you know, these kids start disliking school, they want to miss school, they're not talking to their peers at school. So those are the symptoms that we need to pay attention to in young children.

Dr. Tatiana Falcone: And how about teens? How does depression look in teens?

Dr. Jasdeep Sohi: So teens are the ones, uh, starts affecting their self-esteem. Like the, you know, these are very sensitive to like rejection, sensitivity. We see a lot of changes like in their sleep and appetite. They sometimes, I hear this, these kids are like sleeping a lot or they're not sleeping at all.

They stop eating or they're eating a lot. Eventually I start seeing the risk of like eating disorder in these kids, and they will have academic difficulties. They will start more reckless behaviors, like start experimenting with drugs. They endorse like feeling of un- hopelessness and worthlessness more so than younger children.

Dr. Tatiana Falcone: Before you said something about puberty, how do you, in teenage girls, how do you think it looks a little different versus boys? What are kind of like the difference on depression that you see in girls?

Dr. Jasdeep Sohi: So, early puberty has always shown more so in girls that it increases the risk of depression because, you know, they start seeing their body image as like really different and you know, they're worried about like how everybody is looking at them.

So, you know, early puberty has shown the risk of depression going really up, especially for girls.

Which is really different for the boys. It does not affect their appearance. Like, you know, nothing changes for them, so they don't face that stigma of looking different. So it does impact the girls more if they start having early pub symptoms.

Dr. Tatiana Falcone: So what happened when someone is having symptoms of depression and they're not treated?

Dr. Jasdeep Sohi: Definitely. So untreated depression is the worst thing to happen because we know, like if we don't take care of it, it's going to persist into your adulthood. So these are the kids who definitely will not do well at school, and they're not able to achieve the academic success their peers can achieve because of their depression.

So they will have problems communicating with others. So that affects their social life. So their friendship will not be that big like the other kids who are not struggling with depression. So overall, it starts affecting your quality of life because there are two things which kids usually compare each other with at school.

One is like, do we have friends and how are we doing academically? And depression impacts both of them really badly. And then, you know, it starts impacting your quality of life. And these kids stop taking care of their physical health because most of the time they're spending time on the bed. So they're not caring for themself.

And this neglect can eventually, in old age, can lead to like gain of weight, obesity, and other heart issues. So one thing leads to another. So that's why I think early intervention is really crucial in preventing those long-term bad outcomes.

Dr. Tatiana Falcone: So if I'm a parent and I'm seeing that my kid is struggling, they don't wanna take a shower, they don't wanna go to school, what are things that I can do as a parent to support my teen with depression?

Dr. Jasdeep Sohi: So definitely, you know, when you see a lot of things happening at home, um, you, we know that the family dynamics does play a big role in like how we can like help your child.

So the biggest thing is if you really are worried, like they're not taking a shower, they're not doing, going to school, they're not doing anything, it kind of raises the alarm like something, can you deal with it at home? Or you now need a professional help?

I think that's the time when you really have to talk to your primary care physician and figure out like, how can I help this child?

Dr. Tatiana Falcone: What are some of the things that parents can do to help children build resilience when they're facing depression?

Dr. Jasdeep Sohi: So there are many ways that parents can help build resilience.

The biggest one is, uh, and which can be difficult to do sometimes, is active listening and talking to your child often so that you know, they know they have somebody who cares for them and they want to come to that person and talk to them about their feelings and thoughts all the time.

So spending quality time with your child does seem very simple, but it's like a big component of building resilience.

So it gives them a sense of like, I belong here. And increases their self worth, it offers them a sense of security and, you know, validating their feelings that I know what you're going through and you know, this is not a easy time. Takes a lot to say that, but it means a lot to this child and can help them cope with the stress better.

And then stable environment at home, like, you know, clear rules, low conflict. People are not fighting with each other, like especially the parents. Like model healthy conflict resolution help your child learn how to solve their problems in a positive way. So this further boost their confidence and resilience.

And also promoting healthy habits like, you know, as we know, like kids always learn from more from their parents. If they are eating healthy, they are exercising, they have a balanced diet, and we all know these factors, how they support your mental health wellbeing, it's a good example. It's like setting a good example for your child.

And also teaching them simple relaxation techniques like breathing, mindfulness. I still say that this sounds very simple and sometimes parents will say they're all doing it, but doing it more effectively lead to a good connection with family and further boost up the resilience.

Dr. Tatiana Falcone: Such a good point. I, I know the active listening as a parent can be sometimes hard. You think that you are listening, but the teen will tell you you're not really listening. So just being there for them is such an important tool that sometimes we overlook.

So let's say that my kid is having depression symptoms, like I am trying, I went to a pediatrician, I'm asking for help and I still haven't been able to connect with someone. How can a parent get help?

Dr. Jasdeep Sohi: So the various ways that parents can get help, like what I always advocate of, like supportive system, like, you know, you can talk to other parents and see what they did when their kid was struggling through these kind of symptoms.

The biggest one is like, you know, there's so much help at school that we sometimes don't know, like, you know, they have school counselors, they have teachers, they have social workers that can definitely help us ease some of the stress out. Talking to them can help.

And your primary care physician is a big resource as I'm emphasizing. Like, you know, if your kid is struggling with something and you're not able to help them, it's always a good idea to seek professional help and not keep ignoring it.

I know like some days, sometimes I hear like, you know, kids, they come to us like after struggling with depression and anxiety for several years because their parents will not believe, and there's a social stigma still around mental illness. They'll say, brush it off, it'll go away. You know, it's not a big deal.

But we know, like, you know, all the, as we talked about, like if we don't treat depression eventually your life as adult is not going to be as happy if we can treat some of these things early on.

Dr. Tatiana Falcone: So can depression sometimes look like something else? Like can someone think it might be ADHD or it might be anxiety? How can parents differentiate between depression and other things?

Dr. Jasdeep Sohi: Yeah, definitely.

Depression can be mistaken for these ADHD and anxiety because, you know, some of the symptoms overlap. Like these kids, as I said before, irritability is a big one. Like every symptom, every diagnosis has irritability as one of the DSM criteria for diagnosis. So, and kids don't know any better, like how to express their feelings other than getting angry.

So difficulty concentrating, restlessness, all this can happen in ADHD along with depression. But ADHD is typically a longstanding illness, so it can happen across multiple settings like school and home. These kids are like not able to focus. They're very hyper, they're very impulsive. Depression, on the other hand, is more symptoms like sadness, social withdrawal, loss of interest in things.

So if somebody looks at it like more closely, you are always able to differentiate it from other illnesses. So when you are, um, seeing a professional, they have lot of screening tools like for depression, like PHQE and Children Depression inventory, which help identify symptoms of depression. And then we have Vanderbilt and Connors for assessing ADHD.

You know, a good thorough history, physical exam, input from parents and teachers always help identifying the correct diagnosis. So there's several tools that can help.

Dr. Tatiana Falcone: So when should we seek, like if I'm a parent and I have questions, when should we seek professional help for children and teens?

Dr. Jasdeep Sohi: So, you know, again, like we talked about, if there persistent sadness going on for weeks and months and this kid is like losing interest in things, not sleeping well, they're having thoughts of death, that's time when you will definitely seek professional help.

Dr. Tatiana Falcone: And I know for kids with chronic illness, sometimes when people go to their doctor and they say, well, my kid is having these symptoms, and they might say, oh, this might be some of the side effects of the medication you're taking. Right. Do you feel like for kids with chronic illness are their difference to help diagnose depression and anxiety?

Dr. Jasdeep Sohi: I will say like, you know, when still in doubt, we should be seeking professional help. As I said, like these kids who are struggling with chronic mental and medical issues and having to stay in the hospital longer periods of time, missing on so many other things in their life, there, there is definitely can be a mass depression in them.

So it, it's, it's still a good idea to seek professional help.

Dr. Tatiana Falcone: Yes. Unlike in these kids with like the epilepsy, diabetes, um, migraines they might have yes, some of the symptoms, and I think what we do is we focus a lot on like the emotional symptoms and that help us. So seeking professional help can really improve their quality of life.

So. This is great. Dr. Sohi, thank you so much for joining us today.

Dr. Jasdeep Sohi: Thank you so much for having me.

Dr. Tatiana Falcone: So recognizing the signs of depression in younger people and seeking help promptly can really make a difference and improve their quality of life. Cleveland Clinic Children's provide comprehensive mental health supports for kids, teens, and their families during these challenging times.

If you like to schedule an appointment with one of our providers, please call 216.444.KIDS. That's 216.444.5437.

Speaker 3: Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the little health tips coming, subscribe wherever you get your podcasts. Or visit my.clevelandclinic.org/podcasts/little-health.