How to Tell if a Child Is Depressed

It seems like an oxymoron – a depressed child. After all, children are known for their free spirits, energy, and capacity for joy. And yet it is estimated that more than 2 percent of pre-pubertal children suffer from depression at any given time, and that number has been growing over the last 20 years.

A number of factors make depression a lot harder to pick up in kids. The natural spirit and energy of childhood still breaks through for kids with depression, so that, less often but at least some of the time, they seem “normal.” Children don’t have the same ability to recognize their feelings, understand what is happening, and communicate their internal states to adults. “I feel sad” is something that many kids have a hard time identifying. “I have been down to a greater degree than before, more days than not for the last two weeks” is an insight that is beyond even the brightest kid.

Children also have very poor senses of time and perspective. Ask a child today, “How have you been doing in the last few weeks?” Most likely she will answer “Fine” or “Good” or “OK.” If she is annoyed about something that happened today she may say, “Bad,” but what she won’t be able to do is tell you what you want to know about, which is an overview of how her feeling state has been during the last few weeks.

How can adults tell if their children may be suffering from clinical depression? The signs aren’t always clear, but there are red flags that parents can look for.

1) She feels sick more often. Depressed children are more likely than depressed adults to develop physical symptoms like headaches, stomach aches, nausea, and muscle pains.

2) He “doesn’t care” about anything. He uses the phrases “I’m bored” or “this is boring” more than before. He may decide to drop sports teams and activities he used to love, and doesn’t always want to hang out with friends.

3) Her mood isn’t lifted by new experiences and fun treats. “Let’s go get ice cream!” is not the panacea it once was. Or there is no excitement talking about the upcoming trip to the waterpark.

4) His sleep is poor. A change in sleep patterns can indicate a number of different medical or psychological problems, including depression, and should not be ignored.

5) She says she wants to die. If a child talks about death or suicide, take this seriously and get medical help right away.

6) He is irritable. Sometimes parents tell me, “He can’t be depressed because he is not sad.” But often children with depression don’t seem sad, they seem angry and annoyed. (This can be true for adults too, but it is even more likely in kids.) Everything makes him frustrated. He treats little hassles like catastrophes. He yells at everyone. He tells you with exasperation, “Forget it, you just don’t understand!”

7) She has hurt feelings more easily. She says her friends offend her or “are being mean to me” when nothing seems different to you. She cries over a comment from her teacher and thinks that you are making fun of her when you are just trying to ask her what is wrong.

8) His grades are dropping. It is much harder to get him to do his homework or complete assignments, and his teachers tell you he is losing focus in class, but this was never a problem before.

Sometimes parents see these signs and discount them because something bad has happened, like a divorce, a death, or a traumatic event. Parents may assume, “It is normal that she is irritable and can’t sleep since her grandfather died. She is just sad.” But often a particular stress triggers the onset of the first episode of depression. A child who consistently shows signs of depression two weeks after a trauma may be depressed and, whatever the cause, needs help and support.

The good news is that depression is treatable. Medications are often used for teen depression and can be very helpful treating depression for a younger child. Various forms of therapy have been effective for treating childhood depression, including cognitive behavioral therapy and interpersonal therapy. However, the younger the child, the more important it is to help the family he lives in. For better or worse, children are entwined in the lives of the adults who are raising them, and if parents are struggling with their own mental health problems or are in constant conflict, the child cannot shut that out. Family counseling and treating the mental-health needs of parents are sometimes the most important steps in treating a child.

I have seen many children get over the hurdle of depression and return to the healthy growth and development that is their birthright. Seeing a child recover their inner spark and enthusiasm is a deeply moving experience, like watching the flowers budding again in spring. Parents see their children’s blossoming with profound relief.

Meg van Achterberg, MD, is board certified in general psychiatry and child and adolescent psychiatry. She is the founder of Capitol Hill Child Psychiatry PLLC.

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