Young children experience depression caused by adverse circumstances or genetically inherited dispositions. However, childhood onset of depression is more difficult to recognize and diagnose. Whereas adults become gloomy and sad, children with depression may act out in anger or aggression, therefore it takes time to determine if the behaviors are typical childhood misbehaviors or actual depression. Furthermore, symptoms in children are also somewhat different than those exhibited by teenagers.

Symptoms

A child or adolescent must have four or more of these traits exhibited at both school and home to receive a diagnosis:

  • Extremely sad or irritable mood
  • Rapidly changing moods lasting a few hours to a few days
  • New or recent onset of agitation or aggression toward people, animals, or objects
  • Loss of interest in the usual social or fun activities
  • Frequent and unexplainable physical aches and pains
  • Difficulty with concentration
  • Separation anxiety
  • Defiance of authority
  • Hyperactivity and distractibility
  • Running away from home or talking about running away from home
  • Talking about death or dying, giving away (or talking about giving away) favorite possessions, writing goodbye letters
  • Sleep increase (or decrease)
  • Appetite/weight changes (more likely an increase, in depressed teens)
  • Comments indicating hopelessness or low self-worth
  • Manic traits specific to bipolar disorder
    • Dare-devil behaviors (such as jumping out of moving cars or off roofs)
    • Impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
    • Inappropriate precocious sexual behavior
    • Grandiose belief in own abilities that defy the laws of logic (ability to fly)

Sources:

Anxiety and Depression Association of America, Symptoms of Childhood Depression

PsychCentral, Symptoms of Childhood Bipolar

 

Types

Pediatric Bipolar Disorder is more often diagnosed in teenagers that exhibit extreme highs of hyperactivity or euphoria referred to as mania and severe lows of depression. These two extremes come in cycles ranging anywhere from days to months or years.

Disruptive Mood Dysregulation Disorder (DMDD), a relatively new disorder in DSM-5  (2013), redefines depression in children that were formerly diagnosed as bipolar, but did not show signs of manic stages (extreme highs). This is a condition in which a child is irritable most of the time and has frequent and severe outbursts of anger over seemingly minor issues. These children have a difficult time controlling or regulating their emotions in an age-appropriate way.

Source: Child Mind Institute, DMDD

TIPS: 

Before seeking a diagnosis, consider this!

  1. Typical life circumstances may cause temporary depression in children that will cease after the situation is resolved. For example, loss of a loved one, moving to another town, divorce of parents, or being in a severe accident can cause situational depression.
  2. Some symptoms are part of normal childhood development. For example, it is perfectly normal for young children to fear being separated from parents, but this behavior may be depression when it becomes chronic, irrational, and affecting their daily functioning .
  3. Childhood depression is often misdiagnosed as ADHD because several of the symptoms are similar such as anger outbursts, hyperactivity, restlessness, and daredevil actions. A thorough evaluation is required by a pediatric psychiatrist to differentiate the two disorders.

Diagnosis

It is time to seek an evaluation when lifestyles changes have not been successful and a child’s social, academic, and home functioning continue to be severely affected by symptoms of depression. As with any condition, the earlier the diagnosis, the sooner you can find the appropriate treatment and help required for a healthy successful life.

Not all symptoms have to be present for a diagnosis of depression, but two are required: 1)  irritability and 2) loss of interest in pleasurable activities, along with a few other symptoms that continue over a long period of time.

The first step is to obtain a pediatric medical exam for your child to rule out other conditions that can cause symptoms of depression such as hypothyroidism, anemia, and low levels of vitamin D. Also, other untreated psychiatric conditions may cause symptoms of depression such as ADHD, anxiety, and eating disorders and need to be dealt with first. Finding the appropriate treatment for one of these underlying conditions may alleviate the major symptoms of depression.

Additionally, the pediatrician may administer checklists and observational scales to get deeper input from parents and child. When the medical examination is complete, the pediatrician may refer the child to a pediatric psychiatrist who specializes in childhood onset depression to determine the best treatment.

 

Treatments

Treatment for children and teens usually includes a combination of  the following:

  1. Therapy/counseling
  2. Vitamin and mineral supplements such as:
  3. Medications
  4. Recreational Therapies
  5. Art and/or music therapy

TIPS:

Before using medication as a treatment, consider this!

Treatment of mental illnesses such as anxiety, depression, ADHD, and behavior disorders should always begin with altering the child’s nutrition diet and vitamin/mineral supplements before using mind altering prescription drugs. Be aware that drug therapy may induce negative and dangerous behaviors in children. The following suggestions can have a drastic effect on mood and behavior and are thus worth a try.

  • Routine sleep
    • Going to sleep & waking at approximately the same times each day.
    • A winding down routine before sleep such as reading, warm bath, a warm chamomile tea, and no screen time (TV, computer, phone) one hour before bedtime. Webmed
  • Change of activities
    • Rigorous exercise daily that increases heartbeat, increases blood flow to the brain, and produces sweat! Mayo Clinic
    • Minimal screen time (whatever that is, just begin reducing it). PsychCentral
    • Minimal intake of news, gossip, and stressful conversations.
    • Regular, intimate conversations with loved ones.
    • Journaling and illustrative journaling where the child can express himself
    • Scripture memorization and regular prayer
  • Change of nutrition intake
    • Healthy diet, low sugar and high vegetables, fruit, and protein. Very Well Mind
    • Eliminate processed foods which are high in chemicals.

Resources

Dr. Daniel Amen Clinic for Brain Health

Anxiety and Depression Association of America

National Institute of Mental Health

Very Well Mind, Childhood Depression

PsychCentral, Childhood Bipolar Disorder

Parent Books on Depression

Child Mind Institute