Prior to 1970 children were not depressed. Sad at times, sure, but not depressed. At least that was the prevailing thought among child therapists during those times… and it was 100% wrong.
The truth is that five percent of children (one in twenty) will have a major struggle with depression before reaching the age of 18 years. That is, these children will be so deeply depressed for such an extended period of time that they require referral for professional help.
From the chart above you can see that depression is most common in the pre-teen and teen years. (The same is true of anxiety). This is due to several factors that arise during this time in a youngster's life. These include intense peer pressure, insecurity, conflict with parents, and a pervasive sense of not living up to expectations.
What To Look For To See If Your Child Is Depressed
You may be wondering what depression looks like in a child or teen. The short answer, it looks pretty much like depression in an adult. This includes:
Acting sad (moping around the house, slouched posture, unhappy facial expression)
Crying frequently and easily provoked to tears
Changes in sleep (this could be increased sleep, decreased sleep, problems getting to sleep, etc.)
Changes in appetite (dramatic increases or reductions in appetite, often with changes in body weight).
Lack of energy (they play less, move less, are harder to get moving into the car, to the dinner table, out of bed in the morning, etc.)
Change in attention/concentration. Your child has gone from having adequate focus to having a difficult time concentrating on homework, or other subjects.
Anhedonia. This is a Latin word. It means someone fails to feel pleasure in activities that had been (and normally are) pleasurable. (Pro Insight: We therapists are fond of Latin words, they help us feel that we know something others don’t). The idea with anhedonia is that activities that the child use to be attention grabbing and pleasurable are no longer of interest.
Feeling helpless or hopeless.
You will find those same symptom features in adult depression. The one thing that often stands out differently with children, and often with adolescents, is that when depressed they have a tendency act out, tantrum, and have angry outbursts in addition to the above symptoms.
Anyone looking over that list of symptoms is going to think “Every child does these things from time to time. How do you know when these symptoms mean a kiddo is depressed?” Great question. Come to the front of the class.
Therapists generally refer to specific diagnostic criteria to make that determination. I’m not going to go into the intricacies of different symptoms, and duration of symptoms associated with different depressive disorders.
It is more helpful to make two suggestions.
ONE If your child has three of the symptoms listed above, and they have lasted two weeks or more, consult your pediatrician.
TWO Go to the following website and complete a three-minute ‘childhood depression’ quiz.
Helping the Depressed Child or Adolescent
If you have a child that is depressed, you definitely want to fix, or solve, whatever is causing the depression. Sometimes, however, it is difficult to figure out exactly what is this may be.
One reason finding the cause can be difficult is that younger children lack insight. A child may have experienced a great deal of change in life, and this resulted in high levels of stress, but the youngster does not connect the two. He or she can’t quite put their finger on the cause of stress.
Were they able to do so, they might say “Ah, yes, that’s it. That’s what has changed and it’s bothered me much more than I realized. Yes indeed, it’s really pulled the rug out from under me you know?”
This is not to say that young children lack any insight, but only that it grows slowly - as a part of their brain called the frontal lobes develop, so does their insight.
By the time the child becomes an adolescent insight should be fairly strong. The problem then becomes that adolescents are often rather secretive. It can be easier to find Waldo in a sea of red and white stripe shirted nerds than it is having your teen share some introspective insights.
Another reason it can be tough to know what has caused a child to become depressed is that many children feel self-conscious about admitting to the reason. Frequently children will feel that they are being silly for reacting strongly to some change in life.
Or they worry that if they do tell someone the reason for their depression, this will end up causing them to feel ashamed, or be made the butt of jokes.
The solution, of course, is to reassure your son or daughter that you will be understanding and sympathetic. This carries a lot more weight if the home environment is generally one wherein family members are supportive of one another.
So what can be done for the depressed child, or adolescent, when the reason for distress remains unknown? Quite a bit. Here is a short list of the most important things you should do.
1. Be sympathetic and supportive. Your attitude will do wonders.
2. While being sympathetic and supportive don’t treat your child like an invalid. He or she still needs to go to school, complete homework, honor obligations, finish chores, etc. In other words, life goes on even when one is depressed. This is a good time for your child to learn to be tough. It is one of the single most important qualities you can build to help your son or daughter push through and succeed in life.
3. Keep up your routines at home. Routines are reassuring for those who are depressed. It provides a sense of stability and predicatability.
4. Check in with your child regularly. Let your son, or daughter, know that you are worried. You know they are struggling, you are there to help, or simply to listen. So you will be checking in with them every evening before bedtime and asking if they would like to talk.
5. Some of the reasons a child will give for being depressed may appear foolish to adults (and to their teenage siblings, but then again much of the world seems laughable when you are a teen). I've known parents who gently tease their child about these concerns. They do so in order to provide perspective and 'shake them out of their self pity.' I won't preach. Let's just agree that it won't be helpful for anyone in the family to make fun of, or be dismissive of, the concerns a depressed youngster expresses.
After showing your child that you take his or her concerns seriously, it's fine to provide a more realistic view. Children need that perspective (although by itself it is unlikely to change the depression).
6. If you begin to worry that your child is so depressed as to be at risk of hurting him/herself have a very direct talk about your concerns. No, talking about self-harm, and suicide, does not push someone towards acting on those impulses. That’s a common worry, but unfounded. In addition to talking to your child, if you have these worries it is definitely time to consult with a professional. Do so right away.
7. Exercise is the magical elixcer of life. OK, maybe an overstatement, but it does wonders to alleviate depressive symptoms. Get your child/teen out of the house on a walk, bike ride, hike in the park or mountains, skateboarding, playing some games, etc. This should be done on a daily basis. Most cities will have plenty of opportunities to help you find enticing ways to get your child active. In my town of Folsom, for example, there are miles of hiking trails, numerous arts and crafts activities , organized sports, and numerous other opportunities to get active.
8. Depressed people (even children) tend to isolate themselves from others. This drastically worsens their depression. Don’t let your child become isolated at home. It can be a struggle. Don’t give in. Sure, your child needs some alone time, but he/she should still be involved with family meals, chore time, running errands, move/game nights, etc.
More Options For Helping The Depressed Child/adolescent
If you have tried the above suggestions, and your child remains just as depressed two or three weeks later, it is time to consult with your pediatrician. When doing so you can take one of two strategies.
One, you can describe the reasons for your concerns and have the doctor talk with your child. See what recommendations your pediatrician makes in response to his or her assessment.
The second approach is to simply ask your pediatrician for a referral to a trusted therapist. This bypasses the need for the pediatrician to do an assessment.
Some doctors are fine working this way, others may object and want to make an independent assessment.
When getting a referral for a therapist be sure to ask for at least two names, better yet three. Then use the ‘Finding The Best Therapist’ guide to help decide which of these professionals you wish to engage.
Don’t stop there, however, because there is more you can read. Try this two part series on selecting a therapist: ‘How To Find The Best Therapist Part 1’
The other option, of course, is to simply seek out a therapist on your own. Although this works for many people, I’m not a big fan. Your pediatrician will have worked with many counselors and have received feedback from numerous parents. That type of information is very helpful in sorting out counselors that would be a bad fit, from those that are skilled and ready to help.
Even with the referrals from your pediatrician you will need to do your due diligence. Be certain to retain someone who has a great deal of experience working with children that are depressed, and who are in the same age range as your child.
You will also want to ask counselors on your list what approach they take to therapy. If they mention they exclusively use play therapy, or sand tray therapy, you should be cautious. These forms of therapy for childhood depression are not as well supported by research as Cognitive Behavior Therapy (CBT), or Behavior Therapy (BT).
It’s fine if a therapist uses play, or sand trays, as part of his/her approach. This helps many children relax and engage the counselor. But as the primary, or sole, means of helping a depressed child it is something to be avoided. Really, trust me on this, don’t go there.
The other thing you should look for is a therapist that insists on meeting with you every week. Some child therapists prefer to keep parents at arms length. They do this to protect the child/therapist confidentiality.
What can I say… hmmm, I’ll leave it at ‘not helpful.’ On second thought, I’ll expand. This is too important to just skim over.
You are the parent. That makes you the most important person in your child’s life. Your child’s therapist needs your input on a frequent basis. That means weekly updates where you and the counselor exchange information.
Obviously, as children grow older the amount of information the therapist will provide you changes. That is because your child’s need for confidentiality increases as he, or she, grows older. Nevertheless, you and the therapist will continue to need to meet. This allows the counselor to get your insights into how your child is responding to therapy (i.e., is it working), and provides you with the opportunity to ask questions.
The bottom line is this: you and the therapist need to work as partners, part of a team. That’s impossible to do unless you speak with one another on a regular basis. In fact, there are many instances with young children where a therapist should work more with the parent than the child. Why? Because the parent is the most powerful agent of change that exists in the child’s life! What a waste not to use that relationship to its fullest to help a youngster overcome depression.
Medications for Depressed Children/Adolescents
Numerous medications are available for effectively helping a depressed child/adolescent begin to feel better in a short period of time. The most popular anti-depressants are called SSRIs (selective serotonin reuptake inhibitors). Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft are common examples of SSRI medication. These anti-depressants are generally safe, effective, and well tolerated.
Many pediatricians have an interest, and even limited expertise, in the diagnosis and treatment of childhood psychiatric disorders. These skills make pediatricians a huge asset in your battle against depression.
Nevertheless, when it comes to depressive disorders, it is often best to see a child psychiatrist for an initial evaluation and (if appropriate) prescription. After a child has been stabilized on a particular medication, changing to a pediatrician for medication management may make perfect sense.
Most parents are cautious about having their child take psychotropic medications. This makes sense. Parents need to carefully weigh the benefits and the risks of medication. ‘When Does Medication Make Sense’ is a brief guide that can help you go through that process with greater confidence. Worth a quick look.
On a final note keep in mind that medication by itself is not likely to resolve depression over the long term. Although helpful, medication does not ‘teach new skills' to your child, nor does it resolve guilt, shame, conflict or other concerns that are often associated with the depression.
Psychotherapy is often required in order to make the sort of changes that prevent depression from returning. What’s more, although it is not always needed, the most powerful approach of all is a combination of medication with counseling.
Childhood depression is not uncommon. If you wonder if your child is depressed there are a number of symptoms to look for, and online tests that can help you get a clearer picture. For children that are depressed there are a variety of ways that you can help. By taking a thoughtful approach, remaining flexible about what options to pursue, and communicating clearly with your child, there is every reason to expect depression to eventually become a thing of the past.
Don’t forget to visit the ‘Essential Tools’ page on this same website for more resources on dealing with depression.