Feeling sad is normal but how can you know if your child’s sadness is indicative of a disorder? The following article discusses what childhood depression is, how it is diagnosed, and what to look out for if you have concerns for your child.
What is Childhood Depression?
Just as in adulthood, children experience a full range of emotions; from happiness and excitement to anger and sadness. According to a recent Australian government survey, 2.8% of children between 4-17 years met criteria for a major depressive disorder (Lawrence et al., 2015). Prevalence rates were higher in the 12-17 years age group, affecting more females than males (5.8% and 4.3% respectively; Lawrence et al., 2015).
Depression is a mood disorder characterised by periods of low mood for most of the day, most days for a period of two weeks (American Psychiatric Association [APA], 2013). How it presents and the severity in which it is experienced varies from individual to individual. In children, depression can present itself more like irritability than typical sadness (Australian Government, 2018).
There is no exact way to predict who is more at risk of developing a depressive disorder. It is a likely combination of biological predisposition (i.e. the child tends to focus on the negatives of a situation) and life circumstances. In children, key social stressors focus on pivotal times of change, including family conflict, friendship trouble and difficulties at school (Siu, 2016).
How is Depression diagnosed?
Diagnoses can be made by psychologists and psychiatrists using clinical interviews and observations in context to the Diagnostic Statistical Manual of Mental Disorders or the International Classification of Diseases (DSM-5 and ICD-11 respectively; APA, 2013; World Health Organisation, 2018). Screening questionnaires like the Depression, Anxiety and Stress Scale (DASS; Lovibond & Lovibond, 1995), may be a useful tool to help discern whether an individual is experiencing clinical depression.
To be diagnosed, at least five of the following symptoms need to be observed over a minimum two week period. At least one of the symptoms is either depressed mood or loss of interest/pleasure (APA, 2013). Other symptoms include significant weight changes, sleeping difficulties, psychomotor agitation or slowing, fatigue, feeling worthless or guilty unnecessarily, reduced concentration, and/or thoughts of suicide. These symptoms need to be having a significant impact on different areas of your child’s life (e.g. socially, at school, at home).
Presentations will vary and an initial consultation between the child and psychologist and the parent would best determine whether they are expected to meet the criteria.
Early Signs to look out for
Identifying characteristics of depression in a child can be difficult. Concerns may arise due to the ‘absence’ of behaviours considered to be ‘normal’ development and the ‘presence’ of behaviours considered to be ‘abnormal’ development. Consider seeking help if your child is demonstrating the following behaviours (Australian Government, 2018):
|Emotional Signs||Physical Signs||Behavioural Signs|
|Feeling Sad||Weight gain or loss||Difficulty sleeping (too much or little), nightmares|
|Saying negative comments about themselves or the world around them|
e.g “I am not good at anything”
|Feeling tired, lethargic. Hard to get your child motivated. E.g. ‘dragging their feet’||Trouble at school; with friendship groups or concentrating in class/grades slipping|
|Gives up easily, hopelessness e.g. “what is the point in trying, I won’t be able to do it”||Deliberate harm to self||No longer enjoying games or activities e.g. wanting to drop out of the soccer team. Avoids social interaction|
|Irritability, grumpiness||Dizziness||Changes to eating|
|Low confidence||Tummy Aches||Bed Wetting|
|Sensitive to rejection or being told no||Cry easily||Poor memory forgets details or doesn’t seem to listen|
|Indecisive||Jumpy, cannot settle||Risk-taking behaviours particularly in adolescence e.g. drug taking|
Following diagnosis, recommendations for treatment are provided and they are tailored to each unique needs. Typically, the most common treatment for depression involves a cognitive behavioural approach (Australian Psychological Society, 2018). In addition to working directly with the child, treatment considerations may include working with the parents/carers and family systems to provide strategies to assist at home.
Remember that your child will experience good days and bad days. If you are concerned your child may be depressed, talk to them, and check in on anything that may be troubling them. This can be difficult as they may not know how to verbally communicate the issue. Be supportive and remember, what you might be able to cope with, your child may be finding difficult.
Strategies for Parents
Whether you are worried about your child exhibiting some of the aforementioned childhood depression symptoms, or you are looking to help prevent the onset of childhood depressions symptoms, the following strategies may be used to support your child:
Keep your child active. Research indicates that children that participate in regular physical activity are more likely to exhibit fewer depressive symptoms in later years (Zahl, Steinsbekk, & Wichstrom, 2017).
- Ensure a good diet. Changes to eating patterns is a key sign of depression (APA, 2013). Ensuring your child is well nourished with a balanced diet with limited refined sugar has been shown to foster better mental health in children (O’Neil et al., 2014).
- Develop a good parent-child relationship. Parent rejection has been shown to have a strong relationship with childhood depression (McLeod, Weisz, & Wood, 2007). A parent that is actively involved in presents as interested and encouraging will help your child develop a healthy sense of self.
- Social and emotional learning. Teaching your child to recognise different emotions and label them as they are being experienced can help them to better manage experiences of overwhelming emotion (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2008). It can also help your child to develop better social connections.
Whether your child has a formal diagnosis or not, you know your child best. Start intervention as soon as you suspect that your child’s mood is detrimentally affecting their daily functioning.
Here at The Quirky Kid Clinic, our experienced team of Psychologists are more than happy to meet with you to discuss any concerns you have in relation to your child’s development and behaviour.
We always start with a parent only consultation to ensure that we get a thorough understanding of your child’s developmental history and a sense of your families identity, history and cultural dynamics. From here we provide an individualised case plan dependent on your child and families needs.
Please don’t hesitate to contact our friendly reception on (02) 9362 9297.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Australian Government. (2018) Depression. Retrieved September 3rd, 2018, from https://www.kidsmatter.edu.au/mental-health-matters/mental-health-difficulties/depression
Australian Psychological Society. (2018). Evidence-based interventions in the treatment of mental disorder: A review of the literature. Retrieved from https://www.psychology.org.au/About-Us/What-we-do/advocacy/Position-Papers-Discussion-Papers-and-Reviews/psychological-interventions-mental-disorders
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor R. D., & Schellinger, K. B. (2011). The impact of enhancing student’s social and emotional learning: a meta-analysis of school-based universal interventions. Child Development, 82(1), 405-432. doi: 10.1111/j.1467-8624.2010.01564.x.
Lawrence D., Johnson S., Hafekost J., Boterhoven De Haan K., Sawyer M., Ainley J., & Zubrick S. R. (2015). The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, Australia: Department of Health.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.
McLeod, B. D., Weisz, J. R., & Wood, J. J. (2007). Examining the association between parenting and childhood depression: A meta-analysis. Clinical Psychology Review, 27(8), 986-1003. doi: 10.1016/j.cpr.2007.03.001
O’Neil, A., Quirk, S. E., Housden, S., Brennan, S., L., Williams, L. J., Pasco, J. A., … Jacka, F. N. (2014). Relationship between diet and mental health in children and adolescents: A systematic review. American Journal of Public Health, 104(10), 31-42. doi: 10.2105/AJPH.2014.302110
Parenting Strategies (2018). Preventing depression and anxiety. Retrieved from https://www.parentingstrategies.net/depression/
Siu A. (2016). Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 164(5), 360-366. doi: 10.7326/M15-2957
World Health Organisation (2018). International Classification of Diseases, 11th Revision (ICD-11). Retrieved 21 August, 2018, from https://icd.who.int/browse11/l-m/en
Zahl, T., Steinsbekk, S., & Wichstrom, L. (2017). Physical activity, sedentary behaviour, and symptoms of major depression in middle childhood. American Academy of Pediatrics, 139(2). doi: 10.1542/peds.2016-1711