Many people associate depression with late adolescence or adulthood, but an estimated 2 percent of school-aged kids also suffer from the condition, according to the National Alliance on Mental Illness. Identifying problems and seeking treatment early can help. All kids can be moody, so it may seem tough to gauge how distressed your kid is. Use our guide to help diagnose, assess, and treat depression in kids.
Although some kids may be at higher risk, it's important to remember that any child can experience depression. "We think it's easy to be a kid, but life for a child can be challenging and painful," says Rachelle Theise, Psy.D., a clinical assistant professor and child psychologist at The NYU Child Study Center. Kids who feel "different" because of their looks or interests and kids suffering from a learning disorder or academic failure may be more at risk for childhood depression, as are those who face serious health issues, extended hospital stays, or family problems such as divorce, domestic violence, or substance abuse. Genetics also play a major role. "Children who have first-degree biological relatives with depression are two to four times more likely to be at risk for depression than children without depressed first-degree biological relatives," says Jephtha Tausig-Edwards, Ph.D., a clinical psychologist and clinical instructor at Mt. Sinai Medical Center in New York City.
Usually depression doesn’t have one direct cause, and it results from a combination of different factors. “Looking for a 'smoking gun' or assigning blame is not helpful and can be counterproductive in the treatment process," says Tausig-Edwards. "Very often, children become depressed because of stressful life events, such as a severe illness or passing of a beloved relative, peer, or pet, especially if several of these occur within a relatively short time frame." Children can also become depressed if they do not feel successful academically or socially at school, or if there are conflicts in the home such as regular fighting between their parents or an impending divorce. "Not all children will react to these events by becoming depressed, but it's important to look for the signs and symptoms of depression in children if they do develop," Dr. Tausig-Edwards says. "Depression is treatable and in most cases, individuals experience relief within three months to one year of when their symptoms started."
So how do you know if your child is depressed or just a little blue? There’s no real depression test for kids, so it can be hard to tell. Parents need to rely on their instincts. Any changes in mood or behavior (more sleeping, different eating habits, difficulty concentrating), increased sadness, or irritability—especially when it lasts most of the day and over a period of a week or two—could mean something is off. You might also notice your child withdrawing from or seeming disinterested in things she once enjoyed, like playing tennis or hanging out with the kids in your neighborhood.
"It's important to know the signs of depression in children so parents can accurately understand their kid's distress," Dr. Theise says. And it's important to note that kids who experience any symptoms of depression may not actually be depressed. Some older children may write stories or poems or draw pictures that will provide insight into their moods. "If your child is expressing her feelings, that is therapeutic and should be encouraged," says Stacey Brown, a licensed mental health counselor in Fort Myers, Florida, and a professor of Human Services at Edison State College. "But if the parent is concerned about what is written or drawn, seek professional advice."
Parents should also watch out for these signs of depression in children, which were compiled from the Anxiety & Depression Association of America and the American Academy Child & Adolescent Psychiatry.
Difficulty sleeping or restlessness
Difficulty concentrating or low energy
Frequent complaints of physical illnesses such as headaches and stomachaches
Persistent boredom or withdrawal/decreased interest in friends and favorite activities
Change in grades, getting into trouble at school, or refusing to go to school
Change in eating habits
Anger, irritability, sadness, crying, or mood swings
Feelings of worthlessness, low self-esteem
Talk of death or suicide
Efforts to run away from home
If you're concerned that your child may be depressed, approach her gently. Find a time when you can both talk without distractions—that means no electronics or siblings around, and not the two minutes before she’s racing off to school or going to bed. Stick to open-ended and nonaccusatory questions like, “I noticed you haven’t been as interested in tennis. What’s going on with that?” or “How do you feel when you're at school?” Your child might respond, “I just don’t like tennis anymore. I want to try soccer.” But if she says something like, “I don’t know why I don’t like tennis now. I’m feeling blah,” reassure her that you’re always available to talk.
You can also ask if she’d like to speak with a feelings doctor and tell her that you can find a good one. However, not all kids will want to talk about their emotions. Keep an eye on how she’s doing, and continue to say, “I want to hear about your feelings. How can I help?” Even so, "if the child's behavior or moods are restricting life or [affecting] family activities, if he's not able to demonstrate the usual happiness or joy, withdraws from friendships, has trouble sleeping, or says he'd like to talk to someone, it's time to seek help," Brown says.
When bad stuff happens in the world—a natural disaster, a celebrity death, a terrorist attack—kids feel the impact, especially anxious ones. It’s better to talk about it than to assume he’ll forget it happened. Tell him the basic facts and be prepared to respond to any additional concerns. If he already heard about the incident at school or on the playground, ask, “What do you know so far about Demi Lovato? What questions do you have?” Model calmness and explain that it’s okay to discuss it. If you don’t know the answer, tell him that too. Reassure him that the event is unusual and safety measures have been put in place by the community, politicians, or police to prevent it from happening again. And always explain, “You’re never alone. I want to hear what you’re thinking.”
There are two main forms of treatment for depression in children: psychotherapy and pharmacology. Psychotherapy, or talk therapy, relies on a psychologist (or psychiatrist or social worker) to help your child work through her negative feelings. Pharmacology relies on medication to treat depression; currently, fluoxetine (Prozac) is the only antidepressant specifically approved by the FDA for children. Like all medications, antidepressants can have side effects and parents should be vigilant in asking questions about the benefits and potential risks if medication is recommended by your child's doctor.