By Ankur Desai, MD
A young child who acts up in preschool may be described as “defiant.” An older child who refuses to go to school, “shy.” An adolescent who doesn’t want to participate in after-school activities, “lazy.”
The truth, however, is that all of these children may be suffering from a condition we mostly associate with adults — depression.
The risk of depression increases as children age. It affects younger children at a lower rate, while an estimated 11 percent of children age 12-17 have had a major depressive episode during the past year.
While those numbers are significant, they may not tell the whole story. The symptoms of childhood depression are very different from the symptoms in adults. As a result, depression and other mood disorders in children can go unrecognized.
When it comes to a child’s mental health, the most important thing for parents to look out for is not necessarily how a child behaves, but rather notable changes in his or her behavior and ability to perform daily activities.
Not like little adults
When most people think about someone suffering from depression, they envision a person acting sad or feeling lonely or pessimistic.
While this can be true for adults and older teens, depression in kids is different:
- Young children don’t have the ability to verbally express themselves. For them, depression may first present itself as anger or irritability or even as regression in developmental milestones, such as the loss of bladder control. Depression may also cause a child to experience frequent physical symptoms such as headaches or stomach pain.
- School-aged children are better able to express themselves, but they may not fully understand emotions such as sadness. For them, a mental health condition such as depression may appear as a loss of interest in things they used to enjoy, changes in sleeping or eating patterns, a drop in school performance, anger outbursts or a notable decrease in energy.
- Adolescents experience what we might more classically think of as symptoms of depression. They may feel negative emotions and lack the ability to find pleasure in previously enjoyable activities. They may also become socially isolated and guarded. In extreme cases, adolescents may have thoughts of suicide and engage in self-injurious behaviors.
What causes childhood depression?
Depression causes changes in the way a person thinks, feels and behaves to a point where he or she struggles with daily life. In the most significant cases, it impedes a child’s ability to grow into a successful, resilient individual. While a complex mix of genetic and environmental factors contribute to the development of depression, certain risk factors place young people at greater risk.
- Trauma is often a significant contributing factor to the development of mood disorders in children. Traumatic factors can be easily identifiable — situations involving overt neglect, physical abuse, verbal abuse and emotional abuse. Trauma may also be implicit, where the child is a witness to domestic violence or marital strife.
- Substance abuse is one of the most important risk factors for the development of depression in adolescents. Alcohol and cannabis, the two most common drugs that children misuse, have a direct impact on neuro-chemistry. In combination with other psycho-social stressors, substance abuse can bring about and worsen depressive symptoms.
- In older children, relationship difficulties with friends and family and an increase in academic and social demands can also be important factors in the development of a depressive syndrome.
- Gender can also be a factor. In younger children, depression affects boys and girls at an equal rate. As children grow into adolescents, girls are affected by depressive symptoms at twice the rate as boys. This difference could be attributed to genetic and hormonal factors, in addition to risk factors such as trauma and substance use.
What can parents do about depression?
Any significant changes in your child’s behavior or functional status should be brought to your pediatrician’s attention. This is particularly important if a child has recently experienced a traumatic event — such as a death in the family, accident or divorce.
Parents can also proactively try to prevent mental health problems by:
Maintaining healthy relationships and providing a supportive, loving home environment.
Focusing on general wellness including a healthy diet, exercise and sleep habits.
Keeping an open line of communication.
Implementing a consistent and supportive parenting style.
Developing healthy and adaptive coping strategies and anxiety management strategies.
The positive news about childhood depression is that kids are resilient. Milder cases of depression can usually be treated successfully with psychotherapy, while anti-depressant medication is an option for more serious cases. The anti-depressant fluoxetine (brand name Prozac) is approved for use in children as young as 8 years old.
As with all health conditions, the key to caring for childhood depression is trying to detect and treat a problem as early as possible to prevent it from worsening.
Dr. Ankur Desai is a board-certified child and adolescent psychiatrist on staff at CentraState Medical Center in Freehold. He also maintains a private practice — Premium Psychiatry Services of Central New Jersey LLC — where he provides outpatient medication management and psychotherapy services for children and adults. Dr. Desai can be reached by calling 866-CENTRA7.