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If I were to ask you to close your eyes and imagine a child, what would you see? Would they be laughing and playing? Perhaps running around outside chasing bugs and leaves… Would they be snuggling with their favorite blanket or toy? Or maybe you would see a memory of a child curled up on your lap, deep in sleep and peace… What if I asked you to imagine the sounds of a child, would it be the giggling laughter, squeaking floors as they sneaking down the hall on their tip toes, squals of delight at discovering something new, or just light heartedly going through an afternoon with a disregard for daily stressors and “have-to’s”. In imagining them like this, we may see the innocence and joy that feels nearly impossible to replicate as we become an adult.

But perhaps you would picture something else entirely. A child that has forgotten how to laugh, one that shuts down, snaps at others and gives up easily on tasks… one that is quickly bored, breaks things, cries easily or talks back.

As adults we tend to look back at childhood as a place of peace and joy, we may remember periods of sadness or frustration but assume that’s normal and that kids will bounce back after a given amount of time, love and support. It is normal and natural after all for children and youth to feel sad (as well as angry and irritable) from time to time. The loss of a loved one, a move, friendships that are ended and mean words heard are all reasons for kids to feel down; but when these moods are so severe that it causes problems, it may be depression.  Recognizing depression is extremely important because getting help early on makes a difference, and helps prevent childhood depression from becoming a long term pattern of experiences leading to life long struggles as an adult.

Signs of Childhood Depression

Depression presents differently throughout childhood and into adulthood. We have done our best to present an overview of what you might see in a child who is depressed at the preschool age, at  an elementary age and/or adolescence.

Preschool Children:

  • May come across as sad/ grouchy
  • Anhedonia (think of Eeyore level sadness)
  • Appetite & weight issues (with this age a weight gain or loss of 5 lbs can be significant)
  • Sleep problems (can’t fall asleep, wakes up through the night or can’t wake up in the mornings)
  • Changes in activity levels/ lower energy when doing things
  • Low self esteem- assuming their artwork is ‘bad’, throwing away things that other kids present with pride, making negative statements about themselves or calling themselves bad.
  • Trouble thinking/ concentrating (needing to have things repeated or explained multiple times)
  • Decreased ability to problem solve, needing more guidance with schoolwork or home tasks
  • Decreased level of response to caregivers and other children (may act as if they didn’t hear you or make no facial responses when you are talking to them)
  • Death or suicide themes in play/ talk
  • Critical content in playing- calling dolls/ toys bad, being mean to their toys or other kids
  • Whines/ cries often/ shows a low frustration tolerance

Primary Age Children:

  • Demonstrating boredom easily
  • Loss of interest in most activities
  • Complaints about tiredness and lack of energy for activities that they regularly due or used to enjoy
  • Irritability and moodiness, going from seeming ‘fine’ to severe sadness/ crying or to excessive tantrums
  • Showing a lack of satisfaction or pride in anything
  • Missing or avoiding school and social activities
  • Decreased concentration
  • Giving up easily with schoolwork or games
  • Showing difficulty in coping with basic stressors or tasks
  • Physical symptoms with no identified cause or medical diagnosis
    • Stomach aches, tiredness, sore muscles, headaches

Adolescents:

  • Sad mood, grim outlook on life/ future
  • Withdrawn, uncharacteristically lacking energy and initiative
  • Neglected appearance
  • Slow movements and monotonous voice
  • Heightened sensitivity to rejection by others’ low self esteem
  • Poor concentration, deterioration in school grades
  • Loss of interest in extracurricular activities
  • Sleeping throughout the day or early in the evening
  • Complaints of headaches or stomachaches
  • Use of drugs or alcohol
How common is depression?
  • 1 in 5 children and youth will go through a period of depression by the time they turn 18
  • Between 4 and 8 out of 100 children and youth are experiencing depression at any given time.
Depression As Part of a bigger picture:

The following diagram gives a great representation for how frequently childhood and adolescent depression can present as other illnesses. Often kids will be treated for other medical and mental health issues with depression not being recognized as a root cause.

What causes depression In Children?

There is usually not one single cause but a combination of potential factors:

  • Medical Issues- (Low Vit D/ Thyroid/ Mono)
  • Family history
  • Death/ Transitions/ Losses
  • Stress- Good and Bad Change
  • Parents separation/divorce
  • Bullying
  • Conflicts with friends
  • School Stress
What should you do if you think your child is depressed?
  • If you suspect that your child/youth has depression, have him/her seen by a doctor (such as a family physician or pediatrician) to make sure there aren’t any medical problems (such as hormone imbalances) that might be causing or contributing to the depression. The doctor may recommend more specialized mental health services, or help with referrals to mental health professionals such as a psychologist, psychiatrist or social worker.
  • If you are concerned that your child may be having thoughts of suicide, then consider contacting a crisis line and/or a local hospital emergency room

Sadly, I have known kids as young as 5 years old who have made genuine suicide attempts, thankfully not successfully, but there are numerous cases at very young ages where they have been. Don’t minimize what they say or how they may feel based on age. They may not have the full brain capacity of positive problem solving but they do experience genuine emotional pain and look for solutions to fix that pain, sometimes in the wrong places and in unchangeable ways.

Helping your child Through Depression
  • Let your child know that you notice they are struggling and that you are available to them anytime they need to talk.
  • Don’t make love and encouragement contingent on behaviors or ‘getting better’ at a certain rate of speed.
  • Make time for family activities and check-ins, simple things like dinner together while all sitting at a table, or riding together in a vehicle are great opportunities to engage them in relaxed conversation that can tell you a lot about what is going on inside their heads.
  • Be a good example, show them that you can understand and express your own feelings, use expressive language in general conversation and encourage them to do so as well.
  • Use common language from Movies, TV, books
Healthy living makes a difference
  • Taking care of the basics can go a long way to helping your child feel better. A healthy body supports a healthy mind. The choices of foods we eat fuel our physical and emotional systems.
  • Processed foods and ‘quick carbs’ and sugar products can contribute to significant emotional up and down swings and make it more difficult for a kid to control, understand or express their emotions.
  • Eating too much and too little of even the right things can also impact a kid’s energy and mood. Watch for a balance
  • Activity, interaction and variety through the day can have a big impact.
  • Excessive use of electronics and isolated activities and can also enhance depressive symptoms. Get them up and moving and interacting with you and others in ½-1 hr time chunks through the day.
  • Get enough sleep
  • Get enough sunlight

How is Childhood depression treated?

  • There is no one size fits all approach… your child is a unique person and treatment will need to adjust around that but here are some of the options
  • Individual/ family therapy, it will not just be your child’s treatment, they are part of your family system and it is often important to have that whole system involved. Click here for information on our Child/ Family Therapists and to schedule an evaluation or appointment.
  • There are numerous approaches and treatment modalities. You may have to weed through several approaches and even therapists to find the right fit for your child/family. One of the biggest factors in treatment success is your child’s ability to connect with their therapist. They will also need you to be positive and encouraging about the process. Don’t use treatment as a punishment for negative behaviors.
  • At times when traditional therapy approaches are not working your therapist may discuss an evaluation with your PCP or a psychiatrist for medication options that may enhance treatment effectiveness. With younger children doctors will prefer and many insist in your child having started outpatient counseling before being seen for meds.
  • Additional options for more intense symptoms may include a partial or full hospitalization, intensive outpatient groups and child based groups.
  • However, don’t discount the benefit of exposing your child to activities and outlets that can capture their interest and build self esteem. With many children those elements can circumvent the need for traditional treatment.
Local Child and Adolescent Mental Health Clinics & Resources

Web sites for children and adolescents with emotional distress

  • 7 Cups of Tea- https://www.7cups.com- Online Support/ Listeners
  • Crisis Text Line- Text Home to 741741 – https://www.crisistextline.org/
  • Human Services Center 24 Hr Crisis Line- 724-652-9000 (for Lawrence County, PA Residents)
  • Boy Scouts/ Girl Scouts, Big Brothers/ Big Sisters, etc
  • Churches, Youth Groups, Lawrence County Youth Ministry-http://lcym.info/
  • Family Doctors and Pediatricians

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