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Know The Signs of Childhood Depression

Posted 10/3/2014 by UHBlog

Know the Signs of Childhood Depression

Parents are often very good at spotting the signs that their child is getting sick. Maybe he or she is more tired than usual, or more cranky, or suddenly has no appetite.

But when the problem is mental rather than physical, it can often be hard to tell what’s normal and what’s a sign of something more serious.

Child psychiatrist John Hertzer, MD, helps parents spot the signs.

How can a parent tell the difference between a child who is just experiencing normal sadness and a child who is showing signs of depression?

Dr. Hertzer: We think of clinical depression when there is sadness that may be unexplained and that can be accompanied by a sense of hopelessness, and it persistently interferes with functioning such as in school, with friends, or at home.

How are the signs and symptoms of depression different, depending on the child’s age?

Dr. Hertzer: In the preschool years, depression is marked by irritability, physical complaints, tantrums, either overactivity or underactivity, disturbed sleep patterns including frightening dreams, poor peer interactions, problems following rules and most importantly, diminished interest in play.

Depression in the preschool years is uncommon, but when it does occur, these youngsters are likely to continue to experience depression in elementary and middle school. So if a caregiver observes a preschool child as not seeming to have fun during this typically joyful stage of development, it raises concern about depression, especially if there is family history of depression such as in the child's mother.

As kids get a little older, depression manifests as an unhappy mood, complaints of boredom, loss of interest in favorite activities, concentration problems, changes in sleeping and eating habits (either increased or decreased), poor self-image and unexplained crying. Just like in the preschool years, the child can also have somatic complaints, such as headaches

Once a child reaches the teenage years, depression often includes irritability, social withdrawal and isolation. Shifting moods are typical in adolescence, but when these mood swings are accompanied by a change in the child’s baseline level of functioning for at least two weeks (whether it be social, academic, or work) that we become concerned about a major depressive episode. Becoming more impulsive and reckless can indicate teenage depression as well. It should also be mentioned that depressed teenagers have an increased risk of substance abuse, so if this occurs we also assess if a mood disorder is present.

A depressed child of any age may talk about suicide, but it’s more common in the teenage years than in younger children.

What's the best way for a parent to talk to a child who is showing signs of depression?

Dr. Hertzer: A child may not know why he or she doesn’t feel right, so initially a parent might just comment that how their child feels is important to them. Then, you might ask your child to explain his or her feelings without requiring an explanation or reason. If a parent explains about a time when they felt sad, that can open up these forms of communication.

It’s most important to establish a compassionate, honest, and positive rapport that includes pointing out that the child is not alone, and that there is effective help for the millions of youth who have depression.

If a child is diagnosed with depression, does that mean that he or she will have it for the rest of their lives?

Dr. Hertzer: We know that 20 percent of people will experience a depressive episode before age 18, and of those, 70 percent will have another episode within five years and 50 percent will experience depression as an adult. The key is early identification with continuation of treatment (therapy and/or medication) for 9 to 12 months before you consider scaling back on interventions that helped to stabilize the patient.

John Hertzer, MD, is Director of the Division of Child and Adolescent Psychiatry at University Hospitals Cleveland Medical Center and UH Rainbow Babies & Children’s Hospital. You can request an appointment with Dr. Hertzer online.

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