The Depressed Child

Dr. Emilie M. Storch, PhD

Depression in children is described as a mood, characterized by feelings of sadness, gloom, misery, or despair—typically transient feelings that most people experience at some point in their lives. When the symptoms of sadness are intense, persistent, and occur together with the following, they should be of great concern to the caregiver.

Irritability, loss of interest in previously enjoyed activities, feelings of worthlessness, social isolation, extreme sensitivity to rejection or failure, reckless behaviors, loss of appetite, sleep disturbances, difficulty concentrating, low self-esteem guilt, low energy, psychomotor changes and suicidal ideation.

Depression is frequently called an internalized problem because it often does not present difficulty for caregivers. Internalizing behaviors (depression, anxiety, social withdrawal) often get overlooked because of this. Children who are depressed often think that no one else feels the same way and that no one will understand his or her problems. They frequently feel disliked and persecuted by others. Depressed children have difficulty maintaining an academic focus and it is often hard to engage them to participate in school. These children can have social relationship problems in that they may lack social skills, and peers report liking depressed children less than non-depressed children. Commonly, these children are unlikely to talk about the depression and may just become quiet and withdrawn. Sometimes, pressures of school, family or social situations bring on this condition.

Depressed children may evidence changes in the following:

1. Feelings: unhappiness, worry, anger or rejection
2. Physical changes: headaches, general aches and pains, lack of energy, etc.
3. Thinking: they may say things that indicate low self-esteem, self-dislike or self-blame. Difficulty with concentration
4. Changes in Behavior: withdrawal, crying, decreased interest in sports or previously enjoyed activities

About 5% of children are affected by depression. Both boys and girls are equally at risk in early childhood, but adolescent girls are twice as likely to become depressed as boys. Additionally, there is an increased risk of depression if the child has a parent who was depressed at a young age.

The following is a list of symptoms of depression at various ages.

1. Infants and toddlers: developmental regression, increased crying, increased clinginess and irritability, increased sleep issues, feeding problems, falling off of growth curves, limited speech, limited social interaction, inability to accept comfort, destructive behavior
2. Preschoolers: uncontrollable behavior, hyperactivity, tantrums, breath-holding, biting, kicking, scratching, nightmares, toileting problems (unusual wetting or soiling)
3. School-age children: worsening school and homework performance, homework resistance, headaches, tummy aches, fatigue, lack of motivation, anxiety, stealing, masturbation, difficulty concentrating, complaints of boredom
4. Teens: school failure, promiscuity, delinquent behavior, increased aches and pains, suicidal attempts, may look more like adult depression, moody, irritable, not looking after themselves, eating too much or too little

Depression usually develops over several days or weeks. Without treatment, the course lasts between six months and a year. There are both biochemical and environmental cause of depression. The following list summarizes environmental influences.

	Loss and separation
	Rejection/being left out or unaccepted by important others, conflict in friendships, being bullied
	School failure—anything that lowers self-esteem
	Deprivation—poverty leads to despair
	Physical illness or injury—spinal cord injury patients
	Being the victim of a crime or abuse
	Changing schools
	Having a depressed parent
	Tension in the family
	Young children being left for a long time with someone they do not know well
	Not being listened to
	Abuse

Children who suffer from depression often fail to progress and mature developmentally, and may experience many coexisting psychological problems, such as substance abuse and violent behavior. Teachers are often confused about how to reach depressed students and they may be confused because these children are usually withdrawn but also may be disruptive. Often, teachers working with depressed students feel hopeless. Depressed children voice more physical complaints than do non-depressed children. Adolescents who are depressed often complain of headaches and stomachaches. Younger children exhibit increased separation anxiety and their overall behavior may be more regressed.

HOW TO HELP

Early intervention is essential for the depressed child. Long-term depression negatively affects a child’s view of him or herself, their world and their ability to cope. Many children need both therapy and medication. Therapy can offer the advantage of someone helping the child understand and cope with his or her feelings. Antidepressant medications, especially the SSRIs, can impact an underlying biochemical condition giving the child more emotional resources to cope with their life’s difficulties. Clearly, depressed children need stable figures in their lives that are available for them to talk to and to express to what is going on with them. These caregivers can help children turn to God with their feelings and tell Him their problems (“Casting all your care upon Him,” “I will never leave you,” Heb. 13:5, I Peter 5:7). It is important to understand that depression may consume the child’s mental energy and they may need special academic assistance. Depressed students often feel as if they have little to contribute. Teachers can try to show confidence and faith in the student’s abilities, asking questions for opinions and no clearly correct answer. Depressed students may be more likely to participate when there is a minimal chance for embarrassment. Developing a positive connection between student and teacher can dramatically influence a child’s life. Studies have shown that adults who suffered from depression when they were younger often recall a specific teacher as central to their recovery. Children may be reluctant to discuss their feelings directly. They might instead identify with literary or historical figures and use them to explore their own feelings.

Families of depressed children are encouraged to consult both their pediatrician and a child psychiatrist to find out if there is an underlying physical cause. Equally as important, however, is the need to provide a place for the child to feel understood about what they are feeling.