Thanks to Practitioner Meghann Henderson, MA, RP, a member of The Child Therapy List, who adds her perspective on Childhood Depression, in italics.
Can Children Be Depressed?
Recent studies conclude that depression in children is not the same as adults. The National Center for Biotechnology Information describes this difference by explaining, “Whereas adults with depression are often treated for the disorder specifically, children with depression are often not thought of as ‘having’ depression but as affected by a set of emotional, behavioural, learning, relationship and family problems which need to be considered together, and may still need to be addressed together, even if depression in the child is a primary concern.”
What Symptoms Should I Look For?
It is important for parents and caregivers to know that symptoms of depression in children and teens often have “atypical features”, and do not necessarily look like they would in adults. Although the “core systems” are often the same, there are several significant differences.
“Symptoms” are also known to vary significantly based on culture and region.
The DSM-IV-TR (The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders.) specifically notes that in children, the “depressed mood” symptom can present as “irritable mood”. In my experience, this is often what is seen first, especially in teens.
In my experience, the symptoms that caregivers typically notice first in children and teens (those that are particularly common):
– irritable mood, or “changes” in mood
– social withdrawal
– statements of feeling worthless, guilty, or that they don’t want to live anymore. (Not necessarily suicidal comments, more comments in general about being “dead” or dying.
What Steps Should I Take if I Think my Child is Depressed?
Seeking the guidance of a mental health professional who specializes in children with depression is a great starting point. If you’re not sure or have an inkling or worry that something might be going on for your child, you can always reach out to a mental health practitioner (Registered Psychotherapist, Psychologist, Registered Social Worker).
Personally, I do free 15 minute consultations for this reason, it gives the parents a chance to check in and I can advise if I think it might be appropriate to see the child or not.
If you’re child or teen is making suicidal comments, or even general comments about dying, wanting to die, or wanting to be dead, you should always seek help right away. In my experience, it is always best to take these comments seriously, even in young children.
How Can A Therapist Help a Depressed Child?
There are several effective treatment options for depressed children. You can work hand in hand with a professional to discuss the specific needs of your child.
Cognitive behavioral therapy is one option, in which a therapist helps a child begin challenging negative or limiting beliefs, so they can recognize negative thought patterns and help them learn to think in more positive ways. Although CBT is very “popular” right now, it is not always the best approach for everyone. Your mental health practitioner will create a treatment plan that is right for your child.
Although some basic (simplified) CBT is done with children, CBT relies on the individual to have developed some pretty high level higher order thinking. I always explain it to parents that in order to be able to do CBT successfully, the client needs to be able to think about “thinking”. So, this is not always the best fit for everyone.
Interpersonal therapy is an option, in which the therapist helps children feel more connected to their friends and family in healthy ways. This is done in a one-on-one setting. Interpersonal Therapy for Adolescents (IPT-A) has been identified as an evidence-based treatment that is often used in in-patient or residential settings. It is important to note that it is typically used for teens over the age of 14 (some practitioners say 16), and is not currently considered as “evidence based” for use with those under the age of 12.
Family Therapy centers on helpful, practical ways to create a well-functioning family. Family therapy sessions include key family members, like the child (or teen), the parents, their siblings, and – potentially – grandparents. When working with children and teens, I believe it’s important to include the family in my work as well (when all parties agree). Because parents are with their child more than I am, I like to work with parents to give parents strategies, and tip to use at home (as appropriate and when all parties consent).
Play therapy is a great option.
Play is the language of children, they learn about and explore their world through play, so to me, it seems most logical that children, adolescents, and even teens can heal through art and play as well. There are many different types of play therapy; in general, Play Therapy techniques fall into two categories, Directive, and Non-Directive.
Directive Play Therapy Approaches include Cognitive Behavioral Play Therapy (CBPT), Sand Tray therapy, Trauma-Focused, EMDR Play Therapy, Solution-Focused Play Therapy, and Child-Parent Relationship Therapy.
Non-Directive approaches include: Child-Centered Play Therapy, and Filial Therapy.
A trained Play Therapist can determine which approach(es) are best for your child.
An important note: Play Therapy is NOT just the use of toys in talk therapy sessions. Trained Play Therapists carefully select each toy in the play room based on therapeutic value.
These four treatment options are commonly used but are not the only options available. A mental health professional will be better able to assist you in determining the best option for your specific needs. To learn more about other options, check out this list from the American Academy of Child and Adolescent Psychiatry.
Treatment Can Create Lifetime Shifts (and Hope)
A consultation phone call (where offered), or even a consultation appointment is a monumental first step towards positive changes for your child, regardless of the nature of your concern (whether it’s depression, anxiety, “behavior”, anger management, bullying, or something else).
Intervening when you believe something in your child’s environment is causing signs of depression is courageous and effectively being your child’s advocate. Children will use the tools they learn in therapy for life, and they will forever remember how you stood up for them.