With thanks to Senior Therapist & Supervisor Luz Villagran, MA, LPC, ACS, and Therapist Samantha Levinson, MA, LPC, of Attentive Psychotherapy for their helpful comments and additions. Their additions provide a real sense of hope about depression.
Depression affects people of all ages. But just because the disorder is the same doesn’t mean it looks the same for everyone. Symptoms of depression vary a great deal from one person to another, especially when people are of differing ages. Recognizing and understanding how depression presents in children of all ages makes it easier for parents to seek treatment early and prevent more severe problems from developing.
“I think it’s also important to add the school-aged children often get misdiagnosed as having behavioral issues. I’ve seen this happen where the child becomes excluded and shunned by the teachers and then by peers leading to further depressive symptoms.” Sam Levinson
Depression is a mood disorder. It causes feelings of sadness, hopelessness, and irritability. Although everyone experiences these symptoms from time to time, when they are persistent and last two weeks or longer, doctors diagnose the issues like depression.
Many people with depression struggle with insomnia and have a poor appetite or otherwise disordered eating. They struggle to maintain healthy relationships with others and often lose interest in activities they once enjoyed. Severe depression is often a precursor to suicide or self harm.
Depression Affects People in All Stages of Life
Depression affects people of all ages, including children. Most kids tend to have mood swings, childhood depression is different. It negatively impacts how kids interact with their friends and family and makes it difficult for them to enjoy many typical childhood things, such as hobbies, school, and sports. “Typically children who are the bully present anger, but as this is a secondary emotion, depression is most of the time the underlying issue.” Luz Villagran
Depression and anxiety often go hand-in-hand in children. They are among the most common mental health disorders for younger people and approximately 3% of children ages 3 to 17 have depression and about 75 have anxiety. Kids aged 12 to 17 have the highest risk of developing depression. More than 3 million adolescents in this age range in the United States have experienced at least one major depressive episode. “It is developmentally appropriate for children between these ages to have a “roller coaster” of emotions, but when they begin to display more anger or depressive symptoms, it is good for parents to increase communication with their teen to inquire if the teen is having any specific issues.” Luz Villagran
What does depression look like at each stage of development?
Under Age 7
Depression develops in children as young infants. It tends to be less easily identifiable at these early stages, especially because their personalities are just beginning to develop. Infants who are raised in emotionally cold environments show symptoms of depression so severe some of them do not survive. This has been the case in orphanages, but parent-less children are not the ones at risk of depression. Babies living in severely disturbed families also develop depression at a very young age. “There are many evidence-based studies that have shown that if children have any traumatic events during their early years, the lasting effects are severe and continue throughout their lives. These children as adults have an extremely difficult time resolving their depression due to their trauma being deeply rooted. Children in this age group develop inappropriate coping mechanisms to manage their depression. Some are extroverts that want to get attention in the wrong way from others. These are usually the children who are seen as having conduct disorders. Other children with depression retreat internally and do not want to be noticed by anyone. They do not know how to express their sadness so they may begin to have severe changes in their eating and sleeping patterns. Their activity level will decrease and will isolate from everyone.” Luz Villagran
Preschoolers and young school-age are also at risk of depression. Symptoms of depression in children at this age tend to include:
- Somber or tearful appearance
- Lack of exuberance
- Excessive whining or clinging to their mothers
- Irritability, tantrums, or disruptive behavior
Preteens and Adolescents
Children approaching puberty and teenagers are at risk of developing depression. Many of the same symptoms that occur in younger cases of depression are present for pre-teens and teens, but there are added components. For example, when a child in this age group has depression, he or she also tends to have low self-esteem, blame themselves for the bad things in their lives, and experience social inhibition. They also feel persistent sadness.
“While working with adolescents, a huge component of therapy is building rapport. Sometimes self disclosure is important (identifying what it was like as a therapist being that age and some experiences I had). Also talking about on-the-surface topics with adolescents also can be helpful (where they like to shop, what their friends are like, hobbies, and places they’ve been). One time I spent a full session talking about fashion with an adolescent that helped her build trust in me.
Parents can also google adolescent therapy questions. They are great for getting to know an adolescent. It’s also a good way to say to them, ‘see, you do know yourself!’ (you know things about yourself you like, dislike, etc.). Therapists can have them write their answers down in a journal or notebook. After rapport and trust are built, I will play games where the child picks the emotions they are feeling, and after we discuss their feelings surrounding that emotion and ways they can cope with that emotion.
I’ve also used the game uno as a way to identify emotions and coping skills. For instance, Red represents hot emotions that require fast coping skills like deep breathing, splashing face with cold water or using an ice pack), Yellow for bright coping skills (exercising, dancing, playing with friends, asking for a hug from a parent), Blue are calm coping skills (listening to music, playing a game, journaling) and Green are go to coping skills (playing with fidget toys).”
What Causes Depression in Children?
The causes of depression in children are as varied as they are in adults. However, the majority of kids in the 12-17 year age range who are diagnosed with depression are dealing with one or more of the following:
- Stressful life event
- Stressful environment, including family problems
- Family history of depression
- Alcohol or drug use
- Physical illness
- Traumatic events
Treatment of Depression in Children
The earlier parents, caregivers, and educators seek treatment for children with depression, the greater the likelihood of recovery, and the lower the risk of severe consequences. Many of the treatment options used to treat depression in adults can also be effective for treating children. The American Psychological Association recommends medication and two psychotherapy interventions for adolescents with depression. Practitioners at Attentive Psychotherapy added Play Therapy to the list. Psychotherapy interventions include:
Cognitive-Behavioral Therapy (CBT)
This type of therapy targets existing problems and symptoms. It focuses on the link between behaviors, thoughts, and feelings. It also helps patients learn how to change their patterns to improve their ability to function at their best and increase pleasure in life.
Interpersonal Psychotherapy for Adolescents (IPT-A)
Interpersonal psychotherapy focuses on improving relationships in a patient’s life that are causing stress or that are otherwise problematic. The therapy focuses on dealing with the circumstances that are most closely linked to the adolescent’s depression.
Play Therapy
“Play therapy is a therapeutic modality that is geared toward children. In this form, a therapist encourages a child through play to explore life events that had an effect on their current circumstances. Play therapy helps children communicate, explore thoughts and feelings, and unresolved trauma.” Luz Villagran
“Play intervention is a large component of the therapy I utilize with children who are suffering from depression. With school aged children, I’ll have a bin of stuffed animals and ask them to show me their stuffed animals. Then we touch them and figure out which ones help them feel happy, comforted, and safe. I will also show them educational videos on identifying emotions. Sesame Street has some really good ones; in particular I like, ‘name that emotion’ game and ‘Elmo’s feeling sad’. I will also have children and parents make a calm down zone in their bedroom. It consists of a tent the parent and child pick out together (this helps as a bonding activity). In the tent the child puts all the things that make him or her feel calm and happy (stuffed animals, pillows, meditation music, fidget toys, weighted blankets). This teaches the child necessary distress tolerance skills, which ultimately gives them the independence to self regulate.” Samantha Levinson
In addition to professional medical attention, you can also help your child deal with depression by:
- Making sure your child eats nutritious foods, gets enough sleep, and gets daily physical activity
- Enjoying quality time together
- Being patient and kind, even when your child is struggling or in a difficult mood
According to Michael J. Meaney Ph.D. “Early detection and treatment are key, since the longer depression lasts untreated, the harder it is to treat. The simplest way to do this is to emphasize what is known as collaborative care, which embeds therapists in primary care practices to reduce the problem of stigma and provide easier access for mental health care.”
How Do I Recognize a Risk of Suicide in My Child with Depression?
Suicidal thoughts and behaviors are linked to depression. If you suspect your child has depression or has been diagnosed with depression or anxiety, watch for the following and alert your doctor if you notice any of these behaviors:
- Increased risk-taking
- Self-destructive or self-harming behavior
- Social isolation
- Focus on death and dying or talk of suicide or hopelessness
- Giving away possessions
If you recognize any of these behaviors in your child or have other reasons to be concerned, speak to your child and consult a mental health or medical professional for guidance.
