The Washington PostDemocracy Dies in Darkness

Kids can have depression, too, even toddlers. Here’s how to tell.

(Hadley Hooper for The Washington Post)
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The death of Robin Williams, who was reported to be suffering from severe depression and is believed to have committed suicide, brings into stark relief the very serious but too-often-ignored issue of depression in people of all ages, including teenage students and toddlers.

Childhood depression is characterized this way in a brief issued by the National Association of School Psychologists:

Depression is a serious mental health issue that can affect even very young children. Depressed children are generally lacking in energy and enthusiasm. They often become withdrawn and are unable to concentrate or to enjoy life. If they are in school, they usually perform poorly. Sometimes they are irritable and sulky or even belligerent. If they are old enough to talk, they may refer to themselves as stupid and ugly, friendless, unloved and unlovable, worthless, or even hopeless. They may be preoccupied with themes of death and dying, and, occasionally, they may contemplate or even attempt suicide. Yes, even small children may do reckless, dangerous things designed to hurt or to kill themselves, although their concepts of death are quite different from those of adults.

How young? According to a 2009 report called “Preschool Depression,” researchers found that preschoolers as young as 3 can show signs of major depression, “contradicting traditional developmental theory, which claimed that young children were too cognitively and emotionally immature to experience depressive affects.” According to the American Academy of Child & Adolescent Psychiatry, about 5 percent of children and adolescents suffer from depression at any given point in time.

A new study on the Web site of the National Institutes of Health says that “diagnosing childhood depression can pose a challenge, even for mental health specialists.” This is true in part because signs and symptoms are different for children at the various developmental stages and, according to this 2011 report, “depression rarely presents as the chief complaint” in children. Young children who are depressed may not even seem sad to adults.

So how can a parent, teacher or friend tell if a child or adolescent is depressed?

From ASCD, (formerly the Association for Supervision and Curriculum Development), here’s a chart about how depression presents in children and adolescents:

Characteristics of Depression in Children and Adolescents

Characteristics of Depression in Children What It Looks Like in School
Physical/somatic complaints Complaints of feeling sick, school absence, lack of participation, sleepiness
Irritability Isolation from peers, problems with social skills, defiance
Difficulty concentrating on tasks/activities Poor work completion
Short-term memory impairments Forgetting to complete assignments, difficulty concentrating
Difficulties with planning, organizing, and executing tasks Refusing to complete work, missing deadlines
Facial expressions or body language indicating depression or sadness Working slowly
Hypersensitivity Easily hurt feelings, crying, anger
Poor performance and follow-through on tasks Poor work completion
Inattention Distractability, restlessness
Forgetfulness Poor work submission, variable academic performance
Separation anxiety from parents or caregiver Crying, somatic complaints, frequent absences, school refusal
Characteristics of Depression in Adolescents What It Looks Like in School
Decreased self-esteem and feelings of self-worth Self-deprecating comments
Mild irritability Defiance with authority figures, difficulties interacting with peers, argumentativeness
Negative perceptions of student’s past and present Pessimistic comments, suicidal thoughts
Peer rejection Isolation, frequent change in friends
Lack of interest and involvement in previously enjoyed activities Isolation and withdrawal
Boredom Sulking, noncompliance
Impulsive and risky behavior Theft, sexual activity, alcohol or drug use, truancy
Substance abuse Acting out of character, sleeping in class

From the American Academy of Child & Adolescent Psychiatry:

If one or more of these signs of depression persist, parents should seek help:
Frequent sadness, tearfulness, crying
Decreased interest in activities; or inability to enjoy previously favorite activities
Persistent boredom; low energy
Social isolation, poor communication
Low self – esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger, or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from home
Thoughts or expressions of suicide or self -destructive behavior
A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.
Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.
Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.

Here is some information from the National Institute of Mental Health on depression in adolescents:

Q. What is depression?
A. Depression is a common but serious mental illness typically marked by sad or anxious feelings. Most students occasionally feel sad or anxious, but these emotions usually pass quickly — within a couple of days. Untreated depression lasts for a long time and interferes with your day-to-day activities.
Q. What are the symptoms of depression?
A. Different people experience different symptoms of depression. If you are depressed, you may feel:
You may also experience one or more of the following symptoms:
Depression in adolescence frequently co-occurs with other disorders such as anxiety, disruptive behavior, eating disorders, or substance abuse. It can also lead to increased risk for suicide.
Q. Are there different types of depression?
A. Yes. The most common depressive disorders are:
Other types of depression include:
Q. What causes depression?
A. Depression does not have a single cause. Several factors can lead to depression. Some people carry genes that increase their risk of depression. But not all people with depression have these genes, and not all people with these genes have depression. Environment — your surroundings and life experiences — also affects your risk for depression. Any stressful situation may trigger depression. And high school students encounter a number of stressful situations!
Q. How can I find out if I have depression?
A. The first step is to talk with your parents or a trusted adult who can help you make an appointment to speak with a doctor or mental health care provider. Your family doctor or school counselor may also be able to help you find appropriate care.
The doctor or mental health care provider can do an exam to help determine if you have depression or if you have another health or mental health problem. Some medical conditions or medications can produce symptoms similar to depression. The doctor or mental health care provider will ask you about:
Q. How is depression treated?
A. A number of very effective treatments for depression are available. The most common treatments are antidepressants and psychotherapy. An NIMH-funded clinical trial of 439 teens with major depression found that a combination of medication and psychotherapy was the most effective treatment option. A doctor or mental health care provider can help you find the treatment that’s right for you.
Q. What are antidepressants?
A. Antidepressants work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work.
Q. If a doctor prescribes an antidepressant, how long will I have to take it?
A. You will need to take regular doses of antidepressants for 4 to 6 weeks before you feel the full effect of these medicines. Some people need to take antidepressants for a short time. If your depression is long lasting or comes back again and again, you may need to take antidepressants longer.
Q. What is psychotherapy?
A. Psychotherapy involves talking with a mental health care professional to treat a mental illness. Types of psychotherapy that have been shown to be effective in treating depression include:
Depending on the type and severity of your depression, a mental health professional may recommend short-term therapy, lasting 10 to 20 weeks, or longer-term therapy.
Q. How can I help myself if I am depressed?
A. If you have depression, you may feel exhausted, helpless, and hopeless. But it is important to realize that these feelings are part of the depression and do not reflect your real circumstances. Treatment can help you feel better.
To help yourself feel better:
Q. How can I help a friend who is depressed?
A. If you think a friend may have depression, you can help him or her get diagnosed and treated. Make sure he or she talks to an adult and gets evaluated by a doctor or mental health provider. If your friend seems unable or unwilling to seek help, offer to go with him or her and tell your friend that his or her health and safety is important to you.
Encourage your friend to stay in treatment or seek a different treatment if he or she does not begin to feel better after 6 to 8 weeks.
You can also:
Q. What if I or someone I know is in crisis?
A. If you are thinking about harming yourself or having thoughts of suicide, or if you know someone who is, seek help right away.
Q. What efforts are underway to help high school students who have depression?
A. Researchers continue to study new ways to diagnose and treat depression in high school age students. Some scientists are also looking into different ways to classify symptoms, which may provide news clues about how the disorder develops and which treatments are most effective. Increasing the early detection and treatment of depression can help more students succeed academically and achieve their goals in school and after graduation.
You can find more information about the causes, diagnosis, and treatment of depression, including research related to adolescents and young adults, on the National Institute of Mental Health (NIMH) Web site.
You can also connect with NIMH through social media: