Youth Depression

Detecting Depression in Youths

written by: Rebecca Suffnes, PhD

We all know the classic image of someone with depression. You see it in commercials, television shows and movies. He or she feels sad all the time, cannot get out of bed, and disengages from life. While this is not an incorrect representation of what depression can look like, it is far from universal, and this is even more true in children and teens.

First, depression can begin much younger than many may expect. Depressive symptoms are more common as children age, but symptoms of depression have been identified in children as young as 3-years old. In the early elementary-school years, an initial sign that depression may be developing could be feelings of helplessness, and depressive symptoms may not last as long as the 2-week episodes of depression that are seen in older children.

On the other hand, rates of depression spike as children reach puberty, and this is particularly the case in girls. For example, rates of depression in children range from 0.4% to 2.5%, but rates of depression may be as high as 8.3% during the teen years. These rates do not include those children and teens who may be experiencing depressive symptoms that are not frequent or severe enough to be considered depression but may still be causing them difficulty in their social lives, in school, or in their familial relationships.

For an adult to receive a diagnosis of depression, he or she must have one of two “hallmark” symptoms: a persistently sad mood and/or a loss of interest or pleasure in activities. In children and teens, they can also have a persistently irritable mood. This means that children and teens can receive a diagnosis of depression if they are irritable or cranky much of the time during a depressive episode but do not show much sadness.

However, this does not mean children and teens are depressed just because they snap at their parents or seem easily annoyed. It also does not mean that if you are a teen and you feel easily annoyed that you are depressed. Moodiness is a typical experience during adolescence and not necessarily a cause for concern. The irritable mood that is characteristic of depression means that for most of the day, on more days than not, you feel irritable, cranky, or easily annoyed. Additionally, this period of irritability must last at least two weeks to be considered an episode of depression.

Beyond a sad or irritable mood or a loss of interest or pleasure in activities, an episode of depression requires additional symptoms, which must include some of the following:

  • changes in weight or in appetite
  • changes in sleep, including sleeping too much, not enough, or having difficulty sleeping
  • having difficulty keeping still, or feeling slowed down or that one cannot move as fast as before
  • feelings of worthlessness or excessive or inappropriate guilt
  • difficulty concentrating, slowed thinking, or having trouble making decisions
  • recurrent thoughts of death, recurrent suicidal thoughts (with or without a plan), or a suicide attempt.

These additional symptoms must occur with the hallmark symptoms of a sad or irritable mood and/or a loss of interest or pleasure in activities. These symptoms must also be a change from a child’s or adolescent’s typical functioning. For example, in children with ADHD, difficulty concentrating is often present, so the difficulty concentrating that comes with an episode of depression must be more problematic than what is typical for that particular child.

If you are a child or adolescent and suspect you may have depression, talk to an adult about finding someone to help you feel better. If you are a parent with a child or teen whom you suspect may have depression, there are evidence-based forms of therapy that have been shown to be beneficial. Early intervention is ideal, as these forms of therapy can be helpful before children and teens meet criteria for a depressive episode, so it is never too early to seek help for a child or teen in your life.

If you are interested in learning more about evidence-based therapy for depression contact us at 512-246-7225 or [email protected] Our therapists are currently accepting new clients at both our Round Rock and Austin offices.

 

References

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Angold, A., Costello, E. J., Erkanli, A., & Worthman, C. M. (1999). Pubertal changes in hormone levels and depression in girls. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 29(5), 1043–1053. doi:10.1017/s0033291799008946

Birmaher, B., Ryan, N. D., Williamson, D. E., Brent, D. A., Kaufman, J., Dahl, R. E., … Nelson, B. (1996). Childhood and adolescent depression: A review of the past 10 years, Part I. Journal of the American Academy of Child & Adolescent Psychiatry, 35(11), 1427–1439. doi:10.1097/00004583-199611000-00011

Hankin, B. L., Young, J. F., Abela, J. R. Z., Smolen, A., Jenness, J. L., Gulley, L. D., … Oppenheimer, C. W. (2015). Depression from childhood into late adolescence: Influence of gender, development, genetic susceptibility, and peer stress. Journal of Abnormal Psychology, 124(4), 803–816. doi:10.1037/abn0000089

Hayward, C., & Sanborn, K. (2002). Puberty and the emergence of gender differences in psychopathology. Journal of Adolescent Health, 30(4, Suppl), 49–58. doi:10.1016/s1054-139x(02)00336-1

Kashani, J. H., & Ray, J. S. (1983). Depressive related symptoms among preschool-age children. Child Psychiatry and Human Development, 13(4), 233–238. doi:10.1007/BF00709557

Kistner, J. A., Ziegert, D. I., Castro, R., & Robertson, B. (2001). Helplessness in early childhood: Prediction of symptoms associated with depression and negative self-worth. Merrill-Palmer Quarterly, 47(3), 336–354. doi:10.1353/mpq.2001.0016

Luby, J. L., Heffelfinger, A. K., Mrakotsky, C., Brown, K. M., Hessler, M. J., Wallis, J. M., & Spitznagel, E. L. (2003). The clinical picture of depression in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 340–348. doi:10.1097/00004583-200303000-00015

Stalets, M. M., & Luby, J. L. (2006). Preschool depression. Child and Adolescent Psychiatric Clinics of North America, 15(4), 899–917. doi:10.1016/j.chc.2006.05.011

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