Focus on Pediatrics: Child’s signs of depression often differ from adults

Awareness essential for diagnosis and treatment

Childhood depression needs to be talked about so that more people can identify the signs and symptoms and seek treatment for their children. "The more we talk about it, the more likely the stigma will be removed. It is important to understand that it is no different than having diabetes or asthma or any other health problem," says Jane Tobler, senior director of the Children’s Campaign for Public Education at the National Mental Health Association (NMHA) in Alexandria, VA.

One in every 33 children and as many as one in every eight adolescents suffer from depression, according to the NMHA. It is an illness that children will not snap out of without professional help, and therefore needs to be treated. In fact, telling children who suffer from depression to get back on track adds to the pressure they are under and can exacerbate the problem, says Tobler. Currently, one third of the children in the United States suffering from a diagnosable mental, behavioral, or emotional disorder do not receive treatment.

That’s why in 1997 the NMHA implemented Childhood Depression Awareness Day during the month of May, which is mental health month. This year on May 7, they encourage health care professionals to get the word out to the community about depression and other mental illnesses that affect children, such as anxiety.

The community needs to know how to recognize the signs and symptoms of childhood depression. "Depression in children is different than depression in adults," says Tobler. Children who are depressed often act out. They can become aggressive. Those being treated for depression often say that they acted badly because they were frustrated and didn’t know what to do.

Other signs include a persistent sadness or hopelessness, withdrawal from friends and family members, and lack of interest in something they once enjoyed. For example, they may have loved to play the clarinet in band, but now they don’t even want to attend band practice.

Generally, parents or guardians want to look for a radical change in behavior, says Tobler. If a child has always been a loner, that doesn’t necessarily indicate depression. However, if the child likes to socialize and is always going out with friends and suddenly doesn’t want to participate in social activities anymore, that could be a sign that he or she is depressed.

A change in behavioral patterns such as eating or sleeping habits can also indicate depression. For example, the child may be sleeping a lot more or not nearly as much as he or she used to. Depression can also have physical symptoms such as low energy, chronic fatigue, or frequent complaints such as headache, stomachache, or backache.

"More than one symptom for more than two weeks in more than one setting usually indicates depression," says Tobler. If parents notice a persistent sadness at home, they should ask others who are in contact with the child if they have noticed this symptom as well. For example, ask the child’s teachers what they have observed and ask the coach if the child is sad during basketball practice.

"The best people to recognize change are the parents, family members, and educators because they usually see the child on a day-to-day basis," says Tobler.

Physician always contacted

When depression is suspected, parents should take their child to the family physician or pediatrician and ask for a referral to a psychologist or psychiatrist for diagnosis and treatment. It’s important for parents to track the warning signs they have observed, noting their frequency and duration so that they can discuss them with their physician, says Tobler.

Although it is not clear what causes depression, children under stress, those with other disorders such as attention deficit disorder, or those who have experienced a loss are at a higher risk for depression. Also, adolescent girls are more likely to become depressed than adolescent boys. If parents think something is wrong, they should talk to the child before talking to other adults who are involved with the child. "Those who suffer from depression in childhood are more likely to develop a severe depressive illness in adulthood, so it is really important to get treatment," says Tobler.

To help make people aware of childhood depression, Tobler suggests patient education managers plan educational programs, depression screenings, or participate in a health fair. Plenty of helpful literature can be downloaded from the NMHA web site ( Working with schools to educate children on the signs of depression is a good use of time and resources as well. Any place where there are a lot of children and adults, such as malls and zoos, makes for a good location for informational giveaways.

Partnering with the local bookstore or library is a good way to get the word out as well. Stage a story time and read books about emotions and mental health to the children and then distribute literature to their parents, suggests Tobler.

While most families know that it is important to eat a variety of fruits and vegetables to stay physically healthy, they many not know that there are some things they can do to help foster mental health as well. Good family relationships that include good communication and real support between children and their parents help foster mental health. When children are able to sit down and talk to their parents for 15 minutes a day about any subject they choose, their mental health is improved, says Tobler.