“Good morning, Pooh Bear,” said Eeyore gloomily. “If it is a good morning,” he said. “Which I doubt,” said he. — A.A. Milne

Childhood is usually a happy time for children, and their moods often reflect this. When a toddler or even an adolescent has a change in mood, it’s typically the product of some environmental trigger — such as a parent saying “no” to something — and this unhappiness rarely produces anything more than some pouting or a short-lived tantrum. 

However, when a child appears excessively sad, it may be a sign of depression. Depression distorts normal perception, causes behavior changes and can result in self-injurious behavior or even suicide, usually a rarity in very young children, however, the incidence increases with age.

Like the sad and indecisive gray donkey in Winnie the Pooh, childhood depressive disorders are conditions in which children display persistent negative moods and a lack of pleasure in life. 

What are the signs of childhood depression?

The following symptoms are not all-inclusive, but can be indicators of childhood and adolescent depression.

Feelings of sadness, hopelessness or worry

Feeling inordinately sad is the hallmark symptom of depression. These children will look unhappy, and may appear withdrawn and inhibited, always worrying about themselves, other people, and about things they have little or no control. They may also cry frequently with little or no provocation, and constantly feel rejected and helpless when dealing with life’s circumstances.

Loss of interest or pleasure in usual activities

In addition to being sad, this symptom, known as “anhedonia,” is one of the hallmarks of depression at any age. Children may lose interest in hobbies, sports, even interaction with family members or friends. They may exhibit little or no motivation at home or in school.  They may also spend an inordinate amount of time alone or in their room.

Significant weight loss or weight gain

Children may have a preoccupation with food — such as hiding food in their rooms or possessing a vague but constant need to eat. At the other extreme they might be listless about their food, pushing it around on their plate and saying that they’re full or suffering from a stomachache.

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Insomnia (inability to sleep) or hypersomnia (oversleeping)

Children may fall asleep during any type of passive activity such as watching TV. They may be listless, lethargic and constantly yawning - or, conversely, they may not be able to fall asleep at bedtime or remain asleep through the night.

Fatigue and loss of energy

Normally energetic children will complain of always being tired or bored, dragging themselves through activities or avoiding chores or responsibilities because they feel too tired to do them. They may complain of vague “aches & pains” or headaches and stomachaches that don’t “go away,” especially in the morning or before bedtime.

Motor agitation or retardation

Children may either appear to be moving in slow motion or “jumpy” — almost hyperkinetic and incapable of “sitting still.” A child may also be irritable, display sudden anger or have difficulty getting along with others.

Feelings of worthlessness or excessive guilt

 The child may take the blame for everything that goes wrong not only in their lives but also in everyone else’s. They may be extremely sensitive, easily brought to tears, and talk endlessly about how bad things always seem to be happening to them. They can be extremely unreasonable, holding on to a hurt or nursing a grudge for a long time.

These symptoms don’t always need to be present for a child to be diagnosed as depressed as the symptoms of depression vary dramatically with age.  And because young children have difficulty expressing their feelings verbally, depression is more often inferred from their behavior rather than from what they say.

Depression in childhood is a serious problem that warrants intervention. It is often overlooked as a possible cause of children’s sudden trouble in school, with friends, or as a reason why they have become so confrontational with their family. Depression in childhood may also be mistaken for “normal” developmental problems.  Childhood development is a complex process; children often seem to change their whole personalities during this time. Further complicating the diagnosis is that symptoms of depression share some of the symptoms of Attention Deficit Disorder (ADD).  If ADD is present, it might mask the more dangerous illness of depression.  

Widely used and successful treatments include:

Medication:  Many adolescents benefit from one of the numerous medications prescribed by psychiatrists, available for depression, conjointly with some type of therapy.

Cognitive Behavioral Therapy:  This type of therapy helps to correct negative or self-defeating ways of “thinking,” such as unrealistic expectations or irrational thoughts that lead to depressive feelings and has been found to be extremely beneficial.

Psychotherapy:  Although there are many forms of “talk therapy,” they all look to give adolescents an opportunity to explore and understand their thoughts and feelings.  Therapy may also help them talk about and resolve the feelings that are painful or troubling to them – as well as help them understand how they can develop healthier relationships with people and “cope” with the stresses and frustrations they might be experiencing.

It can still be “the best of times”

Most parents feel today’s adolescents have it easy. However, many social psychologists feel it’s both the “best of times and the worst of times” for today’s teens.  When adolescents are depressed they frequently believe they are alone and that nothing is available that can help improve their lives.  Yet, almost always, with guidance, support, direction and the correct therapy, depression can be treated successfully. Adolescence can indeed be the “best of times” for today’s young people.

 

Paul Schwartz, Ph.D. is a professor of psychology and education at Mount Saint Mary College