Just like adults, adolescents and children can experience periods of low mood, sadness, and irritability. Much of the time such feelings are within the range of typical human experience and are not cause for concern. Sometimes, however, these feelings may be so intense that they impact functioning at home, school, or socially.
In situations where a child or adolescents functioning is significantly impacted, it may be an indication that they are experiencing clinical levels of depression, formally called major depressive disorder (MDD). Although the name of the diagnosis of depression is the same for adults, adolescents, and children, MDD may present differently in youths than it does in adults.
What is major depressive disorder?
Depression is one of the most common mental health disorders around the world (Weersing et al., 2017), and it impacts about 1 in 5 individuals (Forti-Buratti et al., 2016). In order for MDD to be diagnosed, symptoms must be present for most of the day for at least 2 weeks (APA, 2022). At least one symptom must be either depressed mood or the loss of pleasure and/or interest in activities lasting for at least 2 weeks (APA, 2022). Other symptoms include fatigue or low energy, thoughts of death or suicide, trouble concentrating or making choices, changes in level of physical movement, sleeping to little or too much, feelings of guilt or worthlessness, and significant unintended weight gain or loss (APA, 2022).
The criteria for diagnosing depression in children, adolescents, and adults is generally the same. In children and adolescents, depressed mood may present as an irritable mood (APA, 2022). In addition, unintended weight loss or gain may look like failure to attain expected weight (APA, 2022). If you notice these signs and symptoms in your own child or adolescent, it is important to know that treatment for depression is available. At New York Behavioral Health, clinicians utilize best practices when treating depression.
Depression in children and adolescents
Although it is a common disorder globally, depression is infrequent in children and it impacts approximately 1-2% of preadolescent children (Forti-Buratti et al., 2016). While depression is comparatively less frequently found in school age children, children with depression are more likely to develop a psychiatric disorder later in life (Forti-Buratti et al., 2016). Moreover, children impacted by depression are at increased risk for challenges with academic functioning, relationships with peers, and parental relationships (Forti-Buratti et al., 2016).
The incidence of depression increases as individuals age, and is at a prevalence seen in adults by the time adolescents reach their mid-teens (Forti-Buratti et al., 2016). In 2020, estimates are that 17% of adolescents between 12 and 17 years of age in the United States experienced a major depressive episode (NIMH, 2022). Parental history of depression, female gender, stressful life events, and difficulties with emotional regulation are some of the predictors of adolescent depression (Hammen et al., 2008). In addition, several studies have found that parental depression predicts recurrent episodes of depression in adolescents (Hammen et al., 2008). Given that an earlier onset of depression presents a risk for repeated episodes of depression and challenges with functioning in a variety of areas, intervening early and effectively is important (Weersing et al., 2017).
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Treatment
A variety of therapies for children and adolescents exist. Research into the efficacy of commonly used treatments for depression in preadolescent children is ongoing (Forti-Buratti et al., 2016). Given that depression in children and adolescents has implications for long term functioning and quality of life, evidence-based treatment early on is key (Dippel et al., 2022).
One of the most widely studied and best-supported treatments for depression is Cognitive Behavioral therapy, commonly referred to as CBT. CBT is an evidence-based treatment for adolescents, with somewhat weaker support as an intervention for children (Weersing et al., 2017). In one study that examined data from a group of related studies, the authors found that CBT was effective as a treatment for children as compared to no treatment (Yang et al., 2017). Despite some variability in the research between CBT for adolescents and children, CBT continues to be an effective choice of treatment for children and adolescents experiencing depression.
When children or adolescents are seeing a therapist for depression, caregivers and family members may be involved in treatment. Research has shown that family involvement in psychotherapy for adolescents can improve treatment, in general and specifically for depression (Dippel et al., 2022). Caregivers can speak with their child’s therapist to determine if family involvement in treatment would be beneficial.
How do I know if this is normal behavior or depression?
As mentioned above, depression in children and adolescents may look different than it does for adults, with irritability, not sadness, being a main concern. Developmentally, as children age they shift away from being parent-focused to being peer-focused, especially during adolescence. They are also prone to quick changes in mood and increased needs for privacy and independence. Given this, it might feel tough to understand if your child or adolescent is going through the typical ups and downs of development or if they are experiencing depression.
Sometimes marked changes in a child or adolescent’s functioning such as a decline in school performance, withdrawal from friends or family, a loss of interest in their preferred activities, and/or thoughts of wanting to harm themselves may be a sign that something is amiss. A diagnosis of depression will need to come from a trained professional. In general, if you are concerned it is a good idea to speak with your child’s pediatrician or reach out to a therapist for an assessment. If your child is struggling, you can reach out to a New York Behavioral Health therapist, or even schedule a free, 15-minute consultation.
References
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed., Text Revision).
Dippel, N., Szota, K., Cuijpers, P., Christiansen, H., & Brakemeier, E. L. (2022). Family involvement in psychotherapy for depression in children and adolescents: Systematic review and meta-analysis. Psychology and Psychotherapy, 95(3), 656–679. https://doi.org/10.1111/papt.12392
Forti-Buratti, M. A., Saikia, R., Wilkinson, E. L., & Ramchandani, P. G. (2016). Psychological treatments for depression in pre-adolescent children (12 years and younger): Systematic review and meta-analysis of randomised controlled trials. European Child & Adolescent Psychiatry, 25(10), 1045–1054. https://doi.org/10.1007/s00787-016-0834-5
Hammen, C., Brennan, P.A. & Keenan-Miller, D. (2008). Patterns of adolescent depression to age 20: The role of maternal depression and youth interpersonal dysfunction. Journal of Abnormal Child Psychology, 36, 1189–1198. https://doi.org/10.1007/s10802-008-9241-9
National Institute of Mental Health (January, 2022). Major depression. https://www.nimh.nih.gov/health/statistics/major-depression
Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T., & Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 46(1), 11–43. https://doi.org/10.1080/15374416.2016.1220310
Yang, L., Zhou, X., Zhou, C., Zhang, Y., Pu, J., Liu, L., Gong, X., & Xie, P. (2017). Efficacy and acceptability of cognitive behavioral therapy for depression in children: A systematic review and meta-analysis. Academic Pediatrics, 17(1), 9–16. https://doi.org/10.1016/j.acap.2016.08.002
