PARENT SERIES

University of Kansas, Clinical Child Psychology Program

Parent Series Editor: Carolyn S. Schroeder, Ph.D., ABPP

Depression in Children and Adolescents

Jonathan L. Poquiz, M.A. and Andrew L. Frazer, M.A.

Many people believe only adults can have depression, but children and teenagers can also be
affected by depression. About 11 percent of teens experience depression before age 18.

Depression is more than just bad moods and occasional feelings of being down or sad. Those
feelings are normal in children, and especially teenagers. When faced with major
disappointments or setbacks, people feel sad, but the sadness usually lessens with time. Parents
should be concerned when sadness lingers for weeks, months or longer — and limits a child’s or
teenager’s ability to function.

Symptoms of depression can be hard to spot in children. Children may show different symptoms
at different ages, and throughout adolescence.

What Depression Looks Like at Different Ages

Age Behaviors Precursors

Preschoolers Anger, irritability, tantrums Family history of depression
(Ages 2-5) Excessive crying, sad expressions and mental illness
Loss of interest in favorite toys/activities Family history of suicidal
Complains of physical symptoms like ideation and attempts
stomachaches and headaches Family stressors such as
divorce, loved one’s death
Chronic, physical illness
Middle Childhood Behaviors listed above, and: Precursors listed above, and:
(Ages 6-12) Prefers to be alone rather than with family or Low parent/peer social
friends support
Bullying, or being bullied Inconsistent parenting
Sleep problems Bullying, or being bullied
Eating problems such as no appetite, weight- Social isolation/rejection
loss High academic pressure
Difficulty concentrating Other mental illnesses such
Separation anxiety from caregiver as anxiety*, learning
Refusing to attend school disorders, substance abuse
Poor school performance
Thoughts of worthlessness, hurting oneself

Adolescence Behaviors listed above, and: Precursors listed above, and:

(Ages 13-18) Feels hopeless or pessimistic about their future Onset of puberty
No interest and enjoyment in activities Parent-child conflict due to
Low self-esteem and self-worth increased independence
Runs away from home
Substance abuse
Thinks, plans or attempts to hurt oneself
*It is not uncommon for children with anxiety disorders to be diagnosed with depression as well.

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Preschoolers (ages 2-5)
Preschoolers have difficulty verbalizing their emotions, so parents often miss the earliest signs of
depression. However, it is important for parents to recognize that behaviors such as irritability,
crying and physical complaints persisting for weeks and even months can be due to depression.
Research has shown that preschool depression can lead to other mental health illnesses in
childhood and adolescence.

Middle Childhood (ages 6-12)

As the ability to talk about feelings increases, children begin showing symptoms similar to those
in adults. However, the younger children in this age-range may still have difficulty expressing
their feelings, so they can also exhibit behaviors similar to preschoolers. It’s important to note
that more serious symptoms may show up in this age range, such as thoughts of hurting oneself
— “I would be better off dead,” “I wish I wasn’t here anymore,” “I’m no good to anyone
anymore” — for instance. If you hear your child share any of these thoughts, seek services as
soon as possible.

Adolescence (ages13-18)
The risk of depression markedly increases with puberty. Since adolescence is a time for teens to
be more involved in activities, and be more independent, warning signs of depression can
involve friendships and thoughts of the future. Again, if you hear or see your teen share more
serious behaviors, such as substance abuse or suicidal thinking, seek services for him or her as
soon as you can.

Problems Associated with Depression

While children at different ages may exhibit depression with different behaviors, it’s important to
note that they can’t just “snap out of it.” Left untreated, depression can lead to poor school
performance, bad friendships, and other mental health problems like delinquency, substance
abuse or even suicide.

School and Academic Problems

Behaviors that can impact learning include loss of motivation and interest, poor concentration,
and sense of worthlessness. For example, a depressed child may be too distracted by depressive
thoughts, or may lack the energy to concentrate on schoolwork. Additionally, depressed children
or adolescents may get negative and unwanted attention from teachers or friends, fueling feelings
of worthlessness, which affects their engagement in school.

Your child may have some ups and downs in his or her school performance that could be
explained by factors like stressful events including moving, parental divorce or even just the
normal difficulties and frustrations of learning. However, it should always be cause for concern
when you notice a decline in your child’s academic performance with no clear explanation.

Peer Relationship Problems

Having positive and healthy friendships are an important part of growing up. Such relationships
promote positive behavior and emotional adjustment.

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Depressed children, especially if they exhibit aggressive behavior, are more likely to be rejected
or avoided by their friends. This rejection can isolate them,and result in relationships with peers
who engage in negative behaviors such as drug use.

Furthermore, because depressed children are more likely to be rejected by their peers, they are at
higher risk of being bullied, which can perpetuate depressive thoughts and feelings. Likewise,
peer rejection and bullying can lead to depression. That’s why it’s important for parents to be
aware of their children’s social relationships.

Self-Harming and Suicide

For parents, no fear compares to that of their child or adolescent being at risk for suicide.
Suicidal thoughts are not uncommon in adolescents. About one in 10 adolescents contemplated
suicide at some point in the past year. Research has also shown one out of 10 adolescents
reported having attempted suicide, but rates of completed suicides are rare. That said, take
seriously any and all expressions of suicidal behavior. Parents should know the risk factors
of suicidal behaviors.

One of the primary risk factors of suicide is the presence of mental health disorders, particularly
depression. As a parent, be particularly mindful of:
Persistent low mood, pessimism, and hopelessness
A preference to be alone, withdrawing from family and friends
Pronounced anxiety: some youths, particularly those younger than adolescents, may exhibit
depressive symptoms that look similar to anxiety. Be aware if your child has sudden anxiety,
such as being clingy, nervousness, or reporting physical complaints like headaches and
stomachaches without an obvious explanation for the behavior.

Dealing with Suicide

What can parents do?

Be aware. Look out for warning signs, and trust your instincts.
Take it seriously. ALL suicide threats and attempts must be taken seriously.
Get involved. Be emotionally and physically available to your children. Help them process
and understand their feelings. Don’t be afraid to ask if your child is thinking about suicide.
Get specific about their thoughts, and find out if there’s a plan. Using the word “suicide” or
even bringing up the topic of suicide will NOT increase the chances that your child will
attempt suicide.
Do not leave your child alone. Safeguard the area. Closely monitor your child and remove
anything your child could use to hurt himself or herself, such as medications, sharp objectsor
guns.
Seek professional help. Take your child for an immediate evaluation at the nearest
emergency room, or call 911. Seek out professional treatment and be your child’s advocate.
Multiple research studies have found that a combination of both psychotherapy and
medication works best to treat depression. Research evidence also emphasizes that early
intervention may be effective in reducing the probability of future mental health problems
such as anxiety or substance abuse.

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Seeking Professional Help
It’s not only important to find professional help; it’s just as important to find the right “fit”
between the professional and your child. Finding the right professional help can be hard! You
can start by asking your child’s pediatrician or school counselor about potential referrals for
mental health providers in your area.

Your child’s pediatrician may prescribe medications for depression. However, a pediatrician will
usually refer you to a psychiatrist for specialized treatment.

For psychotherapy, mental health professionals that may be available include psychologists,
social workers and mental health counselors.

Before starting treatment, it’s important to speak with the professional over the phone or meet in
person to determine the type of therapy to be provided, and whether it and the therapist would be
suitable for your child.

Evidence-based treatments
Cognitive-Behavioral Therapy (CBT) has been consistently researched and found to be an
effective treatment for depression. This treatment focuses on both cognitive (thoughts) and
behavioral components of depression; specifically identifying and replacing negative thoughts,
and using positive behavioral skills to create and maintain positive moods and healthy
relationships.

Dialectical Behavior Therapy (DBT) is an effective treatment for adolescents with depression,
and particularly suicidal ideation. As a form of CBT, DBT focuses on similar targets, but adds
more components, such as attending a group skills class in addition to individual therapy. DBT
also teaches specific skills like how to manage emotions, how to communicate effectively, and
how to tolerate distress.

Resources for Parents

Books
Free Your Child from Negative Thinking. Tamar Chansky, Da Capo Press, 2008.
Provides advice for caregivers on how negative thinking comes about and how caregivers can
help manage negative thoughts, build optimism, and establish emotional resilience.

What to Do when You Grumble Too Much. Dawn Huebner and Bonnie Matthews, American
Psychological Association, 2007.
A guide for children 6-12, and their caregivers, to learn CBT skills to target negative thinking
through metaphors and illustrations.

Online
Depression Fact Sheet
http://www.nimh.nih.gov/health/publications/depression-in-children-and-adolescents/index.shtml

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National Suicide Prevention Lifeline
www.suicidepreventionlifeline.org

Parent Guide to Recognizing and Treating Depression

http://www.yspp.org/downloads/resources/YSPP_depression_Final_low.pdf

Depression Resource Center

http://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Depression_Resource_Cent
er/Home.aspx

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