By Dr Eugene Brink
As children develop, they endure all kinds of growing pains. Moods and feelings of sadness are therefore nothing strange in children of various ages.
However, if these negative and sad moods are persistent and endure for long periods it is time to intervene because your child may be suffering from childhood depression.
“Childhood depression is different from the everyday ‘blues’ that most kids get as they develop. The fact that a child feels sad, lonely, or irritable does not mean he or she has childhood depression,” writes Dr Dan Brennan, medical expert and contributor at WebMD.
“Childhood depression is persistent sadness. When it occurs, the child feels alone, hopeless, helpless, and worthless. When this type of sadness is unending, it disrupts every part of the child’s life. It interferes with the child’s daily activities, schoolwork and peer relationships. It can also affect the life of each family member.”
Causes and incidence
Brennan says the exact causes of child depression are unknown. “It could be caused by any combination of factors that relate to physical health, life events, family history, environment, genetic vulnerability, and biochemical disturbance.”
Child and adolescent psychiatrist Dr Brendan Belsham believes that genetic and environmental factors play an equal role in contributing towards childhood depression. In South Africa, there are a plethora of environmental factors that could contribute to child depression: divorce, family conflict, emotional and physical abuse, crime, bullying and poverty.
“Although there are no official South African statistics for childhood depression, it is common and underdiagnosed,” he says.
Signs and symptoms
A whole range of signs will intimate that your child could be suffering from depression.
Children could be irritable, angry and “on edge”; they experience persistent feelings of sadness and hopelessness; they are likely to withdraw from activities they usually enjoy; they cry and throw temper tantrums; they have physical complaints such as stomach aches and headaches; their ability to function at school and home is impaired; and sleep difficulties occur.
Although many of these overlap with depression in adults, child depression is not a carbon copy of it. “Depression in childhood and adolescence can manifest somewhat differently than it does in adults. Irritability and/or anger are more common signs of depression in children and teens,” says Dr Richa Bhatia, a child, adolescent and adult psychiatrist.
“When depressed, younger children are more likely to have physical or bodily symptoms, such as aches or pains, restlessness, distress during separation from parents, as they may not have the emotional attunement and/or expressive abilities to talk about their emotions.”
She says that not all the symptoms have to be present for a diagnosis of depression. “Symptoms usually occur on most days, for at least two weeks, in order to meet the criteria for depression.”
Belsham says treatment options for kids are similar to those for adults. “They include psychotherapy (counselling) and medication. Your child’s doctor may suggest psychotherapy first and consider antidepressant medicine as an additional option if symptoms are severe or if there is no significant improvement with psychotherapy alone.
“The best studies to date indicate that a combination of psychotherapy and medication is the most effective method to successfully treat childhood depression.”
According to Bhatia, other medical and psychiatric conditions with symptoms corresponding to depression – such as attention deficit hyperactivity disorder (ADHD) or anaemia – must be ruled out first. “For mild to moderate depression, CBT (cognitive behavioral therapy) is the typical first-line treatment of choice for children and teens. For moderate to severe depression, evidence-based guidelines recommend a combination of CBT and antidepressant medications.”
Belsham says for children aged 4 to 10, play therapy is recommended. For children older than 6, talk therapy could commence. Research has also shown that cognitive therapy is suited to older children as it helps them replace negative emotions and thought with positive ones.
Cleveland Clinic, 16 January 2015, “Depression in children”, https://my.clevelandclinic.org/health/diseases/14938-depression-in-children.
Dan Brennan, 4 November 2018, “Childhood depression”, https://www.webmd.com/depression/childhood-depression#1.
Linda Trump, 17 March 2010, “Childhood depression”, https://www.parent24.com/Child_7-12/Development/Childhood-depression-20150826.
Richa Bhatia, October 2018, “Childhood depression”, https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/childhood-depression.