CASA of Arizona

Childhood Depression - pg. 2

Early Signs



Before a child ever receives professional attention, they exhibit symptoms of depression. Family, friends, and even some doctors may discount this behavior as being part of adolescence or side effects of growing older. But in depression the symptoms are pervasive and long lasting. They do not pass with the "bad day" or the mood swing.

  • Here is a list of symptoms that can indicate a child is suffering from depression.
  • Bad temper, irritable, easily annoyed, quarrelsomeness, lack of respect for authority, and difficulty getting along with others
  • Change in sleep habits, insomnia
  • School performance has dropped, indecision, lack of concentration, or forgetfulness
  • Withdrawal from friends and loss of interest most activities
  • Repeated physical complaints without medical cause (unexplained aches and pains)
  • Fatigue and loss of energy nearly every day
  • Significant increase or decrease in appetite
  • Persistently discouraged and sad, and feelings of being helpless, hopeless, or worthless

Serious and Critical Symptoms

  • Suicidal thoughts, feelings, or self-harming behavior
  • Abuse or prolonged use of alcohol or other drugs
  • Symptoms of depression combined with strange or unusual behavior
There are several useful tools that evaluators use for screening children and adolescents for possible depression. When a youngster screens positive, a comprehensive diagnostic evaluation by a mental health professional is warranted. The evaluation should include interviews with the youth, parents, and when possible, other informants such as teachers and social services personnel.

Diagnosis



It usually takes more time to diagnose major depression in a child than in an adult. The diagnostic process includes interviews of parents and the child. Parents are more likely to report outward signs of depression, while the child may be more aware of inward signs. But children and young adolescents with depression may have difficulty in properly identifying and describing their internal emotional or mood states. For example, instead of communicating how bad they feel, they may act out and be irritable toward others, which may be interpreted simply as misbehavior or disobedience. Research has also found that parents are even less likely to identify major depression in their adolescents than are the adolescents themselves. Sometimes a parent's report is skewed by the parent's own agenda, so school and other outside reports are useful.

The correct diagnosis of depression is complicated. There are many alternative diagnostic systems and criteria for depressive syndromes. Using the Diagnostic and Statistical Manual of Mental Disorders, there are four diagnostic categories involving depression.

  1. Major Depression. A severe form of depression that may involve disturbed sleep, appetite, suicidal thinking or self-harming behavior, loss of interest, problems thinking or concentrating, fatigue or loss of energy, restlessness or lethargy, and lowered self-esteem.
  2. Dysthymia. A less severe form of major depression in which symptoms are less evident and may appear chronic and last more than 2 years.
  3. Separation anxiety disorder. Depressive symptoms that are clearly associated with a child's separation from those to whom he or she is attached.
  4. Adjustment disorder with depressed mood. Depressive symptoms that emerge as a reaction to an identifiable psychosocial stressor. The reaction is viewed as maladaptive and the symptoms are considered in excess of what is usually expected.

To diagnose a child with depression, both dysphoric moods (a state of feeling unwell) and self-deprecatory ideation must be manifest. Examples of these criteria are listed on the Early Signs page of this training module. A depressed child should exhibit at least four of the listed behaviors. Most young people diagnosed with depression actually match seven or eight of the criteria.


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