Even Toddlers Get the Blues
Your 3-year-old isn’t her usual spry self. She no longer brightens at the sight of you first thing in the morning. She refuses to eat & she hasn’t been this
cranky since she first started teething.
Instead of tagging along with her older siblings or contentedly scribbling in her favorite Blues Clues coloring book, she gazes blankly out the window, listless & dejected. Could she be depressed?
Depression in Preschoolers
Like most people, you probably assume preschoolers are too young to get the blues. But new research shows clinical depression knows no age. Depression - & even thoughts of suicide -- are as likely to affect toddlers & adolescents as they are adults.
an ongoing National Institute of Mental Health study, researchers at Washington University School of Medicine revealed
that children experience the same symptoms of depression often found in adults & with the same severity.
Children are more depressed than ever before, prompting a major Surgeon General report on children’s mental health & sending our nation’s
behavioral health caseload soaring to record highs.
According to the National Mental Health Association, 1 in 3 American
children suffers from depression. Magellan Behavior Health, the leading mental health provider in the US, reports that
more than 3,500 of its nearly 149,000 members with depressive disorders are under age 10.
In spite of the staggering statistics, depression remains the most under-diagnosed & under-treated illness among children & adolescents.
Unlike the reddish, raised bumps of chickenpox or the leaky nose of the common cold,
the symptoms of depression aren't so concrete & consequently, often go unnoticed by unsuspecting parents.
What are the signs of childhood depression? What behaviors should parents look out for?
Toddlers & children who are depressed are persistently irritable, withdrawn & lethargic, says Dr. Elizabeth Rody, child & adolescent psychiatrist & medical director for
Magellan Behavioral Health’s New Jersey Regional Service Center.
“Depressed children lose interest in activities that once captivated them,” says Rody. “Like adults who are depressed, an overwhelming sense of hopelessness & doom prevails.”
Other symptoms of pediatric depression parents should be aware of include:
Is It Just a Passing Phase?
It’s not unusual
for children to feel down in the dumps from time to time. Knowing this, how can parents tell normal fluctuations in mood apart
from serious depression? The answer is in the duration of the depressive behavior.
According to Mental Health: A Report of the Surgeon General,
children who are depressed experience depressive episodes that last on average from seven to 9 months, although some child
development experts say depressive behaviors lasting beyond 2 weeks warrant further investigation. Either way, it’s
best to let mental health professionals decide.
Rule Out Physical Illness First
Depression isn’t always to
blame for despondent behavior in children. Physiological problems, such as malnutrition, mononucleosis, allergies & other illnesses
can all spur irritable moods, fatigue & withdrawal. This is why Rody stresses that parents take their children to the family pediatrician first, before booking an appointment with a mental health professional.
Once common health problems are ruled out at the primary care level, the next step is to get a
referral to a child & adolescent psychiatrist for evaluation. In addition to lengthy psychological tests & blood work,
parents should be prepared to review their child’s entire medical history.
Who is at Risk?
Although the precise causes of childhood depression aren't
yet known, studies on adults with depression point to genetic predisposition & environmental influence.
“It’s some nature & some nurture,” says Rody. “Let’s compare depression
to heart disease. You could have a family history of heart disease & at the same time live the couch potato lifestyle.
Both could bring on a heart attack. Depression is the same way. It’s not one or the other. It’s a complex combination
whose parents &/or siblings suffer from depression are more likely to develop symptoms of the disease. Learning disabilities,
says Rody, such as Attention Deficit Hyperactivity Disorder (ADHD) & dyslexia can also contribute to the onset of childhood
Environmental factors that place children at risk for depressive disorders include physical, sexual
& verbal abuse, neglect and a history of substance abuse in the family. Divorce and the loss of a loved one can also cause
emotional upheaval in a child, but are not always precursors to depression.
Taking Your Child’s Emotions Seriously, Asking the Right Questions
Even if your child
is only a toddler, his emotions are very real. Experts believe the more parents pay attention to their children’s feelings,
the better equipped they are to pick up on and seek treatment for depression.
“If your child says, ‘I’m so sad I’m gonna jump out of this window,’ you’d
better take it seriously,” cautions Rody. “Instead of getting trapped into thinking, ‘He’s four. That
couldn’t possibly mean anything,’ you should be following up right away.”
Here are some follow-up questions Rody has used with child and adolescent patients in the past
to get to the root of their depressive behavior:
happened today to make you seem so sad?
makes you happy?
are you looking forward to?
do you wish would happen to you?
you could change something about yourself, what would it be?
Treatment for child and adolescent depression often includes a combination of individual
psychotherapy and family counseling. Optimally, stresses Rody, therapy should involve parents, siblings and other important
figures involved in the child’s life, like day care teachers and grandparents.
More comprehensive treatment plans may include play therapy, ongoing evaluation & in some cases, medication.
Antidepressant medications are often prescribed to treat milder cases of depression. However, it’s important to note that the Food &
Drug Administration hasn't yet approved antidepressants for children under 8 years old.
more information about depression in children, consult the following resources:
The American Academy of Child & Adolescent Psychiatry, 1-(800) 333-7636, www.aacap.org
The National Mental Health Association, 1-(800) 969-NMHA, www.nmha.org
Mental Health: A Report of the Surgeon General, Chapter 3: Children & Mental Health : click here