DEPRESSION
Depression is a mood disorder that causes persistent sadness and loss of interest in things someone used to enjoy. Clinical depression affects how a person feels, thinks, and behaves and can show up in a variety of ways. It often occurs as both emotional (e.g., sadness, irritability) and physical symptoms (e.g., difficulties sleeping, weight loss).
As a parent, it's important to be able to recognize when your child is experiencing normal feelings of sadness, and when they may be dealing with something more serious. Sad thoughts are a normal part of life, and everybody experiences them from time to time. However, if your child is having difficulty in school, or withdrawing from friends and family, it could be a sign of something more serious.
In such cases, it's important to seek professional help. A qualified mental health professional can assess your child's symptoms and provide the necessary support and treatment. With the right help, your child can begin to feel better and get back on track.
- 01
Children and adolescents with depression may experience some or all of these symptoms below everyday, or most of the day:
Feeling or appearing sad, tearful or irritable
Not being able to have fun doing things that were fun before
Eating a lot more or a lot less than usual
Moving around very quickly or very slowly
Sleeping much more or much less than usual
Having a lot less energy than usual
Feeling like they are “no good” or guilty
Having a hard time thinking, concentrating, or remembering
Having thoughts about hurting or killing themselves
Something to note, younger children may have a harder time expressing their sad thoughts than older children. Be on the lookout for signs of increased irritability, boredom, and physical complaints as signs of depression for younger children.
- 02
Research suggests that depression has a genetic component. Depression is more common among kids who have a family history of the condition, and it is believed that certain genes may make some people more vulnerable than others. While the presence of these genes does not guarantee that a person will develop depression, it does increase the risk.
Additionally, stress can also play a role in both the onset and severity of depression. Stress can come in all different forms and might include:
Difficulties with peers
Family relationship challenges
School changes
Loss of a loved one
Developmental factors (such as learning and language disabilities)
Puberty can also be an additional time of stress for an adolescent. During this time, it's normal for children to experience some ups and downs during. After all, they're going through a lot of changes both physically and emotionally. However, for some children, these changes can be overwhelming and can lead to depression and anxiety. Adolescents are likely to react more emotionally due to their stage of brain development and the fact that they don't yet have effective problem-solving skills. With the support of family and friends, most children will eventually adjust to the changes they are experiencing and emerge from puberty unscathed. However, if you are concerned about your child’s emotional well-being, don’t hesitate to seek professional help.
- 03
Depression is a mental health condition that can affect people of all ages, even children. Depression is more common in adolescence, with more than half of adolescents reporting feeling depressed at some point. However, depression can also affect younger children, even preschoolers.
Children and adolescents may not know how to talk about feeling down or worried and may become withdrawn or less cooperative or irritable
- 04
Cognitive Behavioral Therapy (CBT)
CBT is a widely researched form of psychotherapy that has been shown to be an effective form of treatment for youth with depression. CBT focuses on how a child’s thoughts, feelings, and behaviors are interconnected. A CBT therapist will collaboratively work with your child to help them learn new skills, tools, and knowledge needed to help them improve their mood.
A CBT therapist may also work with a child’s caregivers to provide them with [PM1] resources and skills to continue to help their child after therapy ends. CBT therapy sessions that include the caregivers may be together or individual (parent alone, child alone).
CBT will likely also incorporate hands on techniques that you and your child can practice in-between treatment sessions. These in-between practices help your child generalize the lessons learned in treatment to outside of the therapy office.
Pediatric guidelines recommend CBT as a first-line treatment for those with mild depression. However, for those adolescents with more severe depression and those that have treatment-resistant depression, CBT combined with antidepressant medication may be the most effective form of treatment.
CBT alone treatment typically incorporates six to 16 weekly sessions.
Click here for more information.
Interpersonal Psychotherapy-For Adolescents (IPT-A)
Although CBT is the most widely studied psychotherapeutic intervention for adolescents, IPT is a well-established treatment that has been shown to be effective for a variety of mental health conditions.
IPT-A is a type of therapy that can help teens improve their relationships with others. The goal of IPT-A is to learn how to effectively communicate emotions and needs, problem-solve within a significant relationship, and understand the biopsychosocial explanation of depression. A biopsychosocial model emphasizes that negative or distressing events people experience can exacerbate feelings of sadness and worthlessness, both common symptoms of depression. As relationships with others improve, the depressive symptoms may subside, and the person will hopefully experience improved functioning in multiple areas of his/her life. Teens who undergo IPT-A therapy may find that they are better able to manage their depression and have more positive relationships with others.
An IPT-A therapist will focus on improving your adolescent’s communication and problem-solving skills through incorporating techniques such as psychoeducation, affect labeling, and social skills training.
IPT-A will also include techniques that your child can practice in-between treatment sessions. These in-between practices help your child generalize the lessons learned in treatment to outside of the therapy office.
The therapist will work with the adolescent in individual sessions as well as help their caregivers learn additional ways to support their child and monitor their symptoms.
IPT-A treatment typically incorporates 12 to 16 weekly sessions.
Dialectical Behavioral Therapy (DBT)
DBT, is a type of cognitive behavioral therapy that was originally developed for adults. In recent years, however, it has been adapted for use with adolescents. DBT has been proven to be an effective treatment for moderate to severe depression, as well as co-occurring disorders such as anxiety and substance abuse. It is also effective in treating self-harm and suicidal behaviors. DBT is based on CBT, but it also includes strategies for controlling emotions and handling stressful situations. As a result, DBT is a highly effective treatment for adolescents struggling with mental health issues.
DBT is particularly useful for adolescents who have difficulty managing their feelings of intense emotions and mood swings.
A DBT therapist will help your child learn skills related to emotion regulation, managing relationships appropriately, distress tolerance, mindfulness, and finding a balance within their emotional reactions.
DBT incorporates individual therapy sessions for your teen, group sessions with peers, and one-on-one coaching during emotional crises.
DBT treatment typically incorporates 1-2 sessions per week for approximately six months.
Medications
Antidepressant medication can be an effective form of treatment for children and adolescents struggling with depression. In fact, the American Academy of Child and Adolescent Psychiatry indicates that about 55-65% of children and adolescents will respond to initial antidepressant medication treatment. Also, for those that do not respond to antidepressant medication alone, research seems to suggest many youth respond well to medications combined with therapy.
Medications called selective serotonin reuptake inhibitors (SSRIs) are the primary treatment for youth with depression.Currently there are only two SSRIs that are approved by the FDA for treatment of depression for youth.
Fluoxetine (also known as Prozac) has been approved for children 8 years and older.
Escitalopram (also known as Lexapro) has been approved for adolescents 12 years and older.
Important to note, the American Academy of Child and Adolescent Psychiatry indicates that “your doctor may prescribe other antidepressant medications that are not FDA approved based on available data. You should know that prescribing an antidepressant that has not been approved by the FDA for use in children and adolescents (referred to as off-label use or prescribing) is common and is consistent with accepted clinical practice.”
Before your child starts antidepressant medication, it will be important to have your child get a thorough evaluation from a mental health professional.
This can be done by a psychiatrist – or a pediatrician or family physician who is experienced in treating children and adolescents with mood disorders.
A medication evaluation should include:
An assessment of your child’s current emotional and behavioral concerns, particularly related to if your child potentially has multiple problem areas/diagnoses.
An evaluation of your child’s family history of mental health and suicide concerns.
A detailed review of any risk factors that may affect your child and increase their risk of self-harm behaviors.
For more information related to medication management for youth with depression see the American Academy of Child and Adolescent Psychiatry’s Depression: Parents’ Medication Guide.
- 01
If you’re worried your child might be depressed, trust your instincts—it’s important to reach out for help early. Start by talking to your child’s pediatrician or primary care provider. They can listen to your concerns, do a basic screening for depression, and refer you to a mental health professional if needed. You can also contact a child therapist, psychologist, or psychiatrist directly. These professionals are trained to assess your child’s emotional wellbeing and provide support through therapy, and in some cases, medication. If your child is in school, you can also talk to a school counselor or social worker—they may help connect you with local resources. You don’t have to have all the answers to start; reaching out is the first—and most important—step.
- 02
If you’re worried your child might have Depression, talk to their doctor. The doctor may recommend a full psychological assessment to better understand what’s going on. This usually includes talking with you, your child, and sometimes teachers or others who know your child well. The assessment often involves interviews, questionnaires, and tests that help show your child’s strengths, challenges, and how they’re doing at home, school, and with friends.
Learn more here.
- 03
How can I get one for my child? Depending on your particular need, you may seek a psychological assessment from your school’s psychologist (if you are seeking IEP/504 accommodations) and/or outside providers.
Click here for more information on how to seek a psychological assessment through your school.
Click here for a sample letter of how to request that your child receive an evaluation for special education services.
Click here for a list of providers in your area that conduct psychological assessments.
If you are a parent seeking resources from your school, it is important to highlight that when requesting an IEP from your school, you do have the right to have your child evaluated by an outside professional other than your school’s psychologist. To note, in many of these cases, you will have to pay for the private evaluation. Furthermore, while the school must consider the evaluation from the outside provider, they do not necessarily have to accept the results.
- 04
ACTIVITY SCHEDULING
When someone experiences depression they can tend to isolate themselves from others around them. Often times this isolation increases their feelings of depression, causing further isolation and reducing the amount of time they spend doing activities that bring them joy.
Activity scheduling, also known as behavioral activation, is an evidence-based technique that involves helping a child regularly engage in activities that they enjoy. The goal of activity scheduling is to reduce a child’s feelings of depression and increase their mood.
The key to activity scheduling is finding activities that are rewarding to the child and foster their personal values. It has also been shown to be helpful to incorporate activities that are physically engaging (e.g., exercise instead of playing video games) and have a social component (e.g., spending time with friends/family).
Some examples of activities can be:
Exercise: Going on a hike with a friend, playing soccer, skiing
Relationship building: Going to a friend’s house, joining after-school programs
Activities in the community: Try to identify your child’s interests and link those to groups, clubs, and/or teams in your community (e.g., Scouts, dance)
Here’s a resource to help with planning.
More about Activity Scheduling Parents can:
Help your child find and regularly do activities they enjoy.
Join your child in the sport, game, or whatever, whenever possible.
Encourage your child by saying what you see them do or accomplish:
“I saw you hit that basket from way downtown. Wow, way to go!”
“You seriously swam across that pool and back 5 times? I’m impressed!”
“I’m looking at this painting and seeing red, blue, purple—so many colors that make my eyes feel happy and proud of your good work!”
Look for signs that the regular activities are helping:
Has your child’s mood improved?
Is your child more comfortable and positive about going out and doing things?
What should I be looking for from my therapist?
Your therapist should be:
Helping your child understand how engaging in different activities can change how they feel
Working with your child to identify different activities that they may enjoy
Helping you and your child learn bhow to schedule making these pleasant activities a part of their day/week
Using hands on techniques to help you child understand how certain activities can increase their mood
Helping your child identify any mood changes as they start to incorporate more pleasant activities into their schedules
What can I do be doing as a caregiver?
You can:
Support your child to engage in new and enjoyable activities
Participate in activities with your child
Reward and praise your child as they engage in these new activities
Looking for signs this is working:
You may see: Your child’s mood improves
As your child starts to engage more in these activities, they may feel more comfortable and positive about doing these activities.
COGNITIVE WORK
Often times our thoughts can affect how we feel. As an example, when we have more negative thoughts (e.g., “I’m no good at anything.”), we tend to feel more negatively (e.g., sad, frustrated). Cognitive techniques help a child change their thoughts by understanding the meaning they are giving the situation/event.
This technique is often done through a child keeping a record of the different thoughts they have (e.g., “thought record”) during a given period.
When incorporating cognitive techniques into treatment, a therapist will work with your child to help them recognize patterns of thinking and identify ways to test the potential accuracy of these thoughts.
The goal of cognitive techniques is to help children change their thoughts into more positive, helpful thoughts that increase their mood ratings.
What should I be looking for from my therapist?
Working with your child to recognize their current thought patterns
Helping your child question the accuracy of their current thoughts
Assisting your child create more realistic thoughts
Tracking your child’s mood as they progress through treatment
What can I do be doing as a caregiver?
Help your child by recognizing when they may be having an unrealistic negative thought
Help your child create a more realistic thought
Looking for signs this is working:
Your child may start to better recognize when they are having a negative thought
Your child may be able to identify when a thought affects their mood
Your child’s mood improves
Your child may start to use coping skills they are learning in treatment that help them combat their negative thoughts
Your child may start to use coping skills they are learning in treatment that help them combat their negative thoughts
RELAXATION SKILLS
Life can be stressful at times, particularly for youth with mood disorders. Finding ways to relax that works for your child can be a very helpful tool to help them cope during difficult times and improve their mood.
Relaxation techniques are typically done with a therapist at first, in order to help your child learn how to effectively practice and use the tools.
Such tools can include deep breathing activities, progressive muscle relaxation, guided imagery, and/or meditation. It’s important to note that all relaxation techniques work for every child, so it will be helpful for your child’s therapist to identify which techniques work best for them.
What should I be looking for from my therapist?
Educating your child about how physical feelings in your body can affect your emotions
Teaching your child different relaxation techniques
Practicing relaxation techniques with your child
Tracking your child’s mood ratings as they practice relaxation techniques
Helping your child practice the relaxation techniques outside of treatment sessions (e.g., at school, at home)
What can I do be doing as a caregiver?
Help your child practice their relaxation techniques
Praise your child when their use their relaxation techniques
Looking for signs this is working:
That your child is less stressed or tense
That your child voluntarily uses relaxation techniques when they are sad or stressed
- 05