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.

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.

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

If you are worried that your child may be depressed, it is important to discuss this with your child’s doctor. Your child’s doctor may recommend a comprehensive assessment. A comprehensive psychological assessment will include talking to you, your child, and potentially other informants to get information related to the degree and severity of symptoms, psychosocial stressors, and functioning of your child. The psychological assessment will likely include interviews, standardized tests, and questionnaires created to better understand your child’s strengths and weaknesses in several areas. What is a Psychological Assessment? Psychological assessments can be extremely helpful in identifying your child’s strengths and weaknesses in several areas of functioning. These tests can help to identify learning styles and social-emotional patterns of functioning, which can be extremely helpful in designing effective interventions that are tailored to your child. Some parents seek out a psychological assessment when they have concerns about how well their child or teen is functioning, while others are advised to get an assessment by a professional who notice something amiss. No matter the reason for getting an assessment, the important thing is that these assessments can provide valuable information that can help to improve the functioning of children and teens. A psychological assessment should always consider the whole child. This means taking into account everything from family and school life to the child's community. Every child is different, so it's important that assessments are individualized and based on the specific needs of the child. If there are concerns that led to the referral, these should be addressed as well. Some of the things that a psychological assessment may include are: Behavioral, emotional and social development: A social-emotional and personality evaluation is an important tool for understanding a child's mental health. The assessment can provide direction for behavioral management strategies to be used at home or school. If there are mental health concerns, the assessment can also provide therapists with information for treatment planning, including whether or not medication is appropriate. The results of the assessment can help to create a treatment plan for providing the best possible support for your child. Intelligence: Intelligence tests help identify individuals who may have developmental delays, intellectual giftedness, or learning disabilities. They can also be used to determine an individual's strengths and weaknesses in different cognitive areas. Typically, an intelligence test will measure several cognitive skills including: language and communication skills, nonverbal reasoning skills, and speed at absorbing and processing new information. By looking at an individual's performance across these different skills, a child’s treatment team can get a better sense of their strengths and weaknesses, which in turn helps better tailor a child’s educational and treatment recommendations. Achievement: Psychological and educational testing can play an important role in assessing a child's academic strengths and weaknesses. By measuring mastery of reading, mathematics, and writing skills, these tests can provide valuable information about a child's learning abilities and needs. In particular, these tests can help to identify learning disabilities such as dyslexia. For children with special needs, the psychological assessment can help to develop an Individualized Education Plan (IEP) at a Planning and Placement Team meeting (PPT). By working with the child's educators and caregivers, the IEP can help to ensure that the child receives the appropriate educational services and support. For more resources related to IEPs and PPTs, please visit PAVE WEBSITE. Memory and attention: Neuropsychological testing is a valuable tool that can be used to identify a variety of conditions, including attention deficit hyperactivity disorder (ADHD). This set of tests can measure memory skills, reasoning abilities, and executive functioning, like planning and organizational skills. Neuropsychological testing is often used to identify ADHD because it can provide an objective measure of attention and impulsivity. This type of testing can also be used to rule out other potential causes of ADHD symptoms, such as learning disabilities or emotional disorders. In addition, neuropsychological testing can help to identify which specific interventions will be most effective for treating your child’s symptoms. As you may notice, psychological and educational testing can be a valuable tool in helping your child reach their full potential. Findings of a psychological assessment can not only help you better understand your child, but can also be used by your child’s school team to qualify them for academic accommodations in the classroom (e.g., a 504 Plan) or for more formal, individualized support (i.e., an Individualized Education Plan or IEP). In addition, findings from an evaluation can help guide clinical treatments and interventions. Who can do them? Not all treatment providers are able to conduct a psychological assessment. Licensed clinical psychologists (i.e., professionals with a Ph.D. or Psy. D.) or credentialed school psychologists are expertly trained to administer assessments and tests and interpret the results. Licensed clinical psychologists have years of training, experience, and knowledge to select the right tests for each individual client. What to expect from a comprehensive psychological assessment? Typically, a psychological assessment involves a combination of questionnaires, structured interviews, and testing sessions. An evaluator will likely ask you to fill out multiple questionnaires related to your child’s development, medical, social, and academic history. The evaluator may also seek previous evaluations and/or school reports that you may have for your child. This is all in hopes to help create a detailed timeline of symptoms and severity of problems that they can integrate into their findings from testing. In addition to the questionnaire completion, an evaluator will also interview your child, primary caregivers, and potentially school/community informants (e.g., teacher, therapist). The interviews will help provide information about your child’s strengths, weaknesses, and areas of particular concern. The evaluator will also have formal testing sessions with your child. During these testing sessions, the evaluator will be looking at your child’s cognitive, educational, and social-emotional functioning. The interviews, questionnaire completion, and testing sessions can be completed over a lengthy day process and/or broken up into several different sessions. Either way, parents should expect that the process for completing the testing and interviewing will take several hours. And while that may seem difficult to commit to, a comprehensive psychological assessment can be extremely valuable in helping tailor your child’s treatment and educational needs. Once all of the testing, interviews, and data collection are completed, the evaluator will write a comprehensive report that includes the testing results as well as treatment/educational recommendations. Upon report completion, the evaluator will also schedule a time to review the results and recommendations with you (and your child if age appropriate). During the feedback session, you are encouraged to ask as many questions as you may have about the results. No question is a bad question when it is helping you understand your child’s strengths, weaknesses, and ways that you can support their growth.

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. Once I get the results of a comprehensive psychological assessment, what should I do? Once you have received the results of you child’s psychological assessment, you should try to follow the recommendations detailed by the evaluator. This may include discussing the report with your child’s current or future therapist, pediatrician, and/or school team. It will be important for everyone within your child’s treatment team to be on the same page when creating action plans. As your child’s parent you are able to share the report with anyone you think would benefit from reading the materials. If you would like the evaluator to send the report and/or discuss the content with another person, you will need to make sure that you have signed appropriate releases of information that allow the evaluator to discuss this with that other individual. Click here for tips on how to discuss the results of the psychological assessment with my child's school team.

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.