Depression in Children

The symptoms of depression can look different in children vs. adults. Learn more about the signs of depression in children.

Depression is a debilitating mental health disorder. While it is usually thought of as an adolescent or adult condition, children can also suffer from major depression. Depression in children can look different than in adults and can be influenced by their age and developmental stage. Recognizing depression in young children can help a child to get appropriate treatment and return to their usual selves and activities.

Signs of Depression in Children

Due to the differences in psychological and emotional development, depression can present differently in children vs. adults. Children may have a harder time expressing how they are feeling and might act out or become withdrawn. There are many different signs of depression in children that might suggest they are suffering from the disorder. Some of these signs include:

• Appearing sad or unhappy
• Having a hard time being spontaneous
• Frequent whining or angry outbursts
• Loss of interest in activities normally enjoyed
• Boredom or reduced capacity to have fun
• Becoming more socially withdrawn
• Poor concentration
• Physical symptoms like a head or stomach ache
• Refusing to eat

Given that children are still in the early stages of development, they might have a hard time articulating how they are feeling and often act out their feelings. Recognizing these symptoms of depression in children can help parents or guardians seek professional assessment or care.

Causes and Risk Factors for Depression in Children

Mental health is complex, and there’s usually more than one factor or cause of depression. Because of this, it can be difficult to pinpoint exactly what causes depression in children, and it’s likely that a combination of factors is at play.

Underlying causes of depression in children can be linked to a combination of genetics, experiences and individual characteristics. There are a wide range of risk factors for childhood depression, including:

• A family history of depression
• A high level of conflict within the family
• Low levels of parental warmth
• Adversity early in life, such as abuse or poverty
• Aspects of personality, like being self-critical or anxious
• A stressful life event or loss

Of course, a child might experience depression as a result of a traumatic event or sudden loss, but depression can also be a result of ongoing difficulties. If a child is also experiencing an ongoing stressor, such as bullying or problems at home, it might make depression worsen or cause the symptoms to continue.

Types of Depressive Disorders in Children

There are different ways that depressed mood can present itself, and as a result, there are several types of depressive disorders in children. Some of the types of depressive disorders that might be experienced during childhood include:

• Major Depressive Disorder: Major depressive disorder in children includes the same signs and symptoms as in adults, but might present as withdrawn behavior. Symptoms of major depression in children can include low mood, changes in appetite and sleep patterns or difficulty concentrating.
• Persistent Depressive Disorder (PDD): Previously known as dysthymia, PDD in children includes a persistently low or irritable mood for most of the day. PDD is similar to major depression, but chronic in nature, lasting more than a year.
• Adjustment Disorder: Adjustment disorder in children occurs within three months of a stressor or event, and includes the onset of emotional or behavioral symptoms. The symptoms of adjustment disorder don’t continue for longer than six months after the stressor has ended.
• Seasonal Affective Disorder (SAD): In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SAD is known as major depressive disorder with a seasonal pattern. Although it is less common than in adolescents or adults, seasonal affective disorder in children can occur. SAD usually occurs during the winter or fall months and is characterized by increased sleep and low mood.
• Bipolar Depression: Bipolar disorder is extremely rare in children, and there has been a debate about diagnosing bipolar depression in children. Bipolar disorder is characterized by periods of elation and behavioral problems, as well as phases of depression.
• Disruptive Mood Dysregulation Disorder (DMDD): As a new addition to the DSM-5, DMDD includes temper tantrums that are extremely out of proportion to the situation. For a diagnosis to be made, the tantrums must occur on average three times a week or more for more than a year. Disruptive mood dysregulation disorder in children may present as chronic irritability in at least two settings, such as at school and at home.

Related Topic: Disruptive mood dysregulation disorder (DMDD) treatment plan

How Common Is Childhood Depression?

In children, depression is less common than in other stages of life. Depression rates are typically higher in adolescents and adults. However, it’s estimated that depression rates in children aged 6–12 years old are approximately 1–2%.

Children might also demonstrate symptoms of depression that don’t meet the full criteria for a formal depression diagnosis. Although there isn’t a clinical diagnosis, this can still be distressing to both the child and their family. As with depression in other stages of life, depression rates are higher in girls compared to boys.

Diagnosing Depression in Children

Diagnosing depression in children follows the same diagnostic criteria as adults. Previous versions of the Diagnostic and Statistical Manual (DSM) included a childhood specific section, but this is no longer the case. Rather, adult and childhood diagnostic criteria have been combined in the DSM-5.

A formal diagnosis of depression requires the presence of five or more depression symptoms for at least a two-week period. At least one of the symptoms present must be depressed mood or loss of interest in things a person would usually enjoy. Other symptoms include:

• Loss of appetite
• Changes in weight
• Difficulty sleeping
• Low energy
• Trouble concentrating
• Feelings of guilt
• Low self-worth
• Self-harm or thoughts of suicide

When evaluating symptoms of depression in children, it may be important to evaluate a child on their own. A child might feel unwilling or embarrassed to admit that they’re feeling depressed in front of a parent.

Of course, parents, guardians, teachers and members of the community can also provide information on any changes to mood or behavior in the child’s daily life. Adults can help highlight the signs and symptoms that a child may not notice themselves or be unable to articulate. To assist this, health professionals in school and community settings should be trained to identify the signs of childhood depression.

Feelings of depression can lead to suicidal thinking. If you or a loved one is experiencing suicidal thoughts or tendencies, call the National Suicide Prevention Hotline at 1-800-273-8255.

How Depression Looks Different in Children vs. Adults

Even though the symptoms for the diagnosis of depression are the same for all ages, the presentation of these signs might look different in children vs. adults. Children are in a much earlier stage of their emotional and psychological development and might have a harder time recognizing or explaining how they feel. Children are less likely to express feelings of deep or persistent sadness or be able to explain unhelpful thought patterns.

In children, depression might appear more behavioral than emotional. This can mean acting out, throwing temper tantrums or withdrawing from loved ones. Although some of these behaviors can be a normal part of childhood, these behaviors — particularly if they are new or a noticeable change —  can signal an underlying depression.

Treating Depression in Children

Treating depression in children can depend on the severity of depression and whether or not a child is experiencing any other mental health concerns. During childhood, behavioral and cognitive treatment strategies are more common and preferred compared to medication, which might have unpleasant side effects. Treatment often involves members of the family as well as the child themselves.

There is a range of treatment options for children with depression. Treatments usually include identifying underlying causes of depression and developing strategies to address thoughts and behaviors. These treatments can include:

• Psychoeducation to learn about depression
• Cognitive-behavioral therapy
• Interpersonal therapy

In cases where depression is severe or persistent, antidepressant medication might be a treatment option. However, medication should not be offered on its own and should only be used in combination with psychotherapy.

Treatment for children with depression should involve parents and school as much as possible. In some cases, parallel treatment for co-occurring conditions may be required, like anxiety or attention-deficit hyperactivity disorder.

What Parents Can Do to Help

Having a child who is experiencing depression can be extremely hard on parents. It can be difficult for parents to identify how a child is feeling, as a child might not be able to articulate this for themselves.

Seeking professional help can be reassuring to parents who suspect their child might be suffering from depression.  Parents play an important role in noting any changes in mood and behavior in their children and professionals can help identify signs and symptoms for diagnosis. Seeking help or treatment can also help a child to return to their usual activities and behaviors.

Parents also play an important part in treatment, whether it is helping a child learn about the condition or attending family-based therapy. They are an essential support system in finding appropriate treatment and providing ongoing support for their child with depression. With the help of parents and psychologists, treatment can help children learn to manage unhelpful thoughts and behaviors and dramatically improve their quality of life.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more