By Lynn Hagan, PsyD, CTRL, LCSW

	Introduction
	Causes of Depression in Young Children
	Diagnosis Depression in Younger Children
	Interventions
	Final Thoughts

Introduction

Children’s laughter, physical exuberance, and magical play all happen on the playground. Children are happy, joyful, and full of life. What about the toddler sitting on the bench, not engaging with others? She is moody, disinterested, and lethargic. She is encourages to go and play with the others, but is not engaged. Is she just having a bad day or is there some else going on?

Until about 20 years ago, there was skepticism that depression in children could actually exist. Childhood is generally viewed as a carefree time, filled with images of cute little ones in diaper commercials. In recent years, however, clinical, studies began showing that the established criteria for depression could be observed in children as you as age six. Now, even younger children are being studied, questioning if even younger children, between the ages of three and six can exhibit depressive symptoms.

Causes of Depression in Young Children

Like adults, the exact cause of depression in young children is elusive. Biological and environmental triggers are currently being debated. Young children who show depressive symptoms have more relatives with major depression, other similar disorders and suicide attempts or completions.

Preschoolers with clinical depression, as adults with depression, show a different activity pattern of the stress hormone, cortisol, which interferes with the formation and breakdown of serotonin and may disrupt the receptor sites for certain serotonin reuptake inhibitors. The debate about environment verses biology continues.

Diagnosing Depression in Younger Children

Researchers now estimate that current diagnostic criteria fail to identify or misdiagnose about 85 percent of preschool children who meet broad criteria for depressive disorders and who have multiple clinical markers. They found that depression indicators can be established by using a variety of diagnostic techniques for preschoolers including using puppets in interviewing, parent/teacher interviews, observing childhood play. Two instruments, the Preschool Age Psychiatric Assessment and the Preschool Feelings Checklist may also be helpful in diagnosing depression in these young children.

The following symptoms have been identified by the American Academy of Child and Adolescent Psychiatry for recognizing depression in young children.

• Frequent sadness, tearfulness, and/or crying;
• Hopefulness;
• Decreased interest in activities or inability to enjoy previously favorite activities;
• Persistent boredom;
• Low energy;
• Inability to experience joy;
• Social isolation (having the opportunity to play with friends but preferring aloneness);
• Poor communication;
• Low self-esteem and feelings of not being important to anyone;
• Guilt;
• Extreme sensitivity to rejection or failure;
• Increased irritability, anger, or hostility;
• Difficulty with relationships;
• Frequent complaints of physical illnesses such as headaches and stomach aches;
• Frequent absences from school or poor performance in school;
• Poor concentration;
• A major change in eating and/or sleeping patterns;
• Talk of or efforts to run away from home; and
• Thoughts or expressions of suicide or self-destructive behavior.

Interventions

In seeking help for younger children, parents often tend to start at the pediatrician’s office while others go directly to a social worker, child psychologist, or psychiatrist. A correct diagnosis and involvement of the family are essential for proper treatment. Interventions work best with social workers provide parents with information and educate them about early childhood depression.
Antidepressants may be used to treat childhood depression when indicated, but this treatment should not be the only treatment provided young children. Medications are most successful when combined with other treatment modalities, such as behavior modification or play therapy-services social workers are well equipped to provide. Medications also carry risks of which parents must be aware. Antidepressant use in children has been linked to increased risk of suicide, so any medication for depression must be closely monitored by the prescribing physician.

Final Thoughts

Many children have good reason to be sad and hopeless. Many children lead demoralizing lives, which is different from depression. Such demoralizing lives include living with poverty, abuse, neglect, domestic violence, drug use, and inadequate access to education. Children who are over-structured and over-pressured may also exhibit symptoms similar to depression. While these conditions do not necessarily cause depression, they may cause behaviors that mimic depressive symptoms.

Depression should not be ignored and it is imperative that caregivers are attuned to the signs and symptoms of depression in young children. Recognizing that depression is a community health issue in not only adults, but children as well, will lead to further understanding and treatment.