Moodiness, anger, social withdrawal—these could be signs of depression in your child, but they may just be signs that you have a teenager. What is normal developmental behavior versus signals that your child or teen may be struggling with depression?
Your child may not know what is wrong or how to ask for help. It's important for caregivers to know when and how to intervene. Signs of clinical depression in children are different than the symptoms of depression in adults.
What is depression? A formal diagnosis of depression is defined as having a sad, empty or irritable mood lasting up to at least two weeks. What distinguishes depression from clinical depression is a depressed mood that is accompanied by thoughts or physical symptoms that affect functioning.
Signs of depression in children may include the following:
- Sadness that lingers throughout the day.
- More irritability and crankiness than normal.
- Not taking pleasure out of things they usually enjoy.
- Expressions of guilt, low self-esteem.
- Tiredness with no apparent reason.
- Changes in appetite, eating much more or less.
- Trouble sleeping, sleeping too much or too little.
- Hopelessness, helplessness.
- Suicidal thoughts or attempts at self-harm (seek immediate help).
Teachers and school administrators might comment on some of these signs, as well:
- Grouchy, moody, difficulty with peers.
- Isolated, withdrawn from family and peers.
- May not perform well in school, decline in grades.
- Struggling to concentrate when there wasn't a problem with focus before.
- Feeling hopeless, like nothing will ever help and everyone is against them.
- Regressive behavior, taking steps backward in learning or growth.
Reach out to a doctor if you notice any of these behaviors for two weeks or more in your child.
The Two P's: Persistence and Pervasiveness
Another good way to distinguish between depressed mood and clinical depression is noticing persistence and pervasiveness of these behaviors. Is this persisting over time? And, is this behavior pervasive? This means the mood and behaviors don't just happen in one setting (school, but not home, or vice-versa). Are these moods or behaviors pervasive in most environments, in all social groups, or all situations? Children may be able to rally at times, but if you notice pervasive patterns of behavior that is a warning sign.
It's easy to overlook these signs because people tend to think, "That's just adolescence" or they're going through a phase. Listen to your gut and if you're concerned, seek help.
These statistics on suicide from the CDC illustrate why it is so important to seek help early on for your child:
- Suicide is the second leading cause of death for children and teens, ages 10-24.
- More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke pneumonia, influenza, and chronic lung disease combined.
- Each day in the U.S., there are an average of over 5,000 suicide attempts by young people in grades 7-12.
- Four of five teens who attempt suicide have given clear warning signs.
Here are three red flags, or clear warning signs that your child may be thinking about suicide:
- Making statements about not being around anymore. "You'll miss me when I'm gone."
- Saying goodbye and giving away possessions.
- Acute behavior changes or shifts, suddenly acting happy or excited.
Conversations About Depression
One of the biggest myths around suicide is that "If we talk about it, he'll be more likely to do it." When in fact, it is exactly the opposite. If your child is depressed, you need to talk about it with him and stay connected. Conversations, connectedness to family and community, along with clinical and medical help, are all factors in protecting individuals from suicidal thoughts and behaviors, according to the CDC.
Don't be afraid to ask questions, even if it feels scary or uncomfortable. The answers you get will be revealing; they will tell you something about your child's state of mind.
Here are some example questions and conversation starters:
"Have you ever thought about doing something to hurt yourself?" Their answer and their reactions to the question itself can help you know how they're feeling.
"Sometimes when people are sad or depressed, they wish something would happen so that people take care of them. Do you ever feel that way?" A child who is depressed may open up and say yes.
Take time to talk and engage with your child, and ask OFTEN, not just once. Remove all distractions, sit down with them, tell them what you've noticed and why you're worried. "I've noticed you're home all the time, you seem angry, and you don't hang out with your friends like you used to. I'm worried about you. Is there something going on?"
Ask open-ended questions and find ways to help normalize your child's feelings. "Sometimes when people are really depressed they want to sleep and just never wake up. Do you ever feel that way?" Starting a conversation this way helps to normalize a child's experience, and makes them feel less like a "freak" or a "crazy person." It helps them to know they're not alone and that you are not afraid to talk about it.
These conversations about depression and suicide are not easy, but they are very necessary.
Try to avoid saying things like:
- "I don't understand why you're depressed, everything in your life is great?"
- "Why are you acting/feeling this way?" — they may not know why, and you want to talk more about feelings at this stage.
- "I think you're depressed and I've made an appointment for you." Try not to assume you know what the problem is or be too anxious to solve it for them.
- "When I was your age..." At this stage, it's not about you. Keep it about your child and her feelings.
What you can do at home
Talk to your pediatrician: If you're concerned, talk to your healthcare provider. Ask for a referral from your PCP, health insurance, a friend, a family member.
Ask about cognitive behavioral therapy: CBT is a form of psychotherapy that treats problems and boosts happiness by modifying emotions, behaviors, and thoughts. This kind of therapy gives you and your child a toolbox of coping skills for dealing with negative thoughts and changing behaviors.
Get outside: Encourage exercise and schedule regular activities that your child enjoys.
Reduce stress: Reduce stress and pressure to be good at all things, all the time.
Monitor social media: Research suggests that too much spent time on social media may contribute to depressed feelings. Fear of missing out, constant comparison, and bullying can happen easily online. It may not be the cause of depression, but it could be making an already depressed kid feel worse. So, consider restricting social media time.
Model problem solving: Be a good model for solving problems, and help your child develop problem solving strategies. Here is a great article about the 5-step problem solving method for young children (but it works for anyone!).
Sleep patterns: Sleep is so important to your health at any age. Practice good sleep habits and create a good environment for sleep. Set a wake time and bedtime. Do a little research about healthy sleep habits and model those habits yourself.
Building a feelings vocabulary: We have so many words we can use to help define our feelings and share how we are feeling. The words we use are important for expressing how we feel, beyond just mad, sad or happy. Here's a list of "feelings words" that you can use to help your child explore their feelings.
By reading this article, you've helped educate yourself on the signs and symptoms of depression in children. Your attentiveness and simple willingness to engage your child in a conversation about this difficult topic is a great start. Please do not hesitate to reach out to us at Families First for further resources or to talk to someone at the crisis & suicide intervention hotline, or talk about your parenting struggles.