Child development: depressed?

Children as young as two years old have been diagnosed with clinical depression. In fact, 25% of all children and adolescents will experience depression before they are 18. How can you tell if your child just has a case of the blues or if it's something more serious? And what can you do to help?

Children aren't "little adults," so spotting depression in them is more difficult. Small children can't always help in identifying the problem because they don't have the ability to verbalize their feelings. Words like "depressed," "worthless" or "suicidal" aren't always in their vocabulary. The constant stream of "I dunno" that comes out of most adolescents isn't much help either.

And some symptoms of depression can mimic normal developmental phases - just ask any parent with teenagers in the house! Kids might labeled difficult or high strung when really they're depressed.

Remember that a behavior that is acceptable at one age, may not be at another. A two year old who throws a temper tantrum, complete with crying, screaming, and falling on the floor can be called normal. A thirteen year old who does the same thing can't. But what about a three year old? A four or five year old? When does 'normal' stop being normal?

What are the causes and risk factors for depression?

Being sad occasionally is part of everyday life, even for kids. So why do some children go past the blues and into depression?

An event like the death of family member, a divorce or remarriage, chronic illness in the family, or relocation are some of the more obvious causes. So are losing a pet, getting a new teacher or failing a major test. Depression is a normal response to significant events like these. Actually, any period of readjustment or stress can trigger sadness and worry.

A family history of depression can increase the likelihood that a child will also experience it. Just one incident of neglect, physical or emotional abuse, can put a child at risk.

But often depression can't be traced back to any one event or risk factor.

Symptoms of depression in children

A therapist will look at several factors in deciding if your child is depressed. These will include your child's general behavior, eating and sleeping habits, and social performance. These are some of the more common symptoms of depression in children -

Is your child sad?

Irritable? Withdrawn?

Tired all the time?

Often distracted?

Uninterested in enjoy regular activities?

Lonely? Forgetful?

Does your child report feeling unloved? Guilty?

Complain about headaches, stomach aches?

Other minor physical ailments?

Is your child difficult to please? Moody?

Have mood swings, going from very sad to very happy?

Does your child sleep more than usual? Less?

Wake up frequently during the night?

Report nightmares?

Wake up tired?

Seem disinterested in friends?

Has there been a change in school performance?

Does your child avoid school?

Avoid after school activities?

Eat more than usual? Less?

Refuse favorite foods?

Has your child gained or lost some weight? More than 5 lbs.?

Seem afraid?

Having just one of these symptoms isn't enough of an indication to say that your child is depressed. But several symptoms together should cause you to consider having your child evaluated.

How do you get help for your child

First, get your child a complete physical.

Physical illness can often mimic the symptoms of depression. A lack of appetite, sleeping too much or too little, a lack of energy can all be linked to anemia, juvenile diabetes or many other common physical causes.

Once you get a clean bill of health, look for a qualified professional who can diagnose your child's condition. Your doctor might be able to refer you to a therapist. Start there.

Next, check at your child's school for a referral outside the school system. There are a couple of reasons for going outside the school. Most school counselors spend their time identifying learning disabilities or working with teenagers to choose classes and colleges. They may or may not be qualified to diagnose and treat depression. Also, remember that any counseling your child gets at school will become part of a permanent record that will follow your child through college.

United Way and other social service organizations have a referral network in most communities and may even be able to identify a low-cost therapist to work with you.

"Therapists" come from all kinds of educational backgrounds. Someone with a degree in nursing, education, or social work can pass a state exam and work as a "therapist." That isn't enough. You want someone who has at least a master's degree, studied clinical psychology and is licensed to practice as a therapist by a state regulating board. Look for additional credentials, like 'Licensed Family Therapist' or similar titles.

You also want someone who specializes in working with children. Treatment and diagnosis for children is very different than those for adults.

Once you find someone, set up a fact-to-feet meeting. Before meeting with your child, ask the therapist to speak with you and answer some questions.

Ask about the therapist's credentials and work experience, the treatments they usually use with children, if other family members might be included in treatment and when, what role will medication play. Ask about confidentiality, if your teenager reports using drugs or skipping school, will you be informed? Who else has access to this information? How does the therapist handle emergencies?

And ask about the costs of therapy! Selecting a therapist you can't afford is a plan for failure.

Someone who is too busy to talk with you or brushes off your questions isn't the person you want working with your child. A good therapist doesn't mind discussing these things with new clients, most will even suggest it.

If you don't like the answers you get during your meeting with the therapist, don't let them talk to your child. Terminate the meeting, explaining that you are talking to several therapists before you decide on the best 'fit' for your child. Even if the cost of the meeting includes an evaluation, don't let someone you don't like talk to your child.

If the therapist is someone you do want to work with, you should discuss why you suspect that your child is depressed. Report what you have noticed about your child's behavior, attitude and mood, help identify any contributing factors.

What you can expect from therapy

You should be involved in your child's diagnosis and therapy. After talking with you, the therapist should interview your child, maybe even conduct some testing, before giving you a diagnosis.

Any good evaluation requires that the therapist spend some time talking alone with the child. Your child might paint a different picture than you do, since children often misreport their symptoms or their severity. It's the therapist's job to put all the information together and evaluate it.

The therapist should then inform both you and your child about any diagnosis and the three of you can work out a treatment plan. Ask about therapy sessions - how often will your child meet with the therapist? How long will each meeting last? What will happen in each session? Will you get updates about your child's progress? When? Will you sometimes participate in sessions together? Be sure to let your child ask questions. Ask for your child's opinions.

What about outside the therapy sessions? Will there be activities assigned for your child to complete at home? With the family? Such as reading? Attending a class or seminar? Journal keeping? Support groups?

Discuss concrete goals for therapy. How will you and your child be able to tell if the depression is getting better? Set a firm date to review your child's progress. Make sure you, your child, and the therapist all understand what's next.

And most important, stay hopeful. Your positive attitude will help shape your child's response to treatment.

Childhood depression can be devastating, but luckily treatment is available. And identifying the problem is the first step.