Does your child seem unusually sad, irritable or quiet lately? Such changes in mood could be due to a temporary stress in life. But how do you know if it’s something more? According to the Centers for Disease Control and Prevention, 2.1% of children between the ages of 3 and 17 have a current diagnosis of depression.

Risk factors for depression

Alice Ann Holland, Ph.D., ABPP, a board certified clinical neuropsychologist and Research Director of the Neuropsychology Service at Children’s Health℠, explains that it is important parents and caregivers fully understand the risk factors for depression, which can include family history, hormonal changes in puberty and life stressors. “Chronic anxiety is one of the most common risk factors we see,” says Dr. Holland. “This is anxiety that hasn’t been properly diagnosed or treated for anywhere from months to years, which wears children down emotionally over time.”

Life stressors that are risk factors for depression in children can include:

  • Changing to a new school
  • Conflict in the home
  • Dealing with bullying – in person or on social media
  • Dealing with medical issues
  • Parental separation or divorce
  • Starting school

In addition to the above life stressors, adolescents may also deal with the following situations that can trigger depression:

  • Academic stress, especially related to college admissions
  • Athletic performance pressure
  • Dating relationships, including negative relationships and breakups
  • Sleep deprivation

Signs of depression

According to Dr. Holland, there are two signs of depression that are commonly missed. One of those signs is increased irritability. Dr. Holland says, “People often associate depression with sadness, but children and adolescents may simply demonstrate increased irritability rather than overt signs of sadness like crying.” It’s normal for children to be irritable at times – such as when they’re overtired, stressed or not feeling well. But if your child has been unusually short-tempered or moody for weeks to months, this also could be a sign of depression.

The other commonly missed sign of depression in children is somatic symptoms, meaning any health issues, such headaches or stomachaches, that do not have a physical cause. Again, it’s normal for children to not feel well occasionally. However, “If the school nurse says your child is getting a stomachache every day during math class, that could be a red flag,” explains Dr. Holland.

If a medical checkup rules out any underlying physical cause/illness, and especially if the symptoms seem to occur around the same time as certain stressors (such as tests) or at certain times of the week (such as Sunday evenings before the school week starts), anxiety or depression may be the cause.

Signs of depression in children

Signs of depression in children age 12 and younger may include the following:

  • Decreased interest in favorite activities
  • Difficulty initiating and/or maintaining social relationships
  • Extreme sensitivity to rejection or failure
  • Frequent absences from school and/or a sudden decline in grades
  • Physical symptoms with no medical cause
  • Frequent sadness, tearfulness or crying
  • Hopelessness
  • Low energy
  • Low self-esteem
  • Increased irritability
  • Increased frequency or severity of tantrums (for younger children)
  • Major change in eating and/or sleeping patterns
  • Obsessive fears or worries about death
  • Social isolation
  • Talking about or attempting to run away from home
  • Thoughts or expressions of suicide or self-harming behavior
  • Trouble concentrating

Signs of depression in adolescents

Signs of depression in adolescents age 13 to 18 may include all of the above, plus:

  • Increased interest in topics related to death
  • Increased risk-taking behaviors
  • Excessive or inappropriate feelings of guilt
  • Feelings of worthlessness or self-hatred
  • Substance use
  • Short temper
  • Trouble making decisions

How to seek help for your child

Medication can have an important role in the treatment of depression in children and adolescents, and it is especially indicated for cases of severe depression. Dr. Holland also notes, “If a child is too depressed to engage in therapy, medication can kick-start engagement and get them to better engage with therapy and benefit from it.” However, parents may find it reassuring to know that medication is not always necessary.

“Studies have shown that in the majority of cases, therapy is as effective or more effective than medication alone when it comes to treating depression in children and adolescents,” says Dr. Holland. Cognitive-Behavioral Therapy, or CBT, is one common type of therapy that research has shown to be effective for children and adolescents. For very young children or those with limited language skills, research indicates that play therapy is the preferred approach.

If concerned that your child may be experiencing depression, consider the following steps:

  • Start by talking with your child: On a regular basis, ask them about how they’re doing in all aspects of their life. “Establish open communication with your child before you have any concerns, so that if concerns arise, they’re comfortable talking to you about what’s going on,” says Dr. Holland. Still, if concerns do arise, don’t assume your child will tell you if they’re feeling depressed. Young children in particular have difficulty putting their feelings into words. Adolescents may feel ashamed or embarrassed about acknowledging depressed feelings. With children of all ages, parents should convey their concern and ask questions in a loving, supportive way.
  • Get other adults engaged: Speak with your child’s teachers, coaches and anyone else who works with your child regularly. Ask them if they’ve noticed any changes in your child’s mood or behavior. Request they keep an eye on your child and let you know about any out-of-the-ordinary behavior.
  • Consult with a mental health professional: You can go alone to meet with a mental health professional – such as a school psychologist, counselor, therapist or psychiatrist – to discuss your concerns about your child. In speaking with you, this specialist may be able to help you discern if your child is dealing with chronic anxiety, coping with a temporary life stressor, exhibiting typical behavior for their age, or is demonstrating red flags for depression. This initial conversation should help guide your decision whether to have your child by evaluated by or pursue treatment (such as therapy or medication) with that specialist or be evaluated by another mental health professional (since not all mental health providers conduct evaluations).

Keeping your child’s safety a number one priority

If your child or teen is engaging in behaviors that cause you concern for their immediate safety – such as discussing plans for suicide or other forms of self-harm – immediately take them to the nearest emergency room or call 911. Your child’s safety is the top priority. “Better safe than sorry” should be your guiding philosophy in such situations.