Major depression is the most prevalent mental health problem in the world today, to the point that its expansion is beginning to be seen as reaching epidemic proportions.
When we think about this disorder we usually imagine an adult person, with a series of symptoms known to all: sadness, loss of ability to enjoy, recurrent crying, etc. But does depression occur only at this stage of life? Can it also be presented at earlier times? Can children develop mood disorders?
In this article we will address the issue of childhood depression , with special emphasis on the symptoms that differentiate it from that which occurs in adults.
- Related article: ” The 6 stages of childhood (physical and mental development)“
What is childhood depression?
Childhood depression presents multiple differences with respect to that of the adult, although they tend to decrease as the years go by and the stage of adolescence approaches. It is, therefore, a health problem whose expression depends on the evolutionary period. Furthermore, it is important to keep in mind that many children lack the precise words by which to reveal their inner world , which can make diagnosis difficult and even condition data on its prevalence.
For example, sadness is an emotion that is present in children with depression. Despite this, difficulties in managing it generate different symptoms from those expected for adults, as we will point out in the corresponding section. And it is because this requires coping strategies that the child has yet to acquire as his psychological and neurological development progresses.
Studies on this issue show a prevalence for childhood depression of between 0.3% and 7.8% (depending on the evaluation method); and a duration for the same of 7-9 months (similar to that of the adult).
In the following we will deal with the peculiarities of childhood depression. All of them have to alert us to the possible existence of a mood disorder, which requires a specific therapeutic approach.
1. Difficulty saying positive things about themselves
Children with depression often express themselves negatively, and even make surprisingly tough claims about their personal worth , suggesting a damaged base self-esteem.
They may point out that they do not want to play with peers their own age because they do not know how to “do things right”, or for fear that they will be rejected or treated badly. In this way, they often prefer to stay away from symbolic peer-to-peer activities necessary for healthy social development.
When they describe themselves, they frequently allude to undesirable aspects, in which a pattern of pessimism about the future is reproduced and possible guilt for events to which they did not contribute. These biases in the attribution of responsibility, or even in the expectations regarding the future, tend to be about the stressful events that are associated with their emotional state: conflicts between parents, school rejection and even violence in the domestic environment (all of them factors of significant risk).
Loss of confidence tends to spread to more and more areas of the child’s daily life , as time progresses and effective therapeutic solutions are not adopted for his case. In the end, it negatively conditions their performance in the areas in which they participate, such as academics. Negative results would “confirm” the child’s beliefs about himself, entering a pernicious cycle for his mental health and self-image.
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2. Predominance of organic aspects
Children suffering from a depressive disorder often show obvious complaints of physical problems , which lead to numerous visits with the pediatrician and hinder their normal attendance at school. The most common are headache (located in the forehead, temples, and nape), abdominal discomfort (including diarrhea or constipation), persistent fatigue, and nausea. The face would tend to adopt a sad expression, and ostensibly decrease eye contact.
One of the best-known features of childhood depression is that it tends to be irritable, which is much more easily identified by parents than the emotions that could underlie it. In these cases, it is very important to consider that parents are good reporters of their children’s behavior, but they tend to be somewhat more imprecise when inquiring about their internal nuances. That is why sometimes the reason for initial consultation and the problem to be treated are somewhat different.
This circumstance, together with the fact that the child is not described using the term “sad” (as he uses terms such as “grumpy” or “angry”), can delay identification and intervention. In some cases, a diagnosis is even made that does not adhere to the reality of the situation (challenging negativistic disorder, to cite an example). It is necessary, therefore, that the specialist has precise knowledge about the clinical characteristics of depression in children.
4. Vegetative and cognitive symptoms
Depression can be accompanied (both in children and adults) by a series of symptoms that compromise functions such as cognition, sleep, appetite and motor skills. Particular expressions have been observed according to the evolutionary stage of the child, although it is considered that as time passes they are more similar to those of the adult (so that in adolescence they are comparable in many ways, but not in all).
Insomnia (reconciliation), weight loss (or cessation of expected gain for age), and motor agitation are common in the first years of life ; while as the years pass it is more common for hypersomnia, increased appetite and generalized psychomotor slowdown to appear. At school, significant difficulty in maintaining focus (vigilance) and concentrating on tasks becomes evident.
5. Anhedonia and social isolation
The presence of anhedonia suggests a severe depressive state in children. It is an important difficulty to experience pleasure with what was previously reinforcing, including recreational and social activities.
Thus, they may feel apathetic / disinterested in exploring the environment, progressively distancing themselves and yielding to harmful inactivity. It is at this time that it becomes evident that the child is suffering from a different situation than “behavioral problems” , since it is a common symptom in adult people with depression (and therefore much more recognizable for the family).
Along with anhedonia, there is a tendency to social isolation and the refusal to participate in shared activities (playing with the reference group, loss of interest in academic affairs, refusal of school, etc.). This withdrawal is a phenomenon widely described in childhood depression, and one of the reasons why parents decide to consult with a mental health professional.
- You may be interested: ” Anhedonia: the inability to feel pleasure“
There is no single cause for childhood depression, but rather a myriad of risk factors (biological, psychological and / or social) whose convergence contributes to its final appearance. Next we proceed to detail the most relevant, according to the literature.
1. Parents’ cognitive style
Some children have a tendency to interpret the daily events of their lives in catastrophic and clearly disproportionate terms. Despite having formulated many hypotheses to try to explain the phenomenon, there is a fairly broad consensus that it could be the result of vicarious learning : the child would acquire the specific style that one of his parents uses to interpret adversity , adopting it as their own in the future (because attachment figures act as role models).
The phenomenon has also been described in other disorders, such as those included in the category of clinical anxiety. In any case, studies on the issue indicate that there is a four times greater risk that a child will develop depression when either parent suffers from it, in contrast to those with no family history of any kind. However, a precise understanding of how genetics and learning could contribute, as independent realities, to all this has not yet been achieved.
2. Conflicts between care figures
The existence of relational difficulties between the parents stimulates in the child a feeling of helplessness . The foundations on which their sense of security is built would be threatened, which aligns with the usual fears in the age period. Screaming and threats can also precipitate other emotions, such as fear, that would be decisively installed in your internal experience.
Studies on this issue show that attachment figure warmth displays, and consensual parenting agreements, act as protective variables to reduce the risk of the child developing clinically relevant emotional problems. All this regardless of whether the parents remain united as a couple.
3. Family violence
Experiences of sexual abuse and mistreatment (physical or psychic) stand as very important risk factors for the development of childhood depression. Children who suffer from overly authoritarian parenting styles , in which force is unilaterally imposed as a mechanism to manage conflict, may show a state of constant hyperactivation (and helplessness) that results in anxiety and depression. Physical aggressiveness is related to impulsivity in adolescence and adulthood, mediated by the functional relationship between the limbic structures (amygdala) and the cortical (prefrontal cortex).
4. Stressful events
Stressful events, such as a parent’s divorce, moving, or changing schools, may be at the root of depressive disorders during childhood. In this case, the mechanism is very similar to that seen in adults, sadness being the natural result of an adaptation process in the face of loss. However, this legitimate emotion can progress to depression when it involves the summative effect of small additional losses (reduction of rewarding activities), or a limited availability of emotional support and affection.
5. Social rejection
There is evidence that children with few friends are at increased risk of developing depression, as are those living in socially impoverished environments. Conflict with other children in his peer group has also been linked to the disorder . Likewise, bullying (persistent experiences of humiliation, punishment or rejection in the academic environment) has been closely associated with childhood and adolescent depression, and even with increased suicidal ideation (which is fortunately rare among depressed children ).
6. Personality traits and other mental or neurodevelopmental disorders
High negative affectivity, a stable trait for which an important genetic component has been traced (despite the fact that its expression can be shaped through individual experience), has been reported to increase the risk of the infant suffering from depression. It translates into overly intense emotional reactivity to adverse stimuli , which would enhance its effects on emotional life (separation from parents, moving, etc.).
Finally, it has been described that children with neurodevelopmental disorders, such as attention deficit disorder with or without hyperactivity (ADHD and ADD), are also more likely to experience depression. The effect extends to learning disabilities (such as dyslexia, dyscalculia, or dysgraphia), tonic and / or clonic dysphemia (stuttering), and behavioral disturbances.
Cognitive behavioral therapy has been shown to be effective in children. The identification, debate and modification of negative base thoughts is pursued; as well as the progressive and personalized introduction of enjoyable activities. Furthermore, in the case of children, the intervention focuses on tangible aspects located in the present (immediacy), thereby reducing the degree of abstraction required. Parental input is essential throughout the process.
Interpersonal therapy has also been effective in most of the studies in which it has been tested. The purpose of this form of intervention is to investigate the most relevant social problems in the child’s environment (both those that are involved and those that are not directly involved), looking for alternatives aimed at favoring the adaptive resources of the understood family as a system.
Finally, antidepressants can be used in those cases in which the child does not respond adequately to psychotherapy. This part of the intervention must be carefully evaluated by a psychiatrist, who will determine the profile of risks and benefits associated with the consumption of these medications in childhood. There are some caveats that they may increase suicidal ideation in people under the age of 25, but its therapeutic effects are generally considered to far outweigh its drawbacks.