Childhood depression: symptoms, causes and treatment

Major depression is the most prevalent mental health problem in the world today, to the point that it is beginning to be considered that its expansion is 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, recurring crying, etc. But does depression occur only at this stage of life? Can it also occur 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 allow it to be distinguished from that presented in adults.

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What is childhood depression?

Child depression has multiple differences from that of the adult, although they tend to reduce as the years go by and the adolescence stage approaches. It is, therefore, a health problem whose expression depends on the evolutionary period. In addition, 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 their prevalence.

For example, sadness is an emotion that is present in children suffering from depression. In spite of this, the difficulties in managing it generate different symptoms than those expected for the adult, as we will point out in the corresponding section. And that is why coping strategies are required that the child has yet to acquire as his psychic and neurological development progresses.

Studies on this issue show a prevalence for depression in childhood between 0.3% and 7.8% (according to the evaluation method); and a duration for it of 7-9 months (similar to that of the adult).

symptom

From now on we will discuss 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 in a negative way about themselves, and even make surprisingly hard statements about their personal worth , suggesting a damaged self-esteem.

They may point out that they do not want to play with peers of the same age because they do not know how to “do things right”, or for fear of being rejected or treated badly. In this way, they usually prefer to stay out of symbolic peer-to-peer gaming activities, necessary for healthy social development.

When they describe themselves, they frequently refer to undesirable aspects, in which a pattern of pessimism about the future and an eventual guilt for events to which they did not contribute are reproduced . These biases in the attribution of responsibility, or even in the expectations regarding the future, usually deal with the stressful events that are associated with their emotional state: conflicts between parents, school rejection and even violence in the domestic environment (all factors of important risk).

Loss of confidence is usually generalized to more and more areas of the child’s daily life , as time progresses and effective therapeutic solutions are not adopted for their case. In the end, it negatively conditions its performance in the areas in which it participates, such as academics. The negative results “confirm” the child’s beliefs about himself, entering a pernicious cycle for his mental health and self-image.

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2. Prevalence of organic aspects

Children who suffer from a depressive disorder often show obvious complaints of physical problems , which lead to numerous visits with the pediatrician and make it difficult to attend normal school. The most common are headache (located in front, temples and neck), abdominal discomfort (including diarrhea or constipation), persistent fatigue and nausea. The face would tend to adopt a sad expression, and ostensibly diminish eye contact.

3. Irritability

One of the best known peculiarities of childhood depression is that it tends to be irritable, which is much more easily identifiable by parents than the emotions that could underlie it. In these cases, it is very important to consider that parents are good informants of their children’s behavior, but tend to be somewhat more inaccurate at the time they inquire 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 qualifiers as “grumpy” or “angry”), can delay identification and intervention. In some cases, even a diagnosis is drawn up that does not adhere to the reality of the situation (challenging negativist disorder, to name an example). Therefore, it is necessary for the specialist to have precise knowledge about the clinical features of depression in children.

4. Vegetative and cognitive symptoms

Depression can be accompanied (both in the child and in the adult) with 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 in adolescence they are comparable in many ways, not in all).

In the first years of life, insomnia (conciliation), weight loss (or cessation of the expected gain for age) and motor agitation are common ; while as the years go by it is more common for hypersomnia, increased appetite and generalized psychomotor slowing. At school, a significant difficulty is evident in maintaining the focus of attention (vigilance) and in concentrating on homework.

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 once reinforcing, including recreational and social activities.

Thus, they may feel apathetic / disinterested in exploring the environment, progressively distancing themselves and yielding to a harmful inactivity. It is at this time that it becomes clear that the child is suffering from a situation different from “behavioral problems” , as it is a common symptom in adults with depression (and therefore much more recognizable to the family).

Along with anhedonia, there is a tendency to social isolation and the refusal to participate in shared activities (play with the reference group, loss of interest in academic matters, rejection of the 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.

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Causes

There is no single cause for childhood depression, but a myriad of risk factors (biological, psychological and / or social) whose convergence contributes to its final appearance. Then we proceed to detail the most relevant, according to the literature.

1. Parent’s 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 used to interpret adversities. , adopting it as their own from now on (because the 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 fourfold risk of a child developing depression when either parent suffers, in contrast to those who have no family history of any kind. However, a precise knowledge about 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 parents stimulates a feeling of helplessness in the child . The foundations on which your sense of security is built would be threatened, which aligns with the usual fears in the age period. Screams and threats can also precipitate other emotions, such as fear, that would be decisively installed in your inner experience.

Studies on this issue show that the warmth samples of attachment figures, and consensual agreements on parenting, act as protective variables to reduce the risk of the child developing emotional problems of clinical relevance. All this regardless of whether the parents remain united as a couple.

3. Family violence

Experiences of sexual abuse and abuse (physical or psychic) ​​are established as very important risk factors for the development of childhood depression. Children suffering from excessively 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 limbic structures (tonsils) and cortical structures (prefrontal cortex).

4. Stressful events

Stressful events, such as parental divorce, moving or school changes, may be the basis of depressive disorders during childhood. In this case, the mechanism is very similar to that seen in adults, with sadness being the natural result of a process of adaptation to loss. However, this legitimate emotion can progress to a depression when it implies the summative effect of small additional losses (reduction of gratifying activities), or a limited availability of emotional support and affection.

5. Social rejection

There is evidence that children with few friends have a higher risk of developing depression, as well as those living in socially impoverished environments. The conflict with other children in his peer group has also shown a relationship with the disorder . Likewise, suffering from bullying (persistent experiences of humiliation, punishment or rejection in the academic environment) has been closely associated with child and adolescent depression, and even with the increase in suicidal ideation (which, fortunately, is uncommon among depressed children ).

6. Personality traits and other mental or neurodevelopmental disorders

It has been described that high negative affectivity, a stable trait for which an important genetic component has been traced (although its expression can be molded through individual experience), increases the risk of the infant suffering from depression. It translates into an overwhelmingly intense emotional reactivity to adverse stimuli , which would enhance its effects on emotional life (separation of parents, moving, etc.).

Finally, it has been described that children with neurodevelopmental disorders, such as attention deficit disorder with or without hyperactivity (ADHD and ADHD), are also more likely to suffer from depression. The effect is extended to learning problems (such as dyslexia, dyscalculia or dysgraphia), tonic and / or clonic dysphemia (stuttering) and behavioral disturbances.

Treatment

Cognitive-behavioral therapy has proven effective in children. The identification, debate and modification of the basic negative thoughts are pursued; as well as the progressive and personalized introduction of pleasant activities. In addition, in the case of children, the intervention is geared towards tangible aspects located in the present (immediacy), thereby reducing the degree of abstraction required. Parental contribution is essential throughout the process.

Interpersonal therapy has also been effective in most 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 in which it is involved and those in which it is not directly), seeking alternatives aimed at favoring the adaptive resources of the family understood 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 thoroughly 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 may increase suicidal ideation in people under 25 years of age, but in general it is considered that its therapeutic effects far outweigh its disadvantages.

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