Written by Daniel Sheras, Psy.D., a psychologist at Orenstein Solutions, with offices in Cary and Chapel Hill. He specializes in evaluating and treating childhood and teen depression, anxiety, and ADHD.
Depression is a common but somewhat misunderstood problem in children and adolescents. When a child or teenager is frequently sad, irritable, withdrawn or isolative it can be extremely disruptive and distressing to the child and the family, and parents may struggle to identify the best ways to address this issue. When determining how to address a child’s depression, there are several important questions that parents should ask.
QUESTION #1: What are the warning signs that my child may be depressed?
The first step is to identify that something is wrong. There are several behaviors that parents should be on the look-out for that could indicate the presence of depression. Typical warning signs for depression include: sad or irritable mood (i.e. tearfulness, angry outbursts); loss of interest in activities that were once enjoyable; significant weight gain or loss (or inability to gain age-appropriate amounts of weight); difficulty sleeping or sleeping too much; moving slowly; loss of energy; reporting feelings of worthlessness or excessive guilt; recurrent thoughts of death or suicide (which can often be expressed in drawings or journals); or problems concentrating.
QUESTION #2: Is this just normal sadness or “depression?”
As most parents know, even the happiest child will be sad sometimes. This is perfectly normal. However, there is a difference between appropriate levels of sadness and depression. Parents should try and determine whether the sadness is related to environmental factors. For example, it is very normal for a child to be sad when a pet dies or, for a teenager, after a difficult break-up. Furthermore, a certain level of irritability is often present during the teenage years. However, if a parent notices that their child appears to get sad or angry for no reason, is sad all the time, can’t seem to get over his/her sadness, or that the sadness is having a significant negative impact on his/her life (i.e. refusing school; no friends, etc.) then depression may be present. A child or teenager without diagnosable depression may still benefit from some form of treatment. And, if a parent is unsure whether or not his/her child has a diagnosable depressive disorder, the best thing for them to do is to reach out to a qualified mental health professional who can evaluate these symptoms and provide an answer.
QUESTION #3: Who should I talk to if I think my child or teen is depressed?
Many parents don’t know who to turn to when they fear that their child or teen is depressed. If there is a care provider you trust or have a good relationship with, such as a pediatrician or school counselor, talking to them is a good first step. They can offer support and point you in the right direction of an appropriate mental health care professional. Professionals such as psychologists and psychiatrists most commonly provide treatment for depression. On-line web searches and databases will provide the names of appropriate professionals and practices that you can contact. If you talk to a pediatrician, school counselor, etc., ask if they can recommend a professional in the community that specializes in childhood depression. Both psychologists and psychiatrists can assess depression. However, psychologists often provide more extensive therapy for depression, while psychiatrists can prescribe medication if that is indicated for your child. Your provider should help guide you in determining if your child would benefit from therapy, medication or a combination of the two.
QUESTION #4: What should I look for in a treatment provider? What questions should I ask?
When a parent is researching mental health care providers, there are some important questions to ask. Not all professionals are the same, and you want to find one that is a strong fit for your child’s needs. First, you want to ask about the professional’s experience. You will want to ensure that the professional has experience in working with children and adolescents and that they have experience treating depression. You’re child may or may not have clinical depression, but it may prove helpful to find a professional who has experience, training and expertise in this area so that they can accurately assess the symptoms and provide depression-focused treatment if it is indeed needed. Second, you want to ask about the kind of treatment that they will provide. For example, certain therapies have been shown by research to be effective in treating depression in children, and this information is available on-line. Such evidence-based treatment models include Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT). If you are speaking with a psychiatrist, you can ask them about the types of medication they typically use to treat depression in their clients.
QUESTION #5: How should I talk to my child or teen about their depression?
Many parents struggle with how to best approach their child about depression and the possibility of treatment. Each parent has their own style and a unique knowledge of their child. That being said, it is a good idea to express your concern in an empathic, supportive, not-judgmental way. Many children (especially teenagers) might be hesitant to talk about their feelings, so you want to let them know that many people experience depression and that you understand that it is very difficult for them. Furthermore, when discussing treatment, you can reiterate that you love and care about them and want them to live a happier life.