Even Young Children Can Suffer From Depression

Clinical depression is not a disease suffered by adults alone. In fact, according to Dr. Diane Treadwell-Deering, medical director of the Pediatric Psychopharmacology Clinic at Texas Children's Hospital, it can and does strike children.

Depression can be difficult to identify in this age group because young children lack the vocabulary to express how they are feeling. "Feelings are abstract," says Dr. Treadwell-Deering, assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine. "We know young kids understand straightforward things like `my throat hurts' or `my arm is broken,' but things that are less easily seen, touched or describable are just more difficult for them to come up with.

"Sometimes kids can identify feelings or discuss feelings in relationship to how your face looks when you feel that way," she says. "The notion that it can be an inside feeling that you become aware of and can identify is very hard for young kids."

Some children with major depression become withdrawn and quiet; others may express their depression by acting irritable, which, to parents and teachers, may look more like a recalcitrant child who is misbehaving than one suffering from depression. "The descriptive ways we talk about making diagnoses are modified slightly for younger children," Dr. Treadwell-Deering says. "Instead of having to have a depressed mood to qualify for that diagnosis of major depression, in younger kids it can manifest itself as irritability."

A diagnosis of major depression in a young child follows much of the same criteria as that for adolescents and adults. Signs of depression include: disinterest in activities that he or she previously found enjoyable; becoming withdrawn socially; changes in eating and sleeping patterns; physical complaints such as headaches, stomachaches and no energy; and references to death or expressing thoughts of dying.

Sometimes the behavior may be precipitated by a particular event in the child's life, such as a death in the family or a parental divorce. Also important to the diagnosis is a review of the child's family history. There is evidence to suggest that depression may have a genetic or biological component.

If a parent or teacher detects signs of depression in a young child, Dr. Treadwell-Deering suggests the child see his or her primary care physician or pediatrician as a first step. "If that is the person who has been providing ongoing preventive care, that is the person who is going to know the child and the family the best."

Depression is a treatable disease.Once a diagnosis is made, medication may be recommended. "The unfortunate thing is that there aren't the kinds of gold standard studies that support the use of medications in the very young age group, although, there ar

e vast amounts of clinical experience that support the use of medications," says Dr. Treadwell-Deering. "The younger the child, the more difficult it is to do studies, so the less the likelihood that there are going to be studies that are available. I think that clearly our clinical experience suggests that young children respond to the same sets of medications that adolescents and adults do."

Counseling modalities may differ for this age group, however. Therapy may incorporate play or art to demonstrate to a child the ways in which conflict can be resolved or dealt with appropriately.

Parental involvement is an important component of counseling, particularly with young children. "You might be angry at your child if you thought they were misbehaving. If you understood that your child was depressed, you would probably want to respond to it differently," says Dr. Treadwell-Deering.

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©2006 Texas Medical Center

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