Childhood depression: symptoms, causes and treatment
Childhood depression is a mood disorder capable of greatly affecting both boys and girls.
Major depression is the most prevalent mental health problem in the world today, to the point that its spread is beginning to be considered to be reaching epidemic proportions.
When we think of this disorder we usually imagine an adult person, with a series of symptoms known to all: sadness, loss of the capacity for enjoyment, recurrent crying, etc. But does depression only occur at this stage of life, can it also occur earlier in life, and can children develop mood disorders?
In this article we will address the issue of childhood depressionwith special emphasis on the symptoms that allow us to differentiate it from that which occurs in adults.
What is childhood depression?
The infantile depression presents multiple differences with respect to the one that is characteristic of the adult, although they tend to be reduced as the years pass and the stage of the adolescence approaches. It is, therefore, a health problem whose expression depends on the evolutionary period. In addition, it is important to bear in mind that many children lack the precise words through which to reveal their inner world, which can make diagnosis difficult.This can make diagnosis difficult and even condition the data on its prevalence.
For example, sadness is an emotion that is present in children suffering from depression. Despite this, the difficulties in managing it generate symptoms different from those expected for adults, as we will point out in the corresponding section. This requires coping strategies that the child has yet to acquire as his or her 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 assessment method); and (depending on the method of assessment); and a duration of 7-9 months (similar to that of the adult).
In the following we will discuss the particularities of childhood depression. All of them should alert us to the possible existence of a mood disorder which requires a specific therapeutic approach.
1. Difficulty in saying positive things about themselves
Children with depression often express themselves in a negative way about themselves, and even make surprisingly harsh statements about their self-worth, suggesting self-esteem and self-confidence.suggesting an impaired self-esteem at the core.
They may indicate 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. Thus, they often prefer to stay away from symbolic peer play activities, which are necessary for healthy social development.
When describing themselves, they often allude to undesirable aspects, in which a pattern of pessimism about the future is reproduced. a pattern of pessimism about the future and eventual guilt for events to which they did not contribute. for events to which they did not contribute. These biases in the attribution of responsibility, or even in expectations regarding the future, are often related to stressful events associated with their emotional state: conflicts between parents, school rejection and even violence in the domestic environment (all of which are important risk factors).
Loss of confidence often generalizes to more and more areas of the child's daily life.The patient's condition, as time progresses and effective therapeutic solutions are not adopted for his case. In the end, it negatively conditions his performance in the areas in which he participates, such as academics. The negative results would "confirm" the child's beliefs about himself, entering a pernicious cycle for his mental health and self-image.
2. Predominance of organic aspects
Children suffering from a depressive disorder often show evident complaints of physical problemsThese can lead to numerous visits to the pediatrician and make it difficult for them to attend school normally. The most common are headache (located in the forehead, temples and nape of the neck), 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 particularities of childhood depression is that it usually presents with irritability, which is much more easily identifiable by parents than the emotions that may underlie it. In these cases, it is very important to consider that parents are good informants of their children's behavior, but they tend to be somewhat more inaccurate when they are asked about their children's behavior. when inquiring about their inner nuances. This is why sometimes the reason for the initial consultation and the problem to be treated are somewhat different.
This circumstance, together with the fact that the child does not describe himself using the term "sad" (as he resorts to adjectives such as "grumpy" or "angry"), may delay identification and intervention. In some cases, a diagnosis is even made that does not adhere to the reality of the situation (oppositional defiant disorder, to cite one example). It is therefore necessary for the specialist to have precise knowledge of the clinical particularities of depression in children.
4. Vegetative and cognitive symptoms
Depression may be accompanied (in both children and adults) by a series of symptoms that compromise functions such as cognition, sleep, appetite and motor function. Particular expressions have been observed according to the evolutionary stage of the child, although it is considered that as time goes by they become more similar to those of the adult (so that in adolescence they are comparable in many ways, but not in all).
In the first years of life are common insomnia (of conciliation), the loss of weight (or cessation in the gain foreseen for the age) and the motor agitation.As the years go by, hypersomnia, increased appetite and generalized psychomotor slowing are more common. At school a significant difficulty in maintaining focus of attention (vigilance) and in concentrating on tasks becomes evident.
5. Anhedonia and social withdrawal
The presence of anhedonia suggests a severe depressive state in children. This is a significant difficulty in experiencing pleasure from what was previously reinforcing, including play and social activities.
Thus, they may feel apathetic/uninterested in exploring the environment, becoming progressively distant and yielding to harmful inactivity. It is at this point that it becomes evident that the child is suffering from a situation other than "behavioral problems".This is a common symptom in adults with depression (and therefore much more recognizable to the family).
Along with anhedonia, there is a tendency towards social isolation and refusal to participate in shared activities (playing with the reference group, loss of interest in academic matters, rejection of school, etc.). This withdrawal is a phenomenon widely described in childhood depression, and one of the reasons why parents decide to consult a mental health professional.
There is no single cause of childhood depression, but a myriad of risk factors (biological, psychological and/or social). (biological, psychological and/or social) whose convergence contributes to its ultimate onset. We proceed below to detail the most relevant ones, according to the literature.
1. Cognitive style of parents
Some children have a tendency to interpret everyday events in their lives in catastrophic and clearly disproportionate terms. Although many hypotheses have been formulated to try to explain the phenomenon, there is a fairly broad consensus that it could be the result of vicarious learning. result of vicarious learningThe child would acquire the specific style that a parent uses in order to interpret adversities, adopting it as his or her 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 subject indicate that there is a four times greater risk of a child developing depression when either parent suffers from it, in contrast to those with no family history of any kind. However, a precise understanding of the way in which genetics and learning could contribute, as independent realities, to all this has not yet been achieved.
2. Conflicts between caregivers
The existence of relational difficulties between parents stimulates a sense of helplessness in the child.. The foundations on which their sense of security is built are threatened, which is in line with the usual fears of this age group. Shouting and threats can also precipitate other emotions, such as fear, which would be decisively installed in their internal experience.
Studies on this issue show that displays of warmth from attachment figures, and consensual agreements on parenting, act as protective variables to reduce the risk of the child developing clinically relevant emotional problems. All of this regardless of whether the parents remain together as a couple.
3. Family violence
Experiences of sexual abuse and maltreatment (physical or psychological) are very important risk factors for the development of childhood depression. Children who suffer from excessively authoritarian parenting styles, in which unilateralin which force is unilaterally imposed as a mechanism for managing conflict, may show a state of constant hyperarousal (and helplessness) that translates into anxiety and depression. Physical aggressiveness is related to impulsivity in adolescence and adulthood, mediated by the functional relationship between limbic (amygdala) and cortical (prefrontal cortex) structures.
4. Stressful events
Stressful events, such as parental divorce, moves or changes of school, may underlie depressive disorders during childhood. In such a case the mechanism is very similar to that seen in the adult, with sadness being the natural result of an adaptation process in the face of loss. However, this legitimate emotion may progress to depression when it involves the summative effect of additional small losses. the summative effect of additional small losses (reduction of rewarding activities), or poor availability of emotional support and affection.
5. Social rejection
There is evidence that children with few friends have an increased risk of developing depression, as well as those living in socially impoverished environments. Conflict with other children in their peer group has also been shown to be related to the disorder.. Likewise, suffering 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 fortunately is infrequent 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 (although its expression can be shaped by individual experience), has been described as increasing the infant's risk for depression. It translates into an overwhelmingly intense emotional reactivity to adverse stimuli, which would potentiate its effects.which would potentiate its effects on the affective life (separation from parents, moving, etc.).
Finally, it has been reported that children suffering from neurodevelopmental disorders, such as attention deficit disorder with or without hyperactivity (ADHD and ADD), are also more likely to suffer from 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.in the pediatric population. The aim is the identification, discussion and modification of the underlying negative thoughts, as well as the progressive and personalized introduction of pleasant activities. In addition, in the case of children, the intervention is oriented towards tangible aspects located in the present (immediacy), thus reducing the degree of abstraction required. The contribution of parents is essential in the whole process.
Interpersonal therapy has also proven effective in most studies in which it has been tested. 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 in which he/she is involved and those in which he/she is not directly involved), seeking alternatives aimed at favoring the adaptive resources of the family understood as a system.
Finally, antidepressants may be used in those cases in which the child does not respond adequately to psychotherapy. This part of the intervention should be thoroughly assessed by a psychiatrist, who will determine the risk/benefit profile associated with the use of these medications in childhood. There are some warnings that they may increase suicidal ideation in people under 25 years of age, but it is generally considered that their therapeutic effects far outweigh their drawbacks.
- Charles, J. (2017). Depression in Children. Focus, 46(12), 901-907.
- Figuereido, S.M., de Abreu, L.C., Rolim, M.L. and Celestino, F.T. (2013). Childhood depression: a systematic review. Neuropsychiatric Disease and Treatment, 9, 1417-1425.
(Updated at Mar 28 / 2023)