How to Spot Depression in Children, Even Preschoolers

Trigger Warning: Brief discussion of suicidal ideation.

Preschool depression is often overlooked, because the symptoms are difficult to spot or may be explained away by hopeful parents and teachers. Depression in adults is widely known, but can preschoolers suffer clinical depression? Science says they can.

Scientists began studying depression in preschoolers 20 years ago, and the research continues today. According to the conclusion of a new study led by Dr. Joan Luby of the Washington University School of Medicine in St. Louis, preschoolers suffer depression. Luby’s team examined 306 children ranging from 3 to 6 years old. This study demonstrated that 23% of the 3-year-olds endured depressive symptoms every day for two consecutive weeks. As the age of the child increased, the rate of major depressive disorder diagnoses also increased. The 4-year-olds suffered depressive symptoms at a rate of 36%, while the 5-year-olds showed a rate of 41%. The children who had suffered extremely stressful or traumatic events in their lives also had a higher incidence of depression than the controls.

Preschoolers generally can’t describe their emotional states. They’re still learning what emotions are and they lack the ability to vocalize them. This is the difficulty in diagnosing depression in preschoolers, and why you may need help spotting it. In order to allow the study participants to express how they perceive themselves and get a sense of what young children were feeling, Dr. Luby’s team asked a series of questions using puppets. How the children responded gave the researchers a clue about how the kids were feeling.

Further complicating the picture is the prevalence of other conditions along with depression, like Attention Deficit Hyperactivity Disorder (ADHD). In Dr. Luby’s study, about 40% of the study participants also dealt with ADHD, which tends to drown out symptoms of depression, because the symptoms are similar. This can even persist later in life. Children who suffer depression are more than four times as likely to suffer an anxiety disorder later in life than kids who don’t suffer depressive symptoms.

preschooler
A preschool-aged boy in blue hoodie sprawling on a parent’s lap. Credit to flickr.com user Quinn Dombrowski. Used with permission under a Creative Commons license.

But what does depression look like in a 3-to-6-year-old?How can you, as a parent, spot it? Well, depression in children looks a lot like depression in adults. For example, anhedonia, the inability to experience pleasure from normally enjoyable activities, can show up in adults as a lack of enjoyment in things like golfing or writing. Preschoolers with anhedonia find little to no joy in their toys. Both adults and children with depression are restless and irritable. Depressed kids whine a lot, and don’t want to play.

When they do play, children may decide that their stuffed animals decided to “die” today and decide to bury them. Anytime you see a preschooler demonstrate methods of suicide or death with a stuffed animal without mimicking an episode of your life, such as a death in the family, your antennae need to come up. That could indicate suicidal thoughts.

But the most common symptom of depression in children is deep sadness. Not someone who’s sad for a day, but all the time, no matter who he or see is with or what he or she is doing. Sadness in the face of goals that have been thwarted is normal. But depressed children have difficulties resolving the sadness to the point where the misery affects their ability to function regularly. If your child appears to be sad to the point of inability to enjoy anything or regulate their other emotions, then get a recommendation from your pediatrician for a child psychologist or a behavioral therapist.

Other notable symptoms of childhood depression are an exaggerated sense of guilt, shame, and insecurity. Depressed preschoolers generally feel that if they do a naughty thing or disobey, that means they are inherently bad people.

Here’s a breakdown of the symptoms of depression in children of any age, including preschoolers:

  • Deep and persistent sadness
  • Irritability or anger
  • Difficulty sleeping or focusing
  • Refusing to go to school and getting into trouble
  • Change in eating habits
  • Crying spells
  • Withdrawing from friends and toys
  • Fatigue
  • Anhedonia – inability to derive pleasure from enjoyable activities, like playing with toys
  • Whining
  • Low self-esteem and insecurity
  • Shame and guilt
  • Timidity

Preschoolers may be especially vulnerable to depression’s consequences. Young children are sensitive to emotions, but lack the ability to process strong feelings. Early negative experiences–including separation from a caregiver, abuse, and neglect–affect physical health, not just mental. Multiple studies have linked childhood depression to later depression in adulthood.

This is why properly diagnosing and treating these children early is so vital. One established intervention for treating childhood depression is called Parent-Child Interaction Therapy, or PCIT. Originally developed in the 1970s to treat violent or aggressive behaviors in preschoolers, PCIT is a program where, under the supervision of a trained therapist, caregivers are taught to encourage their children to manage their emotions and stress. The program typically lasts from 10 to 16 weeks.

The Bottom Line

Dr. Luby’s research is met with resistance. Laypeople typically think the idea of preschoolers suffering depression ridiculous, and even some doctors and scientists don’t believe children are cognitively advanced enough to suffer from depression. Preschool depression remains a controversial topic, which makes it harder to diagnose in your child.

But depression in children 6 years and older has been well established by decades of data. Is it really so hard to think that preschoolers might suffer depression as well? Dr. Luby and her team have been looking at the data for 20 years, and have concluded that preschoolers can suffer depression, just like older children and adults.

Admitting that your child is depressed may make you feel like you’re a failure. After all, if you can’t protect your children from depression, who can? But clinical depression is chemical. This is not your fault. You may have been told that depression doesn’t exist in preschoolers, or that you’re overreacting. You may be called a helicopter or hovering parent. But trust your instincts. You know your child better than anyone else. Don’t be afraid to go against stigma for your child’s benefit.

Up to 84,000 of America’s 6 million preschoolers may be clinically depressed. If your child is one of them, you are not alone. There is no shame to depression. The condition is not your child’s fault, just as in adults. No parent likes to see her child suffer, and getting help for depressed children is vital to their well-being.

If your child suffers depressive symptoms, especially anhedonia, ask your pediatrician for a recommendation for a behavioral therapist or child psychologist. Typically, the earlier the intervention, the more successful the results.

Good luck.

Related:

 

Children with Bipolar Disorder May Be Diagnosed with Vitamin D Blood Test In the Future

blood test
Credit to flickr.com user CEHURD CEHURD. Used with permission under a Creative Commons license.

Researchers at Ohio State University are searching for a way to and quickly and accurately test for bipolar disorder in children. The scientists think they may have found it: a blood test which looks for a protein associated with vitamin D.

 

Finding a blood test could reduce the current average diagnosis time of ten years, said Ouliana Ziouzenkova, the study’s lead author and an associate professor of human nutrition at Ohio State.

In the study of 36 young people, levels of the vitamin D binding protein were 36 percent higher in those with bipolar disorder than in those without a mood disorder. The study appears online in the journal Translational Psychiatry.

Ziouzenkova said it made sense to look at vitamin D binding protein because it potentially plays a role in brain inflammation. The researchers also looked at inflammatory markers in the blood, but found no significant correlations. Looking for the nutrient vitamin D in the blood, as opposed to the binding protein, appears to have low diagnostic power, she said.

Confirming that the blood test works will take time, but Ziouzenkova and her colleagues are excited about the potential to help kids and their parents.

Materials provided by Ohio State University.

Children at High Risk for Bipolar Disorder Genetically Vulnerable to Stress

children
Credit to flickr.com user tanitta. Used with permission under a Creative Commons license.

Genetic alterations that regulate stress have been found in children at high risk for bipolar disorder, according to research done by scientists at The University of Texas Health Science Center at Houston (UTHealth). The study was published in Translational Psychiatry, a Nature Publishing Group journal.

 

Researchers have long known that children who experience stressors in their lives are more likely to develop bipolar disorder. Parents with bipolar may struggle with their disorders, thus placing stress on their children. But this study shows that children at a high risk for developing bipolar–due to having family members with a history of psychiatric illness–are genetically vulnerable to stress.

The scientists at UTHealth took blood samples from eighteen children, consisting of a set of bipolar patients, a set of apparently neurotypical patients with bipolar parents, and a set of neurotypical controls with parents that have no history of mental illness. The blood samples revealed that, compared with the control group, bipolar children and unaffected kids with bipolar parents have genetic alterations that regulate the response to stress.

So, children with bipolar parents are more vulnerable to stress, and when stressed, tend to develop the disorder. This may sound like bad news all around, but there is a positive approach to this study. Future research may reveal the effects of reducing stress, as well as whether medication might be able to reverse the genetic alterations in children before bipolar disorder matures.

What to do if Your Child has Bipolar Disorder

So you’ve discussed your child’s symptoms with a pediatric mental health specialist, and have a diagnosis of bipolar disorder. What now? Thankfully, there are some suggestions you can take, and taking care of your child with bipolar disorder is similar to taking care of an adult with the disorder.

1. Pay attention to medications and therapy appointments

As a parent, you are responsible for making sure your child follows their treatment plan. Use whatever reminders you can to remember to give him or her the medication that he or she needs.  If your child must take their pills at school, then open a line of communication with his or her teachers and school nurse. Appointments with his or her therapist are also important. Make sure your child attends their appointments

children2
Credit to flickr.com user Cristyan González Alfonso. Used with permission under a Creative Commons license.

2. Monitor side effects

Some side effects of atypical antipsychotics, like weight gain and blood sugar changes, are awful in adults–and children do seem to be more prone to them. These drugs were originally formulated for adults, and few have been tested on kids. Ask your child’s psychiatrist what side effects you need to keep an eye on.

3. Work out agreements with your child’s teachers

Some children with bipolar disorder need more help at school, such as more breaks during manic episodes, or less homework. During especially bad episodes, your child may need to be removed from school until he or she stabilizes. Talk to your child’s teachers. Keeping an open line of communication is the best way to ensure your child has success at school.

4. Keep a schedule

Try to be consistent with mealtimes and bedtimes, as well as waking your child up at the same time every day. This will help keep stress in the home to a minimum. Try to be patient with your child as they adjust to new routines.

5. Go to family therapy, if needed

Taking care of a child with bipolar disorder may put a lot of stress on the family as a whole. Your marriage might suffer, and the child’s siblings might be jealous of all the attention he or she gets. Attending therapy as a family may help you handle these issues.

6. Don’t ignore threats of suicide

Suicide threats are extremely serious, even in young children who may not understand what it means. Talk to your children, and if they do have suicidal ideation, give them a safe environment. Remove all the weapons or pills from the house. And talk with their mental health specialists. Crisis lines are always open.

7. Communicate with your teenager

Teenagers may become irritated or resentful if they feel that you’re compelling them to be treated. Talk to them about why you’re giving them medication and taking them to therapy appointments. Educate your kids about their mental illness. Also, it’s important that your teenager avoid substance abuse, as the risks of developing a problem are much higher in teens with bipolar disorder. Alcohol and drugs can interact with medications poorly and worsen mood episodes, so it’s important that your teenager be made aware of the risks.

All in all, taking care of your child with bipolar disorder requires an extra level of parenting. But you can do it. There are steps you can take to help you.

Bipolar Disorder in Children

Bipolar disorder affects people of all ages, including children as young as six. The disorder has periods of elevated mood, called mania, as well as periods of depression.

Common symptoms in children are:

  • Mood swings ranging from depression to irritability to elation, sometimes up to several times a day
  • Racing thoughts (while manic)
  • Hyperactive or aggressive behavior
  • Casual sex or spending sprees that are out of character
  • Decreased need for sleep
  • Inflated ego
  • Suicidal ideation in older children
  • Separation anxiety
  • Carbohydrate cravings
  • Difficulty waking in the mornings
  • Oversensitivity to emotional situations
  • Bed-wetting (especially in boys)
  • Obsession with gore or other socially inappropriate topics
  • Night terrors

 

children
Credit to flickr.com user Vladimir Pustovit. Used with permission under a Creative Commons license.

Symptoms in children look slightly different than those of adults. Children can be more irritable than adults during a manic phase, with less elevated mood, and are more likely to experience psychotic features, such as auditory hallucinations. As for depression, children are more likely to complain about physical pain. Between episodes, kids return to their normal mood. Something of note is that they cycle between these episodes several times a day, as opposed to weeks or months.

Some experts believe the disorder is rare and thus over-diagnosed; others believe the opposite, so there’s little agreement. It’s also difficult to diagnose the disorder in children, because symptoms can overlap with other diagnoses like conduct disorders or Attention Hyperactivity Deficit Disorder (ADHD)–which can occur in conjunction with bipolar disorder, making an accurate diagnosis even more tricky.

So, if you suspect your child has bipolar disorder, please speak with a mental health professional specializing in disorders in children. Ask your pediatrician for recommendations.

Stay tuned for next week’s post: What to do if Your Child has Bipolar Disorder.