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Depression in Children and Adolescents

For many years, depression was classified as a condition that only occurs in adulthood. More recently, the mental health community has become aware that children and adolescents can also experience depression and that they get better with treatment. Depression occurs in about 5% of the population and often runs in families.

Depression is defined as an ongoing depressed mood with a spectrum of symptoms that significantly interferes with the child’s functioning. However, depression can be hard to recognize in youth because it can look different than it does in adults. A depressed child or adolescent might not appear obviously sad or unhappy. Sometimes, early signs of depression in youth can be: loss of interest in hobbies or sports, not wanting to spend time with friends, changes in sleep or appetite, decline in grades, increased fatigue, or more headaches and stomachaches. Increased moodiness, irritability, anger or acting out behaviors can also be symptoms of depression. Sometimes children or adolescents feel so bad that they have thoughts about not wanting to be alive and may engage in self-injury. Depression can also co-occur with other childhood disorders such as anxiety, ADHD and substance abuse–especially if those conditions have not been diagnosed and treated.

Parents may notice some of these concerning signs and wonder if they are part of normal growth and maturation or whether they should be worried about their child’s emotional well being. A child and adolescent psychiatrist or other mental health professional can help determine whether the child is experiencing depression and can make treatment recommendations. Timely treatment is important because the child’s emotional, behavioral, social and academic development can be negatively impacted by untreated depression. Treatment recommendations often include psychotherapy, and in some cases an antidepressant medication as well.

Anxiety in Children and Adolescents

It is normal for children and adolescents to have some fears and worries. Very young children tend to worry about getting hurt, being in the dark or monsters. School age children commonly worry about doing well in school and making friends. Children sometimes worry about something bad happening to a parent. Adolescents may worry about popularity, academic performance and peer pressure.

Sometimes fears or worries become excessive and interfere with the youth’s functioning at school, in activities or at home. Examples of childhood anxiety disorders include:

-Separation anxiety (which may keep a child from being able to leave the parent and attend school)

-Social anxiety (which may make a child fearful of meeting new people and going to new places)

-Phobias (which occur when a child has an intense, debilitating fear of a particular thing or situation)

-Generalized anxiety (which means that the child worries excessively about many things a lot of the time)

If a child’s worries or fears are causing significant distress and are getting in the way of his or her daily activities, parents can seek evaluation from a mental health professional, such as a child and adolescent psychiatrist. Children and adolescents respond well to therapeutic interventions such as cognitive behavioral therapy, and many get better without needing medication. Other children do best with a combination of psychotherapy and anti-anxiety medication.

What can my child or adolescent and I expect on our first visit?

The first visit is designed to allow the child and adolescent psychiatrist to get to know your child, determine whether the child meets criteria for a psychiatric diagnosis and develop a treatment plan. During the 90 minute initial appointment, the psychiatrist meets with the parents alone, the child alone and the parents and child together to obtain a detailed history. In order to get a multidimensional understanding of the child, the psychiatrist asks a variety of questions about the child’s birth and subsequent development, medical history, family history, personality traits, emotional and behavioral issues, academic performance, social skills etc. The psychiatrist also gathers information from collateral sources (previous mental health clinicians, PCP or pediatrician, other family members, teachers, etc.) When the evaluation is complete, the psychiatrist shares his or her clinical and diagnostic impressions as well as treatment recommendations with parents and child or adolescent. This initial evaluation allows both the psychiatrist and the family to gain an understanding of the difficulties the child is experiencing and whether ongoing treatment would be in the child’s best interests.

Initial treatment recommendations can include a wide spectrum of interventions. Supportive, play, cognitive behavioral or insight-oriented are some of the types of psychotherapy which can be helpful for children and adolescents. In some cases, the psychiatrist also recommends medication which can help children and adolescents who are having significant psychiatric difficulties get better more quickly. Additional workup can also be recommended, such as psychoeducational testing, speech/language testing, an occupational therapy evaluation, medical evaluation or bloodwork.