Major depression is the most prevalent mental health problem in the world today, to the point where it is beginning to be seen as reaching epidemic proportions.
When we think of this disorder, we usually imagine an adult, with a series of symptoms known to all: sadness, loss of pleasure, recurring crying, etc. But does depression only occur at this stage of life? Can it also be presented earlier? Can Children Develop Mood Disorders?
In this article, we will discuss the issue of childhood depression, With particular emphasis on the symptoms that differentiate it from that which occurs in adults.
What is childhood depression?
Childhood depression has many differences from that of an adult, although they tend to decrease over time and as the teenage years approach. It is therefore a health problem whose expression depends on the evolutionary period. In addition, it is important to keep in mind that many children do not have the precise words to reveal their inner worldThis can make the diagnosis difficult and even condition the data on its prevalence.
For example, sadness is an emotion present in children who suffer from depression. Despite this, the management difficulties generate symptoms different from those expected for adults, as we will underline in the corresponding section. And it requires coping strategies that the child has not yet learned as their mental and neurological development progresses.
Studies on this problem show a prevalence of childhood depression between 0.3% and 7.8% (According to the valuation method); and a duration of 7 to 9 months (similar to that of adults).
In the future, we will deal with the peculiarities of childhood depression. All should alert us to the possible existence of a mood disorder, which requires a specific therapeutic approach.
1. Difficulty saying positive things about themselves
Children with depression they often speak negatively about themselves and even make surprisingly harsh self-worth claims, Suggesting a damaged core self-esteem.
They may point out that they don’t want to play with peers their age because they don’t know how to “do it right”, or because they fear rejection or mistreatment. In this way, they often prefer to stay away from symbolic play activities between equals, necessary for healthy social development.
When describing themselves, they often allude to undesirable aspects, in which they breed a model of pessimism about the future and possible guilt for facts to which they did not contribute. These biases in the attribution of responsibility, even in the expectations regarding their future, often revolve around the stressful events associated with their emotional state: parental conflict, school rejection, even violence in the home (all risk factors important).
Loss of confidence tends to spread to more and more areas of a child’s daily life.Over time, no effective therapeutic solution is adopted for your case. Ultimately, it negatively conditions its performance in fields in which it participates, such as academics. Negative results would “confirm” to the child the beliefs he holds about himself, starting a cycle that is harmful to his mental health and his self-image.
2. Predominance of organic aspects
Children with depressive disorder they usually show obvious complaints of physical problems, Which motivate many visits to the pediatrician and hinder their normal attendance at school. The most common are headaches (located in the front, temples and neck), abdominal discomfort (including diarrhea or constipation), persistent fatigue, and nausea. The face would tend to take on a sad expression and apparently lessen eye contact.
One of the best-known characteristics of childhood depression is that it is usually accompanied by irritability, which is much more easily recognized by parents than the emotions that might 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 a bit more inaccurate when its internal nuances are studied. Therefore, sometimes the reason for the initial consultation and the problem to be solved are a little different.
This circumstance, along with the fact that the child is not described using the term “sad” (because he uses adjectives such as “cranky” or “angry”), may delay identification and intervention. . In some cases, he even goes so far as to make a diagnosis that does not adhere to the reality of the situation (contesting the negativist disorder, to cite just one example). It is therefore necessary for the specialist to have precise knowledge of the clinical characteristics of depression in children.
4. Vegetative and cognitive symptoms
Depression can be accompanied (in children and adults) by a number of symptoms that compromise functions such as cognition, sleep, appetite and motor skills. Particular expressions have been observed depending on the stage of development of the child, although over time it is considered that they more closely resemble those of the adult (so in adolescence they are comparable to in many ways, that not at all).
In the first years of life they are common insomnia (conciliation), weight loss (or cessation of gain expected for age) and restlessness; while over the years, hypersomnia, increased appetite and generalized psychomotor slowing are more common. At school, a significant difficulty becomes evident in maintaining attention (alertness) and concentration on tasks.
5. Anhedonism and social isolation
The presence of anhedonia suggests a severe depressive state in the child. This is a major difficulty in experiencing pleasure with what was once reinforcing, including recreational and social activities.
Thus, they may feel listless / disinterested in exploring the environment, gradually distance themselves, and succumb to harmful inactivity. This is when it becomes clear that the child is suffering from a different situation from “behavior problems”As this is a common symptom in adults with depression (and therefore much more recognizable by the family).
Alongside 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 subjects, rejection of school, etc. .). This withdrawal is a phenomenon widely described in childhood depression and one of the reasons parents decide to see a mental health professional.
There is no single cause of childhood depression, but a myriad of risk factors Convergence (biological, psychological and / or social) contributes to its final appearance. Then, we detail the most relevant, according to the literature.
1. Cognitive style of parents
Some children tend to interpret the everyday facts of their lives in catastrophic and clearly disproportionate terms. Despite many hypotheses to try to explain the phenomenon, there is a fairly broad consensus on what it could be. proxy learning outcome: The child would acquire the specific style that one of his parents uses to interpret adversity, now adopting it as his own (because loving characters 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 question point out that there is four times more likely that a child will develop depression when either parent has it, unlike those without a family history of any kind. However, precise knowledge has yet to be reached on how genetics and learning might contribute, as independent realities, to all of this.
2. Conflicts between care figures
The existence of relationship difficulties between the parents stimulates a feeling of helplessness in children. The foundations on which their sense of security are built would be threatened, which corresponded to the usual fears of the time. Screaming and threats can also precipitate other emotions, such as fear, which would be permanently installed in their inner experience.
Studies on this issue show that warmth samples from loving characters and consensual parenting agreements act as protective variables to reduce the risk of the child developing emotionally relevant issues. All this regardless of whether the parents remain united as a couple.
3. Family violence
Experiences of sexual abuse and maltreatment (physical or mental) are identified as very important risk factors for the development of childhood depression. Children who suffer from overly authoritarian parenting stylesIn which force is imposed unilaterally as a conflict management mechanism, can show a state of constant hyperactivity (and helplessness) which results in anxiety and depression. Physical aggression is linked to impulsivity in adolescence and adulthood, mediated by the functional relationship between the limbic (amygdala) and cortical (prefrontal cortex) structures.
4. Stressful events
Stressful events, such as parental divorce, moving house or changing school, can cause depression in children. In this case, the mechanism is very similar to that observed in adults, sadness being the natural result of a process of adaptation to the loss. However, this legitimate emotion can progress to depression when it involves the summative effect of small additional losses (Reduced rewarding activities), or a low availability of emotional support and affection.
5. Social rejection
It is proven that children with few friends have a higher risk of developing depression, as are those who live in socially poor environments. Conflict with other children in her peer group has also been shown to be related to the disorder.. Likewise, bullying (persistent experiences of humiliation, punishment or rejection in the school environment) has been strongly associated with childhood and adolescent depression, and even with the rise of suicidal ideation (this which, fortunately, is rare in depressed children).
6. Personality traits and other mental or neurodevelopmental disorders
It has been described that high negative affectivity, a stable trait for which an important genetic component has been traced (although its expression can be modeled by individual experience), increases the risk of the child suffering from depression. The result is overwhelming emotional responsiveness to unwanted stimuli, Which would strengthen its effects on emotional life (separation of parents, moves, etc.).
Finally, it has been described that children with neurodevelopmental disorders, such as attention deficit disorder with or without hyperactivity (ADHD and ADHD), are also more likely to suffer from depression. The effect extends to learning problems (such as dyslexia, dyscalculia or dysgraphia), tonic and / or clonic dysphamia (stuttering) and behavioral disturbances.
Cognitive behavioral therapy has been shown to be effectivez in the child population. Identification, debate and modification of basic negative thoughts are continued; as well as the gradual and personalized introduction of enjoyable 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. Parental input is essential throughout the process.
Interpersonal therapy has also been shown to be effective in most studies in which it was tested. The aim of this form of intervention is to study the most relevant social problems in the child’s environment (both those involved and those not directly involved), looking for alternatives aimed at promote adaptive family resources understood as a system.
Finally, antidepressants can be used in cases where the child does not respond adequately to psychotherapy. This part of the intervention should be carefully evaluated by a psychiatrist, who will determine the risk-benefit profile associated with the use of these drugs in childhood. Some warnings can increase suicidal ideation in people under 25, but their therapeutic effects are generally considered to outweigh their disadvantages.
- Charles, J. (2017). Depression in children. Focus, 46 (12), 901-907.
- Figuereido, SM, de Abreu, LC, Rolim, ML and Celestino, FT (2013). Childhood depression: a systematic review. Neuropsychiatric disease and treatment, 9, 1417-1425.