Childhood depression: symptoms, causes and treatment

Major depression is the most prevalent mental health problem in the world today, to the point that it is beginning to be considered that its expansion is reaching epidemic proportions.

When we think about this disorder, we usually imagine an adult, with a series of symptoms known to all: sadness, loss of the ability to enjoy, recurrent crying, etc. But does depression occur only at this stage in life? Can it also appear in earlier moments? Can children develop mood disorders?

In this article we will address the issue of childhood depression, with special emphasis on the symptoms that allow it to be differentiated from that which occurs in adults.

• Related article: "The 6 stages of childhood (physical and mental development)"

What is childhood depression?

Childhood depression presents multiple differences from that of adults, although they tend to decrease as the years go by and the stage of adolescence approaches. It is, therefore, a health problem whose expression depends on the evolutionary period. Also, it is important to note that

many children lack the precise words to reveal their inner world, which can make the diagnosis difficult and even condition the data on its prevalence.

For example, sadness is an emotion that is present in children who suffer 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. And it is that this requires coping strategies that the child has yet to acquire as his psychic and neurological development progresses.

Studies on this issue show a prevalence for childhood depression of between 0.3% and 7.8% (according to the evaluation method); and a duration for it of 7-9 months (similar to that of the adult).

Symptoms

Hereinafter we will deal with 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 saying positive things about themselves

Children with depression They tend to express negatively about themselves, and even make surprisingly harsh assertions about their personal worth, which suggests a damaged baseline self-esteem.

They may indicate that they do not want to play with peers their own age because they do not know how to "do things right", or because they fear that they will be rejected or treated badly. In this way, they tend to prefer to stay out of the symbolic play activities between equals, which are necessary for healthy social development.

When they describe themselves, they frequently allude to undesirable aspects, in which they reproduce a pattern of pessimism about the future and eventual guilt for facts to which they did not contribute. These biases in the attribution of responsibility, or even in the expectations regarding the future, usually relate to the stressful events that occur. associated with their emotional state: conflicts between parents, school refusal and even violence in the domestic environment (all of them risk factors important).

The loss of confidence tends to generalize to more and more areas of the child's daily life, as time progresses and effective therapeutic solutions are not adopted for your case. In the end, it negatively affects their performance in the areas in which they participate, such as academics. Negative results "confirm" the child's beliefs about himself, entering a cycle that is harmful to his mental health and his self-image.

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2. Organic aspects predominate

Children with a depressive disorder often show obvious complaints of physical problems, which motivate numerous visits to the pediatrician and hinder their normal attendance at school. The most common are headache (located in the forehead, temples, and neck), abdominal discomfort (including diarrhea or constipation), persistent fatigue, and nausea. The face would tend to take on a sad expression, and to noticeably diminish eye contact.

3. Irritability

One of the most well-known peculiarities of childhood depression is that it usually presents with irritability, which is much more easily identifiable by parents than the emotions that could underlie it. In these cases, it is very important to consider that parents are good informants of their children's behavior, but tend to be somewhat more imprecise at the moment in which he inquires about his inner nuances. That 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 is not described using the term "sad" (since uses qualifiers such as "grumpy" or "angry"), it can 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 about the clinical characteristics of depression in children.

4. Vegetative and cognitive symptoms

Depression can be accompanied (in both children and adults) by a series of symptoms that compromise functions such as cognition, sleep, appetite and motor skills. Particular expressions have been observed according to the developmental stage of the child, although it is considered that as the time passes are more similar to those of the adult (so in adolescence they are comparable in many ways, not in everyone).

In the first years of life they are common insomnia (conciliation), weight loss (or cessation of expected gain for age) and motor agitation; while as the years go by, it is more common for hypersomnia, increased appetite and generalized psychomotor slowing to appear. At school, significant difficulty in keeping the focus of attention (vigilance) and in concentrating on tasks is evident.

5. Anhedonia and social isolation

The presence of anhedonia suggests a severe depressive state in children. It is a significant difficulty in experiencing pleasure with what was previously reinforcing, including recreational and social activities.

Thus, they may feel apathetic / disinterested in exploring the environment, progressively distancing themselves and yielding to harmful inactivity. It is in this moment that it becomes clear that the child is suffering from a situation other than "behavior problems", as it is a common symptom in adults with depression (and therefore much more recognizable for the family).

Along with anhedonia, there is a tendency towards social isolation and refusal to participate in activities shared (playing with the reference group, loss of interest in academic matters, rejection of the school, etc.). This withdrawal is a phenomenon widely described in childhood depression, and one of the reasons why parents decide to consult with a mental health professional.

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Causes

There is no single cause for childhood depression, but a myriad of risk factors (biological, psychological and / or social) whose convergence contributes to its final appearance. Next we proceed to detail the most relevant ones, according to the literature.

1. Parental cognitive style

Some children have a tendency to interpret everyday events in their lives in catastrophic and clearly disproportionate terms. Despite many hypotheses having been formulated to try to explain the phenomenon, there is a fairly broad consensus that it could be result of a vicarious apprenticeship: the child would acquire the specific style that one of her parents uses in order to interpret the adversities, adopting it as their own from now on (because attachment figures act as models of conduct).

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 issue indicate that there is a four times greater risk that a child will develop depression when either parent has 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 reached.

2. Conflicts between the figures of care

The existence of relational difficulties between parents stimulates in the child a feeling of helplessness. The foundations on which their sense of security is built would be threatened, which aligns with common fears of the age period. Shouting and threats can also precipitate other emotions, such as fear, that would be decisively installed in your internal experience.

Studies on this issue show that the warmth of the attachment figures, and the consensual agreements on the parenting, act as protective variables to reduce the risk that the child develops relevant emotional problems clinic. All this regardless of whether the parents remain together as a couple.

3. Domestic violence

Experiences of sexual abuse and mistreatment (physical or mental) stand as very important risk factors for the development of childhood depression. Children with overly authoritarian parenting styles, in which force is imposed unilaterally as a mechanism to manage the conflict, can show a state of constant hyperarousal (and helplessness) that results in 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 school changes, can be the basis for depressive disorders during childhood. In this case, the mechanism is very similar to that seen in adults, sadness being the natural result of a process of adaptation to loss. However, this legitimate emotion can progress to depression when it involves the summative effect of small additional losses (reduction of rewarding activities), or a low availability of emotional support and affection.

5. Social rejection

There is evidence that children with few friends have a higher risk of developing depression, as well as those who live 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 increased suicidal ideation (fortunately rare 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, has been described (although its expression can be shaped through individual experience), increases the risk that the infant suffers depression. It translates into an overwhelmingly intense emotional reactivity to adverse stimuli, which would enhance its effects on emotional life (separation from parents, removals, etc.).

Finally, it has been described that children with neurodevelopmental disorders, such as attention deficit with or without hyperactivity (ADHD and ADD), they are also more likely to suffer depression. The effect extends to learning problems (such as dyslexia, dyscalculia or dysgraphia), tonic and / or clonic dysphemia (stuttering) and behavior disorders.

Treatment

Cognitive behavioral therapy has been shown to be effectivez in children. The identification, debate and modification of the basic negative thoughts is pursued; as well as the progressive and personalized introduction of enjoyable activities. Furthermore, in the case of children, the intervention is oriented towards tangible aspects located in the present (immediacy), thereby reducing the degree of abstraction required. Parental input is essential throughout the entire process.

Also interpersonal therapy has been effective in most studies in which it has been put to the test. The purpose of this form of intervention is to investigate the most relevant social problems in the child's environment (both in which he is involved such as those in which it is not directly), looking for alternatives aimed at favoring the adaptive resources of the family understood as a system.

Finally, they can be used antidepressants in those cases in which the child does not respond adequately to psychotherapy. This part of the intervention must be carefully evaluated by a psychiatrist, who will determine the profile of risks and benefits associated with the consumption of these drugs in childhood. There are some warnings that suicidal ideation may increase in people under 25 years of age. age, but it is generally considered that its therapeutic effects far outweigh its drawbacks.

"Bibliographic references:

• 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.