Child and Adolescent Depression
What Is It?
Child and Adolescent Depression, like depression in adults, is a Mood Disorder characterized by intense and prolonged maladaptive sadness. The child experiences a lack of interest or pleasure in routine activities for a minimum period of two consecutive weeks. Child and Adolescent Depression can also manifest through irritability and physical symptoms (described below) without apparent medical cause. Unlike sadness as an adaptive reaction to adversity, depression can impair the child's or adolescent's ability to function in various areas of life. Without intervention, depressive symptoms can escalate to psychosomatic illnesses, psychotic symptoms, suicidal impulses, and can persist for weeks, months, or even years.
The classic expression of Depression corresponds to Major Depressive Disorder. However, in children and adolescents (between the ages of 6 and 18), another form called 'Disruptive Mood Dysregulation Disorder' may occur. This form of Depression is characterized by persistent irritability and disproportionate anger outbursts unrelated to the developmental phase. The child may demonstrate aggressive behaviors towards themselves, others, or objects. Disruptive Mood Dysregulation Disorder is diagnosed when these symptoms occur on most days for at least one year in at least two settings (e.g., at home and at school). It's essential to distinguish this condition from frustration responses that are adapted to the challenges associated with growth.
Major Signs and Symptoms
Child and Adolescent Depression can be challenging to identify as the symptoms are diverse and may be confused with developmental stages that the child is going through. Therefore, it's important for parents, caregivers, and educators to pay special attention to the following signs:
1) Behavioral Signs: difficulties in learning and concentration, which may lead to a decrease in academic performance; displaying behaviors that are inappropriate for their age; social isolation; excessive passivity or aggressiveness - the child may have a distant and apathetic look or react with constant aggressive crying and screaming; self-mutilation as a way to relieve emotional pain; early substance abuse (e.g., drugs and alcohol in adolescents).
2) Physical Signs: pain, especially abdominal pain, without a medical explanation; insomnia (the child may have trouble falling asleep, wake up during the night, or wake up too early) or hypersomnia (the child has an excessive need for sleep); nausea; enuresis (involuntary urination inappropriate for their age); loss or increase of appetite; failure to achieve expected weight gain; loss of energy.
3) Emotional Signs: prolonged sadness; low self-esteem; exaggerated fears, particularly related to the loss of someone; anxiety and feelings of guilt; suicidal thoughts and a desire for death in adolescents.
4) Cognitive Signs: self-criticism (being overly critical of oneself) and self-control (excessive self-control over thoughts and speech), leading to feelings of inferiority in comparison to peers and difficulty in completing tasks.
Possible Causes and Risk Factors
There are several causes and factors that contribute to child and adolescent depression:
Biological Factors
- Altered neurochemical function;
- Altered hormonal function, such as low production of growth hormone during sleep;
- Reactions to or consequences of possible physical illness;
- Genetic factors, with a significant risk factor being a diagnosis of depression in one of the caregiving figures.
Environmental Factors
- Continuous exposure to conflicts;
- Physical, emotional, and/or sexual abuse;
- Inadequate parenting practices, such as being excessively controlling or excessively flexible without rules;
- Sudden life changes, such as changing homes or schools;
- Low socioeconomic status of the family structure;
- Early use of alcohol and/or drugs in adolescents;
- Social isolation;
- Real losses, such as the death of someone close, or symbolic losses, such as the feeling of the absence of parents or other important figures.
How Can Psychotherapy Help?
It's important to note that the earlier depression appears, the more significant the consequences will be for development and throughout life. Clinical study data suggest a percentage between 20% and 40% recurrence in cases of Child and Adolescent Depression. Thus, depressed children or adolescents are at higher risk of suffering from depression into adulthood, especially when there is no intervention. Research has shown the effectiveness of psychotherapy in cases of Child and Adolescent Depression through various approaches:
- Cognitive-Behavioral Therapy (CBT);
- Dialectical Behavioral Therapy (DBT);
- Systemic and Family Approach Therapy;
- Eye Movement Desensitization and Reprocessing (EMDR);
- Play Therapy;
- Mindfulness.
These approaches allow working on different goals and promote the acquisition of various resources that help the child or adolescent cope with difficulties, such as:
- Improved self-regulation and self-care abilities;
- Enhanced relationship and communication patterns;
- Processing traumatic events;
- Identification and adaptive management of various emotions;
- Enhanced cognitive, behavioral, physiological, and emotional self-awareness for better decision-making;
- Parental psychoeducation to help parents/caregivers recognize and cope with the child/adolescent's difficulties and well-being moments.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.
Bahls, S. (2002). Clinical aspects of depression in children and adolescents. Jornal de Pediatria, 78(5), 359-366.
Clerget, S. (2001). Don't Be Sad, My Child. Understanding and Treating Depression in the Early Years of Life. Porto: Ambar.
Gomes, L. P., Baron, E., Albornoz, A. C. G., & Borsa, J. C. (2013). Children's Depression Inventory (CDI): A review of Brazilian scientific articles. Contextos Clínicos, 6(2), 95-105.
Petersen, C., & Wainer, R. (2011). Cognitive-Behavioral Therapies for Children and Adolescents: Science and Art. Porto Alegre: Artmed.
Ribeiro, M. V., Macuglia, G. C. R. M., & Dutra, M. M. (2013). Cognitive-Behavioral Therapy in Child Depression: An Intervention Proposal. Revista Brasileira de Terapias Cognitivas, 9(2), 81-92.