Considerations for Depression in Children

Diagnosis of Childhood Depression
Treatment of Childhood Depression

Most children cope with the emotions related to cancer and not only adjust well, but show positive emotional growth and development. A small number of children, however, develop psychological problems including depression, anxiety, sleeping problems, relationship problems, and are uncooperative about treatment. A mental health specialist should treat these children.

Children with severe late effects of cancer have more symptoms of depression. Anxiety usually occurs in younger patients, while depression is more common in older children. Most cancer survivors are generally able to adapt and adjust successfully to cancer and its treatment; however, a small number of cancer survivors have difficulty adjusting.

The term depression refers to a symptom or a set of symptoms or conditions that occur together and suggest the presence of depression, or an illness. A diagnosis of depression as an illness depends on how severe the symptoms are and how long they last. For example, a child may be sad in response to trauma, and the sadness usually lasts a short time. Depression, however, is marked by a response that lasts a long time, and is associated with sleeplessness, irritability, changes in eating habits, and problems at school and with friends. Depression should be considered whenever any behavior problem continues. Depression does not refer to temporary moments of sadness, but rather to a disorder that affects development and interferes with the child's progress.

Some signs of depression in the school-aged child include the following:

• Not eating.
• Inactivity.
• Looking sad.
• Aggressive behavior.
• Crying.
• Hyperactivity.
• Physical complaints.
• Fear of death.
• Frustration.
• Feelings of sadness or hopelessness.
• Self-criticism.
• Frequent daydreaming.
• Low self-esteem.
• Refusing to go to school.
• Learning problems.
• Slow movements.
• Showing anger towards parents and teachers.
• Loss of interest in activities that were previously enjoyed.

Some of these signs can occur in response to normal developmental stages; therefore, it is important to determine whether they are related to depression or a developmental stage.

Determining a diagnosis of depression includes evaluating the child's family situation, as well as his or her level of emotional maturity and ability to cope with illness and treatment; the child's age and state of development; and the child's self esteem and prior experience with illness.

A comprehensive assessment for childhood depression is necessary for effective diagnosis and treatment. Evaluation of the child and family situation focuses on the child's health history; observations of the behavior of the child by parents, teachers, or healthcare workers; interviews with the child; and use of psychological tests.

Childhood depression and adult depression are different illnesses due to the developmental issues involved in childhood. The following criteria may also be used for diagnosing depression in children:

• A sad mood (and a sad facial expression in children younger than 6) with at least 4 of the following signs or symptoms present every day for a period of at least 2 weeks:
  • Appetite changes.
  • Either not sleeping or sleeping too much.
  • Being either too active or not active enough.
  • Loss of interest or pleasure in usual activities.
  • Signs of not caring about anything (in children younger than 6).
  • Tiredness or loss of energy.
  • Feelings of worthlessness.
  • Self-criticism or inappropriate guilt.
  • Inability to think or concentrate well.
  • Constant thoughts of death or suicide.

Individual and group counseling are usually used as the first treatment for a child with depression, and are directed at helping the child to master his or her difficulties and develop in the best way possible. Play therapy may be used as a way to explore the younger child's view of him- or herself, the disease, and treatment. From the beginning of treatment, a child needs help to understand, at his or her developmental level, the diagnosis of cancer and the treatment involved. A doctor may prescribe medications, such as antidepressants, for children. Some of the same antidepressants prescribed for adults may also be prescribed for children. (See the Treatment section for information about FDA warnings on antidepressant use in children and adolescents.)

For information about suicide in children and warnings about SSRI use, see the Depression and Suicide section in the PDQ summary on Pediatric Supportive Care.