child-abuse-729-420x0“The test of the morality of a society is what it does for its children.” ~ Dietrich Bonhoeffer.

Depression comes in many forms. Sometimes it appears in obvious formats, such as through a sad face or slumped head and shoulders, or even through little eye contact and the lack of a smile. These are the more obvious forms of depression, as it might appear on the outside. Let’s take a look at how depression looks in children and teens.Children are diverse. There are many ways to be a child and each child has his or her own sense of being in the world. When thinking about things such as depression we want to first understand the child before depression. For some children and teens this will be difficult, as they report having always been depressed or sad. If this is the case we want to understand how this happened to be the case. What was it that made them sad in their span of forever?

If you have a baseline of happiness and later see a change in behavior it may be depression or a combination of depression alternating or co-occurring with anxiety. Children do not always look sad when depressed and they don’t always look nervous when they are anxious.

Children tend to be in the here and now and in their bodies more than adults. This is useful information when determining if a child is depressed. The body will be overly agitated and characterized by a lot of movement when a child is depressed. We call this psychomotor agitation. Conversely, a child may have psychomotor retardation, which refers to the body movements being slowed down and limited. This too is a warning sign for depression. We first look at the body. Is it sped up or is it slowed way down?

Next we look at what the child says. Do they talk? Do they give you the old “I don’t know” or “Fine” ? These are indicators of the child either being unwilling to say what is going on, not wanting to say, or that it simply requires too much energy to say what they feel. This usually means depression or something else going on inside.

Does the child talk about death themes? By this I am referring to all the bad things on the news, the scenes in movies or video games, or things they heard from another. Any preoccupation with themes around death and dying are warning signs. If a child wonders out loud about what it is like to be dead, one should pay attention.

Anger is often mistaken as part of a conduct disorder, part of childhood, or a misstep on the part of a child or teen. Anger reveals much more. Anger is a sentinel emotion often sent out to do the work of other emotions. It is used because it is stronger and people typically back off in its presence. A warning sign of depression in children and teens is anger. Depression doesn’t always look sad; it often looks angry.

Children who are restless, angry, sad, have sleep problems, or who over eat or under eat are often depressed. Too much pressure to succeed or too little parental involvement can lead to depression symptoms. Children will be the last ones to identify depression as the emotional state they are experiencing. Anxiety may be identified and most depression comes with anxiety. For this reason parents, school professionals, and even mental health professionals overlook depression. It alternates with anxious states, worry, and preoccupations of one type or another.

It is fine to get an annual mental health check up for your child or teen just like we would go to the physician for a physical exam. I often see children for an evaluative set of sessions. I see mom and dad, I then see the child or teen for two or three sessions, and then I meet back with mom and dad. I don’t always recommend counseling, but I am able to identify the child’s strengths, challenges, and any major issue such as depression, anxiety, or other problem. Parents feel great about having the feedback and recommendations for what they can do now to avoid issues later. They also voice feeling better having another opinion. They know, based on what I share, that I did get a true sense of their child. The child is often grateful to have had the chance to air concerns with someone they don’t have to worry about. They worry about upsetting their parents.

So, think about your child and depression or anxiety. These are the world’s biggest problems right now. More than 40 million adult Americans suffer from anxiety. Suicide is still one of the leading causes of death. Depression takes the joy out of life. Think about a mental health check up. You don’t have to invest in more than a few sessions and you will get a ton of useful information about what to do.

Be well and take care.

Nanette Burton Mongelluzzo, PhD

Understanding Loss and Grief
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