We are already quite aware of adult depression and know how to recognize it, but diagnosing depression in children is somewhat more challenging.

Depression is one of the most common mental disorders worldwide. According to WHO statistics, Estonia ranks among the countries with the highest rates of depression, with approximately 75,000 Estonians diagnosed—that is, about 5.9% of the population (2018). The three main symptoms of depression are low mood, decreased interest and pleasure, and fatigue or loss of energy. Additionally, there may be a noticeable decline in attention and concentration, changes in appetite, feelings of hopelessness, relationship problems, and more.

Symptoms of depression in children

Depression in children is more difficult to diagnose because it can appear in very different forms. For example, it is common for a child’s depression to manifest as behavioral problems. This can cause confusion among parents and adults, as a child does not always express negative emotions through sadness. A child’s brain is still developing, and each age has its own specific emotional developmental tasks. If a child is depressed, sad, or unmotivated for some reason, it becomes difficult for them to fulfill these developmental tasks. Sometimes this may even result in overcompensation, meaning the child’s behavior becomes provocative and significantly more unpleasant than usual.

A child with depression may be easily irritable, moody, and stubborn. Similarly, adults with depression often exhibit symptoms of excessive anxiety and irritability.

It is also possible that a depressed child is sad, withdrawn, and spends an overwhelming amount of time in virtual worlds, appearing apathetic and losing interest in activities they previously enjoyed. Children may often express thoughts of death. Although the understanding of these thoughts and any actual actions may not always be clear to the child themselves, this can also be part of a developmental phase in the child’s perception of the world.

Assessing the child within the family context

When evaluating different developmental stages in children, it is expected that a 3-4-year-old child may be stubborn, test boundaries, be moody, and have tantrums. However, if a 6-7-year-old child exhibits these behaviors, parents should ask themselves what is happening in the child’s life that they are currently struggling to cope with emotionally.

Could it be confusion in family relationships or conflicts between parents? Or perhaps an age-inappropriate level of responsibility? Children often reflect the emotions of their parents and home environment.

Often, conflicts between parents are the root cause of children’s emotional problems. In such cases, a child may take on excessive responsibility for a parent’s emotions—for example, supporting the so-called “weaker” parent—or may become “invisible” by trying to stay out of their parents’ conflicts altogether.

If there are multiple children in the family and the parents struggle to manage the younger ones, the older child may take on that role from the parents and assume what is called a “parentified child” role. However, this is not age-appropriate for the child, as they have not yet developed the necessary emotional coping skills for such a role.

Social relationships

A child’s stress is often caused by relationships with peers. Sometimes a child may not fit in with their peer group for various reasons or may lack the skills to manage these relationships. Many examples from the “children’s world” show that children who become victims among their peers are often those who are insecure and whose social skills or emotional coping mechanisms are not age-appropriate. There can be several reasons for this; in addition to the ones mentioned earlier, it is possible that the child was somehow different or isolated during an important developmental stage and didn’t have enough opportunities to practice social interactions. For example, the child may have been frequently ill, not attended kindergarten, extracurricular activities, or similar.

Additionally, only children often find it more difficult to form social relationships because the most basic foundation for developing social skills with peers is the home environment and relationships with siblings.

It’s important to remember that every brief, so-called “strange” period in a child’s behavior is not necessarily a mental disorder. Children respond directly to stress, and usually, these phases are temporary. When children have safe adults around them who provide guidance on how to manage their emotions, they generally cope well with their crises.

Where to get help

For school-aged children, the primary contact person could be the school psychologist, who can refer the child to a psychiatrist, clinical child psychologist, or family therapy if needed. For younger children, it may be appropriate to consult a child psychologist or family therapist.

Most often, children receive help when changes occur in their home relationships, as the home is the most important place for a child to develop emotional coping skills, and close relationships at home are usually the primary source of the support they need.

If it feels difficult to find these resources on your own and you lack the necessary skills, significant improvements in a child’s problems can often begin with small changes under the guidance of specialists.

Main signs of depression in children

  • mild irritability;
  • inappropriate emotional reactions (age-appropriate reactions and developmental tasks are freely available online);
  • sudden changes in behavior;
  • problems in social relationships and excessive stress related to those relationships;
  • withdrawal and mistrust;
  • provocative behavior and attention-seeking.

So, what is depression in children?

There is no single answer to this question, and neither does the International Classification of Mental and Behavioural Disorders provide one. It associates childhood depression more with behavioral problems, developmental peculiarities, anxiety, or communication difficulties.

As adults, we have learned many ways to cope with emotions, but a child’s reaction to stress is usually different and much more immediate.

Behavioral problems in children are an important signal for adults — no child is deliberately bad or naughty; usually, these behaviors are expressions of stress or the beginning of a mood disorder.

Most importantly – every parent should be their child’s greatest expert and best source of support.

Teele Reiljan
clinical psychologist and family therapist