Imagine you are the parent of Sofie, a 7-year-old girl who almost always seems happy and carefree. She loves to play with her younger siblings, crushes it at her gymnastics class, and does well in school. Over the past several months, however, you notice that Sofie has become what you can only describe as “increasingly defiant.” She frequently gives you “attitude,” often snapping back with sass at your most innocuous questions. She also seems to get upset more easily than before. Lately, even the slightest change in routine will catapult her into a tantrum. You feel as though you are walking on eggshells every time you are around Sofie. What’s more, she frequently complains of being bored. It is as if all she wants to do now is stare at her tablet or play Roblox. Everything else, from gymnastics to playing with her siblings, is written off as “boring” by Sofie. Finally, Sofie has started to resist basic self-care routines like showering and brushing her teeth.
You may be tempted to think Sofie has a behavioral issue such as oppositional defiant disorder. Even the therapist she sees may also agree with this opinion. What if I told you, however, that she may be depressed? Depression in young children can be tricky to spot. The claws of depression grip children differently, in a more nuanced and subtle way. When we think of “depression” we often associate it with persistent sadness, tearfulness and low self-esteem. While children may exhibit such symptoms (and many times they do), it is often less obvious. Below I describe several of the more subtle signs of childhood depression. As you read this, it may be tempting to conclude your child is depressed. Please remember that the signs below could indicate many things and it is always recommended to have your child assessed by a trained professional.
Irritability: The Raw Nerve
Many children who are indeed depressed may deny persistent feelings of sadness. In the world of adult mental health, persistent sadness is a hallmark symptom of depression. Children, on the other hand, can manifest depression differently. Many children who are depressed exhibit a sharp increase in their level of irritability. It is as if there is an exposed emotional raw nerve that is triggered at the slightest issue. Asking them to do a chore, asking them about their day, or even simply your mere breathing presence may elicit an irritable response. When children experience depressed mood, oftentimes their emotional resilience can decline. Their ability to regulate their behavioral response to routine triggers is hindered. Furthermore, depression tends to give way to a filter of negativity. Benign comments from family members may be misinterpreted as malicious. A question from a place of neutral curiosity (e.g., did you get your homework done?) may be viewed as a critique. Especially if a child’s irritability is new and represents a change from their previous disposition, the possibility of depression should be considered.
Boredom Galore!
In the current iteration of the diagnostic manual of mental disorders, one of the hallmark features of depression is referred to as “anhedonia.” This refers to a diminished ability to experience pleasure or a loss of interest in previously enjoyed activities. While children can certainly endorse anhedonia, a pervasive loss of interest in things is more common in older adolescents and adults. Children, on the other hand, less readily endorse a loss of interest in activities. Instead, they are more likely complain of chronic boredom. They may still enjoy grabbing pizza with friends or playing video games. However, they tend to become bored more easily and more often then before. Furthermore, their baseline sensitivity to boredom may markedly increase. In other words, they may feel the discomfort of boredom more strongly and have trouble enduring or working through discreet periods of boredom.
The Body Tells the Story
Many children, especially younger ones, may lack the emotional insight to articulate their internal experiences. Mental health symptoms can therefore show up somatically. In other words, the body may tell more of the story. Some of the more common physical symptoms associated with depression (and anxiety for that matter) are nausea, headaches and stomach pains. It is important to validate these feelings in your child and view them as genuine. Many mental health issues issues including depression place a real stress on the body. Research suggests that depression can raise inflammation in the body, potentially leading to physical discomfort. Of course, it is always important to consult with your pediatrician to rule out a medical explanation of symptoms.
If you are concerned that your child is depressed, it may a good idea to discuss this with your child’s pediatrician. A child’s pediatrician is often the first line of defense and can direct families to the right resources including therapy and/or medication.
