Key Symptoms of Depressive Disorders
Depressive Disorders of childhood are characterised by:
Feelings of sadness and/or low or irritable mood
Loss of interest and /or pleasure
Fatigue or low energy
- Poor concentration
- Guilt or self-blame
- Low self confidence
- Poor or increased sleep
- Poor or increased appetite
- Agitation or slowing down of movements
- Self-harming or suicidal behaviour
Making A Diagnosis
In order to make a diagnosis of depression the key symptoms must be present, and the mood change must be persistent for at least 2 weeks although these diagnostic criteria may differ in children who show more variable moods and behaviours.
Depending on the number of associated symptoms the depressive disorders can range from mild to severe forms.
Manifestation of symptoms
The clinical symptoms manifest themselves differently through age with young children (who are depressed) being more prone to irritability, worries and separation anxiety, phobias and somatic complaints such as non-specific aches and pains.
Children who have been exposed to a bereavement, parental divorce or separation, moving house and neighbourhood, family ill health, parental mental illness and/or discord, bullying and inability to follow their school work, are more likely to be predisposed to developing depressive symptoms.
Children may not have all the symptoms of depression required for a clinical diagnosis but a teacher may notice that some children look sad, are withdrawn, often cry at the smallest thing, are sometimes uncharacteristically aggressive and do not want to play or be with their friends. They are finding it difficult to follow their schoolwork.
What teachers can do
Talking to the child and listening is of utmost importance. Often the child will openly say that they are unhappy when asked directly. They will also be able to tell a teacher what it is, specifically, what is making them unhappy.
A teacher can watch the child and be alert to their behaviour and feelings. Bringing them from the back of the classroom to the front can be helpful. Allowing extra time so they can catch up with their work is essential. Making decisions can be difficult when depressed, so allowing plenty of time for even the simplest of tasks is recommended. Self-confidence will be improved through regular praise.
Finding a ‘buddy’ to befriend a child who is withdrawn and unhappy during breaks and play time may be helpful. Incorporating physical activities into the daily routine of the whole class will benefit the depressed child but the whole class as well. Ensuring that the child is eating healthily and getting enough exercise and sleep is achieved through liaison with the parent/carer.
What to do next
Should symptoms persist or worsen, the child should be referred for more specialised help such as a designated mental health school lead or local support team or CAMHS team. Parental and carer permission should be sought at all stages during the period of watchful waiting, in providing classroom assistance and ultimately, at the point of referral, for more specialist help. Depressive disorders of childhood can be successfully treated with psychological therapies including Cognitive Behavioural Therapy and in older children judiciously applied medication is of benefit.
Dr Gordana Milavic M.D., F.R.C.Psych
Consultant Child and Adolescent Psychiatrist
Michael Rutter Centre, Maudsley Hospital Conduct Problems Clinic and Adoption and Fostering Team