Dealing with depression in children and young people

Written by Dr. Joshua Harwood

Josh is a chartered clinical psychologist specialising in working with children and families.

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Experiencing sadness or low mood is a natural response to certain events that occur in our own and our children’s lives. Being left out by peers, failing an exam and grief are all things that can make children feel sad.

With support from their loved ones or resolution of the situation, these feelings typically pass with time.  In cases when sadness continues for a long period of time, it may be a sign that something’s not right and your child may be struggling with depression.

Depression is a mood disorder causing persistent sadness and a loss of interest in activities they previously enjoyed. Although it’s more commonly thought of as a difficulty that affects adults, children can experience depression too. The symptoms, however, tend to be slightly different in children, making it more difficult to spot. They are more likely to come across as irritable and grumpy and may have more physical health issues.

Depression can make emotions feel overwhelming for children and prevent them from leading a normal childhood. They may isolate themselves from friends and family and find day-to-day activities such as going to school more difficult. 

If you’re worried that your child may be struggling with their mood, it’s important to seek appropriate professional support, even if you’re unsure. This may be your GP in the first instance, or our Ask the Expert service, which can provide health information and support via email. Getting help as early as possible is vital to ensure your child’s low mood doesn’t turn into a long-term problem. You may also find it helpful to learn a bit more about depression and some tips and tools you can use to help your child manage their mood.

Causes of depression in children

Depression is a complex disorder and the causes differ from person to person. In some cases, depression can be caused by a distressing life event such as:

• The separation of parents
• Bereavement 
• Physical or sexual abuse.

More often depression arises from a mixture of factors, for example:

• Difficulties with peer relationships, such as bullying 
• Issues within the family 
• Feeling like they’ve failed

There are also certain factors that may mean your child is more susceptible to developing depression, including:

• A family history of mental health issues
• Co-morbid conditions, such as anxiety and attention deficit disorders 
• Physical health issues

You may feel responsible or guilty for your child’s low mood, but it’s important to remember that depression is caused by factors beyond your control and you shouldn’t blame yourself. 

Symptoms of depression in children

Depression is more complex than just feeling sad. There are many other signs your child may exhibit if they’re struggling with their mood. Remember these will vary between children and if your child is depressed, they may not necessarily show all these signs.

You may notice your child is demonstrating some of the following behaviours:

• Appearing more irritable than usual
• Experiencing extreme tiredness or a general lack of energy, even if they have slept well the night before
• Becoming more withdrawn from their friends and family. They may talk less with others and avoid social activities 
• Loss of interest in activities they usually find enjoyable, such as playing their favourite game or watching a TV show. They may struggle to find joy and excitement in any activity they do
• Seeming more tearful and generally miserable, which may make them cry more easily
• Deterioration of peer and familial relationships as they become more withdrawn and less motivated to maintain them
• Poor concentration, which may result in a decline in school performance 
• Issues with sleeping, such as difficulty falling asleep, frequently waking in the night and struggling to get back to sleep
• Changes in appetite and eating patterns 
• Thinking that they’re useless or unimportant. They may view themselves as weak or unlikeable, which prevents them from doing certain activities and connecting with their peers
• Feeling hopeless about the future
• Focussing on negative things that have happened in the past.

When to seek more urgent help

If your child is demonstrating any of the following, it may be a sign that you need to seek help more urgently:

• Thoughts about suicide or harming themselves
• Withdrawing completely to their room
• Rapid deterioration of symptoms 
• Flashbacks about a traumatic or scary event
• Using drugs or alcohol to manage their depression
• Frequent risk-taking behaviours and accidents.

You must seek immediate care if you believe your child is in danger. This may mean getting an emergency appointment with your GP, phoning 111 or 999, or taking them to the nearest emergency department. For more information and advice from the NHS go to their website - Where to get urgent help for mental health¹

How to treat depression in children

It can be scary and upsetting to see your child struggling with low mood, and you may be unsure of the best way to support them. There are, however, many useful tips and tools available that you can use to help your child with managing their mood. Here are some examples that clinicians use when treating their patients’ depression:

• If your child is struggling with their mood they may find it difficult to understand why they’re feeling this way. They may not realise they’re depressed. Understanding depression may be a good first step in helping your child to grasp what they are experiencing and learning they are not to blame for how they feel. Try using guides about depression tailored to children, such as this one from Young Minds - Feeling down and unable to cope.²
• Depression becomes a cycle that’s maintained by negative and unhelpful thoughts. For example, your child may feel as though they’re worthless whenever things go badly, like failing a test or falling out with a friend. These thoughts occur automatically and to your child they’ll feel true. It may be useful to teach your child what a thought is. Try showing them a video on thoughts, such as Mindfulness for Kids³. It can help to remind your child that thoughts are just thoughts, and just because they think something, doesn’t mean it’s true. Your child needs to be aware of these thoughts floating around their heads without getting lost in them.
• It’s important for your child to identify their negative thought patterns. Helping your child to create a thought diary is a great way of keeping track of what’s going on. Ask your child to rate how they feel when the negative thoughts occur, so they can start to see how they can affect their emotions. At the moment you don’t need to solve their negative thoughts, just record them. Diaries can then be used as a tool by a clinician within a therapy session.
• If your child is older you can encourage them to challenge and question their negative thoughts as they arise, to help them learn that thoughts are not facts. If your child is in their early teens you could ask them to keep a simple thought challenging record which encourages alternative perspectives to their automatic thoughts. Simply record the negative thought on one side of the table and on the other side answer the question “is there an alternative, more balanced or realistic way of thinking about this situation?”
• Having lots of negative thoughts will make it difficult for your child to perform daily activities, even those they find enjoyable. The more your child avoids these activities, the less likely they are to experience the positive reward they get from doing them. You can help your child to create an activity log to record the things they have done over the past week and how each one made them feel. This will help them to see a pattern between their actions and their mood and identify places where they can schedule in more meaningful activities. 
• It’s important to encourage your child to keep participating in activities, even if they find it difficult.  One way of doing this is through activity scheduling, where you help your child to pick an activity to do in the morning, afternoon and evening. Planning activities over the following week can help your child to focus on certain tasks without becoming overwhelmed. You can also ask them to score how much satisfaction they gained from doing the activity, which could motivate them to do even more. At the start it will be tough for your child to do anything. Remember, it’s just about completing the scheduled activity at first, not necessarily enjoying doing it.
• You may find it helpful to teach your child mindfulness and have a go at trying it with them. You can use guided videos like Mindfulness for kids⁴ or use MIND’S guide to mindfulness for instructions. If your child is older they may prefer to do this by themselves, you can advise apps such as Smiling Mind or HeadSpace which provide guided videos that your child can follow. Teaching your child mindfulness could help to calm their mind.
• It’s important to note that your child may not always be able to talk to you about their feelings. This can be frustrating and upsetting but pushing them too hard can make them withdraw further. Remind them that you’re always there when they’re ready to talk and encourage them to reach out for help when they need it. If your child shares something with you that you don’t view as being very serious, don’t trivialise or minimise how they’re feeling; even if it seems small to you, it may be big to them.

What to do next? 

If you would like to read more about childhood depression and how to manage it, here are some reliable resources:

• The NHS - Depression in children and young people
• YoungMinds – Depression and low mood
• Children’s society - Depression

Books:

For parents to read with children: 

• Me and My Feelings: A Kids' Guide to Understanding and Expressing Themselves by Vanessa Green Allen
• Have You Filled a Bucket Today?: A Guide to Daily Happiness for Kids – Carol McCloud and David Messing.

For parents/carers:

• The Whole-Brain Child: 12 Proven Strategies to Nurture Your Child’s Developing Mind - Dr Tina Payne Bryson and Dr. Daniel Siegel 
• Teenage depression  - A CBT guide for parents: Help your child beat their low mood – Professor Shirley Reynolds and Dr Monika Parkinson.

For teens: 

• Am I Depressed And What Can I Do About It?: A CBT self-help guide for teenagers experiencing low mood and depression.  Professor Shirley Reynolds and Dr Monika Parkinson.

Apps:

• Mood Panda – mood tracking and anonymous support
• Smiling Mind – mindfulness and meditation
• Sleep cycle - track and analyse your sleep so you can get woken up at the perfect time for your mood
• Headspace - train your mind for a healthier, happier life (ages 13-25)
• Mood path - depression and anxiety tracker and test (ages 13-25)
• NHS mental health apps list

Looking after yourself as a parent:

It is not always easy caring for a child with depression and it is important that you take care of your own well-being too. There are organisations available that offer support to carers of children with mental health difficulties. You may find some of these helpful:

• Mind - Parenting with a mental health problem  
• Young Mind Parent Helpline

References

1. NHS - Where to get urgent help for mental health
2. Young Minds - Feeling down and unable to cope.
3. Fablefy - Mindfulness for Kids
4. Cosmic Kids Yoga - Mindfulness for kids

Where we provide links to other websites or third party resources within this article, these links are provided for your information only and are correct at the time of publication. AXA Health has no control over and is not responsible for the content and resources within external websites or apps, nor any link contained therein, or any changes or updates required.