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Depression through Childhood Development

In the past, it was assumed that infants and children could not experience depression, and if they did exhibit depressive symptoms, they would “grow out of" it. Research demonstrates that depression may manifest as early as infancy and that early depression may recur or persist into later developmental stages.

Infants
Depressive symptoms in infants may include sadness, inactivity, withdrawn behavior, agitation, sleep problems, feeding problems, and failure to thrive. A major controversy is whether symptoms may occur endogenously or are always associated with environmental stress (separation from caregivers, maternal depression, neglect, abuse, severe illness). Such symptoms should prompt a search for environmental causes or physical illness. Diagnostic criteria for depression in infancy are available at Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Zero to Three). The proper diagnosis and treatment of such cases demand referral to a specialist. There are no data on treatment in this age group.
Preschoolers
Depressive symptoms may include those listed above for infants, as well as the child’s stated emotions (e.g., “I’m sad”) or observation of depressive themes in the child’s play (e.g., themes of sadness, loss, guilt, aggression, death, or suicide). Somatic symptoms (e.g., headaches, stomachaches) may be present but are less frequent than more typical depressive symptoms. [Luby: 2003] Endogenous depression is less controversial in this age group, but environmental factors are still important to consider. Prevalence is uncertain but may be as high as 1 percent. [Stalets: 2006] As with infant depression, diagnostic criteria are available that have been modified to reflect developmental stage and include decreased number and duration of symptoms. [Luby: 2003] No data exist on treatment in this age group.
School-Age Children
There is little controversy about the existence of endogenous depression in school-age children, and the prevalence is thought to be 1-2 percent and a 1:1 male to female ratio. [Costello: 2003] Diagnosis is based on DSM-5 criteria. [American: 2013] These are unmodified from adult criteria save for the inclusion of irritable mood in addition to depressed or sad mood. School-age children are more able to report their symptoms. Often symptoms reported by the child may be combined with those reported by caregivers to arrive at a diagnosis. School dysfunction may be a strong indicator of the need for evaluation. There are positive research findings for use of medications and cognitive behavioral therapy (CBT) in this age group.
Adolescence
The prevalence of depression in adolescence jumps to 3-8 percent. [Costello: 2003] The sex ratio changes as the prevalence in girls increases relative to boys resulting in a 2:1 female to male ratio that persists until late middle age. Pubertal hormonal and physiologic changes undoubtedly play a role, but research has not yet defined causal factors. [Angold: 2006] Diagnosis is by DSM-5 criteria and often can be made by interview with the adolescent alone, though it is strongly recommended to interview both the adolescent and their caregivers. School dysfunction, social withdrawal, changes in friends, and new onset of arguing or defiant behavior at home may be clues to depression. There are positive research findings in this age group for the use of medications, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and electroconvulsive therapy (ECT).

Resources

Information & Support

For Professionals

Zero to Three
A national nonprofit organization that aims to promote the health and development of infants and toddlers, with information and resources for parents and professionals.

Tools

Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Zero to Three)
A developmentally based system for diagnosing mental health and developmental disorders in infants and toddlers; developed by Zero to Three, National Center for Clinical Infant Programs.

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Authors & Reviewers

Last update/revision: December 2018; initial publication: February 2010
Current Authors and Reviewers:
Author: Thomas G. Conover, MD
Authoring history
2010: first version: Thomas G. Conover, MDA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders, DSM-5.
Fifth ed. Arlington, VA: American Psychiatric Association; 2013. 978-0-89042-554-1

Angold A, Costello EJ.
Puberty and depression.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):919-37, ix. PubMed abstract

Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A.
Prevalence and development of psychiatric disorders in childhood and adolescence.
Arch Gen Psychiatry. 2003;60(8):837-44. PubMed abstract / Full Text

Luby JL, Heffelfinger AK, Mrakotsky C, Brown KM, Hessler MJ, Wallis JM, Spitznagel EL.
The clinical picture of depression in preschool children.
J Am Acad Child Adolesc Psychiatry. 2003;42(3):340-8. PubMed abstract

Luby JL, Mrakotsky C, Heffelfinger A, Brown K, Hessler M, Spitznagel E.
Modification of DSM-IV criteria for depressed preschool children.
Am J Psychiatry. 2003;160(6):1169-72. PubMed abstract / Full Text

Stalets MM, Luby JL.
Preschool depression.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):899-917, viii-ix. PubMed abstract