

(Hadley Hooper for The Washington Post)

The death of Robin Williams, who was reported to be suffering from severe depression and is believed to have committed suicide, brings into stark relief the very serious but too-often-ignored issue of depression in people of all ages, including teenage students and toddlers.

Childhood depression is characterized this way in a brief issued by the National Association of School Psychologists:

Depression is a serious mental health issue that can affect even very young children. Depressed children are generally lacking in energy and enthusiasm. They often become withdrawn and are unable to concentrate or to enjoy life. If they are in school, they usually perform poorly. Sometimes they are irritable and sulky or even belligerent. If they are old enough to talk, they may refer to themselves as stupid and ugly, friendless, unloved and unlovable, worthless, or even hopeless. They may be preoccupied with themes of death and dying, and, occasionally, they may contemplate or even attempt suicide. Yes, even small children may do reckless, dangerous things designed to hurt or to kill themselves, although their concepts of death are quite different from those of adults.

How young? According to a 2009 report called “Preschool Depression,” researchers found that preschoolers as young as 3 can show signs of major depression, “contradicting traditional developmental theory, which claimed that young children were too cognitively and emotionally immature to experience depressive affects.” According to the American Academy of Child & Adolescent Psychiatry, about 5 percent of children and adolescents suffer from depression at any given point in time.

A new study on the Web site of the National Institutes of Health says that “diagnosing childhood depression can pose a challenge, even for mental health specialists.” This is true in part because signs and symptoms are different for children at the various developmental stages and, according to this 2011 report, “depression rarely presents as the chief complaint” in children. Young children who are depressed may not even seem sad to adults.

So how can a parent, teacher or friend tell if a child or adolescent is depressed?

From ASCD, (formerly the Association for Supervision and Curriculum Development), here’s a chart about how depression presents in children and adolescents:

Characteristics of Depression in Children and Adolescents

Characteristics of Depression in Children What It Looks Like in School Physical/somatic complaints Complaints of feeling sick, school absence, lack of participation, sleepiness Irritability Isolation from peers, problems with social skills, defiance Difficulty concentrating on tasks/activities Poor work completion Short-term memory impairments Forgetting to complete assignments, difficulty concentrating Difficulties with planning, organizing, and executing tasks Refusing to complete work, missing deadlines Facial expressions or body language indicating depression or sadness Working slowly Hypersensitivity Easily hurt feelings, crying, anger Poor performance and follow-through on tasks Poor work completion Inattention Distractability, restlessness Forgetfulness Poor work submission, variable academic performance Separation anxiety from parents or caregiver Crying, somatic complaints, frequent absences, school refusal Characteristics of Depression in Adolescents What It Looks Like in School Decreased self-esteem and feelings of self-worth Self-deprecating comments Mild irritability Defiance with authority figures, difficulties interacting with peers, argumentativeness Negative perceptions of student’s past and present Pessimistic comments, suicidal thoughts Peer rejection Isolation, frequent change in friends Lack of interest and involvement in previously enjoyed activities Isolation and withdrawal Boredom Sulking, noncompliance Impulsive and risky behavior Theft, sexual activity, alcohol or drug use, truancy Substance abuse Acting out of character, sleeping in class

From the American Academy of Child & Adolescent Psychiatry:

If one or more of these signs of depression persist, parents should seek help: Frequent sadness, tearfulness, crying Decreased interest in activities; or inability to enjoy previously favorite activities Hopelessness Persistent boredom; low energy Social isolation, poor communication Low self – esteem and guilt Extreme sensitivity to rejection or failure Increased irritability, anger, or hostility Difficulty with relationships Frequent complaints of physical illnesses such as headaches and stomachaches Frequent absences from school or poor performance in school Poor concentration A major change in eating and/or sleeping patterns Talk of or efforts to run away from home Thoughts or expressions of suicide or self -destructive behavior A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better. Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad. Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.

Here is some information from the National Institute of Mental Health on depression in adolescents: