Depression and Mood Difficulties
Every child deserves to feel happy and understood.
Assisting Young Minds Through Depression and Mood Difficulties
What is Depression:
Feeling sad, lonely and depressed from time to time is a completely normal part of human experience. When symptoms become problematic and not typical of how a young person functions, it can be very distressing to both the child or teen and their family. Depressive disorders include a raft of troubling symptoms that range from feelings of sadness, emptiness and irritability to somatic (body) and cognitive changes that will impact in a significant way on the individual’s ability to function.
They can impact a young person’s capacity to participate as they normally would in school as well as activities with friends and family. This can affect the quality of relationships in their life and have a significant effect on how the family is able to function. Depressive symptoms can be present for some time before this develops into a clinical disorder.
Depression in Children:
Depression in children often goes unrecognised, The Black Dog Institute Youth Depression report explains that “given that childhood represents a ‘window of opportunity’ where the critical foundations of emotion regulation are built” it is especially important to provide timely and effective intervention to reduce the chance of children going on to develop more serious mental health disorders. This is especially important in the context of the huge increase in symptoms discussed earlier.
Rates of pre-teen child depression has remained mostly steady (with a slight increase for girls) over previous decades (Australian Child and Adolescent Survey of Mental Health and Wellbeing, 2013-14), however there has been an increase in reported symptoms of depression since the pandemic. A 2022 study conducted by Sicouri and colleagues (https://doi.org/10.1177/00048674221090174) for The Black Dog Institute found a whopping 23.4% of children were exhibiting depressive symptoms.
This was supported by The Royal Children’s Hospital Melbourne’s National Child Health Poll (June 2023; https://rchpoll.org.au/wp-content/uploads/2023/06/Report-3-Mental-health-of-children-8-13-years-in-Australia.pdf) indicating that 1 in 4 Australian children aged 8-13 years are experiencing symptoms of depression. Factors including decreased physical activity, poor sleep and greater family stress may have contributed to increased depressive symptoms during the pandemic.
This does not mean that a quarter of children have been diagnosed with a depressive disorder in Australia, but it does mean that a much larger proportion of children are showing those early signs of a developing depressive illness. The earlier these symptoms are addressed, the better chance there is of avoiding a clinical disorder.
Depression in Teens:
Depression is almost 3 times as common in adolescents as it is in children (according to the second Australian child and adolescent survey of mental health and wellbeing in 2013-14 depression; Lawrence, D., Johnson, S., Hafekost, J., Boterhoven de Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. R. ,2015. The mental health of children and adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing. Department of Health).
International epidemiological research shows that adolescent depression has been on the rise over the past two decades (https://www.blackdoginstitute.org.au/media-releases/youth-depression-rising-at-alarming-rates-especially-for-young-women-says-black-dog-institute/). Factors relating to modern adolescence being a time of fewer opportunities for practicing maturity and independence in day-to-day life couples with increasing exposure to mature content in the digital world are presented as major considerations in the Youth Depression Report (Black Dog Institute, 2022).
Poor sleep and poor levels of in-person social interactions are seen as contributing factors to increased levels of depression in teens. Some hypotheses link this to increased digital media use, though it is also thought that depressed teens may be more likely to seek out ways to regulate their emotions via the same outlet. The effectiveness of social media to provide this help is extremely variable and can actually make teens feel worse, depending on the material they seek out.
The areas that Australian teens themselves reported as factors included falling behind at school, not fitting in, being judged or bullied, difficulty managing anger and anxiety, worrying about parental disappointment, family conflict and separation, financial stress on the family, and global issues like climate change and poverty (Future Proofing Study, 2019 https://osf.io/preprints/psyarxiv/x6vdj_v1).
Recognising the Signs of Depression and Mood Difficulties in Young Minds
Depressive and Mood Disorders encompass a broad spectrum of difficulties with varying degrees of impairment, depending on the types of symptoms that a young person is presenting with. Whilst young people can present with depressive symptoms without meeting the criteria for a clinical disorder (as defined by those found in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revised or DSM-5-TR), children and/or adolescents can present with clinically significant disorders that require treatment:
- Disruptive Mood Dysregulation Disorder (DMDD)
- Major Depressive Episode or Disorder (MDE or MDD)
- Persistent Depressive Disorder or ‘Dysthymia’
- Premenstrual Dysphoric Disorder (PMDD)
- Bipolar I Disorder (BPD-I)
- Bipolar II Disorder (BPD-II)
- Cyclothymia
(Note: the above list does not include depressive and mood disorders that result from another medical condition or substance)
Depression represents clear changes in how a person thinks, feels and behaves and may involve:
- Feeling sad/empty/hopeless or appearing tearful. An irritable mood can be more obvious than sadness in children.
- Diminished pleasure or interest in activities (this can be harder to notice in children who may have less control over their daily activities).
- Change in weight (eating more or less than they would normally).
- Difficulty sleeping (insomnia) or oversleeping (hypersomnia).
- Restlessness or unusual lack of movement (changes in psychomotor activity).
- Fatigue.
- Feelings of worthlessness or guilt
- Difficulty concentrating or indecisiveness
- Recurrent thoughts of death or suicidal ideation
Unipolar vs Bipolar Depression
Depression can be essentially categorised into either unipolar depression (which is the most common type of depression (including DMDD, MDD, dysthymia and PMDD) or bipolar depression (including BPD-I & II as well as cyclothymia). The key difference is the inclusion in the bipolar type of manic or hypomanic symptoms. That is, symptoms that swing between traditionally understood depressive symptoms (see below) and distinct periods of abnormally and persistently elevated, expansive, or irritable mood which goes together with abnormally and persistently increased activity or energy which can be easily observed by others. This represents a total change in functioning that is different to how the young person normally is.
Unipolar depression is far more commonly seen in young people than bipolar types. A childhood variation of depression, called disruptive mood dysregulation disorder presents differently to what we might imagine depression to look like. This is a classification that has been added to the 5th edition of the DSM as bipolar disorder (which is very rare in children and typically onsets during late adolescence or early adulthood) were being applied too frequently to young people who were presenting with these unique symptoms. A core feature of this is chronic, severe persistent irritability with frequent temper outbursts which are developmentally inappropriate as well as an irritable and angry mood which is present throughout much of the time and noticeable to others. It is not diagnosed in children less than 6 or older than 18 years.
Providing a Safe Space for Young Minds to Heal
The Black Dog Institute Youth Report tells us that research shows “parents seeking help for their child with depression are less likely to receive appropriate treatment than are parents seeking help for their adolescent” due to the lack of understanding about how to treat depression in children. Seeking help from a psychologist who works specifically with children and adolescents can increase the chance that your child’s depressive symptoms will be assessed and treated effectively. With awareness of the specific ways in which depression and other mood difficulties present in children and teens, a child and adolescent psychologist will be able to support you and your child through the identification and treatment of symptoms with knowledge and experience.
Cognitive behaviour therapy (CBT) is one of the most efficacious interventions for depression in teens and children. It targets both the behavioural aspects of depression (such as the ‘lethargy loop’ that occurs when someone is depressed: when we are depressed we have low energy and motivation and this makes us less inclined to engage in activities that may help us lift our mood and so the loop continues) as well as the thinking (cognitive) aspects of depression that tends to filter out positive or neutral thinking in favour of distorted negative thoughts that may tend towards being more extreme (see helpful list of thinking mistakes here: https:// childmind.org/article/how-to-change-negative-thinking-patterns/)
Often the first step in treatment is a process called ‘behavioural activation’ which attempts to identify ways to very gradually challenge the young person to increase their activity and interaction to assist in shifting their neurobiology. To do this effectively, it is helpful to collaborate with parents and carers, particularly with pre- teens (and younger teens) who may require assistance from family to engage in activities outside of session.
Sometimes your child or teen will not recognise that there is a problem or want to do anything to change the status quo. This can be difficult, and it is really important that the psychologist you and your child consult with has a keen understanding of children and this common difficulty when bringing a child in for treatment.
The key to successfully treating depressive symptoms in children and adolescents is to work with the young person to create a realistic plan that takes into account where the child or teen is at currently and gradually build motivation around moving forward.
Worried about your child’s wellbeing? Book a consultation today and let our experienced team support you and your family with tailored guidance and care.
The Potential Benefits of Addressing Depression and Mood Difficulties
Whilst sometimes young people do not recognise that there may be a problem or they may be reluctant to seek help, at The Young Mind Clinic, we work with young people exclusively and a central focus within our clinic is engaging young people in the process of change. We aim to deliver efficacious treatment for childhood depression in a warm and developmentally appropriate environment that allows both young clients and their families to feel safe and supported.
Your Depression Psychologist Sydney Questions Answered
The cost of a standard consultation at The Young Mind Clinic is $295
We primarily offer cognitive behavioural therapy as an intervention for depression for children and adolescents. We may utilise adjunct strategies from other therapeutic modes when it is suited to the client or required as part of a more complex presentation. We also offer parent management strategies, particularly when children are young and support may be required for behavioural management that promotes positive interaction.
Yes. Children are more likely to present with irritability, rather than appearing sad and teary. Depression symptoms are more frequently observed in teens than children also. Children are also more likely to present with somatic symptoms like stomach aches and other physical ailments.
Providing a calm and supportive environment with consistency around boundaries, with lots of opportunities for positive interaction (these may be quite small but should exceed the amount of negative interactions). Look for opportunities to spend 1:1 time together playing a favourite game or doing something they might enjoy. Also having opportunities in the day to debrief without pressure. Look for opportunities to be physically active that they may consider as exercise is an excellent mood booster and is often an integral behavioural part of treatment.
If you notice that symptoms are distressing your child, there is a marked change in their behaviour or functioning or they are asking to speak to someone, it is important to talk to a professional. You may like to chat to your GP or simply give us a call to arrange an initial consultation where we can look further into what may be going on for your child and whether there is cause for concern.
Yes. We offer both in person sessions in our clinic as well as the option to utilise Telehealth services.
The number of sessions required will typically be determined by individual circumstances, and this is usually discussed at your first appointment. We suggest booking in a minimum of 6 sessions initially, however the number of sessions required for effective treatment is likely to be more than this.
Sometimes clients request specific psychologists based on recommendation or referral or from reading through the detailed clinician descriptions on the website. We will always try to accommodate your preferences, but we can also recommend who might be best suited to your individual needs.
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Child psychologists are available for you to consult with in Lane Cove or from anywhere via teleconference.
We know that the mountain may seem high, but there is help available. Let us support both you and your child by helping them build themselves up into an engaged and proactive person.
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