Is Your Child Depressed?

If Your Child Is Tired, Irritable, Or Angry, The Answer May Be “Yes”

Adapted from the book of this title by Joel Herskowitz, M.D., published by Pharo Books, NY.

NORMAL DEPRESSION

Depression is a normal part of life. It has been called a human being’s response to loss, something everyone experiences from time to time. This response includes changes in emotional state and behavior Sometimes the word is used simply to mean sadness. A child grieving for the death of his beloved dog is sad--not depressed--unless the sadness is extreme or prolonged. It would be extreme if, for example, associated with thoughts of suicide, prolonged if it interferes with his activities for weeks or months, not just a few days.

Thus, when sadness or other emotion interferes significantly with one or more areas of daily life, you have a disorder.

SPHERES OF ACTIVITY

Think of the child or adolescent functioning in several spheres of activity. These are (1) personal-social, (2) academic, (3) athletic, and (4) occupational.

The boy whose depression makes him withdrawn and irritable, a “drag” for his friends to be with, is not making it in the personal-social sphere. The girl who got A’s and B’s first semester but C’s and D’s second semester because of her mood disturbance is impaired in the academic sphere. The star athlete who loses interest in her favorite sport because of depression is compromised in the athletic sphere. The boy whose sloppiness makes him late for work is experiencing difficulties in the occupational sphere.

Use the checklist in Table 1 to get a sense of the degree to which your child is participating in, or withdrawing from, different kinds of activities.

Table 1 ACTIVITY CHECKLIST

Has your son or daughter lost interest or pleasure in his or her usual activities over the past several weeks? Check those that apply.

Personal-Social

o Not at All o Just a Little o Pretty Much o Very Much

School

o Not at All o Just a Little o Pretty Much o Very Much

Sports

o Not at All o Just a Little o Pretty Much o Very Much

Job

o Not at All o Just a Little o Pretty Much o Very Much

POSITIVE AND NEGATIVE MOODS

Positive moods are described by such words as happy, elated, friendly, cheerful, satisfied, good-tempered, agreeable. Negative moods can be described as sad, angry, irritable, miserable, bad-tempered, spiteful, argumentative, resentful, hopeless, terrified, grouchy, ornery, annoyed, tense.

Use Table 2 to select the mood or moods that best describe your child.

DEPRESSION WITHOUT SADNESS

A useful general term for these states of negative mood is dysphoria. A child or adolescent might simply call it “feeling bad.” When it comes to childhood depression, you don’t have to have sadness or tears. You do generally have to have some form of dysphoria that lasts for two weeks or more.

Table 2 MOOD QUESTIONNAIRE

What has been your child’s mood, his or her overall emotional state, over the past two weeks?

Underline those choices that apply. Then go back a second time and circle those few that apply best of all.

Sad Blue Tearful Worried

Irritable Fearful Bored Relaxed

Angry Happy Grouchy Cheerful

Low Withdrawn Argumentative Annoyed

Hopeless Miserable Discouraged Down in the dumps

Tense Nervous Crabby Bad-tempered

Table 3 MOOD SCALE

On a scale of 1 to 10, where 1 is very down (when a person has thoughts of committing suicide) and 10 is very up (when a person feels on top of the world), how would you rate your child’s mood over the past two weeks? Circle one number.

DOWN 1 2 3 4 5 6 7 8 9 10 UP

OBSERVING YOUR CHILD’S BEHAVIOR

Now that we’ve looked in detail at mood, let’s turn to behavior. What is it about your child’s behavior that will clue you in to the presence of depression?

Table 4 CHILDHOOD DEPRESSION CHECKLIST

Check the behavioral symptoms of depression that apply to your son or daughter. Bring this completed checklist to your physician or other professional for further discussion and planning.

Present Absent

Marked loss of interest or pleasure in most, if not all, activities

Significant increase or decrease in appetite or weight (not due to dieting)

Sleep disturbance (too much sleep , difficulty falling asleep, nightmares)

Activity level increased or decreased (hyper-activity or sluggishness)

Fatigue or loss of energy nearly every day

Excessive or inappropriate guilt; low self-esteem

Problems in thinking in general or in concentrating; indecisiveness

Suicidal thoughts or actions

Physical complaints (headaches, stomach aches)

Table 5 PRESCHOOL DEPRESSION CHECKLIST

How does your preschool child behave with other children and adults? Fill in the blanks that describe your child’s mood and behavior.

Rarely or Never

Sometimes

Often

Always

Social Withdrawal

Looks bored

Appears listless

Seems left out

Not interested in anything

Looks sad and tearful

Doesn’t care about anything

Rejected by others

Avoids contact with others

Depression/Lack of Pleasure

Not involved in activities

Not enthusiastic

Not having fun

Looks unhappy

Doesn’t talk to other children

Cranky/Irritable

Seems cranky or irritable

Needs to rest

Moody or changeable

Cries for no apparent reason

Looks angry

Seems tired

Hyperactivity

Constantly on the move

Fidgety

Hits or fights with others

Talks a lot

Rejects others

Manic Syndrome Checklist

The mood of a person with a manic syndrome is abnormally and persistently elevated, expansive, or irritable. With a manic syndrome, the mood disturbance is sufficiently severe as to interfere significantly in occupational work or other major spheres of activity; or it necessitates hospitalization to prevent harm to self or others.

Three or four of the following symptoms are present in a manic syndrome.

Present Absent

1.______ ______ Inflated self-esteem; grandiosity

2.______ ______ Decreased need for sleep

3.______ ______ Talkative; pressured to keep speaking

4.______ ______ Feels that thoughts are racing; flight of ideas

5.______ ______ Easily distracted

6.______ ______ Agitation; increase in goal-directed activity

7.______ ______ Involves self excessively in pleasurable activities with limited regard for consequences

Anxiety Disorder Checklists

Anxiety often accompanies depression. Or it can occur by itself as a major problem, a disorder. To help you recognize what may be significant anxiety, below are checklists for three anxiety disorders: generalized anxiety disorder, separation anxiety disorder, and panic disorder.

Fill out these checklists and bring them to your doctor for discussion.

GENERALIZED ANXIETY DISORDER

At least six of the following symptoms are generally present during periods of unrealistic or excessive anxiety and worry:

Motor Tension

Present Absent

1. ______ _____ Trembling, twitching, or feeling shaky

2. ______ _____ Muscle tension, aches, or soreness

3. ______ _____ Restlessness

4. ______ _____ Easy fatigability

Autonomic Hyperactivity

5. ______ _____ Shortness of breath; smothering sensations

6. ______ _____ Palpitations; accelerated heart rate

7. ______ _____ Sweating or cold, clammy hands

8. ______ _____ Dry mouth

9. ______ _____ Dizziness or light-headedness

10.______ _____ Nausea, diarrhea, other abdominal distress

11. _____ _____ Flushes (hot flashes) or chills

12. _____ _____ Frequent urination

13. _____ _____ Trouble swallowing; “lump in the throat”

Vigilance and Scanning

14. _____ _____ Feeling keyed up or on edge

15. _____ _____ Exaggerated startle response

16. _____ _____ Difficulty concentrating; mind “going blank” because of anxiety

17. _____ _____ Trouble falling or staying asleep

18. _____ _____ Irritability

SEPARATION ANXIETY DISORDER

Present Absent

1. _____ _____ Excessive worry that harm will befall parents (or other important persons) or that they’ll leave and not return

2. _____ _____ Unrealistic, persistent worry that a calamity will separate the child from parents (or other important persons)

3. _____ _____ Persistent reluctance or refusal to go to school in order to stay with parent(s) or other important persons

4. _____ _____ Persistent reluctance to go to sleep without being near parent (or other important person) or to sleep away from home

5. _____ _____ Persistent avoidance of being alone; clinging to, shadowing parents

6. _____ _____ Repeated nightmares involving the theme of separation

7. _____ _____ Physical complaints (such as headache, stomach ache, nausea) on school days or otherwise upon anticipated separation

8. _____ _____ Excessive distress (tantrums) in anticipation of parents’ leaving home upon even a social occasion

9. _____ _____ Excessive distress when separated from home: desire to return home, call parents

PANIC DISORDER

A panic attack is a discrete period of intense fear, discomfort, or apprehension that includes at least four of the following symptoms:

Present Absent

1. _____ _____ Shortness of breath; smothering sensations

2. _____ _____ Dizziness; unsteady feelings; faintness

3. _____ _____ Palpitations; accelerated heart rate

4. _____ _____ Trembling or shaking

5. _____ _____ Sweating

6. _____ _____ Choking

7. _____ _____ Nausea or abdominal distress

8. _____ _____ Depersonalization or derealization

9. _____ _____ Numbness or tingling sensations

10._____ _____ Flushes (hot flashes) or chills

11._____ _____ Chest pain or discomfort

12._____ _____ Fear of dying

13._____ _____ Fear of going crazy or doing something uncontrolled

Four episodes (essentially unprovoked) must occur within a four-week period (or at least one panic attack followed by one month or more of persistent fear of having another attack). Episodes cannot be accounted for by identifiable organic factors such as drug intoxication (e.g., amphetamines, caffeine) or metabolic disorder (e.g., hyperthyroidism).

Attentional Disorder/Hyperactivity Checklist

At least eight of the following symptoms are required to meet the criteria for the presence of attentional disorder with hyperactivity.

Present Absent

1. _____ _____ Restless; fidgets with hands or feet; squirms in seat

2. _____ _____ Has difficulty keeping seated

3. _____ _____ Easily distracted by extraneous stimuli

4. _____ _____ Has difficulty waiting turn in games or group activities

5. _____ _____ Blurts out answers to questions before they have been completed

6. _____ _____ Has difficulty following through on instructions

7. _____ _____ Has trouble sustaining attention in play or tasks

8. _____ _____ Shifts from one activity to another without completing the first

9. _____ _____ Has difficulty playing quietly