1. The disorder affects 1 in 10 children aged 3 years through adolescence, an estimated 3-6 million cases. Impacting development, well-being and future happiness, depression can debilitate a youth’s entire personality. Untreated clinical depression not only can lead to school failure, alcohol and drug use, but also is the number one cause of suicide among teens. However, if detected early, clinical depression is extremely treatable.

Parents are on the front line of this battle and must act to reduce clinical depression. First, parents must learn to identify the symptoms. Common manifestations are eating and sleeping changes, persistent feelings of sadness or crying, anger outbursts or fighting; somatic complaints (head or stomach aches/frequent visits to the school nurse); self-deprecating statements (“I hate myself,” “I am no good.”); decline in school performance caused by difficulty in focusing or failure to complete assignments; poor grooming; negative changes in peer relations (isolation and withdrawal); inability to enjoy previously favorite activities; increases in pessimism, negativity, and helplessness; overwhelming feelings of despair and futility (“What’s the use?”); self-destructive behaviors (cutting, risk taking); use of alcohol and/or drugs and sexual experimentation; suicidal ideation (“I want to be dead”); gestures or threats (“I am going to kill myself”); and even active planning for the end of life, such as making a plan or giving away possessions.

If five or more of these symptoms seem apparent, the child may be clinically depressed. Parents should notice what behavioral symptom a child shows and how long it has been going on. They should take seriously any persistent changes in the child’s functioning – his words and behaviors.  Parents should take suicidal ideation and threats seriously and get immediate help to keep the child safe from himself.

While there is no single cause for clinical depression in children and adolescents, most authorities see it as resulting from a genetic vulnerability combined with environmental and psychological stressors such as loss (death of parent, friend, pet); illness ( of self, friend, parent); separation and change (move, divorce, re-marriage); trauma (abuse, violence); loss of love or peer rejection; bullying; conflictual, chaotic, or confusing parent-child relationships; stressful life events (poverty, homelessness); alcohol and drug use; and learning or conduct disorders.

Following observation of symptoms, the parent should engage the child in a calm, emotionally supportive way. When the child is alone (so not to embarrass), not sick, relatively calm and it is not late at night, the parent can say (with simple age-appropriate honesty), “I am bringing this up because I love and care about you.” Then cite the symptom/behavior you have noticed. “ It seems that you have been sad (or irritable or your grades are dropping).” “That may mean you are depressed.” The child does not need to agree. Denial and lack of self-awareness are part of depression. It is important that the parent understand and convey to the child that depression is treatable. The earlier the intervention, the better the prognosis. Kids do not need to suffer; they need to hear, “There is help. You do not need to be depressed. I will go with you to see someone.” This can help a child feel cared-for and not alone.

The parent must believe in a child’s potential. Because he is acting/feeling depressed now does not mean that he will continue to be this way. Parents should not  wait and hope that it will go away; clinical depression is extremely treatable. They can and should provide a child with hope and a plan to change for the better. Taking a child to a mental health professional who will make a diagnostic assessment may be beneficial. This usually involves 2-3 sessions with the child and the parent/caretaker to understand the causes of the depression and to develop a strategy to ameliorate the symptoms. Treatment usually involves psychotherapy (play/talk) without or with medication, prescribed by a physician and closely monitored.

Parents are the most important figures in a child’s life. Their emotional attunement with the child in words and actions is the most determinative factor in how a child feels about self. Telling a child he or she is loved and showing it by taking an interest in his or her life cannot be underestimated.  If a child becomes clinically depressed, it is especially important that the parent recognize potential symptoms and then make the adult decision to get help so the child can resume the developmental process.

Ms. Summers, a child, adolescent and adult psychotherapist in private practice, took part in the workshops on child suicide earlier this fall.