How to Spot Depression in Children, Even Preschoolers

Trigger Warning: Brief discussion of suicidal ideation.

Preschool depression is often overlooked, because the symptoms are difficult to spot or may be explained away by hopeful parents and teachers. Depression in adults is widely known, but can preschoolers suffer clinical depression? Science says they can.

Scientists began studying depression in preschoolers 20 years ago, and the research continues today. According to the conclusion of a new study led by Dr. Joan Luby of the Washington University School of Medicine in St. Louis, preschoolers suffer depression. Luby’s team examined 306 children ranging from 3 to 6 years old. This study demonstrated that 23% of the 3-year-olds endured depressive symptoms every day for two consecutive weeks. As the age of the child increased, the rate of major depressive disorder diagnoses also increased. The 4-year-olds suffered depressive symptoms at a rate of 36%, while the 5-year-olds showed a rate of 41%. The children who had suffered extremely stressful or traumatic events in their lives also had a higher incidence of depression than the controls.

Preschoolers generally can’t describe their emotional states. They’re still learning what emotions are and they lack the ability to vocalize them. This is the difficulty in diagnosing depression in preschoolers, and why you may need help spotting it. In order to allow the study participants to express how they perceive themselves and get a sense of what young children were feeling, Dr. Luby’s team asked a series of questions using puppets. How the children responded gave the researchers a clue about how the kids were feeling.

Further complicating the picture is the prevalence of other conditions along with depression, like Attention Deficit Hyperactivity Disorder (ADHD). In Dr. Luby’s study, about 40% of the study participants also dealt with ADHD, which tends to drown out symptoms of depression, because the symptoms are similar. This can even persist later in life. Children who suffer depression are more than four times as likely to suffer an anxiety disorder later in life than kids who don’t suffer depressive symptoms.

preschooler
A preschool-aged boy in blue hoodie sprawling on a parent’s lap. Credit to flickr.com user Quinn Dombrowski. Used with permission under a Creative Commons license.

But what does depression look like in a 3-to-6-year-old?How can you, as a parent, spot it? Well, depression in children looks a lot like depression in adults. For example, anhedonia, the inability to experience pleasure from normally enjoyable activities, can show up in adults as a lack of enjoyment in things like golfing or writing. Preschoolers with anhedonia find little to no joy in their toys. Both adults and children with depression are restless and irritable. Depressed kids whine a lot, and don’t want to play.

When they do play, children may decide that their stuffed animals decided to “die” today and decide to bury them. Anytime you see a preschooler demonstrate methods of suicide or death with a stuffed animal without mimicking an episode of your life, such as a death in the family, your antennae need to come up. That could indicate suicidal thoughts.

But the most common symptom of depression in children is deep sadness. Not someone who’s sad for a day, but all the time, no matter who he or see is with or what he or she is doing. Sadness in the face of goals that have been thwarted is normal. But depressed children have difficulties resolving the sadness to the point where the misery affects their ability to function regularly. If your child appears to be sad to the point of inability to enjoy anything or regulate their other emotions, then get a recommendation from your pediatrician for a child psychologist or a behavioral therapist.

Other notable symptoms of childhood depression are an exaggerated sense of guilt, shame, and insecurity. Depressed preschoolers generally feel that if they do a naughty thing or disobey, that means they are inherently bad people.

Here’s a breakdown of the symptoms of depression in children of any age, including preschoolers:

  • Deep and persistent sadness
  • Irritability or anger
  • Difficulty sleeping or focusing
  • Refusing to go to school and getting into trouble
  • Change in eating habits
  • Crying spells
  • Withdrawing from friends and toys
  • Fatigue
  • Anhedonia – inability to derive pleasure from enjoyable activities, like playing with toys
  • Whining
  • Low self-esteem and insecurity
  • Shame and guilt
  • Timidity

Preschoolers may be especially vulnerable to depression’s consequences. Young children are sensitive to emotions, but lack the ability to process strong feelings. Early negative experiences–including separation from a caregiver, abuse, and neglect–affect physical health, not just mental. Multiple studies have linked childhood depression to later depression in adulthood.

This is why properly diagnosing and treating these children early is so vital. One established intervention for treating childhood depression is called Parent-Child Interaction Therapy, or PCIT. Originally developed in the 1970s to treat violent or aggressive behaviors in preschoolers, PCIT is a program where, under the supervision of a trained therapist, caregivers are taught to encourage their children to manage their emotions and stress. The program typically lasts from 10 to 16 weeks.

The Bottom Line

Dr. Luby’s research is met with resistance. Laypeople typically think the idea of preschoolers suffering depression ridiculous, and even some doctors and scientists don’t believe children are cognitively advanced enough to suffer from depression. Preschool depression remains a controversial topic, which makes it harder to diagnose in your child.

But depression in children 6 years and older has been well established by decades of data. Is it really so hard to think that preschoolers might suffer depression as well? Dr. Luby and her team have been looking at the data for 20 years, and have concluded that preschoolers can suffer depression, just like older children and adults.

Admitting that your child is depressed may make you feel like you’re a failure. After all, if you can’t protect your children from depression, who can? But clinical depression is chemical. This is not your fault. You may have been told that depression doesn’t exist in preschoolers, or that you’re overreacting. You may be called a helicopter or hovering parent. But trust your instincts. You know your child better than anyone else. Don’t be afraid to go against stigma for your child’s benefit.

Up to 84,000 of America’s 6 million preschoolers may be clinically depressed. If your child is one of them, you are not alone. There is no shame to depression. The condition is not your child’s fault, just as in adults. No parent likes to see her child suffer, and getting help for depressed children is vital to their well-being.

If your child suffers depressive symptoms, especially anhedonia, ask your pediatrician for a recommendation for a behavioral therapist or child psychologist. Typically, the earlier the intervention, the more successful the results.

Good luck.

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How to Clean When Your Brain is a Mess, part II

This is part two of a three-part series.
Part I | Part II | Part III

As we talked about in part one, most people with mental illnesses tend to have massive difficulties in keeping their homes ship-shape. The trouble lies in how our brains are wired (of course), but that doesn’t mean our struggle is futile. Here are some more ideas for tackling the mess in your house:

Credited to flickr user gcg2009. Used with permission.

Pump Up the Volume: Pop your favorite upbeat dance song in the stereo. Most articles which contain the words “How to Clean” in the title emphasize this step because it’s so effective. Music therapy is a flourishing science. In patients undergoing chemotherapy, playing music decreased both their anxiety and frequency of vomiting.

Music also stirs up motivation and affects your emotions. Sadness is triggered by minor keys and happiness by fast tempos, but a depressing song with a peppy beat triggers both. Making an enjoyable playlist can be one of the easiest ways to get pumped for cleaning.

Figure Out Where Your Time Goes: If you do nothing else on this list, track your time for a week. Some people use a logbook and others use a color chart; do whatever makes the most sense to you. Next, figure out where you can squeeze in ten-minute bursts of laundry or dishes. If you thrive on a schedule, assign a day to each room and work for however much time you can devote to it. Then, cut activities you don’t really need. According to my graphs, I spend an appalling amount of time glued to my computer chair, so that has to be first to go–ten minutes at a time.

Credited to flickr user koalazymonkey. Used with permission.

Write a List: If you have frequent access to a computer, Remember the Milk is a fantastic listing tool. You can schedule repeated tasks like, “take out trash every Tuesday”, or “Mom’s birthday every November 5th”. You can even tag them with things like home or errands. We also have a printable weekly calendar available on our Downloads page which may make this step easier.

Warning: I’ve been diagnosed with Obsessive Compulsive Disorder (OCD)–which is uncommon in a manic patient–due to my frequent and sometimes uncontrollable listing. If you also deal with this manifestation of perfectionism, please be aware of how vulnerable you can be when setting routines in this manner. Don’t get too caught up in tweaking your list!

What About Guests? – Aha, here’s a challenge. What happens when you’ve been told that your brother-in-law will be crashing at your place in three hours and your home is a toxic wasteland? (True story.) You weep and gnash your teeth, of course!

Or you can take a look at The Emergency Clean Sweep by My Messie House, which is perfect for this situation. Unfortunately, the site is now defunct, but this is a fantastic outline for tidying up on a basic level. With instructions like, “place the bills next to your computer,” it makes far more sense than stuffing everything in a closet until the visit blows over.

In addition to following these instructions for emergencies, I occasionally challenge myself to get through as much of the list as I can during a set time limit. It isn’t a routine, but I find that when my house is just too overwhelming, I need to hit the reset button.

Thanks for reading! Stick around next time for part III of our cleaning series, where we’ll look at how to tidy the house while in the grip of a mood episode.

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How to Clean Your House When Your Brain is a Mess, part I

This is part one of a three-part series.
Part I | Part II | Part III

Also known as, “Hi! I’m Cassandra, and I Live in a Filthy House.”

That isn’t entirely true.  As it stands, my kitchen is clean, which happens roughly three times per year.  But my office is a clutter minefield, and there is an entire room in my house filled with stuff waiting to be put away.  Suffice it to say that I could normally be a contestant on a junior Hoarders.

Credit to flickr user judsond. Used with permission.

All right, show of hands: who else has scrambled to hide the–possibly moldy–dishes when surprise guests drop in?  Parents with mental illnesses, how many Legos have imbedded themselves in your feet in the middle of the night? You’re not alone, and there’s a logical explanation why.

Primarily found in people on the autism spectrum or with Attention-Deficit/Hyperactivity Disorder (ADHD), executive dysfunction is the inability to set and meet goals, self-monitor, and resist wandering off while in the middle of a project. In persons with bipolar I specifically, the wiring in their frontal lobes is so tangled that they suffer these difficulties even during stable periods. It goes without saying that their capacity to execute plans drops sharply during manic states.

It looks like clutter in the mind really does lead to clutter in the house!  Here are a few ways to tackle your piles head on:

Start small!  Most people get excited about starting a routine and try to implement everything at once, like New Year’s resolutions.  Invariably they fail because the habits they need aren’t in place.  In addition, baby steps don’t tend to work well for people with bipolar; they get overwhelmed quickly and have delusions of grandeur about conquering the routine.

Lovely Dishes
Credited to flickr user avrene. Used with permission.

Rather than assigning one room per week at first, try dedicating yourself to one thing at a time. For example, I’ve constantly struggled with my dirty dishes. I tried doing them every three days, then two, then one. Gross? Sure. But it’s what I have to do to ease myself in. Most times I still fail!

Recommended Link: FlyLady – Marla Cilley, also known as the FlyLady, has garnered a lot of praise for sending specific instructions and encouragement via email. She takes a lot of the work out of building a routine for yourself, and one of the biggest proponents of “baby steps” around. If you can handle the volume of emails without being overwhelmed, this site may work for you.

Don’t kick yourself if you make a routine and then stop following it. Just start again tomorrow, or adapt the one you have. Sometimes I’ve made routines that worked well for weeks, and then stopped when I grew bored with them. You have a lot on your plate, so you’ve learned to be flexible. Your cleaning has to be, too. Track where your time goes and then figure out where you can squeeze in a ten minute burst of laundry duty.

Recommended Link: Unf*ck Your Habitat – Billed as an alternative to FlyLady, UFYH lives by the 20 minutes of cleaning/10 minute break method (20/10). They also allow readers to post pictures of their progress. But be careful: the blog mistresses “terrifies” people into cleaning via swear words. On the plus side, the site have a positively reviewed (profanity-filled) app for the iPad and iPhone.

Best of luck whipping your home into shape! But please remember that it’s a process–one we’re not wired for. In part II, we’ll be covering other ways you can build your own time-management scaffolding.

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