Taotao, a nine-year-old boy, has been easily irritable in the recent four months, and is having deteriorating relationship with classmates, he weeps a lot, and regards himself as very thickheaded and incapable. In class, he cannot focus his attention, sometimes he lays on the desk, looking very weak. In the recent tests, his grades decline slightly, and he claims that nobody likes him, and lacks any interest in the activities. Sometimes, he loses his temper at home, flipping the table, throwing bowls, and he couldn’t sleep well at night, accompanied by symptoms of talking in his sleep and early awakening. He also takes in less food. After much inquiry and consideration, his anxious parents took him to Department of Pediatrics of Beijing Anding Hospital and Taotao was diagnosed with depression. His parents could not help but wonder “Can children also be victims of depression?”

Indeed, children can be victims of depression, too. Depression in children is mainly reflected in the form of emotional depression, which is a kind of unhappy, sorrowful and painful experience. Children with depression seem to have lost their interest and joy, speaking less and participating in fewer activities, and often feel “meaningless”, “having no interest”, “spiritless”, and are hard to cheer up. Some even feel they might as well die and may injure themselves or commit suicide.

Due to the fact that small children haven’t fully developed their linguistic skills, they may have some difficulty in expressing how they feel, thus depression in children is reflected in other forms, such as decreasing appetite, weight loss, constant weeping and difficulty to be comforted, poor sleep quality or enuresis. Apart from less speech and lack of interest, children with depression more often have symptoms of physical discomfort, anxiety, agitation, rage, and tendency to destroy things or hurt people. However, depression is seldom seen in pre-adolescent children (uncommon in children aged below eight, with the morbidity rate of less than 1%). Depression is more common in youths, with the morbidity rate of adolescent depression in boys and girls in the mid-term of adolescence at 2% and 4% respectively. In 1998, Guo Lanting surveyed 322 elementary school kids aged between 10 and 12, and reported the occurrence rate of depression symptoms in these children at 3.4%-11.5% using Bullerne Depression Measurement Chart. Among them, the detection rate of depression is 10 persons (3.1%), of whom eight have thought of committing suicide. Therefore, more attention should be paid to child depression.

According to age criterion, child depression can be classified into infant, preschool, pre-puberty and adolescent depression

Infant Depression: Infant depression is mainly due to the impact of mother-child separation on an infant’s mood and behavior in the early period. Six months after birth, an infant have established a relationship of intimate dependency on the mother, if, at this stage, the baby is separated from his mother, he may suffer from depression. Early symptoms are incessant crying, looking for parents everywhere (if the child can walk or speak), and easy agitation. About a week later, this emotion of protest will reduce, and he will show symptoms of depression, withdrawal, non-reaction to ambience, lack of interest and appetite, weight loss, growth standstill, somnipathy, and decreased resistance to diseases. If the infant is reunited with his mother after three or four months, such depressive symptoms can be reversed. Spitz called such depression “anaclitic depression”.

Preschool Depression: Children at this stage haven’t fully developed their linguistic and cognitive abilities, thus, we can observe depression in them mainly through non-verbal means, such as by observing their unhappy faces (e.g. downcast eyes, down-turned lips), their posture, tone, speed of talking, and physical activity level (PAL), etc. Children have limited ability in experiencing depression, and their depression is mainly unhappiness, lack of interest (even in their favorite games), decreased appetite, less sleep, reluctance to get along with other kids, frequent weeping and crying, withdrawal, and reduced PAL.

Depression in School-age Children: Besides clinical manifestation the same as preschool depression, depression in school-age children also includes symptoms of low self-evaluation, self-accusation, attention deficit, memory decline, decreasing thinking ability, reduced activities, lack of interest, refusal to participate in school performances, lack of interest in playing, or less activity participation. Such children may complain or feel bored, for instance, they may complain that they do not have friends, and may suffer from recurring impulse to commit suicide. School-age children are capable of expressing their unhappiness, suicidal thoughts, lack of interest in activities, attention deficit, less sleep, etc. About 25% of those with a history of child depression are diagnosed according to the parents and children’s narration. When only the children are inquired, 1/4 of the children with depression will be missed diagnosis, and when only the parents are inquired, the diagnosis of child depression may be missed.

Adolescent Depression: More adolescents suffer from depression than those in pre-puberty period, with the symptoms more likely to resemble those of adults. Adolescents have more approaches to respond to depression, therefore, apart from being in a depressive mood, they are likely to suffer from behavioral disorders, reduced vitality, creativity, and intellect; they may attack others, engage in sabotage, truancy and absenteeism, and may lose hope in their future. Cases of suicidal acts increase significantly during this period. Some patients indulge in alcohol and drugs to improve depression, According to the author, around 20% of adolescent patients have the problem of drug abuse.

As children haven’t been fully developed physically and mentally, they may not be able to express how they feel as clearly as adults. Thus, children seemingly “all right” may not be calm inside, and may be “very agitated”.

The following are some of the warning signs of psychological problems in children:
1. Suddenly becoming reticent and reluctant to communicate with others
2. Recurrent fear, agitation, fret, dysphoria, and worry
3. Emotional instability and impulsiveness.
4. Easily offended, hostile or constantly losing his temper
5. Lack of interest or prolonged unhappiness
6. Lazy and undisciplined in life, reluctant to go to school
7. Attention deficit
8. Unable to get to sleep or to sleep well
9. Worsening academic performance

Easy-to-do Observation and Judgment Method: When a child’s psychological behavior or emotional expression is inconsistent with his age, and contradict with the social environment, his social experience and level of education, or when his behavior and emotion cause continual and repeated pain to himself and those around him, then the child has "psychological disorder”.

Child depression is reflected in significantly different ways from adult depression. Child depression is not an embryonic form of adult depression, so remember not to apply the same treatment on adult to children. Besides, child depression should be differentiated from stress response, schizophrenia, emotional disorders, conduct disorders, attention deficit hyperactivity disorder (ADHD), tic disorder and other diseases. Victims of child depression not only speak less and lack interest, they also suffer from physical discomfort, anxiety, agitation, rage, and tendency to destroy things or hurt people. Only experienced child psychiatrists are able to diagnose these symptoms. Hence, parents should exert care in selecting a trusted hospital from the few child psychiatry hospitals to treat their children with the abovementioned symptoms. Experienced child psychiatrists will teat them with the right environment, drugs and psychological therapy. Reminder: Never resort to treatment at non-specialized hospitals for the sake of so-called honor and external pressure, otherwise, you may miss the best opportunity for your child’s treatment.