It is normal for children to feel sad or upset at times. In children, mood disorders are often not evidenced by the same types of symptoms compared to adults.
In children, depression can be evidenced by a pervasive sense of sadness, lack of enjoyment, low motivation, poor concentration, social withdrawal from friends and family, emotional outbursts with minimal provocation, irritability, excessive reassurance seeking, recurrent nightmares, difficulty going to sleep or waking throughout the night. Lowered mood can also be associated with anxiety symptoms, or increasingly rebellious behaviour.
Practitioners at Brisbane Specialist Suites help families to manage a range of mood disorders including:
- Dysthymia
- Depression
- Adjustment Disorder
- Grief and Loss
- Bipolar Disorder (this is extremely uncommon in children)
Other conditions which may also be associated with a sad or depressed mood include:
- Coping with separated or blended families
- Transitions to a new home or school
- Loss or death of a loved one
Mood disorders can impact a child’s capacity to move through developmentally appropriate milestones, attend school, or cope with family life. Mood disorders can sometimes persist into adulthood if not appropriately treated.
When do we need to seek treatment?
We recommend requesting specialist assessment when mood is:
- Persistently low despite opportunities to participate in previously pleasurable activities.
- Associated with marked distress (crying or tantrums that persist)
- Associated with insomnia or loss of appetite (particularly if weight loss is present)
- Associated with functional impairment i.e., the child in question cannot go to school, refuses to attend play-dates or parties, or refuses to leave home
- Associated with thoughts of harming oneself or ending one’s life
- Causes a significant disruption to family functioning
What is involved in assessment?
Whether you see a Psychiatrist or Psychologist first, a comprehensive assessment should always involve a detailed history from caregivers. This will involve both parents or guardians. The involvement of both guardians is particularly important if children move between two households. This part of the assessment will focus on:
- Family history of mood disorders or other medical conditions
- Past medical history of the child in question (taking a “bio-psycho-social approach” including developmental & medical history)
- Interventional strategies that have been trialled to date by caregivers and professionals
Your specialist will also request collateral information from prior treatment providers (GP, psychologist) as well as school (teacher, guidance officer or school chaplain).
The second part of the assessment will involve an assessment with your child. Your child may be interviewed alone, which is common practice. Whilst taking a history, your specialist should also screen your child for any co-existing learning or language disorder which might impact on their capacity to self-soothe and participate in school-based activities.
Depending on history, your Specialist may recommend blood tests to exclude possible comorbid medical conditions that can manifest as with anxiety symptoms. This is particularly important if you are considering medication.
What treatment can we expect?
Good practice dictates that first line treatment should consist of psychological treatment from an appropriately skilled Psychologist, Psychotherapist or Child Psychiatrist with experience in the area. Psychotherapeutic sessions will generally occur weekly, and will use principles from Cognitive Behavioural Therapy.
Caregivers are encouraged to be a strong participant in their child’s therapy. Your Specialist at Brisbane Specialist Suites will teach caregivers skills so that they may have the knowledge to reinforce strategies at home.
Medication is only considered when psychological strategies have failed, or when anxiety is of such severity that the child is unable to participate in psychological treatment. Medication should only be considered under the supervision of a Child & Adolescent Psychiatrist.
What is Cognitive Behavioural Therapy?
Cognitive behavioural therapy (CBT) is based upon two components:
- The “Cognitive” part focuses on helping your child to take notice of, and track their thought patterns when feeling sad or depressed. Once these have been mapped out, your child is then taught how to challenge automatic thoughts (by replacing unhelpful thinking) and regulate their emotions (such as mindfulness and attention training, or self-management training).
- The “Behavioural” part focuses on practical behavioural strategies to manage their mood. This may include activities to self-soothe (such as relaxation skills), when they experience unpleasant feelings, but also may include strategies to challenge themselves (such as leaving the house to engage in pleasurable activities, or doing regular exercise).
It is essential that these skills are delivered in a developmentally appropriate way by an appropriately skilled Specialist.