Diagnosis of Childhood Depression
Treatment of Childhood Depression

Most children cope with the emotions related to cancer and not only adjust well, but show positive emotional growth and development. A small number of children, however, develop psychological problems including depression, anxiety, sleeping problems, relationship problems, and are uncooperative about treatment. A mental health specialist should treat these children.

Children with severe late effects of cancer have more symptoms of depression. Anxiety usually occurs in younger patients, while depression is more common in older children. Most cancer survivors are generally able to adapt and adjust successfully to cancer and its treatment; however, a small number of cancer survivors have difficulty adjusting.

The term depression refers to a symptom or a set of symptoms or conditions that occur together and suggest the presence of depression, or an illness. A diagnosis of depression as an illness depends on how severe the symptoms are and how long they last. For example, a child may be sad in response to trauma, and the sadness usually lasts a short time. Depression, however, is marked by a response that lasts a long time, and is associated with sleeplessness, irritability, changes in eating habits, and problems at school and with friends. Depression should be considered whenever any behavior problem continues. Depression does not refer to temporary moments of sadness, but rather to a disorder that affects development and interferes with the child's progress.

Some signs of depression in the school-aged child include the following:

• Not eating.
• Inactivity.
• Looking sad.
• Aggressive behavior.
• Crying.
• Hyperactivity.
• Physical complaints.
• Fear of death.
• Frustration.
• Feelings of sadness or hopelessness.
• Self-criticism.
• Frequent daydreaming.
• Low self-esteem.
• Refusing to go to school.
• Learning problems.
• Slow movements.
• Showing anger towards parents and teachers.
• Loss of interest in activities that were previously enjoyed.

Some of these signs can occur in response to normal developmental stages; therefore, it is important to determine whether they are related to depression or a developmental stage.

Determining a diagnosis of depression includes evaluating the child's family situation, as well as his or her level of emotional maturity and ability to cope with illness and treatment; the child's age and state of development; and the child's self esteem and prior experience with illness.

A comprehensive assessment for childhood depression is necessary for effective diagnosis and treatment. Evaluation of the child and family situation focuses on the child's health history; observations of the behavior of the child by parents, teachers, or healthcare workers; interviews with the child; and use of psychological tests.

Childhood depression and adult depression are different illnesses due to the developmental issues involved in childhood. The following criteria may also be used for diagnosing depression in children:

• A sad mood (and a sad facial expression in children younger than 6) with at least 4 of the following signs or symptoms present every day for a period of at least 2 weeks:
  • Appetite changes.
  • Either not sleeping or sleeping too much.
  • Being either too active or not active enough.
  • Loss of interest or pleasure in usual activities.
  • Signs of not caring about anything (in children younger than 6).
  • Tiredness or loss of energy.
  • Feelings of worthlessness.
  • Self-criticism or inappropriate guilt.
  • Inability to think or concentrate well.
  • Constant thoughts of death or suicide.

Individual and group counseling are usually used as the first treatment for a child with depression, and are directed at helping the child to master his or her difficulties and develop in the best way possible. Play therapy may be used as a way to explore the younger child's view of him- or herself, the disease, and treatment. From the beginning of treatment, a child needs help to understand, at his or her developmental level, the diagnosis of cancer and the treatment involved. A doctor may prescribe medications, such as antidepressants, for children. Some of the same antidepressants prescribed for adults may also be prescribed for children. (Refer to the Treatment ¹ section for information about FDA warnings on antidepressant use in children and adolescents.)

Glossary Terms

A quickly growing cancer.

A drug used to treat depression.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A desire to satisfy a physical or mental need, such as for food, sex, or adventure.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

To adjust to new situations and overcome problems.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The physical, mental, and emotional stages a child goes through as he or she grows and matures.

The process of identifying a disease, such as cancer, from its signs and symptoms.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The FDA also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called Food and Drug Administration.

A higher than normal level of activity. Hyperactivity can be used to describe the increased action of a body function, such as hormone production, or behavior. A person who is hyperactive may seem to be always moving or fidgeting, impulsive, unable to concentrate, and talking too much.

Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.

A doctor's order for medicine or another intervention.

Having to do with how the mind works and how thoughts and feelings affect behavior.

A feeling of self-worth, self-confidence, and self-respect.

The act of taking one's own life on purpose.

One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

Injury to the body, or an event that causes long-lasting mental or emotional damage.