How Is Depression Diagnosed in Children?

Diagnosing depression in children involves a comprehensive assessment that takes into account various factors. Since children may have difficulty expressing their emotions or understanding what they are experiencing, it requires the involvement of parents, caregivers, teachers, and mental health professionals. Here are some common steps and considerations involved in diagnosing depression in children:

1. Initial evaluation: The process usually begins with an initial evaluation conducted by a healthcare professional or mental health specialist. This evaluation may include interviews with both the child and their parents or caregivers. The purpose is to gather information about the child's behavior, emotions, and any noticeable changes in their mood.
2. Diagnostic criteria: Mental health professionals refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association to identify symptoms and establish diagnostic criteria for depression. The DSM-5 outlines specific symptoms, duration, and impairment criteria that need to be met for a diagnosis of depression.
3. Parent and teacher reports: Parents and teachers play a crucial role in providing information about the child's behavior and emotional state. They may be asked to complete questionnaires or rating scales to assess the child's symptoms and functioning across different settings.
4. Clinical interview: A mental health professional will typically conduct a clinical interview with the child to gather more detailed information. This interview aims to explore the child's feelings, thoughts, and experiences related to depression. The professional may use child-friendly techniques and language to facilitate communication.
5. Observations: In addition to interviews, mental health professionals may observe the child's behavior and interactions with others to gather further insights into their emotional state and functioning.
6. Duration and impairment: To make a diagnosis of depression, the symptoms must be present for a specific duration (e.g., at least two weeks) and cause significant impairment in the child's daily life, such as affecting their academic performance, relationships, or overall well-being.
7. Ruling out other conditions: It is important to rule out other medical or psychiatric conditions that may present with similar symptoms. For example, some medical conditions, such as thyroid disorders, can mimic depressive symptoms.
8. Collaboration with other professionals: Depending on the circumstances, the mental health professional may collaborate with other healthcare providers, such as pediatricians or psychologists, to gather additional information or rule out other underlying factors.

It's important to note that diagnosing depression in children can be complex due to developmental considerations, the variability of symptoms, and the need for a comprehensive assessment. Therefore, it is recommended to seek professional help from a qualified mental health specialist or healthcare provider for an accurate diagnosis and appropriate treatment.

When do I need to seek medical advice?

If the symptoms of depression in your child have lasted for at least 2 weeks, schedule a visit with their doctor to make sure there are no physical reasons for the symptoms and to make sure that your child gets proper treatment. A consultation with a mental health care professional who specializes in children is also recommended. Keep in mind that the pediatrician may ask to speak with your child alone.

A mental health evaluation should include interviews with you (the parent or primary caregiver) and your child, and any other psychological testing that is needed. Information from teachers, friends, and classmates can be useful for showing that these symptoms are consistent during your child's various activities and are a marked change from previous behavior.

There are no specific medical or psychological tests that can clearly show depression, but tools such as questionnaires (for both the child and parents), combined with personal information, can be very useful in helping diagnose depression in children. Sometimes those therapy sessions and questionnaires can uncover other concerns that contribute to depression such as ADHD, conduct disorder, and OCD.

Some pediatricians start using mental health screens at a child's 11th-year well visit and each year after.

The United States Preventive Service Task Force recommends screening for anxiety in children and adolescents ages 8 to 18 years and screening for major depressive disorder (MDD) in adolescents ages 12 to 18 years.

Practical Steps

Diagnosing depression in children involves a combination of approaches to gather information and assess their symptoms. Here are the practical steps commonly followed in diagnosing depression in children:

1. Initial screening: The process often begins with a screening questionnaire or tool completed by parents, teachers, or the child themselves. These screening measures help identify potential depressive symptoms and determine the need for further evaluation.
2. Gathering information: The mental health professional or healthcare provider will conduct interviews with both the child and their parents or caregivers. They will ask questions about the child's behavior, emotions, and any changes in mood or functioning. It's important to obtain information from multiple sources to gain a comprehensive understanding of the child's experiences.
3. Diagnostic criteria assessment: The mental health professional will assess the child's symptoms against the diagnostic criteria outlined in the DSM-5. The DSM-5 lists specific symptoms and duration requirements necessary for a diagnosis of depression.
4. Structured interviews: Structured interviews designed specifically for assessing depression in children, such as the Kiddie-SADS or the Children's Depression Inventory (CDI), may be used. These interviews help gather detailed information about the child's symptoms, their severity, and the impact on their daily life.
5. Behavioral observations: The mental health professional may observe the child's behavior and interactions during the assessment. This can provide additional insights into their emotional state, social functioning, and overall well-being.
6. Review of medical history: A review of the child's medical history is essential to identify any physical illnesses, medications, or other factors that could contribute to depressive symptoms or mimic them. Some medical conditions or medications can cause symptoms similar to depression.
7. Collaboration with other professionals: In certain cases, the mental health professional may collaborate with other healthcare providers, such as pediatricians or psychologists, to gather additional information or rule out underlying medical or psychological conditions.
8. Duration and impairment assessment: The duration and severity of the symptoms are evaluated to determine if they meet the criteria for a depressive disorder. The mental health professional will assess how the symptoms impact the child's daily functioning, including their academic performance, relationships, and overall well-being.