Depression in Children and Adolescents: A Primer for Parents and Educators
By Ralph E. Cash, PhD, NCSP
Nova Southeastern University
Depression is a serious health problem that can affect people of all ages, including children and
adolescents. It is generally defined as a persistent experience of a sad or irritable mood as well as
anhedonia, a loss of the ability to experience pleasure in nearly all activities. It also includes a range of
other symptoms such as change in appetite, disrupted sleep patterns, increased or diminished activity
level, impaired attention and concentration, and markedly decreased feelings of self-worth.
Major depressive disorder, often called clinical depression, is more than just feeling down or having a
bad day. It is different from the normal feelings of grief that usually follow an important loss, such as a
death in the family. It is a form of mental illness that affects the entire person. It changes the way the
person feels, thinks, and acts and is not a personal weakness or a character flaw. Children and youth
with depression cannot just snap out of it on their own. If left untreated, depression can lead to school
failure, conduct disorder and delinquency, anorexia and bulimia, school phobia, panic attacks, substance
abuse, or even suicide.
Prevalence and Risk Factors
Research indicates that the onset of depression is occurring earlier in life today than in past
decades and often coexists with other mental health problems such as chronic anxiety and disruptive
behavior disorders. Researchers at the University of Oregon estimate that 28% of all adolescents (ages
13–19) will experience at least one episode of major depression, with the rate estimated as 3–7% from
ages 13–15 and about 1–2% for children under age 13 (see Seely, Rohde, Lewinsohn, & Clarke, 2002, in
“Resources” at the end of this handout). In 2001, suicide was the third leading cause of death among
those 15–24 years old (see the National Institute of Mental Health Fact Sheet in “Resources”). Up to 7%
of adolescents who develop major depressive disorder may eventually commit suicide.
Children and teens who are under stress, who have experienced a significant loss, or who have
attention, learning, or conduct disorders are at greater risk for developing clinical depression. There is
no difference between the sexes in childhood in vulnerability to depression. But during adolescence girls
develop depressive disorders twice as often as boys. Children who suffer from major depression are
likely to have a family history of the disorder, often a parent who also experienced depression at an early
age. Depressed adolescents are also likely to have relatives who have experienced depression, although
the correlation is not as high as it is for younger children.
Other risk factors for child and adolescent depression include previous depressive episodes, anxiety
disorders, family conflict, uncertainty regarding sexual orientation, poor academic performance,
substance abuse disorders, loss of a parent or loved one, break up of a romantic relationship, chronic
illnesses such as diabetes, abuse or neglect, and other traumas, including natural disasters.
Signs and Symptoms
Characteristics of depression that usually occur in children, adolescents, and adults include:
- Persistent sad and irritable mood
- Loss of interest or pleasure in activities once enjoyed
- Significant change in appetite and body weight
- Difficulty sleeping or oversleeping
- Physical signs of agitation or excessive lethargy and loss of energy
- Feelings of worthlessness or inappropriate guilt
- Difficulty concentrating
- Recurrent thoughts of death or suicide
Characteristics of childhood depression. The way
symptoms are expressed varies with the developmental
level of the youngster. Symptoms associated with
depression more commonly in children and adolescents
than in adults include:
- Frequent vague, non-specific physical complaints
- Frequent absences from school or unusually poor
- School refusal or excessive separation anxiety
- Outbursts of shouting, complaining, unexplained
irritability, or crying
- Chronic boredom or apathy
- Lack of interest in playing with friends
- Alcohol or drug abuse
- Withdrawal, social isolation, and poor communication
- Excessive fear of or preoccupation with death
- Extreme sensitivity to rejection or failure
- Unusual temper tantrums, defiance, or oppositional
- Reckless behavior
- Difficulty maintaining relationships
- Regression (acting babyish, resumption of wetting
or soiling after toilet training)
- Increased risk-taking behavior
The presence of one or even all of these signs and
symptoms does not necessarily mean that a particular
person is clinically depressed. If several of the above
characteristics are present, however, it could be a cause
for concern and may suggest the need for professional
Evaluation and Treatment
Diagnostic evaluation. The good news is that
depression is treatable. Virtually everyone who receives
proper, timely intervention can be helped. Early
diagnosis and appropriate treatment are essential for
depressed children and adolescents. Children who
exhibit signs of clinical depression should be referred to
and evaluated by a mental health professional who
specializes in treating children and teens. A thorough
diagnostic evaluation may include a physical
examination, laboratory tests, interviews with the child
and parents, behavioral observations, psychological
testing, and consultation with other professionals.
Treating depression. A comprehensive treatment
plan often involves educating the child or adolescent
and the family about the illness, counseling or
psychotherapy, ongoing evaluation and monitoring, and,
in some cases, psychiatric medication. Optimally this
plan is developed with the family, and, whenever
possible, the child or adolescent participates in
treatment decisions. It is important to recognize that
illnesses in general and mental disorders in particular
have different overt characteristics and respond
differently to treatment in various cultural groups.
Therefore, diagnostic and treatment approaches must
be culturally sensitive to be effective.
What Adults Can Do to Help
It is important that all adults who have frequent
contact with children and adolescents know the warning
signs of depression. If you suspect a child may be
depressed, make sure parents or guardians are
informed. Do not hesitate to ask a child if he or she has
thought about, intends, or has plans to commit suicide.
You will not give the child any new ideas, and you may
save a life by asking. If a child admits to feeling suicidal,
stay with the child and get professional help
immediately. School personnel can also provide
important support by linking families with information
and referral to community agencies. In addition,
parents, school personnel, and other adults may play
key roles in monitoring the effectiveness of and helping
to ensure compliance with treatment plans.
What Schools Can Do
Schools can facilitate prevention, identification, and
treatment for depression in children and adolescents.
Students spend much of their time in schools where they
are constantly observed and evaluated, and come into
contact with many skilled and well-educated professionals.
Effective interventions must involve collaboration
between schools and communities to counter conditions
that produce the frustration, apathy, alienation, and
hopelessness experienced by many of our youth.
Involvement in research-based programs such as the
Surgeon General’s 1999 Call to Action to Prevent Suicide
or the Yellow Ribbon Suicide Prevention Program and
National Depression Screening Day (SOS High School
Suicide Prevention Program) can greatly enhance
schools’ efforts to organize prevention and intervention
programs to combat depression. (See “Resources” for
information about these programs.) Some of the most
important steps for schools to take include:
- Develop a caring, supportive school environment for
children, parents, and faculty.
- Ensure that every child and parent feels welcome in
- Prevent all forms of bullying as a vigorously
enforced school policy.
- Establish clear rules and publicizing and enforcing
them fairly and consistently.
- Have suicide and violence prevention plans in place
and implementing them.
- Have specific plans for dealing with the media,
parents, faculty, and students in the aftermath of
suicide, school violence, or natural disaster.
- Break the conspiracy of silence (making it clear that
it is the duty of every student to report any threat of
violence or suicide to a responsible adult).
- Ensure that at least one responsible adult in the
school takes a special interest in each student.
- Emphasize and facilitate home-school collaboration.
- Train faculty and parents to recognize the risk
factors and warning signs of depression.
- Train faculty and parents in appropriate interventions
for students suspected of being depressed.
- Utilize the expertise of mental health professionals
in the school (school psychologists, school social
workers, and school counselors) in planning
prevention and intervention, as well as in training
Merrell, K. W. (2001). Helping children overcome
depression and anxiety: A practical guide. New York:
Guilford. ISBN: 1-57230-617-3.
National Institute of Mental Health. (2001). Depression
in children and adolescents (Fact Sheet for
Physicians). Bethesda, MD: Author (NIH Publication
No. 00-4744). Available:
National Institute of Mental Health. (2001). Let’s talk
about depression [for teens]. Bethesda, MD: Author
(NIH Publication No. 01-4162). Available:
National Institute of Mental Health. (2001). Suicide
facts. Bethesda, MD: Author. Available :
Seeley, J., Rohde, P., Lewinsohn, P., & Clarke, G. (2002).
Depression in youth: Epidemiology, identification,
and intervention. In M. Shinn, H. Walker, &. G.
Stoner (Eds.), Interventions for academic and
behavior problems II: Preventive and remedial
approaches (pp. 885–912). Bethesda, MD: National
Association of School Psychologists. ISBN: 0-
U.S. Public Health Service. (1999). Mental health: A
report of the Surgeon General. Washington, DC:
Author. Available: www.surgeongeneral.gov
U.S. Public Health Service. (1999). The Surgeon
General’s call to action to prevent suicide.
Washington, DC: Author. Available:
U.S. Public Health Service. (2000). Report of the Surgeon
General’s Conference on Children’s Mental Health: A
national action agenda. Washington, DC: Author.
World Health Organization. (2000). Preventing suicide: A
resource for teachers and other school staff. Geneva:
Mental and Behavioral Disorders, Department of
Mental Health (WHO). Available:
American Academy of Family Physicians, P.O. Box 11210,
Shawnee Mission, KS 66207; (800) 274-2237;
American Psychological Association, 750 First Street,
NE, Washington, DC 20002; (202) 336-5500;
American Psychiatric Association, 1400 K Street, NW,
Washington, DC 20005; (202) 682-6000;
Depression and Bipolar Support Alliance, Suite 501, 730
N. Franklin Street, Chicago, IL 60610; (800) 826-
3632; (312) 642-0049; www.dbsalliance.org
National Association of School Psychologists, Suite 402,
4340 East West Highway, Bethesda, MD 20814;
(301) 657-0270; www.nasponline.org
National Institute of Mental Health, Office of
Communications and Public Liaison, Information
Resources and Inquiries Branch, Room 8184, 6001
Executive Boulevard, MSC 9663, Bethesda, MD
20892; (301) 443-4513; www.nimh.nih.gov
National Mental Health Association, 1021 Prince Street,
Alexandria, VA 22314; (800) 969-NMHA;
SOS High School Suicide Prevention Program/National
Depression Screening Day—
Yellow Ribbon Suicide Prevention Program: (303) 429-
Ralph E. “Gene” Cash, PhD, NCSP, is on the faculty of the
School Psychology program at Nova Southeastern
University in Ft. Lauderdale, FL.
© 2004 National Association of School Psychologists, 4340 East West Highway,
Suite 402, Bethesda, MD 20814—(301) 657-0270.