Mood Disorders Among Children
Mental health problems ranging from depression to bipolar disorder are known as mood disorders or affective disorders. In any of these disorders, a serious change in mood shapes your child’s emotional state. Unlike a normal bad mood a child feels occasionally, a mood disorder involves thoughts and feelings that are intense, difficult to manage, and persistent.
Childhood mood disorders are mental health conditions that affect a child’s emotional state. When a child is experiencing a mood disorder, they will likely have thoughts and feelings that are intense, persistent, and hard to manage. These go beyond mad moods or occasional temper tantrums. An estimated 14.3% of children, ages 13 to 18, have a mood disorder, and an estimated 11.2% have a severe impairment. Mood disorders are also prevalent in approximately 38% of ADHD patients..
Mood disorders can affect children just as they can affect adults. While it is normal for children to experience a wide range of emotions, persistent and extreme mood changes that interfere with their daily functioning may indicate a mood disorder.
Common Mood Disorders among Children
1.Major Depressive Disorder (MDD): Children with MDD experience persistent feelings of sadness, hopelessness, or irritability. They may have a loss of interest in activities they once enjoyed, changes in appetite or sleep patterns, low energy, difficulty concentrating, and thoughts of self-harm or suicide.
2.Persistent Depressive Disorder (PDD): Formerly known as dysthymia, PDD is characterized by a chronically depressed mood lasting for at least one year. Children with PDD may exhibit symptoms similar to MDD but at a less severe level.
3.Bipolar Disorder: Children with bipolar disorder experience extreme mood swings that alternate between depressive episodes and manic or hypomanic episodes. During manic episodes, they may exhibit an elevated mood, increased energy, impulsivity, grandiosity, and decreased need for sleep.
4.Disruptive Mood Dysregulation Disorder (DMDD): This disorder is characterized by severe and recurrent temper outbursts that are grossly out of proportion to the situation. Children with DMDD often have a persistently irritable or angry mood between outbursts.
5.Anxiety and Depression: Anxiety disorders, such as generalized anxiety disorder (GAD) and social anxiety disorder (SAD), commonly co-occur with depression in children. These conditions can intensify one another, leading to greater impairment in daily functioning.
6.Substance-Induced Mood Disorder: In some cases, children or adolescents may trigger a mood disorder through the use of substances. A substance-induced mood disorder can occur after an individual takes medication, is exposed to toxic substances or uses certain drugs. Treatment options will vary based on the mood disorder and the type of drug or substance that induced the disorder.
7.Premenstrual Dysphoric Disorder: Premenstrual dysphoric disorder (PMDD) is a condition that only affects females who have gone through puberty. While premenstrual syndrome (PMS) is a common occurrence for teenagers and women, PMDD is a more severe and debilitating form of PMS. Generally, symptoms of PMDD start before the menstrual cycle and can lead teenage girls to experience extreme moodiness, changes in appetite, sensitivity to rejection and overwhelming feelings. On top of the psychological symptoms, the painful physical symptoms of PMS like bloating, cramping, headaches, and breast tenderness are also present. For some women, PMDD can be managed well with exercise and diet changes. Other women benefit from the use of antidepressants or selective serotonin reuptake inhibitors (SSRIs) in the latter half of their cycle.
Causes of Children Mental Health Disorders
It’s important to note that mood disorders in children can have various causes, including genetic factors, brain chemistry imbalances, family history, trauma, chronic illness, or stressful life events. If you suspect that a child may be experiencing a mood disorder, it is crucial to seek professional help from a paediatrician, child psychiatrist, or psychologist for an accurate diagnosis and appropriate treatment.
Signs and Symptoms of Mood Disorders in Children
Children don’t always exhibit the same signs as an adult and every child is unique, so signs and symptoms will vary from child to child, and be impacted by age, biological makeup, and circumstance.
1.Feeling irritable, angry, or sad on a persistent basis
2.Physical complaints, such as headaches or fatigue
3.Significant changes in sleep or eating patterns
4.Loss of energy
5.Low self-esteem
6.Difficulty in school or with peers
7.Recurrent temper outbursts
8.Increased energy with racing thoughts or fast speech
9.Rebellious or risky behaviour
10.Threats of running away or running away
11.Suicidal thoughts or feelings
Common Sources of Mood Disorders in Children and Teens
1.Trauma, grief and significant life stressors.
2.Anxiety or another clinical issue
3.Infectious disease or toxin exposure
4.Medical issues
5.Poor diet or food restriction
6.Head injury
7.Genetics and brain chemistry
8.Gut bacteria imbalance
9.Genetic mutations
With children and teens who have depression, my clinical experience has been that some prolonged stressor, such as bullying or attention or academic problems, or another underlying mental health or medical issue tend to be a much more common source of depression than genetics.
Many teens with depression have long-term anxiety before they have depression. The constant “rev state” which means you are in a sympathetic dominant stress state, literally wears the body out. That cortisol overdrive taxes the adrenal glands, thyroid and interferes with blood sugar regulation and a healthy gut balance.
Diagnosing Childhood Mood Disorders
In order for a child or adolescent to receive a mood disorder diagnosis, they must be seen by a clinical psychologist, psychiatrist or other qualified mental health professionals for a comprehensive psychiatric evaluation. Mental health professionals will often defer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for a mood disorder and mental health diagnoses. The DSM-5 is a diagnostic tool that contains information about how to recognize and treat patients with mood disorders or other mental health conditions.
According to the Children’s Hospital of Philadelphia, a typical psychiatric evaluation includes:
1.Determining the child’s health and general medical history
- Recording specific symptoms the child.
- Noting how the child acts at home and with others in social settings
- Identifying stresses in the child’s life, both big and small
- Receiving information from teachers and other people who regularly interact with the child
F.The child’s history of mental health conditions, other conditions and medications used
G.How the parent would like to proceed with treatment, as well as a discussion of all treatment options
Treatment of Mood Disorders In Children
Treating mood disorders in children typically involves a combination of therapy, medication (in some cases), and support from parents and caregivers. Here are some common approaches to treating mood disorders in children:
1.Psychotherapy: Different types of therapy can be effective in treating mood disorders in children. Cognitive-behavioural therapy (CBT) helps children identify negative thought patterns and develop healthier coping strategies. Interpersonal therapy (IPT) focuses on improving interpersonal relationships. Family therapy involves working with the entire family to address dynamics and provide support.
2.Medication: In certain cases, medication may be prescribed to help manage mood disorders in children. Antidepressants, mood stabilizers, or antipsychotic medications may be used under the guidance of a child psychiatrist. Medication should always be closely monitored by a qualified healthcare professional. Medications for children with mood disorders include:
1.Mood stabilizers
2.Antidepressants
3.SSRIs
3.Parental and Family Support: Parents and caregivers play a crucial role in supporting children with mood disorders. They can provide a stable and nurturing environment, help the child adhere to treatment plans, and learn effective parenting strategies. Family therapy can also address family dynamics that may contribute to the child’s mood disorder.
4.Lifestyle Changes: Encouraging healthy lifestyle habits can have a positive impact on a child’s mood. This includes promoting regular exercise, a balanced diet, sufficient sleep, and minimizing stressors where possible.
5.School Support: Collaborating with the child’s school is important to create a supportive environment. Communicate with teachers, counsellors, and administrators about the child’s condition and any accommodations or support services they may need.
6.Support Groups: Support groups for children with mood disorders and their families can provide a sense of community, validation, and education. They offer an opportunity for children to connect with peers facing similar challenges and for parents to share experiences and strategies.
Depression Rating Scales for Children and Teens
1.BDI: Beck Depression Inventory is a scale that uses 21 self-reported items that are used to measure various characteristics of depression. It takes around ten minutes to complete this test and is found in many different forms such as computer versions, card forms and paper copies (APA).
2.BASC: The Behavioural Assessment System for Children is a multidimensional, multimethod approach that evaluates the child or adolescent’s emotional or behavioural disorder. The diagnostic components of the BASC scale include:
A.Structured Developmental History
Student Observation System
C.Self-Report of Personality
D.Parent Rating Scale
- Teacher Rating Scale
F.Parent Relationship Questionnaire
The scale aims to help give accurate differential diagnosis of emotional and behavioural problems for individuals 2-21 that can help clinicians develop treatment plans. The scale incorporates traditional and new constructs to help achieve an accurate diagnosis.
3.CDRS: The Children’s Depression Rating Scale was developed in 1979 to diagnose children 6-12 years old with depression. A score between 20-30 indicates borderline depression while a score of 30 indicates significant depression (Shanahan et al., 1987).
4.CDI: The Children’s Depression Inventory is a scale used by mental health professionals that “measures the cognitive, affective and behavioural signs of depression in children and adolescents between the ages 7-17”
5.Patient Health Questionnaire: Nine Items: Modified for teens – Uses self report measures to evaluate depression. There are 9 criteria and it takes around 5 minutes to complete
6.RHRSD: The Revised Hamilton Rating Scale for Depression is used most often with adults and older adolescents. It takes approximately 5-10 minutes to complete.
7.RADS-2: The Reynolds Adolescent Depression Scale is used for 11-20 yr. olds who present with symptoms of depression.
8.CES-DC: The Centres for Epidemiological Studies Depression Scale Modified for Children is helpful because it utilizes a 20 item scale and should be administered to children 6-17 years old. A score greater than 15 indicates significant depressive symptoms.
How to help children cope with mood disorders
Children may not be able to identify or explain their symptoms, so it’s important to keep an open line of communication, help reduce stressors in the home, surround the child with a strong support system, and introduce them to positive habits, such as exercise, meditation, or yoga.
You can also incorporate the following into your child’s life:
Help them maintain a consistent, full night’s sleep. Turning off devices an hour before bed and encouraging your child to go to bed at the same time every day can help with this.
Encourage your child to socialize and engage with others, so they have a strong support system across all areas of their life. You can also sign them up for activities. Just make sure you give them downtime.
In summary mood disorders in children should be treated in accordance to the laws that govern their well-being and treatment plans should be tailored to their specific needs. It is essential to work closely with mental health professionals to develop an individualized treatment plan that addresses the child’s specific symptoms and circumstances.
