AAP Recommends Screening for Depression in Kids

Depression and suicide risk in children has reached unprecedented levels. Last year, amid the pandemic, youth mental health was declared a “national emergency” by a coalition representing over 77,000 physicians and over 200 children’s hospitals. Additionally, the U.S. Surgeon General Dr. Vivek H. Murthy issued a 53-page advisory warning in 2021 of a growing mental health crisis among young people.

The CDC also released a 2022 report revealing a worsening mental health climate—asserting that 21% of teens experienced a major depressive episode before the pandemic, and 9% of children and adolescents experienced anxiety problems. The pandemic has only exacerbated these issues.

In response to this growing crisis, the American Academy of Pediatrics (AAP) recently issued a draft recommendation urging that pediatricians help screen for mental health issues such as major depressive disorder and anxiety. They are also now proposing that all adolescents are screened for suicide risk.

But what can we do as a community of parents and caregivers who undeniably play one of the most critical roles in a child’s life? How can we spot signs of depression in kids, or look out for suicide risk? What can we do to help our child if they are struggling?

Enlisting pediatricians to help

Pediatricians are now being considered another line of defense to combat the youth mental health crisis. In conjunction with the U.S. Preventive Services Task Force (USPSTF), AAP proposes screening all adolescents ages 12 and up for major depressive disorder and youths ages 8 and up for anxiety, even if they’re not showing symptoms.

Additionally, AAP recommends universal screening for all kids age 12 and older for suicide risk—and screening those 8 to 11 years when clinically indicated.

Routine screening is one way to potentially reduce the rate of youth suicide. However, primary care providers must also be equipped with the necessary tools and resources to connect youth with quality mental health care when they screen positive for suicide risk.

While these proposed screening measures could prove to be helpful, research has proven that one of the greatest protective factors against mental health challenges and suicide is a strong connection with primary caregivers. However, in today’s complicated landscape, it has become harder than ever for parents to know what signs to look for to spot depression or suicide.

Signs of depression in kids and teens

Depression is a mood disorder that can cause children (and adults) to feel sad, irritable or hopeless. It may affect sleep, appetite or relationships with others. Depression can also cause people to lose interest in hobbies or activities they once enjoyed. In severe cases, depression can lead to thoughts of suicide.

Diagnosing depression in younger people can be challenging, as this is a developmental period marked by rapid change and lagging verbal ability. For this reason, outside care providers often turn to behavioral patterns to diagnose depression.

Below is a checklist often used to diagnose depression in kids. If you can answer “yes” to more than two of these questions below and the child’s symptoms have persisted most days in a week for at least 2 weeks, then it is likely they are struggling with depression that may warrant a professional opinion.

1. Are they sad or irritable most of the day?

All kids have tantrums, outbursts and are moody from time to time, but when these behaviors seem to be more the norm than the exception, this could mean depression or another mental health challenge is present. In working with children, I have found that if a child is struggling with depression they typically struggle with this pervasive sadness and or irritability both in the home and outside of home (at school, with friends) and for weeks at a time. This sadness/irritability may also be expressed through physical symptoms such as headaches and stomachaches, especially in younger children.

2. Have they lost interest in things that they used to really enjoy? Or a significant decrease in energy and lack of motivation to do much of anything?

It is fairly common to observe motivational difficulties among older children. It can show up as listlessness, fatigue, poor follow-through, non-compliance, academic underperformance and social withdrawal. Children who are struggling with depression are often labeled as “lazy,” and, unfortunately, this can incite more bad feelings.

If your child has had a significant change in motivation, for example, if a young child who was highly active begins complaining about going to activities or school, this could be a sign they are depressed. Teenagers struggling with depression often become socially withdrawn and/or experience academic decline. However, it is critical for parents to first delineate between a tired, worn out child and a depressed child.

3. Have their eating or sleeping habits changed?

Sleeping and eating are great measures of what’s going on with a child; children with unusual sleep or eating habits are often struggling with something else much greater. Depression may show up as sleeping or eating too much or as an inability to sleep or eat.

If your child has repetitive sleep issues or their eating habits seem to have significantly changed, it may be time to seek help.

4. Are they feeling worthless, hopeless about their future, or guilty about things that aren’t their fault?

It is not uncommon to hear a child who is struggling in the moment say things like “I am the worst friend”, “I am so stupid”, “I am ugly”, “I hate myself”. However, when a child begins to take on these statements as who they are and not what they feel, it’s a sign there might be something bigger at play. Children who are struggling with depression have prolonged periods of hopelessness and hold a negative view of themselves and the world around them.

5. Have they had thoughts of suicide?

This is a delicate space, especially when considering the large age range addressed in this article. However, if you have any reason to believe your child may be suicidal, it’s important that you as a parent or caregiver feel empowered to ask them if they have ever thought of “harming, hurting, or killing themselves.”

There seems to be a misconception that discussing difficult subjects “puts ideas” in people’s heads and might lead them to act on these thoughts. In reality, the inadvertent result of not asking difficult questions is a missed opportunity to share, connect, and in some cases save a child’s life.

When to seek urgent help

If your child or someone you know is suicidal, it is critical that they are evaluated by a mental health professional or taken to the closest emergency room.

Additional resources include: the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting HOME to 741741. You can reach Trans Lifeline at 877-565-8860 (U.S.) or 877-330-6366 (Canada).

How to best support a struggling child

Connect

One of the best ways to help a struggling child—and a healthy child—is to find authentic ways to connect with them. These do not need to be large sweeping or grandiose gestures. It is also important that we remember that we don’t always have to ask 20 questions when we are with our child. Sometimes it just takes getting in a car and playing a favorite song or going for a walk with the dog. Small efforts of uninterrupted time together often produce the best grounds for connections.

Listen

Parents often feel like they need to have all the answers, but in reality, children just want to be heard and understood. We also don’t always have to try and turn things for good.

In our attempt to make our children feel better by saying things like “you will be fine” or “it’s not so bad”, we are actually stifling their ability to access their negative feelings, and in turn, preventing them from processing these hard emotions.

When we say things like, “It sounds like you’re having a hard day,” or, “I am sorry you are feeling so bad”, this not only validates their emotions, but it creates a safe space for them to process—and an opportunity to connect with you.

If you’re worried, seek help from a medical professional

A stigma still very much exists around struggles with depression and/or anxiety, but it is important for parents to normalize the need for support from an outside and independent medical professional.

Finding a therapist can be complicated and costly, so starting with a primary care physician is a great place to start.

Helping a child who is struggling with depression can be very taxing on you, as the caregiver, so it is important that parents also seek support from family, friends and or a medical professional.