If you suspect your child is depressed, the next step might be to have them diagnosed by a mental health professional. In order to diagnose a child with depression, they must meet certain criteria that are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. There are several types of depression a clinician may diagnose:
Diagnosis of a major depressive episode
This is the typical diagnosis for most depression. For a diagnosis of major depressive disorder, a child must have at least 5 of the 9 symptoms listed below consistently over a 2-week period (including at least one of the top two). These symptoms also must be causing significant impairment in a child’s life, and cannot be accounted for by a grief reaction, substance abuse, a medical illness, or bipolar disorder.
- Depressed or irritable mood
- Decreased interest or lack of enjoyment
- Decreased concentration or indecision
- Insomnia (difficulty sleeping) or hypersomnia (sleeping excessively)
- Change of appetite or change in weight
- Excessive fatigue
- Feelings of worthlessness or excessive guilt
- Recurrent thoughts of death or suicidal ideation
- Psychomotor agitation or retardation (clumsiness or reduced motor control)
A clinician can assign one of 3 levels of severity: Mild, moderate, or severe, which they do based on a point-rating scale and the number and/or severity of symptoms. There are also 9 specifiers for major depressive disorder. Specifier are basically subcategories that help further define a child’s depression:
- With anxious distress
- With mixed features
- With catatonia
- With melancholic features
- With atypical features
- With mood-congruent psychotic features
- With mood-incongruent psychotic features
- With peripartum onset
- With seasonal pattern
Persistent Depressive Disorder (Dysthymia)
This is used to diagnose a more persistent, longstanding form of depression. Whereas a major depressive episode might come and go, dysthymia involves depression that is a more stable aspect of a child’s life. To meet this criteria, a child must have at least 3 of the following symptoms (including the top symptom as one of the 3), and these need to be present most of the day, on more days than not, for at least a year:
- Sad or irritable mood
- Increased or decreased appetite
- Insomnia or hypersomnia
- Decreased self-esteem
- Poor concentration or indecision
- Feelings of hopelessness
The following additional criteria must also be met:
- During the year, the child has never been without this sad or irritable mood for more than 2 months at a time.
- These symptoms are causing significant distress or impairment in multiple aspects of a child’s life.
- There has never been a manic or hypomanic episode (which is suggestive of bipolar disorder), or symptoms meeting the criteria for cyclothymic disorder.
- These symptoms are not due to a medical or substance abuse problem.
- These symptoms are not better explained by schizophrenia or another psychotic disorder.
Disruptive Mood Dysregulation Disorder (DMDD)
Disruptive mood dysregulation disorder is a recently added category of depressive disorders for children ages 6 to 18, with an age of onset that occurs before the age of 10. Though listed as a depressive disorder, it’s as much of a mood or behavioral disorder as it is typical depression. If you suspect your child falls into this category, you also might benefit from our book Difficult Children. Disruptive Mood Dysregulation Disorder is characterized by the following:
- Severe and persistent irritability or angry mood nearly every day, along with severe and recurrent temper outbursts at least 3 times a week.
- These symptoms are inconsistent with a child’s developmental level, and are present in at least 2 out of 3 settings (for example, home, school, and among peers) and are severe in at least one setting.
- Symptoms have persisted for at least 12 months, and during this time the child has never gone 3 or more months without these symptoms.
- There have never been symptoms lasting for more than a day that would meet the criteria for a manic or hypomanic episode (bipolar disorder) with the exception of duration.
- These symptoms do not occur during a major depressive episode and are not better explained by another mental disorder, and cannot be attributed to medication, substance abuse, or another medical condition.
Bipolar disorder is a unique type of depressive disorder characterized by a swing between depressive lows and hypomanic highs. If you suspect a child has this or they’ve already been diagnosed, refer to our separate information on bipolar disorder.
Other types of depression
The DSM-5 also outlines 4 other categories of depression: Premenstrual dysphoric disorder (a controversial diagnosis defined as depression related to a female’s menstrual cycles), substance/medication-induced depressive disorder (depression that is caused by substance abuse or medication), Depressive disorder due to a medical condition, Seasonal Affective Disorder (officially a subcategory of major depressive disorder, this is a seasonal depression that strikes during winter or periods when the patient receives little sunlight), and other specified depressive disorder and unspecified depressive disorder. This last category, formerly known as Depressive Disorder – NOS (not otherwise specified), is a catch-all category that a clinician can use to diagnose children who don’t actually meet the criteria for the standard definitions of depression. You should always ask for the specifics on what a doctor has diagnosed (don’t just let them say depression and leave it at that), and if it’s this unspecified category (which past history has shown to be the most common category used for many disorders), be extremely cautious. It basically means: “Your child doesn’t fit the criteria for depression but I’m going to diagnose them anyway.
Problems with depression diagnosis
It’s important for parents to remember that this process of diagnosing depression is an imperfect one. In many cases, people are way too eager to stick a label on a child that in turn alters how they perceive and treat that child. When it comes to any mental health issue, there can be a powerful self-fulfilling prophecy dynamic at work.
If a professional made a diagnosis of depression that you or your child doesn’t agree with, it doesn’t mean they are wrong, but it doesn’t mean they are right, either. Make sure you don’t let the diagnosis become a label that attaches itself to your child, and always regard the condition as something that could change at any moment. (You can read more about issues and errors in the diagnostic process in our Child Mental Health Handbook.)