Clinicians and researchers currently recognize mood disorders in children as one of the most frequently underdiagnosed health concerns. Untreated mood disorders in childhood can elevate the risk of developing other problems, such as behavioral issues and substance use disorders, which may persist even after the underlying mood disorder is addressed. Children and teenagers with mood disorders may not always present the same symptoms as adults, making it challenging for parents to identify the issue. This is further complicated by the fact that children may struggle to articulate their thoughts and emotions effectively.

The most frequently diagnosed mood disorders in children and adolescents are:

• Major Depression: Characterized by a persistently depressed or irritable mood lasting for a minimum of two weeks.

• Persistent Depressive Disorder (Dysthymia): A long-term, less severe form of depression involving a chronic, low-grade depressed or irritable mood that lasts for at least a year.

• Bipolar Disorder: Marked by alternating periods of unusually elevated mood (mania or hypomania) and periods of depressed or emotionally flat mood.

• Disruptive Mood Dysregulation Disorder (DMDD): Defined by ongoing irritability and extreme difficulty in managing behavior, often seen in children.

• Premenstrual Dysphoric Disorder (PMDD): A condition affecting females, characterized by significant depressive symptoms, irritability, and emotional tension in the days leading up to menstruation.

• Mood Disorder Due to a General Medical Condition: Mood disturbances that are directly caused by various medical illnesses, including conditions like cancer, physical injuries, and chronic diseases.

• Substance-Induced Mood Disorder: Mood symptoms that are a direct result of drug use, medication side effects, or exposure to toxic substances.

It’s noted that girls are approximately twice as likely as boys to develop depressive disorders. However, bipolar disorder and obsessive-compulsive disorder affect both boys and girls at roughly equal rates.

Causes

The exact causes of mood disorders are not fully understood. However, a combination of factors is believed to contribute, including:

• Brain Chemistry Imbalances: Disruptions in the delicate balance of chemicals in the brain, known as neurotransmitters, are thought to play a significant role.

• Environmental Factors: External influences, such as stressful life events, both unexpected and ongoing chronic stressors, can contribute to the development of mood disorders.

• Genetic Predisposition: Mood disorders frequently have a familial pattern, indicating a genetic component. Children with relatives who have depression are at a higher risk of developing depression themselves. Similarly, a family history of bipolar disorder may increase a child’s susceptibility to bipolar disorder or other mood disorders.

• Gene-Environment Interaction: In some instances, significant stress or a traumatic life event can trigger the expression of genes that predispose an individual to a mood disorder, particularly depression. This illustrates the complex interplay between genetic vulnerability and environmental triggers.

Signs and Symptoms

Children and adolescents may exhibit symptoms of mood disorders differently based on their age and individual biology. Symptoms can also vary depending on the specific type of mood disorder. Common indicators of a mood disorder may include:

• Persistent Mood Changes: A mood that is consistently sad, depressed, irritable, angry, or unusually elevated that seems more intense than typical childhood emotions, lasts for extended periods, or occurs more frequently than normal.

• Family Difficulties: Problems in family relationships, including challenging or disruptive behavior at home.

• Loss of Interest: A noticeable lack of motivation or diminished pleasure in activities that the child previously enjoyed.

• Changes in Sleep, Appetite, or Weight: Significant alterations in usual sleep patterns, eating habits, or weight that are not intentionally caused by dieting.

• Frequent Physical Complaints: Recurring physical symptoms without a clear medical cause, such as headaches, stomachaches, or persistent fatigue.

• Reduced Energy: Persistent fatigue, lack of energy, or feeling tired most of the time.

• Academic Struggles: Difficulty maintaining academic performance or achieving expected levels in school.

• Feelings of Worthlessness and Guilt: Experiencing feelings of worthlessness, excessive guilt, or low self-esteem that are disproportionate to reality.

• Severe Mood Swings: Recurrent and extreme temper outbursts that are significantly out of proportion to the situation.

• Increased Energy or Agitation: Periods of unusually high energy or bursts of energy, often accompanied by racing thoughts or rapid speech.

• Risky Behaviors: Engaging in rebellious or high-risk behaviors that are out of character.

• Running Away or Threats: Running away from home or making threats to run away.

• Peer Relationship Problems: Difficulties in forming or maintaining friendships and positive peer relationships.

• Suicidal Thoughts: Expressing thoughts about suicide or death, which requires immediate professional evaluation.

Diagnosis

A precise diagnosis of the specific mood disorder, alongside any co-occurring conditions, is a crucial first step in effective management. A comprehensive evaluation by a mental health specialist is essential for accurate diagnosis. This evaluation may include:

• Overall Health Assessment: Review of the child’s general physical health and medical history.

• Symptom Evaluation: Detailed assessment of the child’s current symptoms and their duration.

• Behavioral Observation: Examination of the child’s behavior in various settings, including home, school, and social interactions with peers.

• Environmental Stressor Assessment: Identification of potential environmental factors or stressors that may be contributing to the child’s difficulties.

• School Input: Gathering information from teachers or school counselors regarding the child’s behavior and academic performance at school.

• Medication and Therapy History: Review of the child’s past experiences with medications or therapeutic interventions, if any.

• Treatment Preferences: Consideration of the child’s and family’s preferences and opinions regarding treatment options.

Treatment

Mood disorders are treatable conditions, particularly when identified and addressed early. Evidence-based treatments can effectively manage mood episodes, reduce symptom severity, and help prevent future episodes. Treatment can also support the child’s overall development and enhance their quality of life and relationships.

• Individual Therapy:

  • Problem Identification: Therapy helps to pinpoint key challenges and stressors in the child’s life.

  • Coping Skill Development: Therapy focuses on teaching the child effective strategies for managing these stressors.

  • Symptom Management Techniques: Therapists utilize various techniques to help the child manage the symptoms of their mood disorder, including:

    • Cognitive Behavioral Therapy (CBT): A therapeutic approach that aims to modify unhelpful thought patterns, emotional responses, and behaviors that contribute to the mood disorder.

    • Interpersonal Therapy (IPT): A therapy focused on improving social skills and helping children navigate and resolve difficulties in their relationships with others.

• Family Therapy:

  • Family Support System: Recognizing the crucial supportive role of families in a child’s mental health.

  • Parent Education: Family therapy educates parents or guardians on effective methods to support their child in managing mood and behavior problems.

  • Stressor Identification: Therapists may explore potential stressors within the child’s life and examine patterns of interaction within the family system that may be contributing to the child’s difficulties.

  • School Consultation: Consultation with the child’s teachers or guidance counselor may be recommended to ensure a coordinated approach to support across settings.

• Medications:

  • Brain Chemical Modulation: Various medications are highly effective in treating mood disorders by influencing the brain chemicals involved in mood regulation.

  • Symptom Reduction: Depending on the specific mood disorder and the child’s symptoms, medication can help reduce the intensity or frequency of symptoms.

  • Behavioral Improvement: Medications can decrease problematic behaviors associated with mood disorders.

  • Functional Enhancement: Medications can improve overall functioning in daily life.

  • Episode Prevention: Medications can play a role in preventing future mood episodes and maintaining stability.

Outlook

With early and appropriate treatment, many children with mood disorders experience significant improvement and can effectively manage their condition with ongoing support. Even if mood episodes recur, they can typically be managed effectively with therapeutic interventions, including medication, therapy, and additional resources.

Follow-up Care

The duration of follow-up care will depend on the child’s personalized treatment plan. The child and family may continue to meet with a specialist for weeks or months. The focus of individual and family therapy may evolve over time, adapting to the child’s age, progress, and changing needs. Medication needs may also be adjusted over time based on various factors and ongoing evaluation.

SPECIFIC MANAGEMENT OF MOOD DISORDERS

• Assessment: A thorough and ongoing assessment is fundamental to effective management.

• Supportive Environment: Cultivate a secure and nurturing environment aimed at enhancing the child’s emotional well-being. This involves creating a space where the child feels safe, understood, and supported in their emotional experiences.

• Therapeutic Communication: Employ effective communication strategies to establish trust and facilitate the open expression of feelings. This includes active listening, empathy, and validating the child’s emotions without judgment.

• Medication Management: Administer prescribed medications precisely as directed by the healthcare provider. Closely monitor for any potential side effects or fluctuations in mood that may necessitate adjustments to the medication regimen.

• Psychotherapeutic Interventions: Encourage and support the child’s active participation in individual or group therapy sessions. These therapeutic modalities are crucial for addressing the underlying psychological and emotional factors contributing to the mood disorder.

• Education and Psychoeducation: Provide comprehensive education to both the child and their family. This should encompass information about the specific mood disorder, effective coping strategies, and the range of available treatment options, empowering them to understand and manage the condition.

• Behavioral Interventions: Implement structured behavior modification techniques to help manage disruptive behaviors and foster the development of positive and adaptive coping mechanisms. This approach focuses on reinforcing positive behaviors and reducing maladaptive ones.

• Emotional Regulation Skills Training: Teach the child essential emotional regulation skills. These may include mindfulness practices, relaxation techniques, and strategies for identifying and managing intense emotions in a healthy manner.

• Family Involvement and Support: Actively engage the family in the therapeutic process and provide ongoing support. The family’s understanding, involvement, and consistent support are crucial for the child’s recovery and long-term well-being.

• Safety Monitoring: Continuously monitor the child’s safety and well-being, particularly in severe cases. This includes assessing for and actively working to prevent any risk of self-harm or harm to others, ensuring a safe environment and appropriate interventions are in place when needed.