Dear Therapist:

It is scary to hear about kids/teenagers who looked like they were fine but were really suffering emotionally or dealing with very difficult issues that no one was aware of. My friend’s daughter, who is now older, recently told her that she was dealing with some serious depressive thoughts as a teen but had kept it all in and pretended to be happy on the outside. Is it possible that something as significant as depression can go unnoticed? Are there signs that parents should be more aware of to pick up on things like this or are some kids just really good at masking it and there is really nothing to do?

Response:

It can be difficult to recognize signs of depression in children and adolescents. Kids often don’t present with symptoms that we would associate with depression—like feeling down and disinterested, feelings of worthlessness, crying spells, and social withdrawal. Often, depressed children will feel angry, act out, and complain about physical pain. Other symptoms of depression include low energy, irritability, increased sensitivity, changes in appetite or sleep patterns, and trouble concentrating.

Children often don’t understand their own feelings, not recognizing that sadness may lie at the root of their symptoms. They tend to focus on the symbols that they identify as associated with their feelings. A depressed teenager, for instance, may feel and express anger toward their parents. Their focus then is trained on the perceived source of the emotion. Since they identify their feeling as anger, the cause of their problems is seen as whatever it is that they dislike about their parents.

Another possible reason that kids may not exhibit clear symptoms of depression relates to their sense of social acceptability and feelings of acceptance. If a child is ashamed of their feelings of sadness, they may hide these feelings. This too can cause feelings of sadness to convert into less obvious symptoms, like anger and physical pain.

Kids are good at masking their feelings. They are also typically not so good at identifying their feelings. Additionally, parents who see their children on a daily basis usually see a very gradual change in behavior, making it more difficult to recognize this change and what it may represent.

Understanding the less well-known symptoms of depression can help parents to identify problems in their early stages, and to help their children appropriately deal with them. Honest and open discussions about emotions can help kids to feel more comfortable speaking to parents about troubling thoughts and feelings. Reminding kids that negative emotions are normal, and that they can be discussed in a safe, nonjudgmental manner can help to remove any reservations that they have about asking for help.

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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