You already know that children and adolescents are highly emotional beings. You’ve seen first-hand how their moods can shift quickly and dramatically. Your toddler might throw himself onto the grocery store floor in anger because he can’t have the cereal he wants. Your teen might begin the day talkative and cheerful, but go silently to her room after school, slamming the door behind her. And you are left to wonder: is this normal behavior or is my child struggling with something more serious?
There are numerous reasons why children and adolescents can be moody. In addition to common sources of stress in their daily environment, including peer pressures and academic stress, there are significant neurological and developmental shifts that occur throughout adolescence. In fact, it was recently discovered that our brains – specifically the prefrontal cortex, which is the area most associated with reason, judgment, problem-solving and emotional regulation – don’t fully develop until we are in our mid-20s. So our children and teens are left to navigate stress without the full neurological maturity to manage it effectively.
Let’s be clear: emotionality is not a bad thing. Neither is having a child who pushes the limits and is a little rambunctious. Recent findings suggest that strong-willed children typically grow up to become self-motivated leaders. They also tend to be less affected by negative peer pressure. Knowing how to access, identify and express emotion is a valuable skill throughout one’s life. Effective therapeutic work with children focuses on expressing difficult emotions, not suppressing them.
So while it’s not abnormal to be emotional, there are certainly cases when a child’s mood struggles become harmful to his or her well-being. This is when the line between “normal” and “abnormal” gets crossed: when the child’s mood or emotional struggles start to get in the way of her or his everyday functioning. When a depressed child can’t get out of bed. When an anxious child refuses to do their homework out of fear they might not complete it perfectly. When an adolescent’s impulsive behavior puts their life at risk. These are clear examples of when a mental health clinician should be involved.
Children with mood disorders are often misdiagnosed, which can lead to ineffective or even harmful treatments. While it is never a parent’s job to diagnose their child, it helps to know what you are looking for.
A major depressive episode is defined as a child showing a sad or irritable mood for at least two weeks, with the low mood present most of the day, nearly every day. They will experience a loss of interest in nearly everything, and might give up their favorite after-school sport, stop wanting to spend time with friends and need to be pushed to engage in anything. They also will show at least five of the following symptoms for the same period:
- Fatigue or loss of energy
- Moving very slowly OR seeming agitated/restless
- Sleeping much more or less than usual
- Increase or decrease in appetite (accompanied by weight loss/gain)
- Inability to concentrate, difficulty making decisions
- Feelings of worthlessness or guilt
- Suicidal thoughts, plans or actions
Mania / Hypomania
In addition to episodes of depression, some children also experience periods when they feel unusually energetic, hyper, excited or irritable. These episodes represent a notable shift from the child’s “normal” self and are usually immediately apparent to parents, family and friends. This “up” mood may last days, weeks or even longer. To be diagnosed with mania, a child must have had a week or more of feeling euphoric, elevated or irritable nearly every day for most of the day, a notable increase in energy and three or more of the following symptoms:
- Inflated self-esteem or grandiosity (thinking they are better than others, or capable of anything)
- Decreased need for sleep (feeling refreshed and energetic after only a few hours)
- Racing thoughts
- More talkative than usual and too many ideas to keep track of
- Distractibility (hard to keep on task)
- Involvement in risky behaviors that could have negative consequences
Hypomania uses the same diagnostic criteria as mania, but the child’s functioning is significantly less impaired. A hypomanic child may be noticeably more hyper, talkative, social and impulsive, but does not experience significant negative consequences as a result. Bipolar I is defined as major depression plus mania. Bipolar II is major depression plus hypomania.
When your child is diagnosed matters as well. Research indicates that early detection can reduce the frequency and severity of future episodes, making it important to see help if you notice serious symptoms in your child.
David Miklowitz, Ph.D., is director of the UCLA Child & Adolescent Mood Disorders Clinic. Sara Vicendese, LMFT, is the lead research associate. For more information about the clinic, or to set up a phone consultation, call 310-825-2836.