Childhood Mood Disorders and Treatment

Mood disorders encompass a range of mental health issues primarily impacting emotional states. They significantly influence thoughts, behavior, physical well-being and daily functioning. In youth, they can disrupt academic performance, social interactions, extracurricular engagement and overall wellness. Despite diagnostic challenges in youth due to developmental factors, providers are increasingly diagnosing and treating mood disorders in children and adolescents.  

Mood disorders in children and adolescents can stem from various factors like genetics, family background, childhood trauma and medical conditions. Today's youth face unique stressors such as the COVID-19 pandemic, cyberbullying and school shootings, which were not encountered in the same way by previous generations. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2021, about 20.1% of U.S. youth aged 12 to 17 experienced at least one major depressive episode, with the highest prevalence among those identifying with two or more racial/ethnic backgrounds (27.2%). The Centers for Disease Control’s Youth Risk Behavior Survey found that high school students have been increasingly reporting depressive symptoms and suicidal thoughts or behaviors over the last 10 years. 

Types of mood disorders in children

While childhood mood disorders present in various ways, they fall into two main categories. 

Depressive disorders in children 

Depressive disorders encompass episodic conditions marked by feelings of sadness, emptiness or irritability, accompanied by physical and cognitive changes disrupting daily life. Major depressive disorder (MDD) is a common subtype featuring depressed mood, diminished interest or pleasure in activities, changes in appetite or weight, sleep disturbances, physical restlessness or slowed movements, feelings of worthlessness or guilt, difficulty concentrating and recurrent thoughts of death or suicide. In youth, somatic complaints or low energy levels are common, alongside reduced enthusiasm for social interactions. Self-blame or self-criticism is prevalent, especially when facing unattainable expectations created by themselves or others. Anxiety symptoms often coincide with these challenges in youth. 

Bipolar spectrum disorders in children

Bipolar spectrum disorders involve mood swings encompassing depressive episodes and periods of mania or hypomania. In adolescents, mania may present as abnormally elevated, expansive or irritable mood persisting for at least one week, accompanied by increased energy, reduced need for sleep, grandiosity, rapid speech, racing thoughts, heightened activity, restlessness and impulsivity. Bipolar I features at least one manic episode, while Bipolar II entails hypomanic episodes alongside major depressive episodes. Symptoms in children may be less distinct and challenging to diagnose. Individuals can also present with “mixed features” with both depressive and manic or hypomanic symptoms at the same time or in quick succession. A young person might feel overly energetic and restless while also feeling sad and hopeless. They can be challenging and increase the risk of self-harm or suicide. 

Screening tools for pediatric mood disorders and teen suicide

Suicidality remains a growing concern for our youth and a leading cause of death in the U.S. for youth starting at 10 years old. Given the prevalence of mood-related troubles and suicidality among youth, it’s critical that health professionals screen for these concerns with the youth they encounter.  

The American Academy of Pediatrics offers the following recommendations for suicide screening: 

• Youth ages 12+: Universal screening 
• Youth ages 8-11: Screen when clinically indicated.  
• Youth under age 8: Screening not indicated, assess for suicidal thoughts/behaviors if warning signs are present.  

The Ask Suicide-Screening Questions (ASQ) is a suicide screening tool with a set of four brief screening questions that takes 20 seconds to administer. Youth who endorse positive on suicide screening tools should be followed up with a brief suicide safety assessment.  

It can also be helpful for parents or youth to use screening tools. 

Parent-report tools for mood-related concerns

The following screening tools can help parents and providers assess a child’s mood: 

• Mood and Feelings Questionnaire, parent-report (MFQ-Parent) is a parent-report measure of depressive symptoms in youth ages 6 to 17. There is a long version with 34 items and a short version with 13 items.  
• PROMIS Emotional Distress – Depression – Parent/Guardian is an 11-item parent report measures on depressive symptoms.  
• PROMIS Emotion Distress – Anger – Parent/Guardian is a 5-item parent report measure of anger for ages 6 to 17.  
• Affective Reactivity Index (ARI) – Parent/Guardian is a 7-item parent report measure of irritability for youth aged 6 to 17.  
• General Behavior Inventory, Parent Version (P-GBI) Short Form is a 10-item parent report instrument for youth 5 to 17 years old used to assess for mania symptoms.  
• Mania - Parent/Guardian (Adapted from the Altman Self-Rating Mania Scale) is a 5-item parent-report measure that aims to identify mania-related symptoms, including intensity of endorsed symptoms.

Youth self-report tools for mood-related concerns

• Mood and Feelings Questionnaire, self-report (MFQ-Self) is a self-report measure of depressive symptoms for ages 6 to 17. There is a long version with 33 items and a short version with 13 items.
• PHQ-A is a 9-item self-report measure of depressive symptoms for adolescents ages 11 to 17. This measure is quick and easy to administer and often used in health settings with all adolescent patients and has one question to screen for suicidality.
• PROMIS Emotional Distress – Depression – Pediatric is a 14-item self-report measure of depressive symptoms for ages 11 to 17.
• PROMIS Emotional Distress – Anger – Pediatric is a 6-item self-report measure of anger for ages 11 to 17.
• Affective Reactivity Index (ARI) is a 7-item self-report measure of irritability in ages 11 to 17.
• Mania—Child (Adapted from the Altman Self-Rating Mania Scale) is a 5-item self-report measure that aims to identify mania-related symptoms, including intensity of endorsed symptoms.
• Children’s Affective Liability Scale (CALS) is a 20-item self-report measure of affect regulation for youth 8 years of age and older.

Educating caregivers about mood disorders in youth

Depression and other mood disorders in children typically result from a combination of biological factors and environmental stressors. It's increasingly acknowledged that adults with mood disorders often experienced symptoms starting in childhood or adolescence, underscoring the importance of early intervention. Here are some ways to support caregivers: 

• Ensure caregivers know the signs and symptoms of mood disorders in children and adolescents, primarily depression. This empowers parents to recognize worsening symptoms or crises. Help caregivers recognize that occasional, easily resolved symptoms may not be alarming, but persistent symptoms affecting daily life for weeks or months necessitate professional intervention.
• Support caregivers in employing communication strategies to foster open discussions about their child's thoughts and feelings. Encourage caregivers to model open and honest dialogue about mood and suicide. Despite common fears that discussing these topics may lead to increased problems or suicidal feelings, open communication, coupled with active listening, validation and non-judgmental responses from caregivers, is crucial and protective. 

Treatment for teen depression and other mood disorders

According to SAMHSA, among the 5 million adolescents in the U.S. who reported at least one major depressive episode in 2021, only an estimated 40.6% received treatment in the past year. Understanding treatment options can help find youth the care they need. The primary behavioral health treatments for mood disorders are medication and psychotherapy.  

Medication for mood disorders  

Providers may prescribe medication to help alleviate symptoms of mood disorders. Depending on the presentation and type of disorder, including frequency, severity and duration of episodes, medication management can play a crucial role in treatment and achieving stability. 

Psychotherapy for children with depressive disorders 

There are many kinds of therapy that can benefit children living with mood disorders and what is best for each child will depend on their unique circumstances. 

Cognitive behavioral therapy for children 

There is limited and mixed research on the “best” treatment for depression in younger children, however, treatments that utilize a cognitive behavioral therapy (CBT) paradigm have more evidence than other treatments. CBT address depression by targeting distorted thinking patterns and dysfunctional behaviors that perpetuate negative emotions. 

Parent management training or parent-child interaction therapy 

Caregivers with children who demonstrate externalizing and reactive behaviors (e.g., temper tantrums, yelling, hitting), may benefit from parent management training (PMT) or parent-child interaction therapy (PCIT). These treatments highly involve caregivers and are valuable interventions that focus on building positive interactions with their child as well as responding consistently and appropriately to problematic behaviors.  

Dialectical behavior therapy 

For adolescents who engage in non-suicidal self-injury or experience chronic suicidality including planning, intent and attempts, dialectical behavior therapy (DBT) is a treatment that is gaining increased implementation. DBT utilizes strategies from various treatment modalities and aims to help youth manage their emotions, improve interpersonal relationships, and develop coping skills.  

Interpersonal therapy 

Mainly used for adolescents, interpersonal therapy (IPT) focuses on improving relationships and communication skills to alleviate depressive symptoms.

Psychotherapy for bipolar spectrum disorders 

Mental health providers use different approaches for bipolar disorders in children. 

Family focused therapy 

The most promising approaches to bipolar spectrum disorders include psychosocial family-based interventions. The most utilized intervention is family focused therapy (FFT) — a form of behavioral intervention that enhances family dynamics, improves communication, increases management of bipolar symptoms, reduces family stressors and aims to promote stability and recovery from bipolar episodes.  

Interpersonal and social rhythm therapy 

While less studied, interpersonal and social rhythm therapy (IPSRT) and DBT show promise as an early intervention. IPSRT aims to identify behaviors influenced by mood that can trigger stressors and mood episodes while simultaneously improving interpersonal patterns and habits.

Resources for pediatric mood disorders

Below, you’ll find additional resources for families and providers. 

Resources for families: 

• American Academy of Pediatrics, Managing Depression or Sadness: Tips for Families in English or Spanish 
• Suicide Prevention: 12 Things Parents Can Do in English and Spanish 
• Bipolar Disorder in Children and Teens: Beyond Normal Ups and Downs in English and Spanish  
• American Academy of Child & Adolescent Psychiatry and American Psychiatric Association, Depression: Parents’ Medication Guide 

Professional references:  

• APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
• Decision aid for using the guidelines for children and adolescents
• APA Resources for Clinicians for the Treatment of Depression in Children & Adolescents