Signs Your Child Is Suffering from High-Functioning Depression and How to Help

Like adults, children experience emotional ups and downs. But when an emotional “down” period goes on for too long, it may be a sign of depression. Depression and anxiety are among the most common mental health conditions in children, with about 3% of children ages 3 to 17 experiencing the issues. This can cause a child to lose interest in hobbies or activities they once enjoyed and interfere with social activities, interests, home life, and schoolwork. 

Even more concerning, certain types of depression, such as high-functioning depression, may be difficult to identify in children. Children experiencing high-functioning depression often manage to camouflage their inner battles behind a facade of normalcy, underscoring the complexity of their emotions. To provide your child the necessary support, guidance, and treatment it’s crucial to understand this form of depression. 

How Is High-Functioning Depression Different from Regular Depression in Children?

What is “high-functioning depression”? This nonmedical term signals that an individual meets the criteria for clinical depression yet manages to function day-to-day in such a way that their mental illness isn’t apparent to others, or even sometimes to themselves. 

While high-functioning depression is not recognized as a mental health condition by the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), it is a useful phrase that underscores people’s experience of their mental health—appearing outwardly able to function normally while internally struggling. 

The term high-functioning depression can also usefully be applied to children. When you think of a depressed child, you may imagine them spending lots of time in bed or frequently crying, but depression may manifest differently for those who are still able to function at a high level and accomplish necessary tasks each day. 

High-functioning depression often appears hidden to parents, and more difficult to diagnose, because a child is still able to excel at school, at home, or in friendships, despite feeling extremely depressed beneath the surface. High-functioning depression may also include feelings of fear, anxiety, and self-doubt. Even though it may look different than classical manifestations of clinical depression, high-functioning depression can still negatively impact a child’s quality of life. 

What Are the Signs and Symptoms of High-Functioning Depression in Children?

Occasional feelings of hopelessness are part of every child’s life, but when a child begins to feel sad or uninterested in the things they used to enjoy, it could be a symptom of depression. Because outwardly a child may appear okay, it may be difficult to spot signs of high-functioning depression in a child who may not recognize or be able to name these feelings themselves or is actively masking symptoms to get through the day. 

The two most common signs of depression in children include: increasingly frequent feelings of sadness, irritability and a pattern of low mood for most of the day, as well as no longer enjoying activities that previously made them happy. 

Beside these symptoms, other common symptoms of high-functioning depression parents should look out for include:

• Spending less time with friends and more time alone
• Changes in sleep patterns, including trouble falling or staying asleep, or sleeping more than usual
• Trouble focusing or making choices
• Failing and/or struggling with schoolwork 
• Changes in weight or eating
• Talking less and making less eye contact than usual
• More time spent using social media
• Experiencing less energy or motivation than usual, even for simple tasks
• Crying more often and expressing feelings of sadness, worthlessness, or guilt
• Exhibiting self-injury and self-destructive behavior

In extreme cases, depression can lead a child to considering or engaging in self-harm and/or suicidal behavior. For those ages 10 to 24, suicide is among the leading causes of death, so understanding the signs and symptoms of depression is critically important. 

If your child is in crisis, call or text 988, the Suicide and Crisis Lifeline—it is a confidential support resource for anyone in distress. If your child is in a life-threatening situation, call 911 for immediate emergency services.

How Can I Support a Child with High-Functioning Depression?

The good news is there are clinically proven treatments available for children with high-functioning depression. That said, it can take time for a child to start feeling better during treatment, and in the meantime, there are ways a parent or loved one can support a child at home, including:

• Taking time to educate yourself and those around you

What might initially look like laziness or irritability in a child may indeed be a symptom of depression. Above all else, know that your child is not making up the symptoms. 

• Talking to your child about their experience

It is important to let your child know that feelings of hopelessness are a symptom of depression and these hopefully temporary feelings may not be an accurate picture of reality.

• Providing words of encouragement

Help your child look at problems in a more positive way by focusing on your child's strengths, rather than areas that need improvement. Be careful not to invalidate their concerns in your effort to offer encouragement.

• Supporting relaxation and physical health

Encourage your child to get a healthy amount of exercise, sleep, and to eat a healthy diet, as well as helping them to relax with physical, creative, nurturing, and personally meaningful activities. 

• Limiting “social” screen time
  While socializing is helpful, communicating by text or social media isn’t a substitute for face-to-face time with friends or family. Too much screen time can actually make your child feel more cut off from others.

What Are the Specific Treatments for High-Functioning Depression in Children?

Fortunately, there are tools and treatments available to help children with high-functioning depression, and treatment looks much like it does for other depression disorders. There are a number of strategies a clinician or licensed mental health provider may use for those suffering from depression. The treatment a child receives depends on the type of depression they are experiencing, its severity, how long they have experienced symptoms, and their age. 

Common high-functioning depression treatment options include: 

Cognitive behavioral therapy

A common type of talk therapy, CBT typically focuses on the way patterns of thinking and behavior contribute to and maintain symptoms, and in this context, helping children make both cognitive and behavioral changes that lead to improved mood over time. CBT is an important tool to help a child view and cope with challenging situations and see their symptoms more clearly. CBT is a skills-based approach and “homework” is often provided to practice these skills between sessions. 

Parent-management therapy

Used when the primary symptoms are behavioral in nature, parent-management therapy focuses on teaching parents techniques to help their children improve behaviors and learn new coping skills. 

Interpersonal psychotherapy for adolescents (IPT-A)

IPT-A addresses depressive symptoms by focusing on helping children and adolescents improve relationships. This might mean helping them communicate, navigate conflicts or transitions (such as moving or divorce), grief, and conflicts with family or peers.

Medication

In some instances, a doctor may prescribe medication to treat depression symptoms. These may include commonly prescribed medications to treat depression and anxiety like selective serotonin reuptake inhibitors (SSRIs). Research shows that children and adolescents with major depression experience the best results from a combination of cognitive behavior therapy and medicine.

The causes of high-functioning depression among children are complex and may involve a combination of genetic, biological, psychological, and environmental factors. The exact cause may vary from one individual to another, and often, these factors interact and influence one another, making it challenging to pinpoint a single cause.

High-functioning depression in children, though not formally recognized as a clinical disorder, highlights the challenging reality of appearing well-adjusted while engaged in internal struggles. Identifying signs, fostering open dialogue, and providing holistic support are essential. 

Professional interventions, including therapy and, when appropriate, medication, offer avenues for healing and treatment. By acknowledging and addressing high-functioning depression, we pave the way for children to receive the support they need to embark on a path toward better mental health. To get help for a child suffering from high-functioning depression, start with a free consultation from a licensed Handspring Health therapist today.