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Diagnosis and clinical tools

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Transcription Diagnosis and clinical tools


Diagnosing depression in children and adolescents is a complex clinical challenge, as its manifestations can vary significantly depending on age, cognitive development, social environment, and cultural context. To address it comprehensively, complementary assessment tools are required, as well as a deep understanding of the child's environment.

Self-report and hetero-report: roles of family, school, and environment

One of the main diagnostic tools is self-reporting by the child or adolescent, especially from the age of six, when they have a more structured language.

At this age, children can verbalize feelings such as persistent sadness, disinterest in activities, perception of rejection, ideas of inferiority, or even suicidal thoughts. Phrases such as “nobody loves me” or “nobody wants to play with me” can be early manifestations of depressive symptoms that should be taken seriously.

However, self-reporting should be complemented by hetero-reporting, especially in children under five or those who have difficulty expressing their emotions. Here, observation and reports from parents, caregivers, siblings, teachers, and school administrators are essential.

The family environment can provide clues about changes in behavior, irritability, sleep or appetite disturbances, regressive behaviors (such as loss of bladder or bowel control), or frequent somatic manifestations. The school, for its part, allows for observation of the impact on the child's academic performance, socialization, and daily behavior in a structured setting.

DSM diagnostic criteria and subtypes of depressive disorder

The clinical diagnosis is based on the DSM-5 criteria, which define major depressive disorder as the presence of symptoms such as deep sadness, anhedonia (inability to enjoy things), changes in appetite and sleep, fatigue, feelings of guilt or worthlessness, cognitive difficulties, and thoughts of death for at least two weeks.

These symptoms must cause clinically significant distress or interference with daily life.

There are several subtypes of depressive disorder. These include major depressive disorder (which can be mild, moderate, or severe, with or without psychotic symptoms), persistent depressive disorder (dysthymia), adjustment disorder with depressive symptoms—common in children exposed to violence, displacement, or bereavement—bipolar depression (as a phase of bipolar disorder), and other atypical depressive states, such as mild recurrent depression.

It is also important to differentiate depression from other conditions such as ADHD, anxiety, or behavioral disorders, as they may coexist or share symptoms.

Importance of cultural context in interpreting symptoms

Cultural context has a significant influence on the expression and perception of depression. In some regions or cultural groups, symptoms may manifest more through somatic complaints (recurrent pain, fatigue, digestive problems) than through emotional verbalizations.

In certain contexts, there is also a persistent stigma surrounding mental illness, which leads many families to fail to recognize their children's emotional suffering or seek professional help.

Therefore, an accurate diagnosis involves not only applying clinical criteria, but also understanding how culture, family environment, life history, and social dynamics shape the depressive experience in each child or adolescent.


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