Essential elements of clinical diagnosis

The clinical diagnosis of depression in children and adolescents is a complex process that must be carried out with the utmost care and professionalism. Unlike adults, minors do not always have the emotional and verbal tools to clearly describe what they are feeling. Therefore, the work of the mental health professional involves reconstructing the clinical picture from multiple sources of information.

One of the most important elements is the initial clinical interview, in which relevant information is gathered about the child's history, family environment, school performance, sleep habits, diet, and social relationships. Based on this information, a pattern of symptoms that could indicate a depressive or anxiety disorder can be outlined.

Comprehensive assessment: parents, child, observation, and background

A proper assessment should consider several levels of analysis simultaneously. First, the parents or caregivers are interviewed, as they are usually the first to detect that “something is wrong.”

They can provide valuable information about behavioral changes, the family context (such as episodes of violence, separations, addictions, bereavements, etc.) and the child's emotional reactions at home.

Next, an interview is conducted with the child or adolescent, using language that is accessible and appropriate for their age. This conversation explores how they feel, what they think about themselves, their environment, and their future, and gives them space to speak freely.

At the same time, direct observation of behavior during the consultation is also key: facial expressions, tone of voice, energy level, eye contact, among other things, provide relevant clues.

Finally, reviewing the family history allows us to detect possible hereditary risk factors or dysfunctional dynamics that may be influencing the child's emotional well-being.

Contrasting versions: integrating everyone's perspective

In many cases, there is a disparity between what the child says and what the parents report. It is common for the child to say, “I eat well,” while the parent points out that the child has not had an appetite for weeks. Or the child may say that they sleep well, but the family indicates that they are awake until the early hours of the morning. These contrasts should not be seen as contradictions, but as signs that require careful integration.

The professional must validate all versions and cross-check the information, without assuming that one source is “right.” Often, the child is not lying: they are simply unaware of the emotional distress they are experiencing or find it difficult to put into words. Therefore, the clinical analysis must take into account the subjectivity of each participant.

Identification of specific stressors

An essential step in diagnosis is identifying the stressors that are emotionally affecting the child.

These can be diverse and are often related to highly emotional situations such as illness in the child or a family member, bereavement, domestic violence, parental separation, bullying, social rejection, academic problems, among others.

These stressors should not be minimized or interpreted from an adult perspective. A child may become deeply depressed by the loss of a pet, a conflict with a friend, or a constant feeling of exclusion in the classroom. Identifying these triggers is essential to designing an intervention plan that goes beyond the symptoms and addresses the real causes of the suffering.

The fundamental role of context and active listening

Finally, it is essential to recognize that clinical diagnosis is not based solely on a list of symptoms, but on a deep understanding of the child as a whole, within their family, school, and social context.

Listening with empathy, without judgment, and with an open mind is as important as applying technical criteria. The emotional context surrounding the child can amplify or alleviate their symptoms. An environment that validates their emotions, provides support, and makes them feel seen is protective.

On the other hand, an environment that minimizes their pain, compares them, or ignores them can aggravate their mood. Therefore, diagnosis also involves accompanying and building a care network that allows the child to feel supported in their recovery process.