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Information and resources to support children and young people with depression in education and care.
Around 1 in 35 (2.8%) young Australians aged between 4 and 17 experience depression. Depression in adolescence must be taken seriously as youth suicide is the leading cause of death in this age group.
Having depression is more than just being sad. Depression affects the way we think, how we see ourselves and our future. Along with feeling sad or irritable it may seem that nothing is worthwhile and that things will never get better. Depression can stop children and young people enjoying the things they like doing and interferes with normal social activities, interests, school work and family life.
Depression in children is often undiagnosed and untreated because they are passed off as normal emotional and psychological changes. Depression may be masked by acting out or angry behaviour.
Where there are concerns about a child’s depression the family should be encouraged to seek help from a health professional. Early intervention for depression is important.
Signs of depression in children and young people
Children and young people may find it difficult to explain how they are feeling if they are experiencing depression. There are a few key signs and symptoms to look out for, particularly if they happen together or are out of character for the child. The primary symptoms of depression revolve around sadness, a feeling of hopelessness and mood changes.
Children and young people with depression may:
- have low energy and be difficult to motivate
- lose interest easily in an activity they usually enjoy
- have difficulty listening and concentrating on tasks
- make negative comments about themselves
- withdraw from social situations, not want to spend time with friends
- look for what’s wrong rather than see the positives in situations
- be very difficult to please
- be irritable, agitated, easily annoyed or upset
- seem sad and cry easily and be difficult to soothe
- either have no interest in food or overeat
- have problems going to sleep or staying asleep, waking early, or sleeping a lot.
Types of depression
Children may suffer from the episodes of moderate to severe depression associated with major depressive disorder, or more chronic, mild to moderate low mood of dysthymia. Depression may also be part of other mood disorders like bipolar disorder, as a result of psychosis (having symptoms of delusions or hallucinations), as part of a medical condition like hypothyroidism and/or hypo-parathyroidism or the result of exposure to certain medications or drug abuse.
Premenstrual dysphoric disorder (PMDD) is a severe subtype of premenstrual syndrome (PMS) and can occur at any time following the first occurrence of menstruation. Symptoms can include sadness, anxiety, mood swings, irritability and loss of interest in things. PMDD and PMS related depression occur during the two weeks prior to the onset of menstruation and symptoms generally pass when menstruation starts. Refer to the menstrual management page for further information.
Causes of depression
Depression in children does not have one specific cause but rather a number of biological, psychological, and environmental risk factors that are part of its development.
Psychological contributors to depression include low self-esteem, negative social skills, negative body image, being excessively self-critical, and often feeling helpless when dealing with negative events. Children who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), anxiety, or who have cognitive or learning problems, as well as trouble engaging in social activities, also have more risk of developing depression.
Depression may be a reaction to life stresses, like trauma, including verbal, physical, or sexual abuse, the death of a loved one, school problems, bullying, or suffering from peer pressure.
Other contributors to depression include poverty and financial difficulties in general, exposure to violence, social isolation, parental conflict, divorce, and other causes of disruptions to family life. Children who have limited physical activity, poor school performance, or lose a relationship are at higher risk for developing depression.
Treatment for depression
Many children and young people with depression often go undiagnosed and untreated. Often adults don’t recognise the signs of depression in children.
Some of the common treatments for symptoms of depression include:
- behavioural and lifestyle changes
- counselling and psychotherapy (Interpersonal therapy (ITP) and cognitive behavioural therapy (CBT) are the major approaches commonly used to treat childhood depression)
- antidepressant medications which can be prescribed by a General Practitioner (GP) or psychiatrist alternative therapies.
Where a child is prescribed medication for depression and this is required to be administered in education and care services a medication agreement HSP151 (DOC 142KB) must be completed. Refer to the medication management page for further information.
An emotional wellbeing care plan HSP400 (DOC 111KB) can be developed by a treating health professional in consultation with parents to describe additional care or supports required for children and young people with depression in education and care services.
Children with depression are more likely to have poor academic performance and difficulty concentrating in class and completing their work. They may have difficulty relating to classmates and to education and care staff.
Children and young people with depression may display the following behaviours
- difficulty commencing tasks/staying on task or refusal to attempt tasks
- difficulty completing, or refusal to complete, assessments
- lateness to school
- frequent absences and truancy
- lowered self esteem
- aggression towards others
- social isolation/ difficulty sustaining friendships
- defiant or disruptive
- change in interest in school work and activities
- grades may drop due to lack of interest, loss of motivation or excessive absences.
Education and care staff can notice signs of depression by observing changes in a child’s behaviour and mood. Education and care services have a duty of care to address any school-based triggers that may be impacting on children’s mental health and wellbeing. Peer group difﬁculties, especially bullying, are common triggers for children’s depression.
It is important to share information with parents to find out if the child’s mood is similar at home. When mood and behaviour changes are evident in more than one setting it usually indicates that the problems are more severe.
Black Dog Institute has a range of free school resources that are evidence-based and have been developed to assist secondary educators to build mental health and wellbeing education into lessons.
Friends Resilience have developed a range of age specific programs for education and care services to guide the social and emotional development of children and young people through teaching them resilience.
- Fun Friends (4-7 year olds)
- Friends for Life (8-11 year olds)
- My Friends Youth (12-15 year olds)
- Adult Resilience (16-18+ years olds)
Children and young people with depression may have low levels of interoception, which means they are unable to understand or connect with their bodies in ways that would enable them to self-regulate. It is important to integrate the teaching of interoception activities to develop interoceptive awareness.
Refer to the interoception web page for interoception information and resources.
The regulation scale HSP432 (DOC 182KB) is a tool that can be used for any child or young person to identify what is happening around them that is impacting on their mood change, what signals their body is giving them, and ways to respond to their body’s signals that will help them manage the change in mood.
The regulation scale guide HSP432A supports the development of the regulation scale.
The child or young person should be involved as much as possible in developing the scale, with input from parents and staff to support them.
The scale can evolve and change over time as the child develops better interoceptive awareness and expands their vocabulary (non-verbal/verbal). This scale is designed to be used in conjunction with interoception activities so the child is working towards meaningful development of interoception skills.
Interoception is the foundation for developing emotional regulation skills and some children will require explicit teaching to develop these. Some children (especially those who have experienced trauma and/or neglect) struggle to manage mood changes which may be associated with a minor increase in stress levels (new learning, trying something different). For these children, minor stress may induce uncomfortable feelings which trigger a ‘flight, fight, freeze’ response. These children require support to differentiate between feeling slightly challenged/minor discomfort and feeling unsafe/in danger so they can respond differently.
Some examples of completed regulation scales include:
- HSP432 Externalising behaviour (PDF 354KB)
- HSP432 Internalising behaviour (PDF 130KB)
- HSP432 Symbols and reduced language (PDF 170KB)
- HSP432 Year 3 boy (PDF 159KB)
Traditional behaviour management focuses on what to do after behaviour has occurred, but does not determine the purpose of the behaviour.
The behaviour can often be prevented by making modifications to the environment, people, places, time or activities and teaching the child or young person a more appropriate way to get their message across.
It is important to determine the reason for the behaviour before we can try to prevent the occurrence.
This may include:
- identifying dangerous, damaging and disruptive behaviours; and which behaviours are just annoying or irritating to others
- investigating what triggers the behaviour, when and where the behaviour is most likely and least likely to occur
- looking at what happens after the behaviour
By using this information we can identify the purpose of the behaviour and teach appropriate alternative behaviours and new skills.
The HSP433 understanding behaviour template HSP4333 (456KB) is a useful tool to assist in determining the reason a behaviour is occurring and to plan and implement a replacement behaviour. This worksheet is used for a single behaviour and works most effectively when education staff, families and the child or young person work together to develop.
The template includes a most likely/least likely table that can be used to identify possible triggers for the behaviour of concern. Documenting what is happening when the behaviour is most likely to occur (place, people, time and activity) and comparing it to times when the behaviour is least likely to occur. It is equally as important to identify when the behaviour DOESN’T happen. This form is used to gather additional information that can provide useful clues in identifying the purpose of the behaviour. The information concerning least likely times for the behaviour also signals possibilities for the ideal teaching environment best suited to that young person.
Wellness, stress and distress questionnaire (WSDQ)
The wellness, stress and distress questionnaire (WSDQ) HSP426 (XLSX 264KB) is a brief emotional and behavioural screening questionnaire for children and young people. The tool can capture the perspective of children and young people and their teachers.
The 25 items in the WSDQ comprise 5 scales of 5 items each. The scales include:
- emotional symptoms subscale
- conduct problems subscale
- hyperactivity/inattention subscale
- peer relationships problem subscale
- prosocial behaviour subscale.
The WSDQ can be used for various purposes, including clinical assessment, evaluation of outcomes, research and screening.
An emotional wellbeing care plan HSP400 (DOC 111KB) may be completed by a health professional in consultation with parents or legal guardians for children and young people requiring support to manage their depression.
Health support agreement
A health support agreement HSP120 (DOC 243KB) and safety and risk management plan HSP121 (DOC 147KB) may be completed where a parent indicates their child suffers from depression and requires additional support and assistance. There does not need to be a care plan completed by a health professional in place. The support agreement is completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service.
The guide to planning health support – HSP125 can assist in the development of the health support agreement by prompting through a series of questions and considerations.
The health support agreement should clearly identify cultural, spiritual and language needs.
Educational adjustments are designed to support children and young people on an individualised basis. Adjustments should be determined by the parents and education and care service and documented in the support agreement.
Examples of adjustments may include:
- negotiated attendance
- giving frequent feedback on academic, social, and behavioural performance
- teach the child to set short and long term goals
- develop modifications and accommodations to respond to the child’s fluctuations in mood, ability to concentrate, or side effects of medication
- assign one individual to serve as a primary contact and coordinate interventions
- establish areas of interest and ability
- develop strategies to manage behaviours out of class ie in the playground
- conduct whole class sessions on resilience strategies
- allowing access to external support agencies (ie ReachOut, BeyondBlue).
The Department for Education has developed an interoception curriculum that can help children and young people with depression improve their emotional awareness and self-regulation (refer to the interoception webpage).
The Women’s and Children’s Health Network Child and Youth Health have developed information specifically for children about depression.
The Children’s Hospital at Westmead (CHW) have a school link initiative and have developed resources to support the mental health of children and adolescents with an intellectual disability. Resources include the development of a webinar series including Understanding & Responding to Behaviour in the Classroom, Cool, Calm, Collected & Connected in the Classroom, and Mental Health of Young People with Intellectual Disability.
Black Dog Institute has clinical resources, information and fact sheets about depression; including online self-testing, current treatments and wellbeing.
ReachOut is Australia’s leading online mental health organisation for young people. Resources are available for young people, parents and schools.
- ReachOut Schools provides resources and information for teachers and school-based professionals
- Schools resource information pack with a guide to curriculum links
- Self-help for depression
Beyondblue are advocates for positive change, and a better deal for people experiencing anxiety, depression and suicide risk. Resources available on their website include the depression checklist.
Headspace is the national youth mental health foundation dedicated to improving the wellbeing of young Australians. Online programs and apps for young people with depression are available on their website.
The Kids Helpline is a free, private and confidential phone and online counselling service for young people aged 5-25. Phone 1800 551 800.
- HSP421 Interoception support plan (DOC 170KB)
- HSP431 Sensory overview support plan (DOC 389KB)
- HSP426 Wellness, stress and distress questionnaire (WSDQ) (XLSX 264KB)
- HSP432 Regulation scale (DOC 182KB)
- HSP432A Regulation scale guide (PDF 503KB)
- HSP433 Understanding behaviour template (PDF 358KB)
Health support agreement
- HSP120 Health support agreement (DOC 243KB)
- HSP121 Safety and risk management plan (DOC 147KB)
- HSP122 Offsite safety and risk management plan (DOC 148KB)
Planning and management tools
- Ready to learn kit (PDF 6936KB)
- Interoception guide (PDF 610KB)
- HSP422 Interoception activity plan (PDF 74KB)
- HSP423 Interoception personal best tracking sheet (PDF 116KB)
- Interoception small group session structure (PDF 84KB)
- Interoception in the Australian Curriculum (PDF 150KB)
- Black Dog Institute free school resources
- KidsMatter Depression
- Fun Friends (4-7 year olds)
- Friends for Life (8-11 year olds)
- My Friends Youth (12-15 year olds)
- Adult Resilience (16-18+ years olds)
- WCH webinar series
- HSP125 Guide to health support planning (DOC 87KB)
Disability and complex needs team
Phone: 8226 0515
Email: education.health [at] sa.gov.au