Mood disorders among children and adolescents have been increasingly diagnosed and treated with a variety of modalities. Although clinicians and parents have always recognized that children and adolescents may experience transient sadness and despair, it has become clear that persistent disorders of mood occur in children of all ages and under many different circumstances. Two criteria for mood disorders in childhood and adolescence are a disturbance of mood, such as depression or elation, and irritability.

Mood disorders appear in children of all ages and may consist of enduring patterns of disturbed mood; diminished enthusiasm in play activities, sports, friendships, or school; and a general feeling of worthlessness. The core features of major depression are similar in children, adolescents, and adults, with the expression of these features modified to match the age and maturity of the individual.

Young, depressed children commonly show symptoms that appear less often as they grow older, including mood-congruent auditory hallucinations, somatic complaints, withdrawn and sad appearance, and poor self-esteem. Symptoms that are more common among depressed youngsters in late adolescence than in young childhood are pervasive anhedonia, severe psychomotor retardation, delusions, and a sense of hopelessness. Symptoms that appear with the same frequency regardless of age and developmental status include suicidal ideation, depressed or irritable mood, insomnia, and diminished ability to concentrate.

Depressive disorders and bipolar I disorder are generally episodic, although their onset may be insidious. Manic episodes are rare in prepubertal children but fairly common in adolescents. Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder may occur among children who later experience depression. In some cases, conduct disturbances or disorders may occur in the context of a major depressive episode and resolve with the resolution of the depressive episode. Clinicians must clarify the chronology of the symptoms to determine whether a given behavior (e.g., poor concentration, defiance, or temper tantrums) was present before the depressive episode and is unrelated to it or whether the behavior is occurring for the first time and is related to the depressive episode.

Students should study the questions and answers below for a useful review of these disorders.