Qn. “How can one spot depression in a toddler? My nephew looks withdrawn and not hyperactive as children ought to be”
You have asked a difficult question in part because it is unclear. How old is the toddler we are referring to? Is he perhaps two, three or five years old?
Secondly, normal children are described as being active and playful and not by the term that you use (hyperactive), which in most instances when used in reference to children implies excessive physical activity usually seen in Attention Deficit Hyperactivity Disorder (ADHD).
With reference to your question, we can state that a diagnosis of depression in children is unusual before adolescence.
It is also true that some younger children (seven– 10 years) have been diagnosed with depression. This, however, is uncommon.
A few months ago we saw a mother of two, who was in her late twenties treated for a depressive illness and seemed to get better. She went back to work.
A few weeks later, she brought her five-year-old son to us because “he did not seem to obey her”.
Since her hospitalisation and return home, her son had become indisciplined, hyperactive, and only ate “when he chose to”. He refused to go to bed when asked, refused to go to the bathroom to bathe with his brother and blew a tantrum at the drop of a hat.
The home was under his mercy and control.
One relative who had visited the home the weekend before we saw the child stated that the child seemed to be in charge of the home, and had his mother dancing on his little finger. According to the relative, the mother seemed scared of her own child.
In the course of the evaluation, a number of things stood out. First, the fact that his mother had (when we saw her) suffered the depressive illness for at least a year, if not more. During the illness, she had asked her mother to move in to help with things. A few weeks later, her husband was involved in an accident on a Friday night and had himself moved to be with his parents as the fractures healed.
The departure of her husband from the scene left a huge gap in the family. He was close to the five-year-old who now missed daddy a great deal. The family was rapidly falling apart.
When the depression became worse, the mother of the child attempted suicide and was hospitalised. Grandmother took charge of the home and “broke all disciplinary rules” that had been so painfully negotiated in the family over the years.
Upon her return from a private clinic, the depression was much reduced, but her strength was still inadequate to run the home, and in particular the now-out-of-control child.
On account of all the problems now facing her, the mother of the child relapsed into a depressive state, leaving grandmother in charge of the home.
Soon, things moved from bad to tragic.
Grandmother, under the stress of running the home developed severe high blood pressure and because of the headaches and dizziness, could no longer run the home.
When we saw mother and her five-year-old child, both looked like a steamroller had been over them at least twice. Both were depressed.
This rather long story is intended to demonstrate the fact that sometimes children get depressed because of the situation they are brought up in.
A home broken up as we have described can lead to indiscipline, temper tantrums and deep unhappiness in young children.
Going back to the beginning of the answer to your question, remember that the child’s mother was treated for depression some time before her own mother moved in, before her husband had the road accident and indeed before the child was noted to be depressed.
It is possible, therefore, that the mother had a genetic predisposition to depression which, sometimes, runs in families.
If that be the case, then her son might bear the same genes and, therefore, be more likely than others to suffer depression earlier in life.
Suffice it to say, therefore, that social and biological (genetic) factors play a role in the causation of depression.
A mental health expert will take a full history and be able to determine the actual cause, nature and treatment of the condition of the child and or his parents.