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Q
I think my eight-year-old son may be depressed. The school psychologist evaluated him but she didn't indicate this. I also spoke with our pediatrician, who treated me like an hysterical mother. Per the school psychologist, he appears to be borderline ADHD (without hyperactivity), but no one is recommending medication because he's maintaining a solid grade average, although he has difficulty reading.

My son is very emotionally volatile and when he's throwing a temper tantrum, he often says he wishes he were dead, he wishes I were dead, or suggests that he should kill himself. We have discussed his feelings, and I can't ascertain how much of what he says is punitive for my benefit and just said out of anger, or how much he really means it.

I know that as a child, I sometimes thought -- and may even have said -- that I wished I were dead. How serious are these emotions and should I be alarmed? If so, what next steps should I pursue to get the help my family needs. We don't have any specialists in child psychology in the small town where we live.

A
While the school psychologist should be familiar with the warning signs for depression, she may not have had a lot of experience actually identifying this form of mental illness in school-age children. Even a pediatrician may have had limited experience in the diagnosis of depression in children. That's usually the job of a clinical child psychologist or psychiatrist. As a mother, you probably have a very good sense of whether your son is depressed and your question should be taken seriously by professionals. I think your son is giving you some very clear signs (his language and his behavior) that suggest he may very well be depressed.

Depression in children can lead to school failure, alcohol or other drug use, and even suicide. Since there is no child psychologist or psychiatrist in your town, I would encourage you to take a trip to the nearest city in which there is a child mental-health clinic or a children's hospital with a child psychiatry department. With childhood depression, it's better to be safe than sorry. A good comprehensive evaluation, even if it rules out depression, will help you know what to do and what to say when your son exhibits volatile emotions or when he talks about suicide. Extremes of irritability and aggression, rather than a sad mood, are quite common in children who are depressed. There might even be some other condition that's causing these symptoms. It's good to check it out. Before you go, you should take a look at the following websites, where you'll find some very helpful information about depression in children.

LD Online, www.ldonline.org
National Mental Health Association, www.nmha.org
depression.about.com

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