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Mental health experts say the reasons are complicated, but fixable.
More than one in 10 children age 9 to 17 years old -- girls more often than boys -- experience some sort of mood disorder, according to the U.S. Department of Health and Human Services. And about half of them are receiving no therapy or treatment, reported a study in Pediatrics conducted by researchers from the U.S. National Institute of Mental Health.
Kids with anxiety and depression, especially, are going without treatment, the study found.
This is a serious public health problem, doctors say. If left untreated, childhood anxiety and depression can grow into even more serious mental health problems later in life, said Dr. Jon Shaw, a professor and director of child and adolescent psychiatry at the University of Miami Miller School of Medicine.
"We know that 25% of children with major depressive disorder will become bipolar in adulthood," Shaw said. Nearly three-fourths, he said, are likely to have a recurrence of their depression as adults.
However, the conditions often go unrecognized, and thus untreated, in children in part because of the somewhat laissez-faire attitude that adults have had in the past regarding troubled children.
"We've always had the notion that they'll grow out of it so there's this thought that they are just reacting to something and it will be a short-term problem," said Dr. Scott Benson, a child and adolescent psychiatrist in Pensacola, Fla.
Children also often are not as effective as adults in expressing how they feel. "They don't have a good 'feeling' vocabulary," Benson explained.
"The bigger problem has to do with the concept of self-awareness," he said. "Children don't have a consolidated self to measure their feelings against so they don't know how they are supposed to feel. It takes an astute adult observing them from outside to detect that something is wrong."
In addition, childhood anxiety and depression sometimes go unnoticed because troubled kids tend to internalize their symptoms, Shaw said. Kids with mood disorders keep to themselves, tend to be quiet and are rarely disruptive, he said.
"They often do very well academically so teachers tend to overlook them," Shaw said.
Remedying the situation, Benson and Shaw said, starts with the parents.
Parents should keep in mind that family history plays a big part in mood disorders, Shaw explained. A child with one parent who has had a major depressive disorder has a 25% chance of having the mood disorder themselves, he said. If both parents have had depression or anxiety, their child's chances go up to as high as 50%.
That means, Benson said, that children from a family with a history of mood disorders should be watched closely for signs of depression or anxiety.
"If I know my child may have inherited this condition, I can be watching and picking up on symptoms earlier," he said. "If parents are watching for it and catching it early, then our treatments are going to be more effective."
Benson also recommended training daycare and preschool instructors to better detect signs of mood disorders. Teachers at the elementary, middle school and high school levels generally receive this type of training in college education courses, but daycare instructors often have not taken those classes, he said.
"I have children who have been expelled from two or three daycares because their behavior's so awful, and the teachers there want to say this is a bad kid rather than seeing this as an illness that needs treatment," Benson said.
- Loss of interest in activities they once enjoyed.
- Loss of self-confidence.
- Weight changes. Younger kids may develop a poor appetite and lose weight, and older ones may eat more and gain.
- Different sleep habits -- either sleeping more or less than usual.
- Unusual bouts of anger.
- Headaches or stomachaches.
Signs of general anxiety in youngsters, according to the U.S. Department of Health and Human Services, include:
- Unrealistic worry about everyday activities, including academics, sports and leisure-time plans.
- Increased self-consciousness.
- Extreme need to please others.
- Low self-esteem and the need for frequent reassurance.
- Self-doubt and being highly critical of themselves.
- Stomachaches and pains that seem to have no physical cause.
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