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Children with chronic disorders that impair their motor abilities and independence, such as cerebral palsy, are at a heightened risk of developing depression. Depression rates can be twice as high for people with disabilities when compared to non-disabled people. 
As a parent or caregiver, it’s crucial to understand the signs of depression, including warning signs and when to get help immediately.
According to the American Psychiatric Association (APA), depression is defined as a medical condition that affects the way someone acts, feels, and thinks.  Depression symptoms can vary in severity, from mild to severe, and can lead to many physical and emotional ailments. Common symptoms of depression include:
- Weight loss
- Appetite change
- Feelings of persistent sadness
- No interest in previous hobbies and activities
- Thoughts of suicide, and in severe cases, suicide attempts
- Feeling hopeless and “empty” inside
- Slower movements, slower speech
- Excessive irritability and outbursts
- Sleeping too little or too much
- Hand wringing
- Excessive crying
- Difficulties functioning in class and school activities
- Feeling guilty, worthless
- Frequent stomach aches or headaches
- Decreased appetite or binge eating
The APA states that the symptoms must be present for at least two weeks for depression to be medically diagnosed. Other medical conditions can mimic depression and should be ruled out first, including brain tumors, vitamin deficiencies, and thyroid problems.
The Link Between Cerebral Palsy and Depression
According to a study published in The Scientific World Journal (Volume 2013, Article ID 468402), children with cerebral palsy or similar neurodevelopmental disorders are prone to psychiatric issues. 
The study indicated that around 40% to 50% of school-aged children with cerebral palsy exhibit emotional and behavioral problems, and one out of every two children with CP would meet the criteria for some form of psychiatric disorder, with attention deficit hyperactivity disorder (ADHD) being the most prevalent.
The study did note that children with cerebral palsy who suffered from depression and anxiety were generally on the same academic functioning level of their peers, and the mental health issues resulted from more from painful social and classroom experiences than their peers, rather than an inability to perform academically.
Problems with peers seem to be a significant factor in children with CP developing depression, specifically bullying issues. Bullying can happen at any age in school, but middle school tends to be the highest association of bullying, name-calling and ridiculing.
The study also indicated that overlapping conditions were overwhelming in children with CP who developed depression. For example, many of the children with depressive disorders also had ADHD and/or oppositional defiance disorder (ODD).
Symptoms of depression can vary greatly according to each child. While one child may exhibit sadness and isolation, another one may become easily irritated and angered. Biochemistry, genetics, personality, and the child’s environmental factors all play a part in how someone with depression will react.
Stress or Depression?
Children with cerebral palsy are also prone to mood swings and stress, but since the signs are similar, it sometimes becomes difficult to discern whether they’re having a bad day or if they’re truly depressed.
There are a few ways that mood swings differ from depression, but you should keep in mind that since children display depressive behavior in different ways, you should always speak with a healthcare provider if you suspect any issues.
- Depression lasts for days and weeks, whereas a child having mood swings may have several days without symptoms
- Feeling nervous and anxious periodically, but still motivated at school and performing well leans more towards stress or mood swings.
- A feeling of being overwhelmed characterizes stress, but with depression, the overwhelming feelings start to affect the child’s ability to function in school and at home
How is Depression Treated?
APA reports that around 80% to 90% of people with depression will respond favorably to treatment, which is excellent news for parents with children who are going through daily struggles. Yet, to be successful, you’ll need to find the right approach. It takes some trial and error, but with effort, persistence, and with professional medical guidance, the odds of beating depression are typically favorable.
In general, there are three types of traditional treatments that most medical professionals recommend. Some children can benefit from just a single treatment modality, while many have the best results from a combination of approaches.
Psychotherapy is the mainstay of treatment for mental health disorders and often works well as the only treatment modality for mild to moderate symptoms.
Psychotherapy consists of retraining thought processes or negative patterns of thinking to change the way people process and react to the world around them. This teachable skill can change the way daily interactions or perceived and, therefore, the feelings and behaviors that result.
The American Academy of Child and Adolescent Psychiatry reports that there are numerous types of psychotherapy, some of which can be combined for better outcomes. Sometimes various forms of psychotherapy can be combined with medication, which “may be more effective.” 
Some of the common types of psychotherapy for children include:
- Cognitive Behavior Therapy (CBT)
- Family Therapy
- Parent-Child Interaction Therapy (PCIT)
- Play Therapy
- Acceptance and Commitment Therapy (ACT)
- Psychodynamic Psychotherapy
- Supportive Therapy
If brain chemistry contributes to the child’s depression, certain medications may be beneficial in battling depression. Typical drugs for depression include SSRIs or SNRIs, two types of antidepressant prescription medications.
Common brand names include Prozac, Paxil, Zoloft, Lexapro, and Celexa. It can take up to 4-6 weeks to start seeing accurate therapeutic results after starting a medication. 
Medications do come with some side effects which are essential to consider before initiating medication therapy. Among the most common are nausea, dizziness, drowsiness, and dry mouth. In severe cases of depression, suicidal thoughts may become more frequent before they improve, and appropriate monitoring and safety measures should be implemented.
These medications should also not be stopped abruptly, so always talk to your child’s healthcare provider on how best to taper off medicines if you wish to stop the therapy.
Electroconvulsive Therapy (ECT)
ECT treatment is usually reserved for the most severe cases of depression who didn’t have success with other types of treatment.  It involves electrical stimulation of the brain while the patient is put under anesthesia. ECT treatment consists of receiving the stimulation a few times a week, for a total of up to 12 treatments.
Although there is a stigma attached to ECT treatments, the Mayo Clinic suggests it comes from older versions of the procedure, before patients were offered anesthesia, and when extremely high amounts of electric currents were administered.
If You Need Immediate Help
If you suspect your child will self-harm or is suicidal, or if you just need someone to talk to, contact the National Suicide Prevention Hotline at 1-800-273-TALK. Skilled and trained counselors are available 24 hours a day, seven days a week. If your child starts to give away prized possessions and sees no hope for the future, the APA suggests seeking out immediate help.
- Relationship between physical disability and depression by gender: A panel regression model. (2016, November 30). PubMed Central (PMC) National Institutes of Health.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5130183/
- Parekh, M.D., M.P.H., R. (2017, January). What Is Depression? American Psychiatric Association
Retrieved from: https://www.psychiatry.org/patients-families/depression/what-is-depression
- Bjorgaas, H. M., Elgen, I., Boe, T., & Hysing, M. (2013, April 3). Mental health in children with cerebral palsy: Does screening capture the complexity? The Scientific World Journal
Retrieved from: https://www.hindawi.com/journals/tswj/2013/468402/
- Psychotherapy for children and adolescents: Different types. (2019, April). American Academy of Child an Adolescent Psychiatry.
Retrieved from: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychotherapies-For-Children-And-Adolescents-086.aspx
- Antidepressants for children and teens. (2019, June 25). Mayo Clinic.
Retrieved from: https://www.mayoclinic.org/diseases-conditions/teen-depression/in-depth/antidepressants/art-20047502
- McDonald, M.D., W., & Fochtmann, M.D., M.B.I., L. (2019, July). What is Electroconvulsive therapy (ECT)? American Psychiatric Association.
Retrieved from: https://www.psychiatry.org/patients-families/ect