Pediatric Depression Differential Diagnoses

Updated: Dec 20, 2022
  • Author: Angelo P Giardino, MD, PhD, MPH, FAAP; Chief Editor: Caroly Pataki, MD  more...
  • Print

Diagnostic Considerations

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5), diagnostic criteria for depressive disorders are the same for children and adolescents as for adults. [1]

Major depressive disorder (MDD) is diagnosed when the required DSM5 symptoms are present and other disorders have been ruled out. Symptom clusters, such as seasonality, atypical symptoms, psychosis, or hypomania, characterize different subtypes of depression. Identify these subtypes because they require different modes of treatment.

It is important to be alert to changes in the patient that might signify a switch from a depressive state to a manic state. Childhood-onset depression is commonly a precursor of bipolar disorder. In youths, manic and depressive symptoms may be mixed (mixed episode), which is a common presentation of bipolar disorder among youths. Hypomanic symptoms may be quite brief at the onset of bipolar disorder and may be disregarded.

Comorbid symptoms of attention deficit hyperactivity disorder (ADHD), anxiety, posttraumatic stress disorder, substance abuse, and sleep disorders are often overlooked and require careful assessment and treatment. Consideration should be given to the diagnosis and treatment of youths with subclinical depression, because these children are at high risk to develop depression, and early intervention may be beneficial.

Health-risk behaviors such as smoking, marijuana use, early sexual debut, and hard drug use begin earlier in adolescents who have higher depressive symptoms when compared with their peers. Intervention and instituting treatment programs during early adolescence may help to prevent these risk behaviors later in adolescence. [39]

Other conditions to be considered include medication reaction, substance abuse, and organic disease presenting as depressive disorder.

Differential Diagnoses