12 The American Psychiatric Association’s Diagnostic and statistical manual of mental disorders (DSM) did not represent children until its third edition in 1980. 11 Prior to the 1970s, depression was typically viewed as an adult disorder because children were seen as too developmentally immature to have this disorder. Historically, society disregarded the notion that a child’s mental health could be disturbed. GPs therefore need to have an understanding of how childhood MDD presents and how to assess and treat it, and have a network of professionals to whom children can be referred when necessary and appropriate. It can be a challenging clinical scenario for GPs to recognise MDD in a child, and formulate the presenting problem in the broader system within which the child exists. Parents will often approach their general practitioner (GP) with concerns about their child’s behaviour and/or with their child’s complaints of somatic symptoms. 7–10Ĭhildhood MDD typically presents to primary care and is undertreated. 5,6 Additionally, MDD that emerges in children aged 5–12 years can be severe and lead to poorer outcomes, compared with later onset MDD. 2–4 There is evolving evidence to suggest MDD, as we currently understand it, can even exist in preschoolers. 1 Longitudinal research, however, has continually demonstrated that most adult disorders have their origins in childhood, and most childhood disorders have consequences that persist to adulthood. Important debates continue regarding the validity of psychiatric diagnoses, especially in children and adolescents. Diagnosing major depressive disorder (MDD) in children (5–12 years of age) can be confronting.
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