Childhood Mood Disorders and Treatment

Mental health struggles in youth are more common — and more serious — than many adults realize. Mood disorders like depression and bipolar disorder can affect how kids think, feel, sleep, eat, interact and perform at school. The challenge? These symptoms are often missed or misunderstood, especially in children and teens who may not be able to explain what they’re feeling. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 1 in 5 U.S. teens experienced a major depressive episode in 2021, and the CDC’s Youth Risk Behavior Survey shows that symptoms of depression and suicidal thoughts have steadily increased over the past decade. 

But there’s good news: With early diagnosis, structured therapy and strong caregiver support, many kids and teens can find relief — even thrive. Helping a child name their emotions, understand their states of mind or pause before reacting can change the course of their life. For families, providers and schools, supporting mental wellness means asking the right questions early and responding with compassion and clarity. 

Why diagnosis and assessment are crucial 

It’s easy to dismiss emotional changes in teens as “just hormones” or growing pains. But in many cases, underlying mood disorders are at play. These may show up as sadness, irritability, fatigue and poor concentration, or even physical symptoms like stomachaches or headaches. 

Because symptoms overlap with typical adolescent development and other mental health conditions, accurate assessment is essential. Early identification leads to early treatment, which often means better long-term outcomes. 

Screening tools for providers and caregivers 

Validated tools help determine whether a child needs further mental health evaluation. These tools aren’t diagnostic, but they provide crucial information that helps clinicians determine next steps and open the door to life-changing care. The following tools can be helpful for providers and caregivers: 

• Ask Suicide-Screening Questions (ASQ): A quick four-question screener for suicide risk. Recommended for all youth ages 12 and above. 
• PHQ-A: A brief depression screener with one question specifically assessing suicidality. 
• Mood and Feelings Questionnaire (MFQ): A reporting measure available in long and short versions for both youth and parents. 
• PROMIS Emotional Distress tools: A tool to assess depression, anger and irritability in youth ages 6 to 17. 
• General Behavior Inventory – Parent Version (P-GBI): Screens for mania-related symptoms in youth. 

Types of mood disorders in children and adolescents 

Most mood disorders in youth fall into two broad categories, either depressive disorders or bipolar spectrum disorders. 

Depressive disorders 

Depressive disorders include major depressive disorder (MDD) and persistent depressive disorder (dysthymia). Symptoms may include: 

• Persistent sadness or irritability 
• Low energy or fatigue 
• Sleep and appetite changes 
• Feelings of guilt or worthlessness 
• Thoughts of death or suicide 
• Withdrawal from family or friends 

In younger children, signs may include somatic complaints (like stomachaches) or separation anxiety. 

Bipolar spectrum disorders 

Bipolar spectrum disorders involve episodes of depression alternating with mania or hypomania. Manic symptoms in youth may include: 

• Elevated or irritable mood 
• Inflated self-esteem or grandiosity 
• Less need for sleep 
• Racing thoughts 
• Risk-taking behavior 

Children can also present with mixed features, like feeling sad and energized at the same time, which increases the risk of self-harm and can be harder to diagnose. 

The role of dialectical behavior therapy (DBT) 

For youth experiencing intense emotions, self-harm or chronic suicidal thoughts, dialectical behavior therapy (DBT) is a well-researched and highly structured form of therapy that teaches kids how to manage distress and improve relationships. 

Originally developed by American psychologist Marsha Linehan, PhD, for adults with borderline personality disorder, DBT is now widely used for teens with mood disorders, especially those who struggle with impulsivity, emotional outbursts or suicidal ideation. 

There are two core skill areas in the practice of DBT: mindfulness and distress tolerance.  

Mindfulness in DBT 

Mindfulness is at the heart of DBT. It’s not about clearing the mind — it’s about noticing what you’re thinking and feeling without trying to fix or judge it. 

Through DBT, teens learn to identify three mental states: 

• Reasonable Mind: Logical, fact-based thinking 
• Emotional Mind: Decisions based purely on feelings 
• Wise Mind: A balance between emotion and logic 

Helping teens pause and ask, “Which mind am I in right now?” empowers them to respond thoughtfully instead of reacting impulsively. 

Even simple practices, like focusing on breathing for one minute, can help build mindfulness and emotional regulation. Primary care providers can introduce this during wellness visits as a powerful but accessible mental health tool. 

Distress tolerance and TIPP skills 

When emotions are overwhelming, kids need strategies to survive the moment without making it worse. That’s where DBT’s TIPP skills come in. The TIPP acronym stands for: 

• Temperature: Splashing the face with cold water or using an ice pack can quickly calm the body by activating the parasympathetic nervous system. 
• Intense exercise: Ten minutes of jumping jacks, running or even dancing can help discharge emotional energy. 
• Paced breathing: Slowing the breath (in for 4 counts, out for 6) reduces physiological arousal. 
• Progressive muscle relaxation: Tensing and releasing muscles one body section at a time teaches physical and emotional awareness. 

These simple skills are memorable, teachable and easy to practice, making them useful both in and outside of therapy. 

Additional therapy options and medication 

DBT is highly effective for teens dealing with emotional dysregulation or self-injury, but it’s part of a bigger toolbox of treatments for mood disorders. Other treatment options include: 

• Cognitive Behavioral Therapy (CBT): Helps kids reframe negative thoughts and change unhelpful behaviors. 
• Interpersonal Therapy (IPT): Focuses on improving communication and social support. 
• Parent-Child Interaction Therapy (PCIT): Especially helpful for younger children with behavioral challenges. 
• Family-Focused Therapy (FFT): Often used in treating bipolar disorder by improving family communication and routines. 
• Medication: Antidepressants or mood stabilizers can be lifesaving for moderate-to-severe symptoms, particularly when combined with therapy. 

The right combination depends on the child’s symptoms, diagnosis, and family context. 

Tips for supporting caregivers 

Mental health care works best when caregivers are involved. Educating families on what to look for and how to respond makes a huge difference. 

Encourage caregivers to: 

• Learn the warning signs of depression, mania, and suicide risk 
• Use screening tools at home or in coordination with providers 
• Keep communication open and talk honestly about emotions and suicidal thoughts 
• Model calm, validating responses even when emotions are high 

Many caregivers worry that bringing up suicide might “plant the idea,” but the opposite is true. Talking openly protects kids and gives them a safe space to be honest. 

Additional resources 

1. American Academy of Pediatrics, Suicide: Blueprint for Youth Suicide Prevention 
2. Children’s Colorado primary care article, Dialectic Behavior Therapy 
3. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press. 
4. Partners for Children’s Mental Health, Mental Health Resources