A Guide To Managing SAD In Children

Seasonal affective disorder (SAD) is a mood disorder that has a distinct and unique seasonal pattern. It’s regarded as a subtype of either major depressive disorder or bipolar disorder. 

Winter SAD is the most common type. It begins with minor symptoms in the autumn, which continue and often worsen throughout the winter. People suffering from SAD experience a complete recovery from their symptoms in the spring and summer, until the cycle begins again in autumn. 

Some people with SAD experience the opposite seasonal pattern, where symptoms occur in summer and end in winter. However, this is much rarer. 

How common is SAD in children?

Although SAD is rare in people under 20¹, it is still possible for children to develop it. 

SAD is estimated to affect between 1.7% and 5.5%² of children between 9 and 19 years. 

Signs and symptoms of SAD in children

A child with SAD will generally experience many of the same symptoms that adults do but in a slightly different way. They tend to suffer more from sleep difficulties and low energy levels rather than the more obvious symptoms of depression. 

It can be difficult to recognize depression in children because their underlying symptoms are often hidden behind behavioral and physical changes, which you might believe are caused by something else. 

Young children may be unable to convey their feelings and emotions and might act out in ways they usually wouldn’t. 

Signs and symptoms to look out for in children include: 

Changes in mood

Children with SAD may be more irritable than usual or have more temper tantrums. This differs from adults, where having a depressed mood is more common.

Loss of interest in everyday activities

Children may frequently complain of boredom and lose interest in sports, games, and other hobbies or everyday activities that they usually enjoy.

Appetite and weight changes

Children with summer SAD may experience a decreased appetite and lose weight or struggle to put on healthy weight as a child should. 

Children with winter SAD may have an increased appetite, particularly for simple carbohydrates, and gain weight as a result. 

Sleep problems

Children with summer SAD may have difficulty falling asleep (insomnia).

On the other hand, sleeping too much is a common symptom in children with winter SAD. They may find it difficult to wake up early in the morning or stay awake at school.

In children with depression, sleep disturbance and insomnia—common symptoms of SAD—are associated with greater severity of depression³, fatigue, and suicidal behavior. It may also make treatment more difficult.  

Energy levels

Children may frequently be tired or appear to be lazy despite sleeping more. 

Feelings of worthlessness and guilt

Children may be overly critical of themselves and feel stupid, worthless, or as if nobody likes them. 

Concentration and school

Children may have trouble concentrating and, as a result, may have academic problems at school. These children may be seen as misbehaving and might miss more school days. 

Psychomotor agitation/retardation

Children with SAD may experience psychomotor agitation, which involves feeling restless, making unintentional movements, and finding it difficult to sit still.

On the other hand, some children may experience psychomotor retardation and make fewer movements or feel slowed down due to their low mood and energy levels that prevent them from being active. 

Risks of suicide and suicidal thoughts

In severe circumstances, you might notice a child start to talk and think about death more. A big warning sign is a child giving away toys and other belongings. 

Seek urgent medical attention if you are concerned about this, even if you think the risk is minor. 

Managing and treating SAD in children

Supporting your child

As a parent or caregiver of a child with SAD, it’s important for you to be involved in the treatment. Depending on the child’s age, you may need to take direct action with carrying out treatments or initiating lifestyle changes. 

Ask your doctor what you can do best to support your child. Keeping your child’s school up to date and informed is also beneficial so they can support them too. 

Since SAD is relatively rare in children, very few studies have been conducted specifically on treating children with this condition. However, studies have been done on treating major depressive disorder in children, which is a mood disorder similar to  SAD.

See a doctor

If you suspect your child has SAD, you should take them to see their pediatrician as soon as possible. A prompt diagnosis means that other medical causes that may explain their symptoms can be ruled out, and treatment can be started earlier. 

After a diagnosis has been made, your child’s pediatrician may refer them to a specialist. This may include a therapist, psychiatrist, and/or a psychologist who can further work with your child to manage their symptoms. 

Natural light exposure

Symptoms of winter SAD are thought to develop due to the decreased hours of sunlight in autumn and winter. So, maximizing light exposure as much as possible can help reduce symptoms. 

This can be done naturally by: 

• Taking advantage of the sunshine by going for a walk with your child or encouraging them to play outside. 

• Opening up the curtains to let the morning light in, which could help your child feel more alert. 

• Making sure that there are no branches or other objects that can block sunlight from passing through the windows. 

Light therapy

Light therapy is a very common treatment for SAD in adults, but it’s also thought to effectively treat depression in children and adolescents⁴.

A light box emits artificial light, which mimics natural sunlight. Your child will need to follow important instructions to maximize its benefits, such as using it:

• As soon as possible after waking 

• Every morning

• For around 30 minutes a day

One of the benefits of light therapy is that your child can do everyday tasks at the same time, like playing with their toys, reading a book, or eating breakfast. 

Despite this, younger children may still find it challenging to comply with the instructions, particularly the recommendation of using light therapy every morning. You may need to sit with them to make sure they stay in front of the light so it can reach their eyes indirectly.  

If your child has summer SAD, you’ll need to focus on minimizing bright light, so light therapy isn’t a recommendation. It’s thought that summer SAD occurs due to the increased hours of sunlight. 

Counseling and psychotherapy

Cognitive behavioral therapy (CBT) is a type of talk therapy based on the connections between thoughts, emotions, and behavior. It is used for several mental health conditions, including anxiety, depression, and SAD.

CBT can help:

• Increase coping skills

• Improve communication skills and relationships

• Solve problems

• Identify and replace negative thinking patterns

• Regulate emotions

Children can find it difficult to deal with their emotions in a healthy way, and it’s thought that CBT can help.

The American Academy of Child and Adolescent Psychiatry recommends that CBT be used in children with depression. It’s often regarded as the treatment of choice for children with mild depression.

CBT is effective for people with moderate to severe depression when combined with other treatments such as antidepressants.

Medications

Medications, such as antidepressants, are a common treatment for depressive conditions, including SAD.

Antidepressants are usually not recommended as the first treatment choice for people under the age of 25. This is because the Food and Drug Administration (FDA) has published a black box warning stating that antidepressants in this age group are associated with an increased risk of suicidal thoughts and behaviors.

Some doctors do recommend antidepressants for children if they believe it will be safe and if the child can be closely monitored.

Antidepressants help balance chemical messengers in the brain that regulate mood, such as serotonin and noradrenaline.

There are two FDA-approved antidepressants for children with depression⁵, both selective serotonin reuptake inhibitors (SSRIs):

• Escitalopram (Lexapro), for children and adolescents over the age of 12

• Fluoxetine (Prozac) for children and adolescents over the age of 8

Improving sleep hygiene

Getting enough good quality sleep is vital for growing children.

Since SAD disrupts sleep through either insomnia or excessive sleep, an essential part of treatment for children with SAD involves optimizing their sleep hygiene⁶. This can be done by:

• Keeping their room dark, quiet, and cool

• Stopping screen-time a couple of hours before bed

• Following a regular schedule of waking up and going to bed at the same time each day

• Feeling relaxed in the evening, which you can help with by doing comforting activities with them, such as giving them a warm bubble bath or reading a bedtime story

The lowdown

Having a child go through SAD can be difficult for both your child and you as their caregiver. If you notice negative changes in their mood or behavior when the seasons change, you should take this as a warning sign and speak with your child’s pediatrician.

Fortunately, there are very effective treatments that can be used with children to help reduce their symptoms of seasonal affective disorder. These will allow them to enjoy a healthy childhood with good quality of life.