Depression in kids appears to start as early as age 11, according to a new study published in the journal of Translational Psychiatry. How can parents tell if a child that young is depressed?

“The child may not say, ‘I’m sad,’ ” says Dr. Victor Fornari, director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, Queens. Here are signs to watch for:

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  • Depression often begins in children as high anxiety, Fornari says. They may refuse to go to school or may worry about a parent dying. They may have headaches, stomachaches or pretend to be sick. They may be afraid to fail or be rejected. Things they felt comfortable doing they may not be comfortable doing anymore.
  • “With 11- or 12-year-olds, usually you look for a change in functioning,” Fornari says. It could be a change in sleep habits or appetite or a loss of interest in activities previously enjoyed.
  • “Irritability can be a hallmark of depression,” Fornari says. “Everything annoys them. They fight with the parents. They fight with siblings.” Parents think it’s a discipline issue, but at age 11 kids aren’t usually so rebellious, Fornari says. “They’re having a problem; they’re not being bad,” he says.
  • Children may have negative thoughts about themselves or their bodies.
  • They may be extremely sensitive to being teased. “When people are feeling bad, comments can really feel like harpoons,” Fornari says.

If parents suspect depression, they should contact the pediatrician or family doctor for an evaluation. Talking to the child’s teachers can also help, because they may also notice changes in behavior or demeanor. A child can be referred to a mental health professional for cognitive behavioral therapy or medication if necessary.