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The clinical picture of depression in adults, namely retardation in mental and physical activity, insomnia, feelings of depression, apathy, worthlessness, and nihilism as well as suicidal preoccupations, are seldom seen in children and adolescents. It is the author's thesis that depression, a most important problem in childhood and in adolescence, is masked by varying symptoms depending on the developmental level of the child. Depression in infants is often evidenced by eating and sleeping disturbances, colic, crying, and head-banging. At a later, age, withdrawal, apathy, and regression are evident. An older child presents behavioral problems such as temper tantrums, disobedience, truancy, running away from home, accident-proneness, masochism, and self-destructive behavior as an equivalent of depressive feelings. Difficulty in concentration is a frequent complaint of depressed children. In adolescents, acting out and denial as the chief methods of handling problems frequently will mask a severe depression. Delinquents especially often reveal a severe underlying depression. Sexual acting out, such as using animals as love objects, may be a method of relieving depressive feelings. Dreams and fantasies of being unloved and unwanted are frequently encountered in depressive withdrawal. Suicide is a danger, especially in adolescents. Often the suicidal attempts are manipulative in nature, directed against the parents, and express the fantasy: 'You will be sorry when I'm dead'. They also express a desire for peace and a nirvanalike existence, a desire to join a dead parent, or a reaction to a hallucinatory command.
Toolan points out that the common denominator in all depressive reactions is the loss of the desired love object, whether in fact or in fantasy. In very young children, the consequences are serious because the development of the ego and its various functions is affected, since object relations cannot be formed and identification will be impaired. W