Depression in Children 


What does depression in children look like?

Because children often don’t know how to verbally express their feelings, when they are distressed, it often shows up in behavioral or somatic terms. What we often think of as depression in adults can look rather different when depression manifests in children or in adolescents. These signs are common:

  • angry outbursts or persistent “bad” mood 
  • changes in appetite 
  • isolate themselves
  • trouble focusing/learning 
  • increase in conflicts with others, e.g., siblings
  • lethargic/fatigue (slow in speech and movement) 
  • “irrational” destructive behavior (e.g., ruining a birthday cake) and they can’t tell you why they did it
  • somatic symptoms like tummy ache or headache, especially in young children
  • wish of hurting themselves (active: “I want to jump off the building;” passive: “I wish I wasn’t here”)
  • self-harm behavior like cutting, pinching themselves, or banging their heads on the wall (the purpose is to release psychological pain via physical pain)

While a depressed adult might look withdrawn and perceptibly sad, and communicate their feelings in words, which solicits concern and care from others; some depressed children can act in such a way that pushes people away. They can be very defiant, verbally aggressive, and confrontational, which could solicit punishing responses from others, which further aggravates their depression. Some depressed children are so withdrawn that it feels as if they have disappeared into a different world where you can’t reach them.

Learn more about adult depression and adolescent and high-functioning depression.

SEN Comorbidity 

Children with learning difficulties are more susceptible to anxiety and depression (called comorbid conditions). This is because children are very observant and they get a sense of who they are by comparing themselves to others. For example, a child with ADHD will at some point arrive at the unwarranted conclusion that they are “stupid,” “lazy” or “worthless,” because they see other people accomplish with ease what they find extremely difficult to do (e.g., doing their homework or remembering the times tables). Or a child with autism/asperger’s might find the world and other people confusing, and experience a lot of difficulty fitting in, or even be bullied. These negative feelings and experiences, if persistent and severe, are the precursors of depression.

Academic Stress and Depression

SCMP: Hong Kong children overwhelmed by academic pressure, with suicide accounting for a third of young unnatural deaths 

I have never met a child who wants to fail at school! If they look like they don’t care, it is because they have already given up, after feeling let down repeatedly (“if you don’t try, you don’t fail”). Children want to do well naturally, which gives them a sense of pride and mastery, and so when a child struggles academically and feels a lot of pressure and receives little help/support and understanding (which doesn’t necessarily mean tutoring classes), they will give up eventually. 

For a child to develop optimally, they need to have a sense that they are lovable, capable, and valued. When a child keeps hearing criticism related to their academic performance, and there is little positive interaction between them and their parents (e.g., being praised, appreciated and listened to), their psychological development will suffer. They will overgeneralize to think that because their academic is bad they are bad. When the majority of their early years are shaped by feeling unconfident, helpless, lonely, criticized and unloved, and in some more extreme case worthless, useless, and hopeless, depression might not be that far away.

If your child exhibits signs of depression, that will need to be the first order of business. Seek professional help from a psychologist or therapist. Early interventions means you stop a problem from getting worse, so your child can get better sooner. 

Of course academics matters, but pressuring a child is not the answer, especially when it proves ineffective after years and years of repetitive struggles. If your child has a learning disability and a psychological condition like depression and anxiety, it will be important to seek help. Help can mean child therapy and/or parenting consultation with a psychologist. It can also mean making use of free and available resources like a school social worker, counsellor, and/or teacher, to find out what support your child needs and what resources are available, as a starting point. Some teachers, if they know your child well, can also be a great resource. 

Some children and teens suffer from high-functioning depression. They make the grades but suffer in silence.

What can I do to help my child?

  • Allocate time for bonding and connection 

Bonding activity needs to be child-centered. Find out what they like and schedule time to do them consistently. Do nails together, play a board game, go to the movies. This sends the message you love them and enjoy spending time with them. Love to children means quality time and positive attention. (Note: when children don’t get enough positive attention, they will prefer negative attention to no attention. In other words, they will act out to get you to look at them. And when you spend time with them and you are on your phone, their love cup will remain unfilled because your attention is not on them.)

If they like Minecraft and you don’t, remember you are the adult here and your child is important. Tell them you will play half an hour with them and then you will want to do something else, like reading (in other words, make what you want them to do as a condition for doing what they want to do; you guys are taking turns!).  

  • Invite them to talk so you can listen

A lot of times we listen to respond (tell others what we think, provide solutions, etc). We don’t listen to understand the other person. If you cultivate an atmosphere at home that children can talk to you and you will listen, with empathy, sensitivity and understanding, this will save you a lot of headaches down the road. 

Children are not skilled at talking about feelings, so ask questions to help them name their feelings: “How does that make you feel?” “Does that make you sad?” “Oh I bet that sucks, doesn’t it?” “You are wiggling. Are you scared?”

When they tell you how they feel, remind yourself not to correct or criticize them. Your good intention to help by saying “You don’t need to feel sad” might make them feel they are doing something wrong. Feelings don’t go away just because we want them to. Say, “I can understand how that would make you sad. Is there anything we can do to make you feel better?” 

  • Praise often and let them know they are loved and valued 

In some cases, after years of negative feedback loops between parents and child, it can feel to you like you have the worse child in the world. So you will need to dig deep and look with new eyes. If your child got one math problem right and 9 other wrong, focus on what they did right. Praise is a reward that motivates your child to keep at it and work harder, because they want your praise. (The parenting assumption that criticism and punishment can motivate a child is misguided). Say, “Great, you got one right. Good job! (You need to mean it because children can tell.) Now, let’s figure out the other 9 together. I will help you.” 

When they are clearly doing something wrong (such as running around a swimming pool), instead of slamming “Can you stop that?!!”, consider holding their hand and asking, “What do you think will happen if you do X?” They will likely catch on and say “Hurt myself.” Then ask, “That’s very smart! So what can you do instead?” and reward their cooperative behavior. The spirit of this approach can help set up your child to want to listen to you and work with you. Because the alternative behavior is something they themselves come up with, and they are praised for it, they will be less tempted to fight you.

Remember, when you praise them, be sincere and enthusiastic. Or this approach won’t be as effective. The child can feel your energy, positive or negative! 

  • SEN and academic stress

HK is notorious for the copious amount of work assigned by schools. Children without learning difficulties will struggle, let alone those with an SEN condition. If your child is suffering, let the teachers know and work out accommodations to protect your child’s mental and physical health. Remember, twenty years down the road, no one cares whether your child turned in 20 or 10 math problems a day in grade 2. What really matters is that they learned the material. But mental illness can have serious and long term consequences. Pick your battle wisely. 

How do I tell if my child is depressed or sad?

If your child’s mood interferes with their functioning for an extended period of time, whether it is depression or not, it is a good idea to talk to a psychologist. Some parents feel overwhelmed when they hear labels such as depression, anxiety, or ADHD; these are terms that designate clusters of behavioral and emotional patterns. What is important is that your child’s particular areas of difficulties are understood and targeted at treatment. Labels or not, the goal is that they develop in a healthy way and function at an optimal level. 

My article in SCMP: Diagnosis is not a yes or no checklist 

Does my child need to see a psychologist or therapist for their depression?

If your child is expressing a wish to hurt themselves, to “disappear,” or exhibit self-harm behavior, it is important to see a psychologist or therapist ASAP. 

If your child’s mood and/or behavior interferes significantly with their functioning, it is a good idea to seek professional help. Learn more about child therapy and parenting consultation

To find out what your child might be struggling with, screeners might provide some initial pointers.