Understanding Depression in Children
- Admin
- Jun 3
- 5 min read
When behaviour becomes a child’s only language, therapy helps decode the unspoken pain of depression and offers pathways to healing, connection and resilience.

In the vibrant and often chaotic world of childhood, filled with scraped knees and spontaneous laughter, there is a hidden dimension we frequently overlook. Children, despite what our nostalgia might suggest, are not immune to the quiet reach of depression. While their struggles are often dismissed as passing moods or growing pains, research tells a more sobering story: around 3% of children in Singapore experience depression before the age of 12, with rates continuing to rise through adolescence.
Beyond Temporary Sadness
Depression in children often looks different from depression in adults. This difference contributes to how often it goes unnoticed. Rather than showing obvious sadness, children may become irritable, complain of unexplained physical symptoms, or withdraw from activities they once enjoyed. These signs are easily mistaken for normal developmental changes or behavioural challenges, leaving parents unsure of how to respond.
Children usually lack the emotional vocabulary to say they are feeling depressed. Instead, they express distress through changes in behaviour, sleep, or academic performance. The real challenge is recognising these shifts as signs of emotional struggle.
When left untreated, childhood depression can lead to lasting consequences. It increases the risk of repeated depressive episodes in adulthood, and is linked to higher chances of substance use and suicidal thoughts. With early and appropriate support, children can build emotional resilience and learn coping strategies that strengthen their wellbeing over time.
Evidence-Based Therapeutic Approaches
When treating childhood depression, the evidence overwhelmingly supports a multimodal approach. While medication may play a role in severe cases, psychotherapy remains the cornerstone of effective treatment. Several modalities have demonstrated particular efficacy:
Sandplay Therapy
Sandplay therapy offers a particularly powerful approach for children struggling with depression. In this modality, children create scenes in a sand tray using miniature figures, allowing them to externalise internal conflicts and emotions in a tangible, three-dimensional form.
The sand tray serves as a contained microcosm where children can safely explore complicated feelings without words. A child with depression might initially create barren landscapes with isolated figures or build barriers and walls, physically representing their emotional isolation. These scenes often evolve as therapy progresses to show greater integration, connection, and vitality, mirroring the internal healing process.
Neurobiologically, sandplay engages multiple sensory pathways simultaneously. The tactile quality of sand has a regulating effect on the nervous system. At the same time, symbolic play activates the right brain processing of emotions that may be too complex for verbal expression. Sandplay particularly effective for children whose depression stems from pre-verbal or traumatic experiences.
The non-directive nature of sandplay creates a unique therapeutic environment where children experience unconditional acceptance. Without interpretations imposed, children can authentically express their inner world at their own pace, gradually developing insight into their emotional landscape and finding pathways toward healing.
Play Therapy
Children process their sense of the world through play. Through play, children feel free to express their inner feelings and deepest emotions. Since children often struggle to express themselves adequately in the adult world, play therapy is an effective therapeutic intervention that enables them to share and process their feelings. Through play, the play therapist engages and communicates with children using various therapeutic techniques, such as movement, storytelling, pretend play, or drama, to help facilitate healing.
Expressive Therapy
Expressive arts therapy is a multimodal intervention that uses creative expression to help children and adolescents make sense of their challenges. It utilises creative expressions, including drawing, movement, music, sandplay, and symbols.
Expressive Arts Therapy is exceptionally well-suited to children and adolescents with difficulty articulating their inner world using words alone. These clients can use the many forms of creative arts to express themselves.
Trauma-Focused Cognitive Behavioural Therapy (CBT)
TFCBT addresses the interplay between thoughts, feelings, and behaviours, teaching children to identify negative thought patterns and develop healthier alternatives. These skills serve as psychological antibodies against future depressive episodes.
In practice, TFCBT might look like a game of "thought detective," where the child investigates evidence for and against beliefs like "nobody likes me" or "I'm terrible at everything." Through structured activities, therapists help children reconstruct their internal narratives and develop more balanced perspectives about themselves and their world.
The skills acquired through TFCBT—recognising cognitive distortions, challenging negative assumptions, and generating alternative interpretations—become lifelong tools. As children master these techniques, they gain increasing autonomy in managing their emotional wellbeing, setting the stage for healthy psychological development.
Family Therapy
Recognising that children exist within complex familial systems, family therapy examines and addresses relational patterns that might contribute to or maintain depressive symptoms. This approach is particularly relevant in Singapore's collectivist culture, where family dynamics significantly influence a child's psychological development.
Sessions focus on improving communication, adjusting expectations, or helping parents develop more effective responses to their child's emotional needs. By treating the family as the client rather than just the child, family therapy acknowledges the reciprocal influence of relationships on mental health. It creates sustainable change within the child's primary support system.
In Singapore, many families face academic pressure or intergenerational patterns that impact their children's emotional well-being. When the entire family system shifts toward healthier interaction patterns, children often experience significant symptom relief and develop more secure attachments, protective factors against future depressive episodes.
Benefits Beyond Symptom Relief
Early therapeutic intervention yields benefits far beyond alleviating current symptoms. As depressive symptoms subside, academic performance typically improves, accompanied by enhanced concentration, motivation, and increased engagement in learning. Social relationships flourish as children develop emotional intelligence and interpersonal skills through the therapeutic process.
Perhaps most significantly, successful therapy builds a child's confidence in their ability to overcome difficulties. They learn that emotional struggles are neither permanent nor defining—a perspective that protects against future episodes and promotes resilience when challenges arise.
Parents play an essential role in this healing journey. Your attunement to subtle changes in your child's behaviour, willingness to seek guidance, and consistent emotional support create the foundation for recovery. While initially overwhelming, remember that childhood depression responds remarkably well to proper intervention. The investment made now yields returns throughout your child's lifetime.
Children possess natural resilience that, when supported through evidence-based therapy, allows the vast majority to recover completely. The therapeutic process not only alleviates current suffering but equips children with emotional skills that become strengths as they mature—transforming early vulnerability into lasting psychological resources.
Restoring Peace is a private mental health centre which provides counselling and psychotherapy services for children, adolescents, youths, adult individuals, couples and groups with anxiety, depression, trauma, grief and various mental health and relationship challenges. For more information, please visit www.restoringpeace.com.sg or WhatsApp at +65 8889 1848. For periodic updates, we invite you to join our telegram group: https://t.me/restoringpeace.
References
APA CLINICAL PRACTICE GUIDELINE for the treatment of depression across three age cohorts. (2019). In APA, APA CLINICAL PRACTICE GUIDELINE for the Treatment of Depression Across Three Age Cohorts [Report]. American Psychological Association. https://www.apa.org/depression-guideline/guideline.pdf
Koplewicz, H. S. (n.d.). More than Moody: Recognizing and Treating Adolescent Depression. The Brown University Child and Adolescent Behavior Letter, Vol. 18, No. 12. https://www.daveneefoundation.org/wp-content/uploads/More-than-Moody-Adolescent-Depression.pdf
Johari, N. (2025, February 28). Adolescent self-harm and suicide attempts: An analysis of emergency department presentations in Singapore -. Annals Singapore. https://annals.edu.sg/adolescent-self-harm-and-suicide-attempts-an-analysis-of-emergency-department-presentations-in-singapore/
Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychological bulletin, 132(1), 132–149. https://doi.org/10.1037/0033-2909.132.1.132
Pietrangelo, A. (2019, October 11). How play therapy treats and benefits children and some adults. Healthline. https://www.healthline.com/health/play-therapy
Pradhan, B., & Sahoo, M. (2023). Psychotherapies for the Youth: Evolution, Progress, and on Way to Eclecticism. Journal of Indian Association for Child and Adolescent Mental Health, 19(1), 95–103. https://doi.org/10.1177/09731342231179033
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