Depression in Children May Not Always Look Like Sadness: What New Singapore Research Tells Us

When we think about depression in children and teenagers, we may picture a young person who appears sad, withdrawn or tearful.

But depression does not always present in the same way.

Recent Singapore research reported in The Straits Times highlights an important point for parents and caregivers: the pathways associated with later depressive symptoms may begin much earlier in childhood, and the symptoms we eventually see can differ from one child to another.

What did the Singapore study find?

The study followed children from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort. Researchers examined brain development during early childhood and subsequently looked at depressive symptoms when the children reached adolescence.

Researchers found associations between patterns of early brain development and different depressive symptoms at age 13.

Among girls, developmental changes involving areas associated with emotional processing were linked with symptoms such as low mood and poorer self-esteem. Among boys, changes in other areas were associated with symptoms including tiredness and feeling ineffective.

The findings do not mean that there is a particular "girl depression" or "boy depression", nor that a child's future mental health can be determined from a brain scan.

Instead, the research reinforces something important when understanding children and adolescents: emotional distress does not necessarily look the same in every child.

What can depression look like in children and teenagers?

A child experiencing emotional difficulties may not necessarily tell a parent, "I feel depressed."

Sometimes, parents may notice changes such as:

• becoming unusually tired or lacking energy

• losing interest or motivation for school or activities

• becoming more irritable or easily frustrated

• withdrawing from friends or family

• becoming increasingly self-critical

• expressing feelings of worthlessness or hopelessness

• changes in sleep, appetite or everyday routines

• physical complaints such as headaches or stomach aches

These signs can have many possible explanations and do not automatically mean that a child has depression.

What may be more helpful is noticing changes from your child's usual pattern, particularly when several changes persist or begin affecting school, friendships, family relationships or

everyday functioning.

Looking beyond a child's behaviour

A child who suddenly stops trying at school may be described as "lazy".

A teenager who spends increasingly more time alone may appear "difficult" or "antisocial".

A child who becomes angry easily may simply seem badly behaved.

But behaviour is often the part of a child's experience that adults can see.

Underneath it may be anxiety, shame, exhaustion, loneliness, difficulties with peers, academic pressure, low self-esteem or other emotional struggles.

Rather than immediately asking:

"How do we stop this behaviour?"

It may also be helpful to ask:

"What might this behaviour be communicating?"

This shift can help parents move from simply responding to the behaviour towards becoming curious about what their child may be experiencing underneath it.

Why early mental health support matters for children

One important message from this research is the value of paying attention to children's emotional wellbeing before difficulties become severe.

Mental health support does not have to begin only when a child receives a diagnosis.

Parents and caregivers can support children's emotional development by helping them recognise and name emotions, talk about difficult experiences, manage disappointment and stress, develop healthy relationships and know that they can approach trusted adults when something feels overwhelming.

Sometimes, children simply need more opportunities for connection and conversation.

For others, particularly when difficulties persist or begin interfering with school, friendships, sleep, family relationships or everyday life, professional support may be helpful.

Every child needs to be understood individually

Research examining differences between boys and girls can help us ask better questions, but it should not become another set of assumptions about children.

A boy can experience profound sadness and low self-esteem. A girl can present primarily with tiredness, irritability or loss of motivation.

A child's temperament, relationships, developmental experiences, family circumstances, culture, neurodiversity and stressful life experiences can all influence how emotional distress is expressed.

This is why it is important to consider the whole child rather than one symptom or behaviour in isolation.

Instead of only asking:

"Does my child look depressed?"

Another useful question may be:

"Something seems to have changed. What might my child be trying to cope with?"

How Inside Out can support children and adolescents

At Inside Out Counselling & Wellness Practice in Singapore, we support children and adolescents experiencing a range of emotional, behavioural and relationship difficulties.

Some young people are able to tell us clearly what is troubling them. Others may communicate their distress through anxiety, withdrawal, irritability, changes in behaviour, difficulties at school, physical complaints or changes in their relationships.

Our approach is therefore to understand the young person as a whole, taking into consideration their developmental stage, emotional wellbeing, relationships, family circumstances, school environment and individual experiences.

Depending on the child's age and needs, counselling may help them:

• understand and express difficult emotions

• develop strategies for managing anxiety, low mood and stress

• strengthen emotional regulation and coping skills

• explore school, friendship and relationship difficulties

• work through experiences affecting confidence or self-esteem

• understand patterns of avoidance or withdrawal

• develop healthier ways of communicating their needs

For younger children, counselling may incorporate play, creative activities and other developmentally appropriate approaches. With adolescents, therapy can provide a confidential space to explore their experiences, relationships, pressures, identity and concerns.

Where appropriate, we also work with parents and caregivers, helping them better understand what may be happening beneath their child's behaviour and consider ways of supporting their emotional needs while maintaining appropriate boundaries.

When should parents consider counselling?

You do not necessarily have to wait until your child is in significant distress before asking for support.

If you have noticed persistent changes in your child's mood, behaviour, sleep, motivation, school engagement or relationships, it may be helpful to explore what is happening.

At Inside Out Counselling Wellness Practice, our practitioners provide child and adolescent counselling in Singapore, with in-person appointments available at our Bishan and Orchard locations. for concerns including anxiety, low mood, emotional regulation difficulties, school-related difficulties, trauma, OCD-related concerns, self-esteem and family or relationship difficulties.

Concerned about a change in your child or teenager?

You can contact Inside Out Counselling & Wellness Practice to discuss your concerns and which practitioner may be suitable for your child and family.

This article is for general educational purposes and is not intended to diagnose depression or replace an individual assessment by an appropriately qualified professional.

References

News article

Shafeeq, S. (2026, June 5). Boys and girls show different depressive symptoms tied to early brain development: ASTAR-led study*. The Straits Times.