Working with the sad child: tearfulness, sadness and depression in primary aged children

If you ask parents what they most want for their child, many will say something like this:  “I just want my child to be happy”.  Whilst most of them know, at a logical level, that they can’t make this happen, seeing their children frequently or deeply sad, is very confronting.

This is true for us as professionals too.  While we may be quite used to supporting and working with children who are anxious, frequently frustrated and disappointed, and know the steps to take in helping children manage these other emotions, there is something additionally challenging about working with a child who appears frequently or deeply sad.   

It is also challenging to work with parents of these children.  Often parents who have children who experience frequent or strong sadness themselves feel helpless, frustrated, worried – and like a failure at some very deep level.   Sometimes they express their pain in being particularly demanding towards us.  This then leads to even more pressure for us as professionals to “do something”!

However, the truth is - it is not uncommon for children to experience times of sadness.   Although only about 2-3% of prepubertal children will experience the type and extent of sadness psychologists will diagnose as a formal depressive disorder, many more children experience slightly less severe – but still persistent and frequent – sadness at some point during their childhood.

Which children experience frequent and persistent sad moods – and when?

Children are more likely to experience sad moods when they are dealing with tough life circumstances.  For example, children who are managing family separation, grief, physical illness, learning problems, family poverty, family ill health or other tough life situations are more likely to experience frequent sadness.  Indigenous children are also more likely to experience frequent sad moods, probably partly because there are higher rates of this population dealing with the above “tough life circumstances”.   Older children are more likely to experience sadness than younger children. 

Children are also more likely to experience sad and hopeless moods if they have a biological tendency towards psychological and emotional sensitivity.   Although psychologists might refer to this as high levels of neuroticism, I like to call these children, “kids with big feelings”.  These children experience strong reactions to life, feel things deeply and think about life deeply.  Sometimes they are clever, creative and socially and emotionally sensitive.  These “kids with big feelings” are more prone to experiencing times of sadness too. 

The perfect storm therefore is an older (8 plus years) child, biologically prone to “big feelings” who is experiencing one or more tough life circumstances.  These are the children we see quite often in our clinics and are probably the ones who turn up in your rooms/you see crying in your classrooms too.

What does persistent sadness look like in children? 

Here’s an example of what this kind of sadness might look like in the life of a child.

Justin*, aged 9, came to see me after his parents had separated.  His parents told me they were worried about him and also frustrated by his behavior in the past few months.  They said he was always irritable and angry with his younger siblings, would cry “at the drop of a hat”, was always saying he was “tired”, had asked to drop out of his (previously enjoyed) soccer team and had begun to sit alone and recess and lunch time, despite being asked to play with his friends.  When I spoke to Justin, he said to me he doesn’t have many friends and that he doesn’t like soccer anymore.  He said he misses his Dad when he lives at his Mum’s house, and misses his Mum when he lives at Dad’s house.  He also said he feels like “school is stupid”, and that he feels sad and angry a lot but he doesn’t really know why.  His eyes filled with tears while talking with me in the session, and I was soon to discover that this would happen each session for some time. 

Justin’s story is typical of a child who is experiencing frequent sad moods.  As you can see, these kids will be less interested in socializing, find life more effortful, will be less interested in being physical active or doing enjoyable activities and will be more likely to cry more often.  They may be irritable about everything, and complain about pain or fatigue.  They may appear to have low self esteem and say things like “I’m no good”.  Some children may even talk about death “I’d rather be dead”, “there is no point to life” and “I wish I’d never been born”.  They may choose to do assignments or projects on subjects related to death.

Parents with children who are experiencing this are likely to feel helpless and worried.  It is also likely that they feel frustrated and angry with their sad child at least on some occasion, because their patience and empathy has worn thin.  Parents of children like this may also express frustration and anger towards others.  I’ve talked with parents who feel angry with their child’s peers, teachers, other parent – and feel like they are not helping.  They might know deep down it’s not these individual’s fault their child is sad – but they are hurting, and looking for someone to blame. 

Justin’s parents felt helpless.  They had tried to encourage Justin to “think positively” and they’d try to cheer him up.  They’d also frequently been frustrated with him and shouted at times, particularly when Justin had acted in particularly irritable and angry ways with his siblings.   They also expressed frustration with Justin’s peer group who they felt were not being kind, they had also felt the school hadn’t managed some bullying which had occurred in the previous year. 

What should professionals working with sad children do?

1.      First the obvious - be empathic.   When you are working with or having a conversation with a child who is obviously sad, start by recognising the sadness.  Say “I’m sorry you are feeling sad at the moment”.   

2.      If you can, look at them and sit with them for a minute.  Stop and notice how this feels to you, this “not fixing it” and sit with this feeling in yourself for a moment too.

3.      Try to be patient with the child.  Remember the child can’t “make themselves” be positive or happy.   You may have tried really hard with this child, and still see negativity and sadness – this is when we need to draw upon all our reserves of patience and empathy!

4.      If you have time and permission, investigate specific “sad time triggers”.  Although children will sometimes be sad “for no reason”, it is more often that there are at least some situations, thoughts or events which do trigger or cause sadness.  Even for children where there is an obvious and larger source of sadness (ie grief, family problems etc) see if you can find more specific and more immediate sources of sadness.  Use chronological cartoon box drawings (in this box you were feeling okay, but in this box you were feeling sad – let’s draw what happened in the middle box – who was there, what was in your head) or “pick a box” strategies (here are 5 things which might make kids feel sad, pick one that you think happened then) to elicit these.

5.      When you know specific or immediate triggers, help the child problem solve about how these can be managed differently (or avoided).   

6.      If you have a strong relationship with the child, and have the time available – help the child understand that their negative thoughts about their mood, the world and themselves, are not necessarily 100% true.  I teach children that our brains are designed to focus on problems when we feel sad or worried.  I explain that our brains will subconsciously “block out” positive memories, interactions, people and events when we are feeling bad.  This isn’t their fault – it’s just something brains do.  But this doesn’t mean the positive parts of life are not there – they are just being “blocked”.

7.      Again, if you have time, and permission - help the child to notice when they felt good or interested or absorbed in something.  I have an activity sheet I use with children called “positive parts of my day” (you can make one yourself).  Ask children to fill something like this in, or just answer some questions about what was positive for them that day (Who was kind to you?  What was a little bit interesting?  What made you smile?).  It’s important to make sure we don’t minimize sadness in the process of helping children notice the positives, but provided we have a strong relationship with children and have been empathic then it’s possible to do this sensitively. 

8.      Keep working on increasing social connection – it is very difficult to reduce sadness in children if they are socially isolated and have no positive source of friendship.  Even if there are other obvious and larger sadness triggers (ie grief, family separation, learning problems, health problems) – increasing social connection will help children feel less sad as they deal with them.

9.      Keep working on helping the child finding sources of self esteem and meaning.  Children (like adults) need to feel they are good at something, or that there is something interesting and important for them to do. 

10.   If possible, help parents work on physical activity, sleep and nutrition.  Sadness eases when children are more physically fit and active, get enough sleep and eat well.  If we are working with parents, it’s important to help them look at these areas.

11.   If you have time and the right relationship/role - explicitly teach children ways to cope with periods of sadness.  Help them make a list of “busy brain” activities so that when they are sad they do not withdraw or ruminate for long.  Help them use words to tell people about their sadness rather than get angry or cry.  Help them identify a problem which triggers their sadness and see if they can come up with potential steps to manage it.

12.   Where appropriate suggest the family get support from other professionals.  If you are a psychologist/ allied health therapist working with the child, consider asking the family to alert and get support from the teacher.  If you are a teacher or other professional, consider asking the family to get support from a counsellor or child psychologist.  A GP may also be a good source of support as there are sometimes physical health related reasons for frequent sadness.  A team of individuals supporting a sad child will often see more results than us working individually.

How to work with parents of sad children

How to work with parents will depend on the relationship we have with them and our role. 

However at a minimum, it’s important to recognize parental distress and worry.  Say something like: “I’m sorry she/he is having such a hard time.” and “I’m sure that must be hard”.  We should try to understand that any frustration they might express to us may simply be a result of their own pain and worry about their child.

Ask the parents directly if they have any thoughts, requests or ideas about how to help.  Parents often won’t tell us their opinion, what they’d like us to do or their ideas – because they believe that we are the “professionals”.   This means we are working partly in the dark.  These days I start almost every session with questions:  “Is there anything else you’d like me to know today” and “Is there anything in particular you’d like me to do?”

It can also be useful, in the right context, to help parents understand that their child – even while sad – is having some positive moments during their day. I will talk with parents about the fact that even children who are frequently sad, have many moments each day of being absorbed in a task, enjoying an activity for a moment or to have some periods of time when they are looking forward to something.  Sometimes I ask children (in front of parents) to talk about the positives aspects of their day, or show the parents the “positives” sheet we have worked on in session.

However, I know that this will backfire unless those parents know for sure I care about their child’s sadness and know that I’m not minimizing their distress.  So I’m careful about when and how I help parents to notice the happy moments their child has.

I also find it is important to express hope to parents about their child’s sadness.  I tell them that persistent and long lasting depression in childhood is extremely rare.  I explain that the chances are excellent that their child will feel less sad, less often at some point in the near future.  I tell them that their child will adjust to difficult life events, grief will resolve, they will have a change in peer group, they will find an activity or part of life which feels meaningful and interesting for them, or life will change for them in some other way. 

Even if the sources of sadness do not change significantly, they are likely to learn to think about life and cope with life in ways which make sadness less frequent.

I also talk with parents about how they can help their sad child.

Parents often feel helpless when their attempts to help their sad child don’t seem to help.  They feel like there is nothing they can do.  This is not true.  I go through a number of actions parents can take – I won’t go into these here in this article, but they are very similar to those I’ve listed above for us as professionals.  For a full list of these, you can click here to read the parent version of this article (as always, please feel free to give this to/distribute to parents if this is helpful).

Finally, I encourage parents to look after themselves. 

Supporting children who are frequently sad is an extremely challenging, sad and stressful experience for parents and we should not under-estimate the toll it may be taking on parents.  We should encourage (again, depending on our role) parents to talk to others, get professional support, take breaks from parenting or do whatever else works for them in looking after themselves.

Best wishes in this important work

Kirrilie

If you have a child in your therapy room/classroom who is frequently sad or negative about life, we have a short animation for 5 to 11 year olds called “Sadness, and ideas to manage it” in our Calm Kid Central program.  There is also an activity sheet for children about noticing the positive aspects of their day and their life which children can use to help track positives.  To get access to the video and worksheet, click here.