Depression and anxiety in children

1. Depression and anxiety in children Presenters: Clinical Psychologists Melissa Theobald Rowena Micha Psychological Solutions

2. Anxiety and Depression are on the Increase • Anxiety and depression are occurring more and more in primary aged children • It is estimated that 1 in 10 children are considered to have ‘clinical’ or ‘diagnosable’ problems with anxiety and depression. • Most children who experience depression have some anxiety at the same time.

3. Risk Factors for Anxiety and Depression • Research indicates that there are three main causes of anxiety and depression in children. • Genetics • Learning • Environmental Stressors

4. Risk Factor- Genetics • Emotional sensitivity – seems to be genetically based (some children are simply born more sensitive). • These children can be more prone to developing anxiety and depression. • Children of parents who have a history of depression and anxiety may be more at risk of developing it themselves.

5. Risk Factors - Learned • Kids who are anxious and depressed may have learned to expect that the world is a dangerous place • This can be from observing parents or friends i.e. if a mother reacts with intense fear when she sees a spider, it is likely that her child will also fear spiders. • Anxiety - can be learned from a bad experience i.e. being bitten by a dog or being in a car accident. • Depression – can be learned following a series of stressful events – especially if there is little time to recover between events • Negative body image can lead to depression in adolescence

6. Risk Factors - Environmental Stressors • Interactions with others can encourage negative emotions in children – i.e. chronic bullying • Parents/cares can become over protective – a child can learn that they need to be protected and they are not capable of handling things • Ongoing conflict with family or peers can lead to depression and anxiety in children

7. Some Things that are Stressful for Children • Disability – their own, another child or parent • Parents separation or divorce • If their parents are ill • A new baby being born • If parents see their child as “difficult” • Too many changes in a child’s life e.g. schools, where they live and who cares for them. Not all children who experience these events will become anxious or depressed

8. Anxiety - Normal Fears for Children • 6-9 months – fear of separating from parents or fear of strangers • Toddler – fear of monsters, insects, the dark and water • Middle to late childhood- children become more self aware and worry about fitting in – this increases in the following years and peaks in adolescence

9. When is Anxiety a Problem? • Some fears become more intense and more extensive than others. Anxiety is a problem if; • It interferes with functioning or cause difficulties for your child. • The fear stops your child from doing things they would enjoy – like making friends • Your child’s worrying is affecting their academic or sporting functioning.

10. What does Anxiety in Children Look Like? When children are anxious they notice it in three ways First it is noticed in the mental processes or thoughts children have –their thoughts/worries center around some type of danger or threat Secondly- physically – when a child becomes anxious their body is ‘pumped up’. Increase heart rate, breathing, stomach aches, headaches, diarrhea, sweating and tiredness Thirdly – it affects children’s behaviour. They may freeze, fidget, pace, cry, cling or shake. It usually involves avoidance of feared situation.

11. What does Depression in Children Look like Symptoms of depression can vary for children Sometimes can be “masked depression” which is evidenced by acting out or angry behaviour (occurs more in younger children) Can also look like sadness / low mood – much like in adults

12. Indicators of Depression in Children • Irritability or anger • Continuous feelings of sadness or hopelessness • Social withdrawal • Increased sensitivity to rejection • Changes in appetite -- either increased or decreased • Changes in sleep – either increased or decreased • Vocal outbursts or crying • Fatigue /low energy • Physical complaints (headaches, stomach aches) that do not respond to treatment • Reduced ability to function at school or social settings • Feelings of worthlessness or guilt • Thoughts of death or suicide

13. Depression in Children Not all children have all these symptoms and some children will still function reasonably well Some will suffer noticeable changes in; • Social activities (withdrawing more) • Poor academic performance (change in performance) • Loss of interest in school and other things • Sometimes a change in appearance (lack of hygiene or self care)

14. Depression in Children Suicidal thoughts are relatively rare in children under 12 years They can occur (in children with serious depression) and need to be taken seriously, assessed and managed appropriately with professional help

15. What is Normal for all Children? It is important to remember that all children (and adults) have sad times and stressful periods i.e. after a loss or during times of change i.e. going to high school. It is when these feelings persist over a long period that we consider Depression

16. Parent Strategies to Prevent Depression/Anxiety • Create structure and routine at home – children respond well to knowing what their day looks like and what is expected (helps to reduce anxiety) • Develop realistic and achievable expectations for your children. Help your children know what the expectations are – clear communication • Keep extra activities balanced – not every afternoon needs to be full of extra activities as can create extra pressure. • Communicate regularly with your children – stay in touch with them, their interests and their friends • Provide opportunities for success – find your child’s strengths and interests and encourage your child to engage in these

17. Parent strategies to prevent Depression/Anxiety • Protect your child from adult problems • Ensure your child feels secure and wanted • Promote a sense of belonging and importance in the family • Special responsibilities/chores • Encourage children to be involved in family decisions/discussions • Create family traditions

18. Parent strategies to prevent Depression/Anxiety • Promote healthy self esteem – lots of praise and recognition for who they are, choices they make and other successes • Encourage social contact to develop healthy friendships • Encourage healthy lifestyle – some activity and good nutrition. This also assists with development of positive body image. • Be aware of amount of screen time – whilst not linked to depression or anxiety has been linked with increased anger and frustration

19. Parent strategies to prevent depression/anxiety • Give approval and encouragement for trying something new • Provide opportunity for your child to do things they are good at – this helps to build strong self esteem • Start to teach your child how to solve their own problems – promote some independence – ask them what they think they can do to fix the problem

20. Parent Strategies to prevent Depression/Anxiety Attention and Praise • The most powerful way to influence your child’s behaviour – pay attention to your child when you notice positive coping behaviour and spending time when things are calm • Give regular praise to reinforce appropriate behaviours – make the praise clear, concrete and specific

21. What to do to support your Anxious/Depressed child… Listen to your child • Let them talk without interruption • Give them your full attention • Try to pick up on what they may be feeling • Avoid judgments Empathise with your child • Try to understand the world from your child’s point of view – remember your were a child once too

22. What you can do to help… • Provide support and check in with your child regularly about how they are feeling and coping • Ask your child what they think will help them through • It might involve problem solving any stressful situations that the child may be experiencing • It might be helpful (with your child’s input) to talk with their teacher about their anxiety or depression so the school can support them also

23. And more ….. Positive Communication • Communicate with your child in a positive way - If your child feels unsure, communicate to them that you understand how they feel and that they are safe • try to be as reassuring as you can. Stay Calm • When your child is uncomfortable – Seeing you anxious or worried can make your child feel more nervous or guilty. • If your child is anxious - Try not to rush to save them if he or she is not really in danger. This will actually impair their self-esteem, preventing them from overcoming fears on their own.

24. More things you can do …… Help your child to problem solve. • Talk with your child about the fears or concerns • Come up with solutions prior to the activity that they are apprehensive about. i.e. if she is nervous about attending a party where she doesn't know anyone, suggest things she can do to get through it, such as ways to strike up a conversation or introduce herself to someone new. • Teach your child calming techniques, such as deep breathing or progressive muscle relaxation.

25. And More …. Take Baby Steps • Expose your child to anxiety-causing situations in small doses and build up to the ultimate goal if you can. E.g. if your little one is scared of large groups of kids, invite just a few over to play, then join a group at the park, slowing building up to larger groups. E.g. If he is reluctant to try horseback riding, let him approach the horse on the other side of the fence first, then go up to pet or brush the horse, then sit in the saddle without moving. Eventually, his comfort level will improve.

26. More you can do…. Lead by Example • To help your child overcome fears, let him see you try new things, and communicate that even you feel scared sometimes but you keep going anyway. • Or tell a story about a time you experienced fear but overcame it. Courage does not mean that you have no fear. It means proceeding in the face of fear. • Or model – relaxing or taking time out as children need to learn balance

27. More you can do…… Be Patient • Overcoming anxiety and depression can take considerable time and effort – try not to show your frustrations • Try to aim for a balance between encouragement and not ‘pushing’ your child • Have realistic expectations – remember your child may have good and bad days Respect and Accept • Believe your child – try not to dismiss their feelings • Accept that your child is experiencing difficulty – ignorance and denial can negatively affect long term outcomes

28. When to Seek Help If you are worried about your child’s symptoms i.e. they do not improve or continue to negatively affect their functioning then it might be time to seek help • See your GP • Referral to see a Psychologist or trained professional • Or call us at Psychological Solutions on 6360 3551