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Understanding depression, anxiety, bullying and suicide

You will find the answers to some of your questions from our most recent CHEO Connects session below. Stay tuned - we will be posting more next week. 

If one of the parents has been diagnosed with schizophrenia, should their child be assessed for it as well?

If a parent has schizophrenia, their child has a 1/10 chance of developing it at some point in their lifetime. They also have a higher risk of other problems such as anxiety or mood disorders. Whether or not a full psychiatric assessment is needed should be determined on a case by case basis. If the child is doing well, there may be no need. However, if some challenges or issues have been identified then it is important to seek help sooner rather than later. In the meantime, there is some evidence that if the child takes omega-3 supplements it may help prevent psychosis from developing in the future. 

My son spends a lot of time alone in his room playing video games. He says that it helps him deal with stress, but could it be depression? 

With limited information about your son, his preference to isolate himself and plays video games for long time to deal with his stress warrants further evaluation of depression by his family doctor. I also advise you to visit http://www.ementalhealth.ca/ for more information on depression

My children suffer from anxiety when they visit their father. How can I help them better deal with their stress during these visits?

If your children have anxiety during visits with their father, it would be important to try to explore what your children are anxious about. If it is simply that they are not used to the visits and it is a new experience, hopefully their anxiety will simply resolve over time. If however, the anxiety does not resolve on its own, it may suggest a more serious issue. You might ask your children, "How are the visits? What do you like about the visits with dad? What do you not like? What is stressful about the visits? etc…"

For more information, consider reading the CHEO Handout on SEPARATION / DIVORCE

How do you stop a teen from running away? 

If a teen is trying to run away, it suggests that somehow, the teenager is looking outside of the family in order to meet his/her needs. The fact that you are asking this question, implies that you are worried about your teen, and want your teen to turn back to the family, in order to meet his/her needs. It would be important to talk to your teenager, about what needs are being met by running away, and then finding healthier ways to have those needs met by the family. Even if your teen tells you something unhealthy, e.g. "I run away in order to do drugs with friends", there is still usually a healthy component, such as 'trying to help your teen meet his social needs' in a healthier way, etc… Universal things that all teens secretly want with their parents include regular 1:1 time with their parent, and for a parent to listen, accept, and validate how the teen feels, no matter what… If your teen can turn to you to meet those needs, your teen will eventually learn that parents can provide those needs far better than any peers or friends can.

For more information, consider reading, "HOLD ON TO YOUR KIDS", by Gord Neufeld

Can children have mood swings as a means of getting attention? When my child has a mood swing, I cannot tell if it is something I should be worried about or not.

A child may do any behaviour, including mood swings for attention. Most likely however, mood swings are not for attention, because there are simpler ways than having a mood swing. Nonetheless, let's assume a child is having a mood swing for attention. It is the case, that some children have high needs for attention. There is no solution however, other than to meet your child's need for attention. There are low and high yield ways however. Low yield ways would be spending time together, but while doing activities where you aren't really connected to your child, e.g. such as watching a movie togehter. High yield ways might include going for a walk with just you and your child, and during that time, your child is able to express his/her deep seated thoughts, feelings and worries, and have you empathize or validate those worries.

For more information, consider reading, "Peaceful Parent, Happy Kids", by Laura Markham. 

If a child asks you to ignore their mental health issues, including self-harm, because that is the only hope they have for feeling normal, what do you suggest a parent’s approach should be?

Review that as a parent you love them & want to support him/her the best they can with open lines of communication. Validate their need for “normality”, but as part of a parent’s job one can’t ignore self-harm/safety issues. Provide support & encouragement that there is no shame in seeking help, & that you will be there to support & respect their privacy while getting help. Kid/teens need boundaries & parents to take control & provide guidance when they fell unwell & having no control/direction, even if they express resistance to the same on the surface.

For more information, consider reading the CHEO Handout on SELF-HARM, as well as DEPRESSION, on either http://www.cheo.on.ca/controls/content/www.cheo.on.ca, or http://www.cheo.on.ca/controls/content/www.ementalhealth.ca

My child has developed a sudden habit of picking his fingernails and toenails at night. Despite wearing socks and mittens to bed, he still continues. How can I help him overcome this problem as I’m concerned it could persist into adulthood?

It is really good that you are concerned about your son picking his nails. I think this picking could well be a signal that he is stressed out and may have underlying anxiety. So, I would suggest the possible management of underlying stress‎ and anxiety be the focus for him and you and the nail picking then becomes his and your way of knowing how well he is dealing with his stress and anxiety. I would suggest he could ask for initial help from your Family Doctor, school guidance, or the mental health nurse in the school. They may suggest and connect you with other mental health professionals.

What advice do you have for parents of the bully?

Do not excuse the bullying as being normal behaviour. Bullying is often the first step to more serious problems such as skipping school, alcohol/drug use and even criminal activity. Inform the school and work together with them Increase supervision. Ask others about your child's behaviour, rather than waiting for someone else to report it. Talk with your child and make it clear that bullying behaviour is not tolerated. The child must learn that there is no excuse for bullying. He/she will only learn that if adults accept no excuse. If there is bullying, intervene immediately with appropriate, non-physical consequences, e.g., removal of privileges for a period of time.

How do you make a child listen when they never listen, no matter what the consequences?

This means that you are engaged in a power struggle and that your child has the impression that you never listen. Turn away from a strategy that does not work, and try to listen and problem solve with your child. You will find more on this Collaborative Problem Solving Approach on this website http://thinkkids.org/ and on this one http://www.livesinthebalance.org/

My child is very hard on himself despite maintaining excellent grades at school. We always encourage our children to do their best and assure them that that is good enough for us. What else can I do to address this issue?

It seems that your child is a perfectionist in his/her temperament. Statements such as doing your best is good enough, has a meaning to your child of being perfect (doing 100% or even more) . If your child only invests him/herself in academics he/she would benefit in diversifying his/her interests through multiple activities like sports, arts, volunteer work... A shift in the speech such as just have fun with your friends, or have fun at your piano lessons or enjoy learning something new, would help your child to decrease his/her high self-expectations.If your child becomes depressed or is having high levels of anxiety because he/she is disappointed with his/her academic grades he/she would need deeper assessment in order to rule out any mental health issues.

My child has no sense of belonging, either within our family, or at school. I don’t think I am treating him any different than his siblings, but I don’t know what else to do or say to him to convince him that he is wanted and belongs in our family.

Inviting your child to explain and give examples of his understanding of belonging in a family or school would be helpful to get a sense of his experience. It may take some time to fully understand what is fuelling your child’s perception. With an understanding of why your child may feel this way, you and your family will be able to collaborate with your child to develop strategies to help him feel that he is part of the family (and assist his teachers-school including him in the school community). Helping your child understand how his unique strengths are valued and appreciated by his family will contribute to his self-esteem. Having your child contribute to how he can develop a sense of belonging will engage him in the process.

How should I deal with my child’s mood swings? Should I push to find out the reason or leave him/her alone?

Mood swings means that a child is having troubles coping with one's moods, which could mean many different things. The best way to deal with your child's mood swings in the moment, while your child is having a mood swing, is to be with your child so that you can help your child 'self-regulate' or 'co-regulate' his/her mood swings, for example: "I can see you are very upset right now. I'm so sorry. I'm here… How can I be supportive? Do you want me to sit with you? If not, I'll give you some space and I'll be nearby and I'll check on you in a few minutes…" When the mood swing has passed, and your child is feeling better, it is important to find a time where you and your child can talk about what stresses your child is under. If your child is having mood swings, it indicates that your child is not able to manage his/her moods on their own, and it suggests that your child does require help and support from an adult to figure out the stress, and help with managing it. Leave your child alone, if s/he absolutely refuses your help during a mood swing, but when your child is calmer, hopefully your child will allow you to provide help and support.

How does marijuana use affect anxiety? What can you do when your see that your child uses marijuana and they have underlying anxiety issues?

Smoking marijuana can decrease anxiety and lead a person to feel more relaxed, happy and 'laid back'. Therefore, people with anxiety (as well as other mental illnesses, such as depression) are at increased risk for abusing marijuana. Occasionally, for a few people, instead of having a calming effect, marijuana can have the opposite effect and can cause panic attacks, paranoia and even psychosis (eg. hallucinations).

However, marijuana should not be used to treat anxiety because, like alcohol, while it feels good in the moment, it has some more negative long-term effects (not counting the effects on the lungs), including memory loss and cognitive impairment, and lack of motivation. Marijuana also affects brain development (adolescent brains are still developing), and when it is used heavily by young people, its effects on thinking and memory may even be permanent, resulting in difficulties learning and retaining information.

You can start by arming yourself with information. There are many good websites for this, such as the National Institute for Drug Abuse in Bethesda, Maryland (www.nida.nih.gov) or the Centre for Addiction and Mental Health in Toronto, Ontario (www.camh.net).People can use alcohol and drugs for different reasons. It’s easier to help someone with alcohol and drug use if you figure out their reasons for using because then you can 1) agree with them on their reason (i.e. their goal) for using (which helps form trust with them), and 2) then find a healthier way to get to that same goal.When talking to your teen about substance use, keep in mind that many adults are aware that they have habits that are not healthy, but this doesn’t change their behavior.Lecturing them doesn’t seem to change their behavior.

Research shows that the best way to change behavior such as this is through “motivational interviewing,” which involves helping the person to explore their own values and goals and to consider the pros and cons of their ‘bad habit’ in a neutral, caring environment, with the goal of increasing their motivation to quit. Rewards for success can be very helpful, as can encouragement and praise. A counselor or therapist can help both to treat underlying anxiety and to improve motivation to stop using drugs. Parents can help by showing they care, giving support, and getting treatment, both for any underlying anxiety disorders (and depression) and for the drug use.

Is medical marijuana ever a consideration for the treatment of anxiety or depression for teens?

No although I’ve had teens request this at times. Marijuana use often reflects an attempt to “self-medicate” the anxiety or depression but is associated with other issues including drug dependency. It is also associated with bringing on psychotic symptoms (e.g., hallucinations) in those who have a vulnerability to these types of disorders. Cognitive behavioural therapy with or without medication is generally the treatment of choice for depression and anxiety

What should primary schools (jk-6th grade) be doing to assist in educating children about bullying? When incidents occur, what programs are in place to deal with the situation?

When we talk about educating our children about bullying I am assuming we are really talking about helping children become a part of the solution to the bullying that goes on in their schools.

It will be important for students to learn that they can have a say and an impact on the school culture. This begins by ensuring that schools have a clear strategy around promoting safe, responsible and respectful behaviour among its students. Clear messages about bullying, what it is and the school’s stance on it, is important and should be communicated to the student body. The school should help organize bystanders to bullying so that they don’t feel alone when deciding what to do as a witness to bullying.

Identifying bullies and helping to redirect their desires for power and control into more prosocial roles of leadership is more effective than trying to strong arm them into giving up power and control.

For children that are targeted by bullies, building resilience is important. Helping them includes working on their presentation style, helping them practice reactions to teasing and developing their friendship skills and network.

All students should know how to report bullying and the school will need to consider how it can convince students that they will not simply react but will work with students to help foster a safer learning environment.

In terms of what programs are in place, it will be important to check with each individual school and get a copy of their plan. There is not one single plan that all school follow.

What can you tell us about ODD (Oppositional Defiant Disorder) and Autism as a co-morbidity?

In order to understand why children with an Autism Spectrum Disorder (ASD) might also be labelled as having Oppositional Defiant Disorder (ODD) it is important to understand some of the characteristics of these conditions.

ODD is characterized by a pattern of behaviour that tends to be angry in nature, argumentative, defiant and/or vindictive. It is a diagnosis that pretends to be an answer but instead only tends to describes behaviour without bringing us closer to knowing what it is all about. If a child has a pattern of being noncompliant, resentful and/or blaming it begs the question…Why?

Individuals with an Autism Spectrum Disorder are more likely to have difficulty understanding the nuances of their social world. They tend to struggle with social-emotional reciprocity, have difficulty with nonverbal cues and can be quite literal in their interpretations of the things said to them.

As a result, children with ASD may at times have a difficult time understanding what is being asked of them.

When an individual with ASD appears to be noncompliant or oppositional it is important to explore whether that person understood what was being asked of him/her. While this is a consideration I would suggest for any child, children with ASD are more likely to misinterpret social communications and are therefore at a greater risk of being mistakenly labeled with ODD.

How does one differentiate between clinical depression and drug induced dependency?

Depression and substance abuse can often co-exist, and drug use can reflect a youth’s attempt to self-medicate their depression. While historically, therapists would sometimes decline to treat a depression until the substance abuse was dealt with, we now understand that the most effective intervention involves addressing both “co-morbid” disorders simultaneously. 

My child has been diagnosed with anxiety and depression and is seeing a counsellor. How so I know if it’s a situational or chemical imbalance?

If your child is comfortable with this, then you could speak directly with her/his counsellor to get a sense of what is contributing to the anxiety. But trying to differentiate between something that is “situational” versus a “chemical imbalance” probably reflects an artificial dichotomy. Any anxiety we experience has an impact on the chemicals in our brain, perhaps most obvious with the release of adrenaline in response to extremely stressful experiences. Studies suggest that cognitive behavioural therapy (a kind of talk therapy) can be effective on its own for mild depression and anxiety, while moderate to severe depression often responds best to a combination of medication and therapy. Discussing whether medication is appropriate is something that is best discussed with your child’s physician.

How do I help my kids with their anxiety at home and at school?

To begin with, your connection with your kids will be the most important relationship they have, and should remain most important, even as they continue through adolescence when friends can compete for their attention and energy (note, it’s normal for peers to become increasingly important at this time, but friendships should never be more important than parents’ involvement). Staying connected involves an ongoing commitment of time and energy (and is helped with everyone putting down their technology devices on a regular basis), but your kids being secure in this connection will be invaluable in their efforts to deal with anxiety. Regular family meal times, board games, physical activity (which will assist their management of some anxiety symptoms), and just travelling in the car “unplugged” can all help with the parent-youth connection.

Talking about mental health is also important. Avoidance is associated with increased anxiety, so we do have to support children to confront their fears. Avoiding talking about the anxiety itself can compound a child or youth’s difficulty, contributing to any sense of stigma that is often associated with mental illness.

Finally, modelling your own positive coping can also help your kids deal with their fears. If they see that you can talk about things that make you anxious, but also how you’re willing to confront (rather than avoid) the sources of stress, they are more likely to adopt similarly positive coping strategies. At school, you can advocate for your children by contacting the school psychologist or social worker – while these professionals often have a long waiting list, they are generally available for consultation and can advise school staff on how best to accommodate an anxious student.

Is anxiety an extension of a child's personality trait or merely an under-developed coping ability?

Yes. Anxiety can come from many places. We know that anxiety runs in families and that some individuals are just more likely to struggle to manage anxiety than others. The good news however, is that anxiety is one of the most treatable mental health conditions and this is likely due to the fact that they are both uncomfortable and energizing. This is a combination that results in people that are motivated to change and have the energy to do so. Relaxation skills, problem-solving approaches and cognitive-behaviour therapy are just some of the non-medicinal approaches that have a strong and empirically supported track record in the treatment of these conditions.

My 16 year old daughter plays competitive volleyball and feels a lot of pressure from her coaches and father. It makes her very anxious. How can she cope?

Competitive sports are by nature filled with pressure. In order to best answer this question one would have to determine what your daughter wants. If she doesn’t really want to be in competitive sports any more than it will be important to discuss her exit strategy, how to tell her father and coaches and teammates. The difficult thing about competitive sports is that it comes along with a strong social network making it difficult to leave the sport because of the social cost.

If your daughter wants to remain in competitive sports than there are a few things she will need to do. 1) Accept the notion that pressure will be a part of the experience. However, it is important to communicate with her father about the added pressures she is experiencing from him and how it is impacting her overall stress level and their relationship with each other. 2) It will be important for parents to be involved in the process and ensure that your child is being treated appropriately. 3) Depending on the approachability of the coach it may be helpful for your daughter to approach her coach and express her concerns. 4) If the pressure being experienced is related to balancing school, social, leisure and the sport, then it will be important to consult the schedule that exists in every family that has a child in competitive sports. It is always important to ensure that our children are not going beyond what they can handle and that they have enough diversity in their lives so that should something happen that makes competitive sports untenable, they have a fall-back plan in place. 5) Learning about relaxation skills, problem-solving approaches and other anxiety management tools is always helpful in managing one’s personal experience of anxiety. '

My young teenage son/daughter suffers from severe mental health problems stemming from childhood abuse but refuses to accept help for them. This is beginning to affect his/her school and social life. How can I help them?

Generally speaking you cannot force any one to have an assessment or therapy. As the parent you could use gentle persuasion. A relative he or she is comfortable with could also try gentle persuasion. You could let the individual know what your observation is as to how he or she is being affected and that you are ready to help whenever he or she is ready.

Can you talk about the research connecting diet (ie. gluten, dairy, etc.) to aggressive and/or withdrawn behaviour in children with autism and/or schizophrenia?

There is active research looking into the question of whether gluten and casein play a role in autism and schizophrenia. The research in autism is inconclusive, so that there is not enough evidence to recommend a gluten free diet. In the study of schizophrenia, there are some researchers looking at subsets of individuals with the condition who have significant improvement in symptoms when a gluten free diet is introduced. In these patients, antibodies to wheat and gluten appear to be higher in serum concentration, but the clear mechanisms of effect remain unknown.

How do you address self-esteem issues in a problematic child?

As a start I would recommend reviewing the American Psychological Association’s information on resilience in children and youth at www.apa.org/helpcenter/resilience.aspx


 

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