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MOOD AND ANXIETY DISORDERS IN CHILDREN Dr. Marjorie Robb Assistant Professor, UOttawa Children’s Hospital of Eastern Ontario.

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Presentation on theme: "MOOD AND ANXIETY DISORDERS IN CHILDREN Dr. Marjorie Robb Assistant Professor, UOttawa Children’s Hospital of Eastern Ontario."— Presentation transcript:

1 MOOD AND ANXIETY DISORDERS IN CHILDREN Dr. Marjorie Robb Assistant Professor, UOttawa Children’s Hospital of Eastern Ontario

2 Some troubling statistics At least 20% of children under age 18 have significant mental health problems 75% of those don’t get help

3 ANXIETY IN CHILDREN

4 Jesse Is 8 years old. He has a great family, lives in the country, and likes to play outside. Jesse has a learning disability and has a hard time in school Around age 7 ½ he started to worry a lot: Will there be enough time to play? Will there be enough time to do my homework? I won’t be able to do this homework. I don’t want mom to go out at night. He also started to complain of headaches and stomachaches quite a lot. Parents say he is so anxious he doesn’t enjoy much.

5 Taylor Taylor is 7. She does well at school and has friends there. At home she has started to be afraid to eat – she fears the food will make her sick She especially refuses to eat anything her older brother has touched because “he’s gross” She is afraid to go to sleep because she might get sick Bedtime takes a very long time She has frequent meltdowns when things “don’t go right” She seems very tired and unhappy much of the time She is not gaining weight as she should

6 Cecelia Cecelia is 9. She has developed a fear of germs She won’t use the washroom at school or at the mall She doesn’t want her parents to have visitors or to let friends drive in their car (because they bring in germs). She has to wash her hands for a long time and frequently She insists that her family wash their hands whenever anyone comes in from outside and has a meltdown if they don’t After visitors leave she sprays disinfectant on the furniture

7 Anxiety Disorders Anxiety disorders are the most common mental health disorders Many anxiety disorders start in childhood and if untreated, they may persist into adulthood Children may have more than one kind of anxiety disorder Up to 6% of children and youth have an anxiety disorder severe enough to need treatment

8 Why do children get anxiety disorders? Often there is a family (genetic) tendency to anxiety Children who live with too much stress can become anxious Stress can be in family, school or neighborhood Anxious parents can model anxious behaviour for children

9 Kinds of Childhood Anxiety Disorders Separation anxiety Social phobia Generalized anxiety disorder Selective mutism Obsessive Compulsive Disorder Panic Disorder Phobias Post Traumatic Stress Disorder

10 Separation Anxiety Disorder Child is afraid of leaving their parent(s) They may worry that something bad will happen to the parent or to someone they love or to themselves May refuse to go to school May have stomachaches, headaches, or throw up if they fear separation May refuse to go to playdates at other people’s houses Diagnosed if it causes problems at school or socially and has been going on at least 4 weeks

11 Generalized Anxiety Disorder Children with this kind of anxiety may: Have lots of worries and fears Have problems sleeping because of worries Have trouble concentrating Get tired easily or have tension headaches Be tense or restless Be perfectionist Have an anxious desire for approval

12 Obsessive-Compulsive Disorder OCD often begins in early childhood or adolescence. Children with this kind of anxiety may: Have frequent uncontrollable thoughts (obsessions) Usually they don’t like these thoughts, or they may think they don’t make sense Perform certain behaviours or rituals to try and prevent something bad from happening (or to get rid of thoughts) Examples are: handwashing a lot if there is a fear of germs; checking that doors are locked; special touching rituals

13 Panic Disorder Happens less often with younger children People with this kind of anxiety have panic attacks Feel very scared Heart pounding, hard to breathe May feel shaky, dizzy, or sick May feel like they are going crazy or something really awful is going to happen Sometimes they avoid school or want to stay in the house Frequent panic attacks = panic disorder

14 Selective Mutism Children may not talk to anyone who is not close to them, such as immediate family They may look down, withdraw, turn red if required to talk Often they whisper if they do speak in a situation where they are anxious Up to 2% of school age children may have these symptoms Some kids outgrow it; some go on to have social phobia

15 Social Anxiety/Social Phobia Happens more in teens than in young children Fear and worry about social situations Going to school Speaking in class Social events including recess and lunch Shy, self-conscious Easily embarrassed These kids tend to be sensitive to criticism and find it hard to be assertive

16 Post Traumatic Stress Disorder Symptoms start after a physical or emotional trauma or very frightening event Can be marked by several of Behavioural changes Repetitive play Zoning out, numbing of feelings Jumpiness and watchfulness of surroundings Nightmares and sleep problems “Flashbacks” Not very common in young children

17 Anxiety disorders - What to watch for: Avoidance of school (refuses to go) Frequent stomachaches or headaches in the morning before school Avoidance of activities Easily upset – distress out of proportion You spend a lot of time comforting your child and/or urging her/him to participate in regular activities You feel that your family functioning is being disrupted by your child's fears and worries, or meltdowns

18 What you can do: Be patient, calm and reassuring Be positive about their ability to manage the situation (with support) Help your child succeed by doing “small steps” Reward and praise your child’s efforts as well as successes Be a model for your child – manage your own anxieties Help your child “avoid avoidance” with planned gradual exposure to things they fear Teach your child positive self-talk

19 What you can do: Teach your child basic relaxation strategies such as belly breathing and muscle relaxation Teach your child to visualize or imagine a pleasant, relaxing “happy place” Keep stress low at home. Avoid parental conflict when the children are present. Be calm and positive as much as possible. Deal with external situations that require adult intervention, such as bullying Healthy living: enough sleep, regular routines, balanced diet, exercise Take time to have fun and relax with your child

20 Don’t: Criticize or yell at your child Tease or make fun of your child for anxiety Ignore the problem or wait for the child to get over it Tell the child to “toughen up” Pressure your child to do more than s/he can do Have unrealistic expectations Make it easy for your child to avoid anything that scares them

21 Treatment of anxiety If your child is having significant problems with school, missing a lot of school, or having other problems functioning, you should talk to your doctor Anxiety disorders can be treated! The most common treatment is cognitive behaviour therapy (CBT) in groups or individually In CBT children learn relaxation and stress management plus Gradual exposure to things that make them anxious, to decrease the fear Coping strategies to reduce anxiety CBT is first choice, but medication may be needed in severe situations

22 DEPRESSION IN CHILDREN

23 Tyler Tyler is a 9 year old boy who lives with his mom and sees his dad every second weekend His parents have been in a bitter custody battle He has trouble getting to sleep and is always tired in the morning He still plays with his friends, but doesn’t seem to enjoy himself as much as he used to; he wants to quit hockey He is angry and cranky with mom much of the time and he has meltdowns over small things Sometimes he falls asleep in school; he can’t concentrate and his marks have gone down

24 Emily Emily is 8 and lives with mom, dad and 2 brothers Recently she has started to complain of stomachaches often in the morning She sometimes says “I’m stupid” or “I’m ugly” She cries at night and sometimes says “I wish I wasn’t here” She plays with her dolls by herself and doesn’t want to go outside after school When frustrated she will sometimes hit herself on the head She says other kids are mean to her

25 Depression Depression is common: in Canada and US about 1 in 5 children will go through a depression before finishing high school 4 – 8 of 100 children have a major depression at any point in time Symptoms include: Feeling sad, irritable or angry Not enjoying life, school or activities as much Trouble coping with home, school or work Feeling hopeless or worthless Problems with sleep, appetite, energy and concentration

26 What causes depression? Family history (genetics) Stress, including: Conflict between parents, or with parents or siblings Depression or too much stress in parents Separation or divorce of parents Conflicts with friends or classmates, Social stress School stress – not doing well, or too much pressure Bullying Loss of someone important

27 What should you do if you think your child is depressed? Take your child to your family doctor or pediatrician The doctor can check for medical problems that could be causing the changes in behaviour She/he may suggest mental health services (psychologist, counselor, social worker, psychiatrist) IF YOU ARE WORRIED YOUR CHILD MAY HURT HIMSELF/HERSELF, TAKE IMMEDIATE ACTION Call your doctor, the crisis line or the emergency department

28 Can depression be treated? YES Young children are most often treated with their family. Working with parents to help them help their child Family therapy if family problems are part of the problem Therapy: by a counselor, psychologist or psychiatrist Cognitive Behavioural Therapy is proved to be very effective The child learns ways to manage stress, do things that help her feel better, and think more positively Medication Only used when other treatments don’t work, or when the depression is so severe that other treatments aren’t possible Antidepressants are safe and effective when used correctly and monitored by a doctor

29 Remember the basics!! Get enough sleep Eat healthy meals and snacks Take vitamin D supplements and consider omega 3 fatty acids Get exercise – an hour a day if possible. Get enough sunlight (in winter, vitamin D supplements) Plan enjoyable activities and one on one time with your child Parents need to take care of themselves too!

30 What else can parents do? Listen actively to your child. Let them know you notice something is wrong. Don’t overly pressure the child to talk, but make sure that you do talk Help the child problem-solve ways to deal with stresses Step in as the parent when stresses are beyond the child’s ability to handle Speak to the school if there is school stress or if the depression is affecting how your child does at school Maintain an atmosphere of calm and consistency at home Protect time for fun activities together

31 Don’t Blame or criticize your child for symptoms of depression Tell your child to “just get over it” or “just snap out of it” Get into power struggles. Help your child have a sense of control by giving choices whenever possible. Remove all expectations and let the child miss a lot of school, not get up in the morning, play video games for hours Make home stressful by fighting, yelling, criticizing, etc. Dismiss or belittle the child’s problems

32 Putting it all together:

33 Red Flags to Watch For Feeling sad or depressed for more than 2 weeks Increase in irritability and anger Drastic changes in behaviour or personality Expressions of wanting to die or plans to harm him/herself Severe mood swings affecting ability to function Intense worries or fears that interfere with daily activities Sudden overwhelming fear for no reason, often with difficulty breathing and racing or pounding heart Decline in school performance Wanting to avoid school

34 What to do if you are worried Talk (and listen) to your child Keep a calm and positive attitude Problem-solve with your child Look for resources on-line or in books Teach your child positive self-talk and self- encouragement Teach your child deep breathing and relaxation skills Identify what is stressing your child and address it Intervene on child’s behalf when appropriate Call your doctor. Consider calling the school counselor. Be aware of resources in your area

35 And what not to do: Ignore the problem Expect your child to “just snap out of it” Blame your child for the problem. These are medical problems and cause changes in the brain. Keep it a secret. Anxiety and depression are very common problems. Everyone gets hurt when they stay in the shadows. Let your own anxiety or depression weigh down your child

36 If your child is being treated by a professional Take a matter-of-fact approach, as you would if they had a broken leg Ask what resources you should read or look at Ask what you can do to help Communicate with the professional Remember you and your child are the most important members of the treatment team!

37 Prevention – There’s lots you can do Make the home environment as calm and consistent as possible Establish a regular routine: mealtimes, playtime, homework time etc. Eat meals together as a family. Avoid negative talk at meals. Enough sleep Balanced meals and not too much junk food Have frequent one-on-one time with your child Make fun and enjoyable activities frequent and regular Limit video game, computer and TV time 7-9 year olds are too young for cell phones and Facebook

38 Relationship Matters Because Relationships Protect GO PLACES with your child: Give many more positive comments than negative ones. One on one time: have fun, laugh, do something you both enjoy, play cards – make it a positive zone. Positive active responses whenever possible Listen more than you speak, validate the primary emotion Assert yourself calmly Connection before correction Emotional banking: everything you do counts Stick to your values but consider all points of view

39 Resources www.ementalhealth.ca Provides information about mental health disorders, recommendations for books and videos, and details about where to look for help www.anxietybc.com Good information about self-help which parents can adapt for kids www.caringforkids.cps.ca/behaviourparenting/Fears.htm From the Canadian Pediatric Society http://www.cmho.org http://www.knowledge.offordcentre.com/ Information on a range of mental health problems

40 Question Time


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