1. New York Association of School Psychologists & New York State Office of Mental Health Present Depression in Young Children: A Workshop for Adults Who Care

2. The New York State Office of Mental Health has initiated the SPEAK public information campaign to raise awareness about suicide. The New York Association of School Psychologists is partnering with OMH to develop and present workshops on suicide prevention for children.

3. Workshop Overview  Understanding depression in young children  Fact versus fiction about depression and suicide  Risk and protective factors  Recognizing warning signs and taking action  Suicide prevention resources

4. Understanding Depression in Young Children

5. Facts about depression  Children of all ages can become depressed  Estimates suggest about 3% of preadolescents have depression  Rates of depression increase with age  Among children, boys and girls are equally affected by depression

6. Developmental Differences in Understanding Death & Suicide  Young children have difficulty understanding that death is not reversible  Young children tend to show regressive tendencies in their behavior  Young children tend to withdraw into play  Young children tend to act out what they are feeling, difficulty verbalizing feelings

7. Symptoms of depression  Persistent sadness, crying, or bad mood  Loss of interest in activities  Feelings of being worthless or guilty  Frequent thoughts about death

8. Symptoms of depression  Changes in appetite and/or weight  Difficulty sleeping OR excessive sleeping  Loss of energy OR physical agitation  Difficulty concentrating

9. How depression is expressed in children  Rather than sadness, children may have high levels of anger, irritability or hostility  Lack of interest in playing with friends or chronic boredom  Feelings of rejection or sensitivity to failure  Agitation may show up as frequent outbursts of shouting, crying, or complaining

10. How depression is expressed in children  Physical symptoms, such as headache, stomachache, or muscle aches are common  Concentration difficulties are common to both adults and children  Changes in weight are not as common, but children may lose their appetite.  Sleep problems can include difficulty falling asleep or waking at night due to bad dreams.

11. How depression is expressed in children  Poor school attendance may indicate lack of interest or lack of sleep  Death thoughts may take the form of bad dreams about dying or preoccupation with play that involves death  Some children are fearful that they are going die.

12. Fact or fiction? Children are too young to take their own lives. Children are too young to take their own lives.

13.  Young children can take their own lives. Suicides among children ages 10-14 are estimated at 1.5 deaths per 100,000 kids Suicides among children ages 10-14 are estimated at 1.5 deaths per 100,000 kids FICTION! THE FACT IS THAT:

14. Fact or fiction? Children plan out their suicides. Children plan out their suicides.

15. Children in elementary school can plan and carry out a suicide. Children in elementary school can plan and carry out a suicide. Fortunately, the younger the child, the more likely they are to choose a method that is not lethal. Fortunately, the younger the child, the more likely they are to choose a method that is not lethal. FACT:

16. Fact or fiction? Most children complete suicide Most children complete suicide by poisoning themselves. by poisoning themselves.

17.  Drug overdoses are the most common method of suicide attempts…  But guns are the most frequent method used to complete suicide (60% of deaths) FICTION!

18. Fact or fiction? Children’s suicides can be predicted based on prior behavior. Children’s suicides can be predicted based on prior behavior.

19. Most children’s suicides can be linked to upsetting events or circumstances in their lives. Most children’s suicides can be linked to upsetting events or circumstances in their lives. Thus we can monitor the reactions of children to such events to minimize risk of suicide. Thus we can monitor the reactions of children to such events to minimize risk of suicide. FACT :

20. Risk factors for suicide

21. Risk factors for major depression and suicide in children  History of child abuse or domestic violence  Family stresses, such as parental divorce or separation, or serious illness in the family.  Significant loss, such as death of a family member  Family history of depression or psychiatric disorders

22. Risk factors for major depression and suicide in children  Significant oppositional or conduct problems  History of aggressive and impulsive behaviors  Drug and alcohol use  Conflict with or punishment by parents

23. Protective factors

24. Protective factors to reduce the risk of children’s suicide  Good skills in solving problems of everyday living  Ability to handle anger appropriately  Strong connections to family, teachers, and community

25. Protective factors to reduce the risk of children’s suicide  Access to mental health services  Restricted access to lethal means of committing suicide  Religious and cultural taboos against suicide

26. Warning signs of possible suicide

27. Warning signs: The FACTS  Feelings  Actions  Change  Threats

28. Warning Signs: Feelings  Hopelessness (“It will never get any better”)  Helplessness (“No one cares about me”)  Overwhelming guilt, shame, and self-hatred  Persistent sadness or anger  Fear of losing control, going crazy, or hurting self or others

29. Warning Signs: Actions  Writing or drawing about death and dying  Cutting, biting, or scratching oneself  Talking about death  Withdrawal or isolation from family and friends  Agitation or restlessness  Reckless or risky behavior that endangers the child’s own safety or that of others

30. Warning Signs: Changes  Personality – more withdrawn, apathetic, indecisive or more talkative and boisterous  Sleep – insomnia, often with early waking  Eating- loss of appetite and weight drop  Self-Care - decline or regression in grooming  Sudden improvement after low mood

31. Warning Signs: Threats  Giving away possessions  Making out a will or talking about funeral arrangements  Indirect threats (“I won’t be around much longer”, “I want to go to heaven with daddy”)  Writing or telling another of plans for suicide  Suicide attempts, such as cutting wrists

32. What You Can Do: Listen  Be willing to listen, even to a child’s feelings that may upset or frighten you  Be direct and open in talking about depression and suicide  Don’t convey feelings of shock or surprise.  Be non-judgmental in your responses.  Parent’s perception of symptoms may be different than child’s

33. What You Can Do: Be Available  Seek out the suicidal child if another child shares information about threats.  Remind children they did the right thing to tell.  Make an immediate response your first priority  Don’t leave the child alone if he or she seems suicidal

34. What You Can Do: Take Action  Don’t agree to keep a secret  Offer hope that alternatives are available  Remove the means for lethal action, such a guns or stockpiled pills or poisons  Get help immediately from a mental health professional. Call 911 if the child is in danger.

35. Resources in your community regarding suicide Suicide Prevention Resource Center Suicide Prevention Resource Center www.sprc.org www.sprc.orgwww.sprc.org National Association of School Psychologists www.nasponline.org National Association of School Psychologists www.nasponline.org www.nasponline.org Centers for Disease Control Centers for Disease Control www.cdc.gov/ncipc/factsheets www.cdc.gov/ncipc/factsheetswww.cdc.gov/ncipc/factsheets