Laurie Harrison PhD School Psychologist Snohomish School District Seattle Hill Elementary AIM High School Parent Partnership Transition Program ReEntry Program Snohomish School District ID: 776033
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Slide1
Anxiety, Depression & Suicide Prevention
Laurie Harrison, Ph.D.
School Psychologist
Snohomish School District
Seattle Hill Elementary, AIM High School, Parent Partnership,
Transition Program,
ReEntry
Program
Slide2Snohomish School District
https://www.sno.wednet.edu/
Slide3Anxiety
Anxiety is one of the most common experiences of children and adults.
It is a normal, adaptive reaction, because it creates a level of arousal and alertness to danger.
The primary characteristic of anxiety is worry, which is fear that future events will have negative outcomes.
Anxious children are much more likely than their peers to see minor events as potentially threatening. For example, giving a brief oral report might be slightly anxiety-producing for most children, but the anxious child is much more likely to believe that his or her performance will be a complete disaster.
Slide4Anxiety
Anxious children are likely to engage in a variety of avoidance behaviors to reduce exposure to threat.
In the classroom, they may be withdrawn, not initiate interactions, select easy over difficult tasks, and avoid situations where they anticipate increased risk for failure.
Socially, they may feel uncomfortable in new situations, not initiate conversations, or avoid group interactions.
They worry about being evaluated socially and fear that others will view them negatively.
Slide5Anxiety
Although there may be some basis for worry, it is usually out of proportion to the situation and is unrealistic.
Either a real or imagined threat may be enough to trigger an anxiety reaction.
Slide6Defining Anxiety:
From early childhood through adolescence, anxiety can be a normal reaction to stressful situations.
Infancy and Preschool
Anxiety first appears at about 7–8 months of age as stranger anxiety, when an infant becomes distressed in the presence of strangers. At about 12–15 months of age, toddlers show separation anxiety when parents are not nearby. Both of these reactions are typical and indicate that development is progressing as expected. In general, severe stranger and separation anxiety dissipate by the end of the second year of life. Anxiety at this age is primarily associated with fears of strangers, new situations, animals, the dark, loud noises, falling, and injury
Slide7Defining Anxiety
School Age
Up to about age 8, many causes of anxiety continue from preschool levels with a focus on specific, identifiable events. With age, sources of anxiety become more social and abstract, such as worrying about friends, social acceptance, the future, and coping with a move to a new school.
Adolescents tend to become more worried about sexual, religious, and moral issues as they continue to develop. In the vast majority of cases, children and adolescents cope well with these situations and severe or chronic anxiety is not common.
Slide8Emotions
Emotions manifest themselves outwardly in visible changes to the body, such as muscle contractions, blood vessel dilations, and facial expressions.
Powerful emotions can deeply carve events into memory, alter behavior and physical health, contribute to good or bad decision making, and even cause a person to be literally scared to death.
Slide9Signs of Anxiety: Cognitive
Concentration problems
Memory problems
Attention problems
Problem-solving difficulties
Worry
Slide10Signs of Anxiety: Behavioral
RestlessnessFidgetingTask avoidanceRapid speechIrritability
Withdrawal
Perfectionism
Lack of participation
Failing to complete tasks
Seeking easy tasks
Slide11Signs of Anxiety: Physical
Stomach discomfortRapid heart rateFlushing of the skinPerspiration
Headaches
Muscle tension
Sleeping problems
Nausea
Slide12Mistakes Adults Make That Can Trigger Anxiety
Unexpected Triggers
You are a smart person you can figure it out.Everyone else workingHow many times do I have to tell you…Why do you always…
Child's Interpretation
If I can’t figure it out I must be stupid.
I’m worthless
What is wrong with me
I will never be a good student
My parent hates me
Slide13Universal Facial Expressions
Psychological research has classified six facial expressions which correspond to distinct universal emotions: disgust, sadness, happiness, fear, anger, surprise. It is interesting to note that four out of the six are negative emotions.
Slide14Universal Facial Expressions
Happiness
Fear
Slide15Universal Facial Expressions
Sadness
Surprise
Slide16Universal Facial Expressions
Anger
Disgust
Slide17Emotional imitation and contagion
We begin to recognize emotions in others at an early age and copy what we see. Imitation helps create the parent-child bond during the first months of a child’s life. This urge to mimic the emotional behavior of others, called emotional contagion, continues throughout life. When you look at another’s facial expression, you often take on the aspects of that expression yourself. The brain perceives an emotion in the face of another and automatically signals its own emotional circuits.
Slide18Negative Emotions
Bad news sticks longer in memory than good news, and unpleasant encounters affect the brain more powerfully than pleasant ones. Fear, anxiety, and anger prepare the body for fight of flight.
Anger and fear are quick to ignite.
Once triggered can take up 30 to 40 minutes to relax.
Slide19Strategies to Support Children with Anxiety
Be consistent in how you handle problems and administer discipline.
Be patient and be prepared to listen.
Avoid being overly critical, disparaging, impatient, or cynical.
Maintain realistic, attainable goals and expectations for your child.
Do not communicate that perfection is expected or acceptable.
Maintain consistent but flexible routines for homework, chores, activities, etc.
Slide20Strategies to Support Children with Anxiety
Accept that mistakes are a normal part of growing up and that no one is expected to do everything equally well.
Praise and reinforce effort, even if success is less than expected. Practice and rehearse upcoming events, such as giving a speech or other performance.
Teach your child simple strategies to help with anxiety, such as organizing materials and time, developing small scripts of what to do and say to himself or herself when anxiety increases, and learning how to relax under stressful conditions.
Slide21Strategies to Support Children with Anxiety
Do not treat feelings, questions, and statements about feeling anxious as silly or unimportant.
Often, reasoning is not effective in reducing anxiety. Do not criticize your child for not being able to respond to rational approaches.
Seek outside help if the problem persists and continues to interfere with daily activities.
Slide22Depression
Depression is one of the most common yet
underidentified
mental health problems of childhood and adolescence.
Left unidentified and untreated, depression can have pervasive and long-term effects on social, personal, and academic performance.
When school personnel know how to identify and intervene with children who have depression, they can provide them with opportunities for effective support.
Slide23Depression
Depression is not easily recognized or may be mistaken as another problem, such as lack of motivation.
Although severe depression might be displayed in symptoms such as suicide attempts, severe withdrawal, or emotional swings, the vast majority of cases are much milder and do not attract attention from adults.
Moreover, children and adolescents are not as likely as adults to refer themselves for mental health problems.
Slide24Characteristics of Depression
Children and adolescents can demonstrate depression in cognitive, behavioral, and physiological behaviors or patterns. Although not all children will show all signs, or the signs may vary in frequency, intensity, and duration at different times, a persistent pattern over a relatively long time is likely to be associated with a variety of personal, social, and academic problems.
Many of these symptoms could easily be mistaken for behavior problems associated with academic or social difficulties, such as apathy, low performance, or uncooperativeness. It is important for school personnel to know the signs so that early identification and intervention can occur.
Slide25Signs of Depression: Cognitive
“All or none” thinkingCatastrophizingMemory ProblemsConcentration ProblemsAttention ProblemsExternal locus of controlNegative view of self, world, and futureAutomatic Thinking
Negative affect
Feelings of helplessness
Feelings of hopelessness
Low self-esteem
Difficulty making decisions
Feels loss of control
Suicidal Thoughts
Negative attributional style
Slide26Behavioral Characteristics of Depression
Depressed MoodSocial WithdrawalDoes not participate in usual activitiesShows limited effortDecline in self-care or personal appearanceDecreased work or school performance
Appears detached from others
Crying for no apparent reason
Inappropriate responses to events
Irritability
Apathy
Uncooperative
Suicide Attempts
Slide27Physical Characteristics of Depression
Psychomotor agitation or retardationSomatic complaintsPoor appetite or over eating
Insomnia or
hypersominia
Low energy or fatigue
Slide28Prevalence and Development of Depression in Children and Adolescents
Depression in preadolescent children is rather rare, occurring in about 1.5% of children.
Depression in preschool children is very rare, with a prevalence rate of less than 1% of the population.
In younger children depression is more likely to be displayed as high levels of stress, noncompliance, and irritability.
Symptoms shown in late childhood and adolescence, which are more similar to those of adults.
Slide29Development of Depression
In the early elementary years, prevalence rates for boys and girls are about equal, but as adolescence nears, girls are more likely to show depression than boys. The overall rate of depression in adolescent girls versus boys is about 2:1 to 3:1.
Reasons for these differences are many, including hormonal differences, impact of different social stressors, variations in gender expectations, and coping methods.
Slide30Development of Depression
Most often, the approximate onset of depressive disorders is at about 11 to 14 years. Depression may have a long-term course, persisting over several weeks, months, or years, or it may be a recent onset, such as in trauma.
Most major depressive episodes last about seven to nine months, although 6–10% of cases may persist for several months to a few years. If one considers that up to 10% of adolescents have significant depression, about three students in a class of 30 would be affected, with two of them being girls.
Slide31Risk Factors
The causes of depression are multiple and complex.
Some people have a greater likelihood of developing it, such as those who have first-degree relatives with depression (e.g., a parent).
Those who live in highly stressful and demanding environments.
Those who have experienced a traumatic event (e.g., loss of a loved one). Children with disabilities, such as learning problems or medical problems, are also more vulnerable to developing depression.
Slide32Risk Factors
Sudden onset often is associated with a recent environmental stressor or change in medical or physical status.
Children who perceive that others do not view them as competent are more likely to develop depression. If teachers and peers view a student as not being academically or socially capable, the risk for depression increases.
Similarly, schools can be stressful places for children who are not successful, which puts them at increased risk for depression.
Slide33Coexisting Conditions
Depression is associated with other conditions seen in children and youth. For example, approximately 50% of children with depression also have problems with anxiety.
Depression also co-occurs with attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, and substance abuse problems in 17% to 79% of cases.
Therefore, some acting out problems may receive more attention, with less consideration of the possibility of depression.
Slide34Strategies to Support Children with Depression
The list of suggestions follows the most frequently cited symptoms of childhood depression.
Self-esteem and self-critical tendencies: give frequent and genuine praise; accentuate the positive; supportively challenge self-criticism; point out negative thinking.
Family stability: maintain routine and minimize changes in family matters; discuss changes beforehand and reduce worry.
Helplessness and hopelessness: have the child write or tell immediate feelings and any pleasant aspects 3 or 4 times a day to increase pleasant thoughts over 4 - 6 weeks.
Slide35Strategies to Support Children with Depression
Mood elevation: arrange one interesting activity a day; plan for special events to come; discuss enjoyable topics.
Appetite and weight problems: don’t force eating; prepare favorite foods; make meal-time a pleasant occasion.
Sleep difficulties: keep regular bedtime hours; do relaxing and calming activities one hour before bedtime such as reading or listening to soft music; end the day on a “positive note.”
Slide36Strategies to support students with Depression
Agitation and restlessness: change activities causing agitation; teach the child to relax; massage may help; encourage physical exercise and recreation activities.
Excessive fears: minimize anxiety-causing situations and uncertainty; be supportive and reassuring; planning may reduce uncertainty, relaxation exercises might help.
Aggression and anger: encourage the child to discuss his angry feelings; do not react with anger; provide an acceptable avenue for acting out behavior.
Slide37Strategies to support students with Depression
Concentration and thinking difficulties: encourage increased participation in games, activities, discussions; work with the teachers and school psychologist to promote learning.
Suicidal thoughts: be aware of the warning signs of suicide; immediately seek professional help.
If depression persists: consult your family doctor for a referral to a psychologist or psychiatrist.
Slide38Suicide Prevention
Suicide is the second leading cause of death among school age youth. However,
suicide is preventable
.
Youth who are contemplating suicide frequently give warning signs of their distress.
Parents, teachers, and friends are in a key position to pick up on these signs and get help.
Most important is to never take these warning signs lightly or promise to keep them secret.
Slide39Suicide Risk Factors
Although far from perfect predictors, certain characteristics are associated with increased odd of having suicidal thoughts. These include:
Mental illness including depression, conduct disorders, and substance abuse.
Family stress/dysfunction.
Environmental risks, including presence of a firearm in the home.
Situational crises (e.g., traumatic death of a loved one, physical or sexual abuse, family violence)
Slide40Suicide Warning Signs
Most suicidal youth demonstrate observable behaviors that signal their suicidal thinking. These include:
Suicidal threats in the form of direct ("I am going to kill myself") and indirect ("I wish I could fall asleep and never wake up again") statements.
Suicide notes and plans (including online postings).
Prior suicidal behavior.
Slide41Suicide Warning Signs
Most suicidal youth demonstrate observable behaviors that signal their suicidal thinking. These include:
Making final arrangements (e.g., making funeral arrangements, writing a will, giving away prized possessions).
Preoccupation with death.
Changes in behavior, appearance, thoughts and/or feelings.
Slide42What To Do If You have Concerns Your Child is Considering Suicide
Youth who feel suicidal are not likely to seek help directly; however, parents, school personnel, and peers can recognize the warning signs and take immediate action to keep the youth safe. When a youth gives signs that they may be considering suicide, the following actions should be taken:
Remain calm.
Ask the youth directly if he or she is thinking about suicide (e.g., "Are you thinking of suicide?").
Slide43What To Do If You have Concerns Your Child is Considering Suicide
Focus on your concern for their well-being and avoid being accusatory.
Listen.
Reassure them that there is help and they will not feel like this forever.
Do not judge.
Provide constant supervision. Do not leave the youth alone.
Slide44What To Do If You have Concerns Your Child is Considering Suicide
Remove means for self-harm
Get Help
: No one should ever agree to keep a youth's suicidal thoughts a secret. Parents should seek help from school or community mental health resources as soon as possible.
Snohomish School District has a protocol to support youth at risk for suicide.
Slide45Resiliency Factors
The presence of resiliency factors can lessen the potential of risk factors to lead to suicidal ideation and behaviors. Once a child or adolescent is considered at risk, schools, families, and friends should work to build these factors in and around the youth. These include:
Family support and cohesion, including good communication.
Peer support and close social networks.
School and community connectedness.
Slide46Resiliency Factors
Cultural or religious beliefs that discourage suicide and promote healthy living.
Adaptive coping and problem-solving skills, including conflict-resolution.
General life satisfaction, good self-esteem, sense of purpose.
Easy access to effective medical and mental health resources.
Slide47References
https
://www.nasponline.org/resources-and-publications/resources/mental-health/mental-health-disorders/anxiety-and-anxiety-disorders-in-children-information-for-parents
© 2015, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814; (301) 657-0270, Fax (301) 657-0275;
www.nasponline.org
Slide48References
Huberty
, T. J. (2008). Best practices in school-based interventions for anxiety and depression. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology V (pp. 1473–1486). Bethesda, MD: National Association of School Psychologists.
Helping Children at Home and School III. Handouts for Families and Educators (NASP 2010).
Snohomish School District: Resources and Suicide Crisis Prevention and Response Handbook
- https://www.sno.wednet.edu/site/Default.aspx?PageID=3979
https://people.ece.cornell.edu/land/OldStudentProjects/cs490-95to96/HJKIM/emotions.html
Slide49References
http://ejop.psychopen.eu/article/download/241/pdf
https://www.nasponline.org/resources-and-publications/resources/school-safety-and-crisis/preventing-youth-suicide/preventing-youth-suicide-tips-for-parents-and-educators
https://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are?language=en