Mental Health is. A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

Transcription

1 1 Mental Health is A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity World Health Organization

2 The Wisdom of the Elders Consider the interest of the next 7 generations when decisions are being made

3 Human Milk Banking Association of N America Las Vegas 2012

4 Mental Health Exists on a Continuum 4

5 Some troubling statistics At least 20% of children under age 18 have significant mental health problems 75% of those don t get help

6 ANXIETY IN CHILDREN

7 Does any of this sound like your child or teen? Clinging, crying and/or tantrums when you separate Excessive shyness, avoiding social situations Constant worry Avoiding situations or places because of fears Complaints of frequent stomachaches or headaches Experiencing sudden and frequent panic attacks If you answered yes to any of these statements your child may be experiencing anxiety.

8 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.

9 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

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11 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

12 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

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

14 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

15 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

16 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

17 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

18 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

19 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

20 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

21 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

22 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

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24 Centre on the Developing Child at Harvard University

25 Stress..don t go NUTS Novelty, Unpredictability, Threat to the ego, Sense of loss of control Dr Sonia Lupien Centre for Studies on HumanStress

26 The Fear Response: Fight or Flight and Stress Visual Thalamus Visual Cortex Amygdala Scientific American The Hidden Mind, 2002, Volume 12, Number 1

27 Sympathetic Nervous System Physiologic arousal FIGHT/FLIGHT/FRIGHT Signal danger Enhance alertness Prepare body for action

28 Anxiety and the Brain

29 Anxiety involves Our Body racing heart, tight chest, sore muscles, tummy-aches, headaches, nausea, dizziness etc. Our thoughts (attention to threat, catastrophic misinterpretations, negative thinking, worries) Our Actions (Avoidance, reassurance seeking, clinging, repeated checking, crying, emotional outburst, freezing, not talking)

30 When is it a problem? No Danger Brain Registers DANGER! ANXIETY Nose Ears Sensory Perception Taste Touch Eyes Initiation of Physiologic Cascade Thoughts Internal Signals Emotions Physical Heart Rate Alertness Perception Tension

31 Cortisol & Brain Development Cortisol affects the parts of the brain that: regulate stress store memory are involved in planning and executing complex functions are involved in language

32 Emotional Stimulus Amygdala Cortisol Hypothalamus PVN CRF ACTH PIT Adrenal Cortex Hippocampus Cortisol LeDoux, Synaptic Self

33 Amygdala and Hippocampus

34 Centre on the Developing Child at Harvard University Toxic Stress Changes Brain Architecture Normal Typical neuron many connections Toxic stress Damaged neuron fewer connections Prefrontal Cortex and Hippocampus Sources: Radley et al. (2004) Bock et al. (2005)

35 3 TIMES THAT CHILDREN WORRY Anticipation Experiencing the Feared Event Rumination

36 Some core underlying fears Fear of harm to self or others Fear of being alone/apart from primary Fear of losing control or going crazy Fear of being responsible for something terrible Fear of embarassement Fear of being judge Fear of being imperfect MUST FACE CORE FEARS TO GET OVER. SEE I DID SURVIVE THE WORST DIDN T HAPPEN. I DIDNT LIKE IT, BUT I CAN Bear it

37 HOW IS ANXIETY MAINTAINED? Self-talk or automatic thoughts Avoidant behavior Inappropriate response to a fearful event

38 38 The Good News Proven strategies and supports Psychosocial and pharmacological treatments are most common, and are often used together While many mental disorders are chronic, we can help with coping Early identification and intervention improves prognosis

39 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

40 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

41 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

42 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

43 Putting it all together:

44 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 selfencouragement 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

45 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

46 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!

47 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

48 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

49 Resources Provides information about mental health disorders, recommendations for books and videos, and details about where to look for help Good information about self-help which parents can adapt for kids From the Canadian Pediatric Society Information on a range of mental health problems