FASD and Depression. Depression

Transcription

1 FASD and Depression Jacqueline Pei, R.Psych., Ph.D. Depression Depression is a serious mood disorder that can take the joy from a child s life. 1

2 Depression Depression isn't just bad moods and occasional melancholy. It's not just feeling down or sad, either. These feelings are normal in children, especially during the teen years. Depression Even when major disappointments and setbacks make people feel sad and angry, the negative feelings usually lessen with time. 2

3 Depression But when a depressive state, or mood, lingers for a long time weeks, months, or even longer and limits a child's ability to function normally, it can be diagnosed as depression. Depression More than mood alone the entire system is depressed 3

4 Depression Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. Still, many children don't get the treatment they need. Depression The lack of treatment is partly because it can be hard to tell the difference between depression and normal moodiness or other disabilities such as ODD and ADHD. Also, depression may not look the same in a child as in an adult. 4

5 Types of Depression Types of depression include: major depression Dysthymia adjustment disorder with depressed mood seasonal affective disorder bipolar disorder or manic depression All of these can affect children. Symptoms of Major Depression A child may be depressed if he or she has five or more of the following symptoms for more than 2 weeks: is grumpy, sad, or bored most of the time does not take pleasure in things (s)he used to enjoy a lack of energy, feeling unable to do the simplest task a lack of desire to be with friends or family members feelings of irritability, anger, or anxiety weight loss or gain sleeping too much or too little feeling hopeless, worthless, or guilty having trouble concentrating, thinking, or making decisions thinking about death or suicide a lot 5

6 Dysthymia Dysthymia may be diagnosed if the sadness is not as severe but continues for a year or longer. Children with dysthymia often feel down in the dumps. Unlike major depression, dysthymia does not severely interfere with day-to-day functioning but the down mood is a pervasive part of the child s world. Symptoms of Dysthymia A child who has dysthymia must experience two or more of the following symptoms almost all the time for at least 1 year: feelings of hopelessness low self-esteem sleeping too much or being unable to sleep extreme fatigue difficulty concentrating lack of appetite or overeating 6

7 Age Factors in Depression The symptoms may be different depending on how old the child is. Very young children: may lack energy and become withdrawn may show little emotion seem to feel hopeless have trouble sleeping Age Factors in Depression Grade school children: may have a lot of headaches or stomachaches may lose interest in friends and activities that they once liked may, in some children with severe depression, see or hear things that aren't there (hallucinate) or have false beliefs (delusions) 7

8 Age Factors in Depression Teens: may sleep a lot or move or speak more slowly than usual may become very agitated may hallucinate or have delusions if they have severe depression Causes of Depression Depression usually isn't caused by one event or thing; it's typically the result of one or more factors, and its causes vary from child to child. altered levels of neurotransmitters (chemicals that carry signals through the nervous system) in the brain can limit a person's ability to feel good Depression can run in families, so a child who has a close relative with depression may be more likely to experience it 8

9 Causes of Depression Significant life events such as the death of a loved one Stress also can be a factor, e.g. environmental factors and trauma chronic illness can contribute to depression, as can the side effects of certain medicines or infections. Secondary Disabilities Depressed kids and teens are more likely to use alcohol and drugs than those who aren't depressed. Because these substances can momentarily allow a child to forget about the depression, they seem like perfect fixes. But they don't fix anything; in fact, they can ultimately make the depressed child feel even worse. 9

10 Treatment of Depression Depression can be treated with psychotherapy, medicine, or a combination of therapy and medicine. A psychiatrist can prescribe medicine, and although it may take a few tries to find the right drug for your child, most people who follow their prescribed regimen eventually begin to feel better. Treatment of Depression Psychotherapy focuses on the causes of the depression and works to help change negative thoughts and find ways to allow your child to feel better. Feeling is healing, and talking about feelings can be a powerful antidote for depression. A good therapist will communicate this to your child. 10

11 Treatment of Depression cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Comprehensive treatment often includes both individual and family therapy FASD refers to individuals who may have physical, mental, behavioral, and/or learning disabilities as a result of maternal alcohol consumption (Chudley et al., 2005) 11

12 FASD Includes diagnoses of: Fetal Alcohol Syndrome (FAS) Fetal Alcohol Effect (FAE) Alcohol-Related Neurodevelopmental Disorder (ARND) among others What is FASD? Brain injury to the developing brain Caused by alcohol exposure in utero May look different in different individuals A consistent pattern of inconsistencies A lot of study has been conducted to evaluate cognitive abilities in FASD - but mental health outcomes are less well studied 12

13 FASD and Mental Health: the existing research Emotional difficulties in this population may result from the interaction of many factors: CNS damage, genetic factors, and adverse postnatal experiences. (Streissguth and O Malley, 2000; Auti-Ramo, 2000) Biopsychosocial interaction FASD and Mental Health: the existing research A high percentage of individuals with FASD have been described as meeting the criteria for a psychiatric disorder, with the majority exhibiting symptoms of mood disorder (61%) (O Conner et al., 2002), particularly for girls (O Conner et al., 2001). 13

14 FASD and Mental Health: the existing research 1996 study by Streissguth revealed that 94% of the sample experienced mental health problems according to caregiver reports Other similar studies have documented this pattern of high rates of mental health problems, particularly depression and other mood disorders in children and adults with FASD FASD and Mental Health: the existing research Study by Fryer et al. (2008): 39 children with heavy prenatal alcohol exposure were compared to 30 control children Interviews were conducted with caregivers and the children Children with FASD had higher rates of ADHD, ODD, and depressive disorders Emphasized that the impairments associated with alcohol teratogenesis are not limited to disruptive behaviour 14

15 FASD and Mental Health: the existing research Study by Fryer et al. (2008): Internalizing nature of depressive disorders may be more difficult to recognize than externalizing behaviour problems. Data underscores the need for special services, such as assessment for individuals with prenatal alcohol exposure Limitations: small sample size, clinically referred population, failure to match for family placement More research needed! FASD and Mental Health: caution interpreting the research A sample is just that, a sample - does not mean it is predictive/descriptive of the whole population Other factors need to be considered: what supports were in place, what brought them into the sample, what other explanations could produced the results we are seeing This means we need to keep doing the research to enhance our understanding, and remain critical thinkers 15

16 FASD and Mental Health: food for thought Risk/Protective factors: Genetics? Awareness of disabilities? The unique pattern of disability in an individual will impact their experience of and likelihood of developing a depressive disorder. It is a complex neurodevelopment disorder that does not play itself out the same way in every child. Environmental stressors? Amount of stability in their life. FASD and Mental Health: food for thought Secondary Disabilities: Substance abuse Suicide Criminal behaviour - accidental due to self medication patterns Transience, homelessness, marginalization - contribute to and make worse any unstable mental health 16

17 FASD and Mental Health: what do we do? Know and understand the unique needs of the individual Support systems that look at multi-dimensional factors - NOT cognitive alone, or criminal alone, or mental health alone Medication may be effective FASD and Mental Health: what do we do? Awareness of cognitive and language functioning when considering treatment options such as counselling. As such traditional counselling options do not work well. Instead developmentally appropriate interventions e.g. play therapy, action oriented therapies (e.g. art, drama, phototherapy), cultural connections. Uniquely plan for the unique child Realistic expectations - preventative approaches (eg. Structure, appropriate schooling, opportunities for success) 17

18 FASD and Depression Jacqueline Pei, R.Psych., Ph.D. 18