We all have our anxious moments or times when we are depressed. It’s normal to feel these emotions when we are in stressful situations. In children, anxiety and depression can manifest differently than it does in adults. We often see more dramatic signs of frustration, irritability, and even anger. Kids might be restless, withdraw socially, or lose their appetite.
Usually these conditions go away once conditions improve. For many children, however, anxiety or depression can drag on and on. It may get worse over time and might even start to interfere with their school life, social relationships, or daily activities. When it reaches this point, it is likely that the child has an anxiety or mood disorder that requires treatment from a child psychologist. Be assured that these conditions are highly treatable.
Traditionally, children who are undergoing treatment for anxiety or depression will see their therapist once or twice a week for 30-60 minute sessions. These sessions often continue for three to four months, but could go on much longer depending on the severity of the child’s disorder. However, a relatively new concept in psychotherapy, called intensive outpatient therapy, is showing promise for helping kids get better faster.
Intensive outpatient therapy is focused therapy that is given over longer treatment sessions. For example, intensive treatment might be concentrated into daily, three-hour sessions given five days in a row over a two to four week period.
Just as with a regular psychotherapy session, intensive treatment uses methods like cognitive behavior therapy CBT, mindfulness, and exposure response and prevention (ERP). The idea behind the intensive sessions is to teach strategies to decrease the child’s symptoms and provide support, but to do it within a framework that allows them to live at home and continue school and family activities.
An intensive outpatient therapy program includes:
Although intensive therapy is fairly new, research is showing that it is just as beneficial as long term therapy or in-patient centered therapy. A 2012 study of adults by Ritschel, Cheavens, and Nelson at the Emory University School of Medicine reported that, “Depression and anxiety scores decreased significantly and hope scores increased significantly over the course of treatment.“
Children who have anxiety and depression make similar advances when they undergo intensive outpatient therapy. These gains are long-lasting, just as they are for traditional treatment.
Intensive therapy involves parents as well as children. During treatment, family meetings are held so that parents can better understand the therapy process and learn how to best support their child.
Additionally, children may interact with other kids so they can see that others are going through similar challenges. This is also an opportunity for them to relate to children their own age in a way they may not be able to with their peers or siblings who don’t face the same concerns.
If you are looking for an intensive program for your child, be sure that whichever one you choose utilizes therapists who have been highly trained in treating anxiety and depression in children and teens.
Also, you want the program to be individualized to your child. They should feel a connection with the therapist. The therapist should work with your child to develop a plan specifically for their needs in order to maximize the outcome of their treatment.
Sometimes a child struggles with depression or anxiety symptoms while still being able to function in their daily life. At other times, they may need more focused therapy and support. Intensive outpatient treatment would work for both children. Intensive therapy can also provide rapid and effective management in someone with severe symptoms who has taken time away from school for their recovery.
To be most effective, children who participate in intensive therapy should:
Learning coping skills and effective management of symptoms may continue on and off during a child’s life. Sometimes kids need a “booster” even after intensive therapy, but trusting that the psychotherapists and treatment will help can aid in quickly reducing and managing moderate to severe anxiety and depression.
For more information about our upcoming intensive outpatient therapy sessions for children and teens, talk to the professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.
If your child is hungry, be wary of letting them reach for the chips or soda – junk foods could affect their mood. In fact, recent studies are showing that food and mental health are more closely linked than we realize.
Felice Jacka, president of the International Society for Nutritional Psychiatry Research reports that, “a very large body of evidence now exists that suggests diet is as important to mental health as it is to physical health. A healthy diet is protective and an unhealthy diet is a risk factor for depression and anxiety.”
In the U. S., mental health conditions are more common than you might think.The Centers for Disease Control and Prevention (CDC) estimates that around 50 percent of Americans will be diagnosed with a mental health condition some time during their lives. They report that, as of 2018, “mental illnesses, such as depression, are the third most common cause of hospitalization in the United States for those aged 18-44 years old.”
These alarming statistics, coupled with the fact that the Western diet is often filled with junk food, made scientists wonder if there was a connection between the two. Could it be that nutrition affects the brain as much as it does the body? To find out, researchers began to look into the relationship between food and mental health about a decade ago.
Drew Ramsey, MD, an assistant clinical professor at Columbia University reports that the last ten years of study has shown that, “the risk of depression increases about 80% when you compare teens with the lowest-quality diet, or what we call the Western diet, to those who eat a higher-quality, whole-foods diet.” He also points out that, “the risk of attention-deficit disorder (ADD) doubles.”
Because they are seeing that nutrition can play a role in mental health, researchers are now even thinking that food allergies might affect bipolar disorder and schizophrenia.
Most of the recent studies have revolved around the connection between a healthy diet and anxiety and depression. Although direct evidence linking food and mental health has not been found yet, there are trials in progress to prove it.
Meanwhile, we do know that a healthy diet affects brain health by:
We now know that a nutrient-rich diet creates changes in brain proteins that improves the connections between brain cells. But diets that are high in refined sugars and saturated fats have been shown to have a “very potent negative impact on brain proteins,” Jacka says.
Moreover, we know that a high sugar, high fat diet decreases the healthy bacteria in the gut. Some studies have shown that a diet that is high in sugar may worsen the symptoms of schizophrenia. And, a 2017 study of the sugar intake of 23,000 people by Knuppel, et al., “confirms an adverse effect of sugar intake from sweet food/beverage on long-term psychological health and suggests that lower intake of sugar may be associated with better psychological health.”
It’s logical that the foods that are best for the body should also be the foods that promote brain health. This theory is supported by the results from a large European study that shows that nutrient-dense foods like the ones found on the Mediterranean diet may actually help prevent depression.
The nutrients that may help brain health include:
Eating nutrient-dense foods like whole grains, leafy greens, colorful vegetables, beans and legumes, seafood, and fruits will boost the body’s overall health – including brain health. Both the Mediterranean diet and the DASH diet, which eliminates sugar, were found to significantly improve symptoms in the patients who took part in one study.
Adding fermented foods like sauerkraut, miso, kimchi, pickles, or kombucha, to your diet can improve gut health and increase serotonin levels. Serotonin is a neurotransmitter that helps to regulate sleep and stabilize mood. About 95% of serotonin is produced in the gut, so it is understandable that eating these foods can make you feel more emotionally healthy. The next time your child reaches for the chips and soda, ask yourself if those empty calories are benefiting their developing brains. Since they probably aren’t, hand them some cultured yogurt or an apple instead. Remember – every bite counts!
Note: Dietary changes shouldn’t substitute for treatment. If your child is on medications for a mental health disorder, don’t replace or reduce them with food on your own. Speak with their pediatrician or mental health professional about what they should eat, as well as what they shouldn’t. Medications will work better in a healthy body than an unhealthy one.
For more information about how your child’s diet could be affecting their mental health, talk to the professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.
It’s just one month past the first anniversary of the massacre at Marjorie Stoneman Douglas High School and we have all been saddened to hear that two students who survived the attack recently took their lives within days of each other. Also, the father of a child who was killed in the 2012 Sandy Hook school shootings died this week in an apparent suicide. Now experts are concerned that these deaths may be the result of suicide contagion.
There is strong evidence to suggest that suicides can occur in groups. When the media reports that someone famous has died by suicide, it seems that other, similar deaths quickly follow. It is almost as if suicide somehow becomes “contagious.”
We saw this happen last summer when Anthony Bourdain took his own life within days of Kate Spade’s death. Now we have this most recent suicide cluster involving the Parkland students and the Sandy Hook father. Were they due to suicide contagion?
Suicide contagion is also known as the Werther Effect – a phrase coined in the 1970s by suicide researcher, David Phillips. The name refers to a character called Werther from a 1774 novel by Johann Wolfgang von Goethe. In the book, Werther takes his life when he learns that the woman he loves has married another man.
After its release, Goethe’s novel was blamed for numerous copycat suicides across Europe. In this early example of suicide contagion, many of the victims died in a similar manner to the way the Werther character killed himself in the book. Some people used the same type of gun and some dressed in the style of clothing that Werther wore. Some were even found with a copy of the novel on or near their bodies.
Phillips’ research into suicide clusters led him to conclude that copycat suicides rise when there is excessive news coverage of the suicide of famous figures. In addition to Phillips’ investigations, several other studies have found that suicide rates go up after media coverage of a notable death. These rates also fall when the media coverage stops.
“The way suicide is reported is a significant factor in media-related suicide contagion, with more dramatic headlines and more prominently placed (i.e., front page) stories associated with greater increases in subsequent suicide rates,” says Dr. Madelyn Gould, a suicide researcher from Columbia University.
As with Goethe’s book, suicide clusters also occur when fictional characters die by their own hand. Dr. Gould has reported that, “Research into the impact of media stories about suicide has demonstrated an increase in suicide rates after both nonfictional and fictional stories about suicide.”
There is an ongoing debate among experts about why suicide contagion follows these reports. Is it that the news coverage itself causes someone else to take their own life or do they do it because they are already in a vulnerable state?
Regardless of the reason, media guidelines for reporting a death by suicide have been in place in many parts of the world since the end of the twentieth century. Both the Centers for Disease Controls and Prevention (CDC) and the World Health Organization (WHO) have issued policies for how news reports should cover notable and celebrity suicides.
Today, however, we have a new concern. In the twenty-first century, we rely less on standard media reporting and depend more on online sources to find out what is going on in the world. In particular, young people get their news from social media and the internet. These methods can spread a topic far more quickly than a news broadcast and – unfortunately – will do so with no filtering.
In the case of the Parkland tragedy, we know that the first student to take her life was struggling with post-traumatic stress disorder (PTSD). She also suffered with survivor’s guilt, as do many of the teens who were at the school that day.
Suicide is already the second leading cause of death for young people between the ages of 10 and 24 and this is without factoring in the trauma of a massacre like the one in Parkland. Clearly, we need to talk more openly with young people about suicide prevention.
We all can help avert this type of suicide by watching for youth suicide signs and risk factors and by asking direct questions.
A risk factor can’t predict if someone will take their own life, but having one or more of them makes it more likely the person will either consider or attempt suicide. These risk factors are:
The first step in preventing a suicide is the awareness that someone is considering ending their life. The next step is determining whether immediate intervention is needed.
If you think someone you know may be at risk, you can help them by using the Columbia Protocol suicide risk assessment. The Columbia Protocol was developed jointly by researchers from Columbia University, the University of Pennsylvania, and the University of Pittsburgh, along with the National Institute of Mental Health (NIMH). It was adopted by the CDC in 2011 and today it is used worldwide to assess at-risk individuals.
The Columbia Protocol is a series of three to six direct questions that you ask the person you are worried about. Their answers will provide enough information to know if they need help and if urgent action is necessary (click here to download the free Columbia Protocol toolkit now).
If your child or someone you know tells you they are considering suicide, don’t judge them. Instead, show empathy for their feelings and let them know you care about them. Next, get help from a mental health professional or a suicide crisis hotline. A crisis hotline is especially critical if the person is in immediate danger of attempting suicide.
Never leave someone alone if they are threatening suicide. If you believe they are in immediate danger, call 911 or the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) in the United States. The line is open 24/7.
If you are worried about your child or a loved one who may be at risk for suicide, talk to the specially trained mental health professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.
Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6. II.4, THE CONTAGION OF SUICIDAL BEHAVIOR.Available from: https://www.ncbi.nlm.nih.gov/books/NBK207262/
Recently, the media has been reporting that 2018’s online Momo challenge has resurfaced. They talk about children encountering it in seemingly innocent YouTube videos. Originating on WhatsApp, the reemergence of the scary social media game has prompted schools and police stations to issue warnings about the challenge so that parents can discuss it with their kids.
The Momo figure was actually a sculpture called “Mother Bird”. It was created by Japanese artist, Keisuke Aisawa. The sculpture featured a wraith-like figure with bulging eyes and long, stringy hair. To date, no evidence suggests that the artist or his special effects company had anything to do with the Momo challenge and the sculpture has since been destroyed.
Reports say that when the game first started, children were contacted to participate in the Momo challenge through their interaction with WhatsApp. More recently, however, the media is warning that the figure has apparently been popping up in Peppa Pig or Fortnight YouTube videos.
When a child participates in the game, they are actually interacting with someone who tells them to perform certain tasks to avoid being “cursed.” Reportedly, these assignments often require the child to do something harmful to themselves or others. They might be told to take pills or stab or otherwise hurt someone. The tasks even go as far as telling the child to take their own life.
The Momo figure asks the child to prove they have completed a task by providing a photograph of themselves while engaged in the assignment. To advance through the game, the child must show this proof. At the end of the game, the child’s final assignment is to commit suicide while recording it for social media.
When the Momo game initially came out on social media, critics were quick to dismiss it as a hoax. While there have been a few child suicides that were thought to have been a result of the challenge, there has never been any definitive proof linking them to the game.
Additionally, it is difficult to find online images of kids participating in the game. Doubters think that if the challenge was real, there would be many more social media pictures of Momo collaborations.
ReignBot, a YouTuber who is famous for videos that explore creepy things on the Internet says, “Finding screenshots of interactions with Momo is nearly impossible and you’d think there’d be more for such a supposedly widespread thing.”
Often, the warnings about dangerous online challenges spread farther and faster than the actual game. That said, it is potentially dangerous for a child who is vulnerable to self-esteem and other psychological issues to be exposed to something that could be harmful.
Regardless of whether the game is real, experts agree that parents need to address the topic with their children preemptively. Dr. Ryan Seidman, a child and adolescent psychologist and the Clinical Director at our Children’s Center, says parents should warn their kids about these online challenges.
“Discuss with younger children what to do if they see the face,” she advises. You might start by asking the child if they have heard of Momo, then tell them to get a parent or other adult if something scary or threatening ever pops up on an app or video.
For teens and adolescents who want more independence, it’s good to have periodic discussions about online encounters, as well as anything in their lives that is frightening or threatening to them.
Encourage your kids to tell you if they are being bullied (by the way, Momo is a form of cyber-bullying). Be sure they understand that you are trusting them to let you know.
It’s unlikely that an online challenge would affect a psychologically healthy child, but it could push kids who self harm or who are contemplating suicide to act on their thoughts.
Self harm isn’t restricted to a certain age group or race, or to someone with a certain socioeconomic or educational background. Anyone may engage in self harm, but the behavior happens most often in teens and young adults.
Self harm happens most frequently in:
Keep in mind that suicide is the result of a mental illness. People who are vulnerable to online cyber-bullying and content like the Momo challenge are often already suffering from mental health issues, such as low self esteem, anxiety, or depression.
As mentioned above, the Momo game is thought to have led to several teen suicides last year, although the link hasn’t been proven.
Suicide is the second leading cause of teen deaths, but could a dangerous challenge increase risky behavior in an susceptible teen?
Madelyn S. Gould, Ph.D., a psychiatrist at Columbia University, thinks so. She says, “The magnitude of the increase [in the number of suicides] is proportional to the amount, duration, and prominence of media coverage. We know from a number of studies that the celebrity status of a suicide victim increases the impact of the suicide.”
Add to that the feeling of being alone in their pain and it’s possible a challenge could push a distressed teen over the edge.
Adolescents and teens who are considering suicide usually give unmistakable warning signs:
Your child needs to know you are taking them seriously and that you care about them. If you are concerned that they are exhibiting some of these signs, ask the child directly if they are considering suicide (or have someone else they trust ask them). Be assured that it is okay to use the word “suicide” – saying the word will not raise the chance that they will act on the idea.
If your child admits that they are considering suicide, be empathetic about their feelings – don’t judge them. Seek help from a mental health professional such as those at our Children’s Center, from your child’s pediatrician, or from a suicide crisis hotline. The crisis hotline is especially critical if you think your child is in imminent danger of attempting suicide.
For more information about our children’s mental health services, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.
This week marks the first anniversary of the school shootings at the Marjory Stoneman Douglas High School in Parkland, FL. On February 14, 2018, 17 students and teachers were senselessly killed and 14 more were wounded.
Reflecting on the tragedy and remembering those who lost their lives will no doubt bring up strong emotions in some children. Even those who weren’t personally connected to the event may feel sad and re-experience a sense of loss. For some kids, the anniversary may even trigger or worsen symptoms of post-traumatic stress disorder (PTSD).
Distressing events such as school shootings can affect children just like they can affect adults. In fact, it’s normal for kids to go through a range of emotions when they hear about a tragedy – they might have trouble sleeping or may express fear, sadness, anger, and grief.
While many people have moved past the distress brought on by the Parkland shootings, some students may have developed post traumatic stress disorder (PTSD) afterward. This is because children who saw the news coverage or heard about the event may have felt scared, threatened, and unsafe in their own school. Now, the anniversary may bring these troubling thoughts to the surface again.
PTSD is often the result after exposure to a terrifying event or ordeal, especially one in which intense physical harm has occurred or was threatened. It isn’t uncommon for people who were not personally present during a tragedy to find themselves going through some of the symptoms of PTSD, as well.
Just think of your reaction to the events on September 11, 2001. We all watched countless news images of the planes impacting the Twin Towers and of their eventual collapse. Many Americans had strong emotional responses during the tragedy – it seemed as if that’s all we talked about for weeks afterward.
In simple terms, we felt threatened. In this way, you can see how varying degrees of PTSD were the result for many people. Kids can feel the same symptoms after something that hits close to home for them, such as a school tragedy.
The symptoms of PTSD fall into three categories:
With hyperarousal, the person may have problems sleeping or anger easily. They may also be easily startled or seem to be constantly tense and on alert.
Those kids who experience avoidance symptoms might have strong feelings of guilt or worry. Some may be depressed or emotionally numb or may lose interest in the things they used to enjoy. Others might avoid anything that reminds them of the ordeal.
Kids whose PTSD falls into the group that re-experiences the trauma may be burdened with nightmares or frightening, overwhelming thoughts.
Younger children may reenact the event or draw it out on paper. They may also regress or show fearful behavior.
With time and a period of adjustment, most people will recover from a traumatic event. If a child has gone through a trauma, however, and still has PTSD symptoms for more than a month, seek help from an expert.
A therapist can work with your child to address their symptoms and depression. They will move at the child’s own pace while helping your teen or child adjust.
The therapist may use cognitive behavioral therapy (CBT), which is very effective for dealing with the negative feelings and thoughts that come with PTSD. CBT helps the child replace the destructive emotions with positive ones.
Eye movement desensitization and reprocessing (EMDR) is another therapy that has a proven track record in the treatment of post traumatic stress disorder. It uses focused eye movements to treat PTSD and works in combination with cognitive behavioral therapy.
For young children, engaging in play therapy can be a great way to help them deal with a trauma.
Medication is sometimes prescribed to help a child cope after a tragic event. This is usually reserved for serious symptoms of depression and anxiety.
A child who has been through a trauma needs an adjustment period to help them process the event. During this time, they will need plenty of love, support, patience and understanding from you.
Our Children’s Center staff has specially trained clinicians to help those who need help dealing with the anniversary of the school shooting or other traumatic situations. For more information, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.
Studies have shown that children in the United States have many mental health needs that remain unidentified. In 2015, the Centers for Disease Control and Prevention (CDC) reported that about 20% of the nation’s youth have or will have an emotional, mental, or behavioral disorder. Only about 7.4% of these children report having received any type of mental health services, however.
A 2014 National Center for Biotechnology Information (NCBI) study by Jane Burns and Emma Birrell noted that many mental health problems escalate in adolescence and young adulthood. The effects of these under treated childhood mental health issues can be higher rates of substance abuse, anxiety, and depression, as well as suicidal ideation and self harm.
There is a stigma surrounding mental illness and its treatment. This disapproval is a barrier that keeps young people from seeking assistance. The consequence is that they are not receiving appropriate care, which translates to an increased chance of dropping out of school, employment or relationship problems, future incarceration, or even suicide.
The most prevalent mental disorder in children is attention deficit hyperactive disorder (ADHD). Other common conditions are:
A 2013 study by Khong, et. al. stated that “The highest-ranking top 25 causes of disability include anxiety disorders, drug and alcohol problems, schizophrenia, and bipolar effect disorders. By age 5, mental health and behavioral problems become an important and soon dominant cause of years lost to disability, peaking between ages 20–29.”
There is often a gap of up to 15 years between the onset of symptoms and the person getting the appropriate care. Because behavioral and mental health concerns are not being addressed early enough, they become issues down the road – major depression is one of the top four causes of disability in adulthood.
As the study noted, mental health conditions can begin to emerge as early as 5 or 6 years old. Symptoms of anxiety disorders often include:
Children with mental health challenges are often marginalized or bullied by their peers. This social exclusion keeps them suffering in silence, discouraging the majority of adolescents and teens from seeking help.
To destigmatize mental health in general, we need to:
People who are challenged with mental health issues often feel alone. The reality is that the majority of us have some type of mental health condition. Great examples include the new mother with postpartum depression, the college student with ADHD, and the coworker who has post-traumatic stress disorder from their military service.
By destigmatizing mental health problems and services from a young age, we can teach children to challenge negative attitudes so they are more comfortable asking for help.
For more information about our services to treat mental disorders in children, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.
Monshat K, Khong B, Hassed C, et al. “A conscious control over life and my emotions:” mindfulness practice and healthy young people. A qualitative study. J Adolesc Health. 2013;52(5):572–577.
Self harm or self-injury is the intentional wounding of one’s own body. Most often, people who self harm will cut themselves with a sharp object.
Self harming may also include:
Generally, people who self-harm do so in private. Often, they follow a ritual. For example, they might have a favorite object that they use to cut themselves or they may listen to certain music while they self injure.
Self harmers will target any area of the body, but the legs, arms, or front of the body are the most commonly selected. These areas are not only easy to reach, they are also easy to cover up, allowing the person to hide their wounds away from judgmental eyes.
Additionally, self harm can include actions that don’t seem so obvious to others. Activities like excessive substance abuse or binge drinking, driving recklessly or having unsafe sex can all be signs of self harm.
There are many reasons that people engage in the unhealthy coping mechanism of self-injury.
Oftentimes, a self-mutilator may have trouble understanding or expressing their emotions. Those who self harm report feelings of worthlessness and rejection, loneliness or isolation, guilt, self-hatred, and anger.
When a self harmer attacks their own body, they are really seeking:
People who self injure often feel an intense yearning to injure themselves. Even though they know it’s destructive, this feeling grows stronger until they complete the act of mutilation. Feeling the resulting pain releases their distress and anxiety. This relief is only temporary, though, until their shame, guilt, and emotional pain triggers them to injure themselves again.
Self injury happens in all walks of life. It is not restricted to a certain race or age group, nor to a particular educational or socioeconomic background.
It does happen more often in:
Although anyone may self harm, the behavior occurs most frequently in teens and young adults. Females tend to engage in cutting and other forms of self-mutilation at an earlier age than males, but adolescent boys have the highest incidence of non-suicidal self injury.
Physical signs of self harm may include:
Emotional signs of self harm may include:
The first step in getting help for self harm is to tell someone that you are injuring yourself. Make sure the person is someone you trust, like a parent, your significant other, or a close friend. If you feel uncomfortable telling someone close to you, tell a teacher, counselor, religious or spiritual advisor, or a mental health professional.
Professional treatment for self injury depends on the specific case and whether or not there are any related mental health concerns. For example, if the person is self harming but also has depression, treatment with address the underlying mood disorder as well.
Most commonly, self harm is treated with a psychotherapy modality, such as:
Treatment for self injury may include group therapy or family therapy in addition to individual therapy.
Self care for self-harming includes:
If your loved one self-injures:
Are you concerned that your child is engaging in self harm? Don’t wait to seek help – speak to a compassionate child psychologist at The Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us for more information or call us at (561) 223-6568.