Category: depression

Unsettling: What psychosis looks like in children and young people

Unsettling: What psychosis looks like in children and young people

kill him street
This eerie painting is by a young woman of 22 diagnosed with schizophrenia. She is encountering a threat, real or imagined, and her paranoia is compounded by being watched from the window above. Note the symbolic references to communications links and satellites.

Odd, eccentric, a little weird:  people experiencing psychosis are living in dream space.  If you haven’t experienced psychosis yourself, it’s a little like the period just before you awake, when you’re in a dream but also aware of your surroundings.  Your dream and emerging consciousness weave together in a wonderful or horrible or simply odd narrative.  If you try to explain it someone, you realize it makes no sense, yet it made a lot of sense while you were dreaming.

To a parent watching a psychotic child, you may observe that they see, feel, hear, move about, and respond to you as if fully conscious, but it’s important to know that they simultaneously inhabit the subconscious. As a result, they don’t notice that what they do and think is any different from anyone else.  The term “anosognosia” refers to their inability to recognize this, and it explains why so many resent being told they have a problem and need treatment.  They simply aren’t aware that anything is different about them.

Evidence of psychotic behavior

Parents of a child who was eventually diagnosed with a psychotic disorder often report that their child was always a bit different from their peers–slightly eccentric, a unique individual who had an interesting way of looking at the world. Parents have also reported the following behaviors when their child was exhibiting psychosis.  (Not all of these are present in each child.)

  • A belief in something that isn’t rational, and the belief is unusual or unreal or impossible.  The person cannot be talked out of the belief.  And rational, logical reason only increases resistance to reason.
    • If the psychotic episode is positive or magical, the person may have powerful religious feelings and a sense of omnipotence or clairvoyance. They may believe they have been instructed to give a message to save the world, for example.
    • If the episode is negative and paranoid, they can become very agitated, fearful, or they may panic.  They may act negatively on irrational beliefs.  They are attracted to paranoid or extremist views, especially those with high emotional content.
  • Smiling or laughing at nothing in particular and for no apparent reason. It’s as if someone has just told them a joke.
  • Yelling or ranting, this could be at an object or at someone or at nothing apparent. The ranting can happen online.  The ranting has repeated themes, and the themes are unique to each person.
  • Intense, crushing anxiety, irritability, accusations, and obsessive troubling thoughts.
  • Talking and gesturing as if they’re in a conversation with an invisible someone. (Normal people also gesture they think, but they are aware they are not literally communicating with someone.)
  • Wandering eyes and shifting body language as if they are seeing or feeling things that aren’t there.
  • Abrupt personality change from seemingly normal behavior.  Often, a child’s eyes will have a disquieting faraway ‘look’, as if the child is not in their body, and a they’ve been overtaken by a demon.
  • Fear, anxiety, and paranoia–they feel watched, trapped, and controlled in some way. They stop trusting people.  They hide or try to block experiences to protect themselves.
  • Intense obsessions with ideas, things, or events (even if they occurred long past). Themes emerge which often refer to actual events that elicited strong emotions.
  • Seeing patterns and connections in events that aren’t connected.
  • Unusual and confusing responses when communicating with others—a comment that doesn’t seem to apply, or a a string of words that defy interpretation.
  • A preference for solitude and closing themselves off from others.  This is for self-protection.
  • Loss of interest in self-care: not wearing clean clothes, bathing, or organizing their surroundings.

The most common diagnoses that have psychotic features are schizophrenia, schizoaffective disorder, bipolar disorder, and depression.  This story about schizoaffective disorder gives some real world examples of psychosis:  “Life with a Schizoaffective Teen.”

Psychotic behavior can have a long slow onset

brain degeneration in schizophrenia
The image on the left is of a 15-year-old boy with early onset schizophrenia. The purple regions have normal neuron density, red regions have low neuron density. In the 2nd image, the red area at the top of the brain is in the cerebral cortex, the region of executive function and rational thought.

It’s easy to miss signs of early psychosis!  Sometimes a child or young person starts showing eccentric behaviors that aren’t serious or are easy to interpret as something else: creativity and imagination; immaturity; puberty; influences from immature friends; too much video gaming…  Your child may have been experiencing mild visual or aural hallucinations for some time, even a couple of years, and just assumed it happened to everyone so they never reported it.  As psychosis emerges in the early teens, their thoughts and behaviors start affecting friendships or school work.  The child stops doing things they once enjoyed.  Someone might assume they’re experimenting with drugs.  They seem so much like other difficult, distracted, or defiant teens that a parent can be lulled into thinking they are not seriously mentally ill… but psychosis is very serious.

If this describes your child, immediately (and I mean immediately) find a psychiatrist and get an assessment.  The earlier you can treat psychosis, the better the outcome for your child.  Psychosis is degenerative.  The longer a brain stays in a state of psychosis, the more neurons it loses.  Early treatment via therapies, medication, diet, and other physical supports can literally prevent neuron loss and future psychotic breaks that require hospitalization.

Psychosis can emerge abruptly

For disorders on the schizophrenic spectrum, this is common in young men in the late teens and early 20’s.  However, adults in their 30’s and 40’s have also been known to have sudden onset of psychosis.  It’s tragic, you witness this young person launching into adulthood, studying in college or starting employment, and suddenly his or her personality changes.  Their behavior worsens, and it becomes evident they’ll never be able to have the future they planned.  They need immediate treatment, possibly hospitalization if the psychotic break reaches a crisis point.  If this is your child and they are past age 18, use every means possible to get help for them!

Kendall art
Self-portrait by a 24-year-old woman diagnosed with schizoaffective disorder. Her image is a modified mug shot photo taken of her after an arrest.

What worsens psychosis and what you can do to relieve it

  • Poor sleep and reduced sleep.

Help your child get enough hours of sound sleep. The best sleep environment is a cool very dark room.  Once my child became unable to attend high school, I allowed her to nap any time of the day.

  • Closing themselves off from the world.

Your child needs mental and sensory stimulation to keep their mind from spinning out on their obsessions, hallucinations, and paranoia, but the amount must be tolerable.   Stimulus must come from the tangible, sensory world (e.g. not screen time, videos, books).  Concrete interaction with reality diverts their attention from obsessive thoughts or voices.  They will benefit from regular (perhaps limited) social interaction*, an undemanding therapy animal, creative work (such as art and music), and being out in nature.

  • Marijuana use–specifically the THC in marijuana

CBD in marijuana has many medical benefits and is considered safe, but the THC is not.  THC is also addictive, and available in very highly concentrated oils… extremely dangerous.  Like THC, any addictive substance, from alcohol to methamphetamine, will interfere with treatment for psychosis.  The drug’s influence trumps everything.  Drugs are literally self-induced psychosis.  See:  “Marijuana is Uniquely Harmful to Troubled Teens”;  “Marijuana is Dangerous.”

  • Continual exposure to things they already obsess on or that make them paranoid, angry, or anxious.

In every way possible, keep your child away from any material, people, or messages that upsets them.  These only add gasoline to the fire and increase the likelihood of future psychotic breaks.  They may obsess on the same things for the rest of their lives.  If someone who’s psychotic is exposed to intense emotional experiences that feed their obsessions and paranoia, people have been known to do to horrible things to themselves or others.  An example at the time of this writing is of a young woman with psychotic bipolar mania who tragically pulled out her own eyes.

Find ways to redirect your child’s attention elsewhere and help them get a grasp on the reality.  Help them calm down (“deescalate” them) and help them learn ways to calm themselves down.

A diagnosis of an illness that includes psychosis is devastating

Face to facePsychosis and/or a psychotic crisis in a child who previously led a normal healthy life blindsides everyone, especially the family.  Allow yourself to go through the stages of grief as you would after any death…  because it can feel like the ‘death’ of your child and their future and your hopes for them.  Get help from others as you would after any death.  Here you are, grieving, but your child needs you to be strong!  Get help for your own mental health.

Reason for hope

Children who receive regular social support from family and loved ones do well over the decades.  They can avoid homelessness, hospitalizations, harm.  They can get advanced education, keep strong relationships, maintain employment.  They get a life of wellbeing.  This has happened with my adult child after years of horrendous experiences.

Cognitive Enhancement Therapy

A relatively new therapy has been developed and tested that meaningfully helps people with chronic psychotic disorders.  “CET attempts to increase mental stamina, active information processing, and the spontaneous negotiation of unrehearsed social challenges. It does so with a focus on enhancing perspective taking, social context appraisal, and other components of social cognition… CET has been shown to have remarkable and enduring effects in a study of persons with schizophrenia or schizoaffective disorder…”
–CET Training LLC, “approved and recognized by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice.

What are your experiences?  Have you found anything that helps?

–Margaret

 

*Social Interaction Increases Survival by 50%
Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”


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Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Inattention and distractibility are caused by many medical conditions and life situations.  You child may not have ADHD or ADD if they didn’t show signs when they were young.

Children don’t just catch ADHD or ADD

If your child has a behavioral change you haven’t seen before, there may be an underlying medical or co-occurring mental disorder that’s causing ADHD symptoms… especially if they’re on ADHD-ADD medications which are not working well.

“It is vital not to mistake another medical or psychiatric condition as ADHD.”
Richa Bhatia, MD, Fellow of the American Psychiatric Association

The medical conditions listed below produce ADHD and/or ADD symptoms such as slow processing speed, impulsive behavior, and limited attention and focus.

  • Epileptic seizures: some types cause a brief freeze in thinking–the child’s brain goes blank for a few moments (“absence seizures”)
  • Diseases of the brain: Lyme disease, HIV infection, parasitic and viral infections, brain tumors
  • Brain damage from head injury or toxins (e.g. narcotics)
  • Chemotherapy side-effects, “stupor”
  • Hypothyroidism.  Too little thyroid hormone results in memory, attention, and concentration problems. It decreases blood flow in brain regions that mediate attention and executive functioning (the hippocampus and cerebral cortexes).
  • Hyperthyroidism. At the other extreme, too much thyroid hormone causes anxiety and tension, irritability and impatience, and hyperactivity and distraction.
  • Sleep apnea. A condition where a child stops breathing during sleep, for a few seconds to a few minutes several times per night.  The following day, the child can’t pay attention, remember, or follow a sequence of steps.  It also causes hyperactivity and belligerence.


Mental health disorders with ADHD-like symptoms:

Anxiety disorders are common to most other mental health conditions, and create problems with concentration.  The chronic stress from anxiety affects the brain regions responsible for memory and cognitive functions.   If a child does not have a history of ADHD symptoms, than significant and pervasive anxiety may be the cause of inattention and distraction.

Abuse or trauma. Difficulty concentrating is one of the core symptoms of post-traumatic stress disorder (PTSD), and recent abuse or trauma can cause agitation, restlessness, and behavioral disturbance—symptoms that mimic ADHD.

Depression – Difficulty concentrating also is a criterion for major depressive disorder.

Bipolar disorder – ADHD symptoms are apparent in children with suspected bipolar disorder. Both disorders can cause distractibility, increased energy, and instant mood swings. (Some children are eventually diagnosed with both disorders.)

Drug abuse using marijuana, cocaine, ecstasy, produce similar symptoms of ADHD because they affect the same brain regions affected by anxiety.  MRI scans of the brain were taken of young children who were exposed to cocaine in the womb. The scans revealed frontal lobe malformations which predicted long-term problems with attention and impulse control.

Common stimulant foods and beverages with excess caffeine or sugar

Insomnia from medical conditions. Sleep plays a huge role in memory and attention. Sleep disorders (e.g., sleep apnea, restless legs syndrome) can produce chronic tiredness and significantly reduce attention, concentration, and cognitive functioning in children, adolescents, and adults.

Plain old lack of sleep in healthy children can cause inattention and reduce academic achievement.  There are many causes of sleep loss:  early school hours; screen time at least an hour before bed (because the blue light suppresses sleepiness); or allowing the use of technology in the bedroom at nighttime.  What helps getting to sleep and staying asleep:

  • A cool, dark room
  • Thirty minutes of reading or drawing on paper before lights out.
  • Removing phones, laptops, or desktops from the bedroom at night.


Learning disorders:
Children with an undiagnosed learning disorder often present with ADHD symptoms. An undiagnosed reading or mathematics disorder (dyslexia), or an autism spectrum disorder that’s not yet diagnosed, can have a significant impact on classroom behavior.  The child might not be paying attention because of his (her) restricted ability to grasp the subject matter, or because they are frustrated and irritated with the struggle to keep up.

Caution:  Teachers often report a student’s inattention and confused thinking to parents, and suggest a diagnosis of ADHD when the real problem may be lack of sleep or something else.  It’s useful to hear classroom observations of your child, but teachers are not trained in mental health diagnosis—get a second opinion from a professional!

More on the consequences of untreated ADHD or another underlying disorder is in this article:  “ADHD kids become troubled adults.”

–Margaret


Subject matter was drawn from this article by psychiatrist Dr. Richa Bhatia.

“Rule out these causes of inattention before diagnosing ADHD”
Richa Bhatia, MD, FAPA, Current Psychiatry. 2016 October; 15(10):32-C3

How to pick the ideal therapy pet for your child or teen

How to pick the ideal therapy pet for your child or teen

“A pet is an island of sanity in what appears to be an insane world. Whether a dog, cat, bird, fish, turtle, or what have you, one can rely upon the fact that one’s pet will always remain a faithful, intimate, non-competitive friend, regardless of the good or ill fortune life brings us.”
–Boris Levinson, PsyD, Child Psychologist

Any animal can be a therapy pet, but put thought into finding the ideal pet

It depends on your child’s individual needs and his or her innate appreciation of or connection with the creature.  Parents often think of furry animals like dogs or cats or “pocket pets” as the best therapy animals.  Dogs and cats are the most common, but they are not the only effective options.  (And some are problematic:  perhaps a family dog or cat is of no interest to your child, or is stressful because its behavior–easily agitated cats and chronically fussy dogs aren’t therapeutic!

What fascinates your child? What do they want–what creature(s) are they drawn to?  And are you willing to take care of this pet?  Your child’s therapy pet is not a lesson in responsibility… though that may be an outcome someday.  The pet is a therapist first, not a teaching tool.  Since you may be the responsible one, the pet must work for your needs and household too.

The right creature will reduce your child’s stress and continually delight them in some way.

Dogs and cats

Under the best circumstances, the right dog or cat will choose your child, calming them down or drawing them out of their shell. Dogs and cats are ideal for symptoms of anxiety, autism spectrum disorders, or depression. The right dog or cat is calm, loyal, and patient, and helps an insecure child or one who can’t handle emotional demands. Dogs also support physical exercise, and provide opportunities for significant life lessons.

True story – Some juvenile prison systems have dog programs, where the inmate is assigned a troubled shelter dog to train and teach appropriate dog behavior. Young inmates often empathize with a dog’s abuse history, and training the dog helps them learn patience, forbearance, and anger management.  The trained dogs are them adopted out to the community.  A program I personally know about has had very positive outcomes.

Pocket pets

Pocket pets help children who like touch, and bring out a child’s nurturing side. Small animals can also be playful and amusing–ferrets have especially silly antics.  It’s important the pet likes to be held, but it’s also important to prevent it from escaping and hiding. Their small size and habitat needs are better for small living spaces, and they can go anywhere with the child in a small carrier.  A concern may be their shorter lifespans. Is your child able to handle loss and learn from it?

Birds

Birds are smart ‘pocket pets’ and very loyal to the person they bond with.  A bird that’s purchased young or been hand-fed as a chick is tame and will readily perch on a child’s shoulder or finger… or happily hide out in a pocket.  Most birds can be taught words, whistles, or even songs in human language.  They are pretty, charming, highly interactive, and long-lived.  Birds are good for depressed children who need energy and stimulation, and children with ADHD who need attention and interaction.  Like a pocket pet, a bird can also travel with a child in a small carrier.

Reptiles

Reptiles aren’t often considered as therapy pets, but reptile lovers will tell you that they are indeed therapeutic and have inidividual personalities. Most are quite beautiful. Many like to be held and carried.

“She fell asleep in my shirt and nobody saw her. I noticed I was able to communicate with other people without problems. When I started to feel anxiety I put my hand over her and it calmed me downI was able to go in [a store], do what I needed to do and get out without a panic attack.”
–Teen with social anxiety disorder speaking about her Bearded Dragon.

Ask if a pet store will allow your child to hold one of their reptiles for sale.  Common pet store lizards that are good for children are:  leopard geckos, bearded dragons, and iguanas (which need lots of handling at first).  Like other small animals, reptiles can escape. Turtles are usually easy to find, but not lizards or snakes.  There are lizard leashes on the market for this reason.  Most snakes available on the market like to be held, or will accept it if handled often.

Fish

Beautiful calming aquariums are excellent sources of visual delight and serenity. There is a reason aquariums are placed in waiting rooms and in psychiatric hospital settings.  They provide gentle entrancing movement in a miniature natural world—they are healing like Nature is healing.  An aquarium is good for children with intense anxiety they can’t express, often with schizophrenic or autistic symptoms.  The soft bubbling sound can be calming because it is steady and hides noises that may overstimulate a child who’s grappling with a stream of upsetting thoughts.  Read more about “calming rooms” and how visual and audio environments help children with tantrums, “Calming room ideas to prevent tantrums in autism and other disorders.”

Insects (yes, insects)

I have two stories about therapy with insects

True story – A depressed 9-year-old boy was regularly teased at school, then came home to a single mother who was always too distracted by dating concerns to spend time with him. His father found a second wife and started a new family and showed little interest in him.  The boy was smart and very interested in science.  He befriended a neighbor who kept hissing cockroaches to feed her lizards, and he would visit often and ask to hold a roach and pet it to make it hiss.  The neighbor allowed the boy to borrow one to take to school for show-and-tell, which he brought along in a plastic container.  The students were both fearful and intensely curious about this giant roach.  Except for the squeamish, everyone wanted to pet it to make it hiss.  He became the coolest kid in class.  His teacher was impressed because he told the story about hissing cockroaches, where they were from, and how they were part of a forest ecosystem.  He stopped being teased, and his teacher gave him more attention with science studies… all thanks to a lowly roach.

True story – An 11–year-old boy with ADHD found a praying mantis in his backyard and picked it up. He knew from school it wouldn’t bite, and that it caught and ate other insects.  He wandered around nearby homes looking for bugs to feed it.  When he caught something, he enjoyed watching the mantis snatch the bug from his finger and eat it with gross crunching sounds and goo…. awesome for a kid like him. He was allowed to keep the mantis in an empty aquarium. As Nature has it, it died in the Fall. His parents, however, purchased mantis eggs from a nursery to populate the yard the next summer. When they hatched, the boy spent hours amusing himself by finding and feeding the baby mantis population,and watching them grow to adulthood.  It reduced the hours he’d spend indoors on video games,and connected him with nature outdoors.

 

–Margaret

The Brain Diet for Troubled Kids

The Brain Diet for Troubled Kids

Kids with brain disorders need a whole body/whole life approach to treatment–no one medical practice is sufficient. Neither mainstream psychiatry or naturopathy have all the answers for mental health, but both provide important treatments:  diet, medication, therapy, exercise, gut health, and sleep, etc. This article is about brain diet specifically–foods which support or improve brain health.

These are some general rules for this food:

  • Food should be raw or as close raw as possible. Cooking removes some of the essential nutrients.
  • In the case of fish, raw may not be appropriate except for sushi or pickled herring.  For fish that’s canned, choose fish packed in oil, not water.  Omega-3’s are in the oil, but washed away in water.
  • Variety is important.  Concentrating on a few foods exclusively is not helpful because you and your child still need additional nutrients that are important for your overall health.
  • Food is better than supplements because food nutrients are properly absorbed in the body in the right ‘dosages.’  This is especially true of Kava kava–supplements and tinctures provide tiny amounts of kavalcones!  Kava should be prepared as a tea from dried ground root–at least a cup or more.  (Methods are available on the internet.)  It is very bitter, but from personal experience, very worth it!

Be aware of food fads.  There are no miracle foods.

Over the decades, people bombarded by some dietary research, and immediately demand foods that fit the limited knowledge at the time.  Food producers then label and provide whatever the public wants.

  • A good example of a fad years ago was fat-free and oil-free foods.  As it turns out, additional studies proved this was actually harmful–people need fats in their diet, but just a selection of fats.
  • For decades, coffee and chocolate were once considered harmful, but this has since been proven wrong for most people.
  • Diet sodas were supposed to be better than sugary sodas, but as medical research and understanding advanced, this was disproven.  Sugar-free sodas are actually more harmful.
  • There’s been an antioxidant craze. Yes, antioxidants are important, but these nutrients alone are insufficient for brain health.
  • The “paleo diet” was big for a while.  It was the great idea of someone who was not a paleontologist.  Paleontologists themselves aren’t comfortable with it because they are still finding evidence of what early humans actually ate.
  • Lately, everyone wants gluten-free foods. Gluten is very bad for a small segment of the population, but not most people. What’s funny as that even water is labeled gluten-free.  This is from a dish detergent label:
Seriously? Gluten free dish detergent?Labels like this are for marketing, not your health. They also reinforce a fad which is misleading.

 

High consumption of a single brain food does not improve your brain unless a test confirms you have a deficiency. 

Vitamin D deficiency is serious for mental health:  In the case of psychiatric health, severe Vitamin D deficiency was discovered in 72% of adults tested in a psychiatric hospital.  Other studies have shown that those with mental illness tend to have abnormally low levels of Vitamin D.

“Vitamin D’s effect on mental health extends beyond depression. Schizophrenia has also been linked with abnormal levels of vitamin D.”

“..vitamin D activates genes that regulate the immune system and release neurotransmitters (e.g., dopamine, serotonin) that effect brain function and development. Researchers have found vitamin D receptors on a handful of cells in regions in the same brain regions linked with depression.”

 

Take the time to learn how to prepare these foods in ways that your and your kids like!

–Margaret

 

Resources:

The Psychological Consequences of Vitamin D Deficiency

These Foods for Anxiety Are the Good Kind of Stress Eating

Should you get your nutrients from food or from supplements? – Supplements can plug dietary gaps, but nutrients from food are most important

Mental Health Medications for Children ages 3 – 12

Mental Health Medications for Children ages 3 – 12

This is an excerpt from an article contributed by Drugwatch, an organization devoted to informing the public about the uses and risks of drugs and medications, and the use of medical devices.

Doctors may prescribe the use of medications to treat the health effects of bullying.

For example, children who suffer from depression or anxiety disorders (two health effects of bullying) may be prescribed selective serotonin reuptake inhibitors (SSRIs), such as Prozac. It’s important for parents to be aware that all SSRIs carry risks.

Childhood Bullying & Its Health Effects

Research shows that bullying behavior can start as early as age 3. Both children who are bullied and those who bully others may have serious lasting health problems as a result of these actions.

Bullying may cause lasting health issues for both parties involved.

A 2017 study by University of Pittsburgh researchers, for example, found that children who are bullied experience mental and physical health issues that can last well into adulthood. The study shows that bullied children are more likely to have trouble with finances and to be treated unfairly by others. They are also more pessimistic about their futures, according to the study.

On the other hand, the study revealed bullies are more likely to be stressed, hostile and aggressive, and to smoke cigarettes and marijuana. Both bullies and their victims are at a higher risk of heart disease, which is the leading cause of death for both men and women.

Doctors may prescribe Cymbalta to treat generalized anxiety disorder in children ages 7 to 17.Childhood developmental or learning disorders are often diagnosed when a child is of school-age. Mental illnesses, however, can be hard for a parent to identify. Although children can develop the same mental health conditions as adults, they sometimes express them in different ways. In 2013 alone, more than 8.3 million children were taking psychiatric medications. About half of the medicated children were between the ages of 6 and 12.

ANXIETY DISORDERS

Anxiety disorders are a group of mental disorders branded by feelings of anxiety and fear. Children may have more than one anxiety disorder. More than 2 million children were on anti-anxiety medications in 2013. The age group with the largest number of medicated children was ages 6 to 12 years.

Generalized Anxiety Disorder (GAD)

It’s perfectly normal for your child to stress about grades or an upcoming sporting event. However, if your child worries excessively or if anxiety and fear affect your child’s ability to perform daily activities, your child may be suffering from GAD. Doctors may prescribe Cymbalta, a serotonin-norepinephrine reuptake inhibitor (SNRI) as treatment. In 2014, the FDA approved Cymbalta for the treatment of generalized anxiety disorder in children ages 7 to 17. SNRI medications carry serious risks, including birth defects, skin disease, suicidal thoughts and liver toxicity. The FDA also warns of Cymbalta discontinuation syndrome, which is when a person experiences withdrawal side effects after stopping Cymbalta. Effexor, another SNRI, has not been approved by the FDA for use in children, but some doctors prescribe it for older teens as an off-label treatment for depression and anxiety.

Obsessive Compulsive Disorder (OCD)

Prozac, Zoloft and Luvox are among the drugs used to treat OCD in children.

Children with OCD experience unwanted and intrusive thoughts — or obsessions. They feel compelled to repeat rituals and routines to try to lessen their anxiety. OCD can affect children as young as 2 or 3, though most children with OCD are diagnosed around age 10. The FDA has approved several drugs to help control the symptoms of OCD in children, including Prozac, Zoloft and Luvox.

The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.

Tourette Syndrome

Children with Tourette syndrome may make unusual movements or sounds known as tics. The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.  All three medications have the potential to cause unwanted side effects, so most doctors prescribe the blood pressure medications guanfacine or clonidine. This is known as “off-label” use because the FDA has not approved either drug for treatment of tics.

MOOD DISORDERS

Every child can feel sad or depressed at times, but mood disorders are more extreme and harder to manage than typical sadness. Doctors may prescribe antidepressants or antipsychotics to treat mood disorders in children. SSRIs are popular antidepressants, despite an increased risk of suicidal thoughts in children. Prozac is the only SSRI approved for use in children older than 8 years of age. Antipsychotics prescribed to children include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone).

These new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and movement disorders. Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.

Nearly 2.2 million children were on antidepressants in 2013, and more than 830,000 were taking antipsychotics. In addition, doctors often prescribe the anti-seizure drug Depakote for children with bipolar disorder, a use not approved by the FDA. The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults.

(Blog owner’s note: Antidepressants are sometimes mistakenly prescribed to depressed children who are actually experiencing the depressed phase of bipolar disorder. The risk is that antidepressants can bump a child’s mood way too high, into mania.)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Doctors use stimulants like Ritalin and Adderall to treat ADHD.

Doctors have been diagnosing children as young as 4 with ADHD. In the past nearly 30 years, the number of children diagnosed with ADHD has grown six-fold. Scientists estimate about 5 percent of children actually have ADHD, but the CDC shows that 15 percent are diagnosed.

Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects of these drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes. Data from 2013 showed more than 4.4 million children were on ADHD drugs.

Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.

Children & Medications

Children are particularly vulnerable to the potentially harmful side effects of drugs during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk.

AUTHOR

Emily Miller
emiller@drugwatch.com
407-955-4198

 

This is the full article from which the above post is excerpted:
“Children’s Comprehensive Health Guide – From Newborn to Preteen”

 

Use the “S” word: talk openly with your child about suicide

Use the “S” word: talk openly with your child about suicide

Don’t be silent on the subject of suicide, even if there’s no evidence your child has considered it.  Bring it in the open, especially if you have a hunch something is wrong and they may have suicidal thoughts.  This article addresses:

  1. Why you should talk about suicide with your child
  2. How to respond if there’s been a threat
  3. How to respond if there’s been an attempt

Parents talk about many uncomfortable subjects with their child; and suicide must be one of them.

Don’t let suicide become a ‘sensitive’ subject.  Your child needs to hear about it from you.  They should feel safe talking about it.  Don’t expect them to bring this subject up.  They may fear you will overreact, and worsen their depression, or you could under-react or dismiss it because you’re uncomfortable.  Neither response helps.

Won’t this give my child ideas and encourage suicidal thoughts?

No.  Children usually know what suicide is and will have wondered about it—even young children. Ask what your child thinks. Children as young as 7 and 8 have asked about suicide or communicated they had suicidal thoughts.  Children as young as 10 and 11 have attempted or completed suicide.  The ages of highest suicide risk are between 10 to 24.

Talk with your child. Don’t leave him or her alone with thoughts or questions about suicide.

An 11-year-old boy died of suicide a couple of weeks before this article was written. There had been no prior signs.  He killed himself after receiving a prank text saying his girlfriend had committed suicide. He told no one beforehand.  His parents had no idea he was even at risk.

Why might my child become suicidal?

Mental health professionals assess risk by using the Biopsychosocial Model.  The more negatives in the biological, social, and psychological aspects of one’s life, the higher the risk of suicide or other mental health problems.

The major risks of suicide are in the central part of this diagram: drug effects, temperament, IQ, family relationships, trauma.

From Pinterest and the blog, Social Workers Scrapbook

What can you control and change at home?
What do you and family members need to reduce these risks?
Communicate about these with everyone. (Can be hard to do, but try.)

What can trigger suicidal thoughts?

Examples from two states that did the research:

Oregon: Survey results for an exceptionally high suicide rate among 10-24 year olds by population, 180 individuals in one year (“Suicide circumstances by life stage, 2013-2014”).

  • 62% – Current depressed mood
  • 53% – Relationship problems
  • 47% – Current mental health problems
  • 43% – Current/past mental health treatment
  • 42% – History of suicidal thoughts/plans
  • 31% – Recent/imminent crisis
  • 22% – Family relationship problems
  • 21% – Non-alcohol substance abuse problems
  • 8% – School problem

New York: Life situations of children completing suicide, 88 individuals; (“Suicide Prevention, Children Ages 10 to 19 Years”, 2016)

  • Feeling hopeless and worthless (often because of bullying at school, home, or online)
  • Previous suicide attempt(s)
  • Physical illness
  • Feeling detached and isolated from friends, peers, and family
  • Family history of suicide, mental illness, or depression
  • Family violence, including physical or sexual abuse
  • Access to a weapon in the home
  • Knowing someone with suicidal behavior or who committed suicide, such as a family member, friend, or celebrity
  • Coping with homosexuality in an unsupported family, community, or hostile school environmental
  • Incarceration (time in juvenile detention or youth prison)

What if my child has threatened suicide?

A threat opens a door for a discussion.  A good approach is to interview your child about their feelings, plans, needs, and reasons.  Listen earnestly without input.*  You might be surprised to find their problem is solvable, but their depressed mood paints it as hopeless.  Listening helps them get clarity and feel heard and respected.  Once you understand their problems, you assist them in identifying options and provide emotional support.

* I have a friend who worked for a suicide hotline, and he said the job wasn’t difficult at all.  He said, “All I did was listen and show understanding of their feelings and just let them talk. “

After a frustrating discussion about my teenage daughter’s suicidal threats, I gave up and said “No.  I’m telling you not to commit suicide.”  She was incredulous; “You can’t tell me what to do!  You can’t stop me!”  I responded, “Don’t commit suicide. You’re important to us.  You have important things to do in life.”  She made a few attempts in the following years (they were always public… as if she wanted to be discovered and prevented), and she always reached out to her family afterwards for support.  Did my words make a difference?

What if a threat is just for attention?

It’s hard to tell. It could be genuine  or manipulative.  Some children use threats to prevent parents from asserting rules.  Angry children, especially teens, use threats to blame and hurt parents emotionally.  If you think a threat is not genuine, open up the suicide discussion.  “Talk to me about this”, “It seems like an extreme reaction to something we can fix.” “What needs to change?”  “How can I help?”  Focusing on the threat will either expose the ruse or draw out important information for addressing an underlying problem.

What else can I do if my child threatens suicide?

  1. Observe and investigate.
  • Do they have access to unsafe objects or substances?  You can legally search their room.
  • Do they frequent unsafe places or spend time with people who encourage drug use?
  • Do they have extreme mood swings (up or down), or a chronic dark mood?
  • Do they take dangerous risks and seek dangerous activities?
  • Are there any other danger signs?
  1. Build a network of eyes–choose people who will observe your child and keep you advised of risk, e.g. a mature sibling, a teacher, your child’s friend or the friend’s parents, your child’s boyfriend or girlfriend, a relative, or a trusted person who knows your child.
  1. Make changes you have control over, and solidly commit to these changes. Bring the whole family along on the plan.  FOLLOW THROUGH.
  • In family life – reduce chaos, fighting, blaming, or bullying; express appreciation; neglect no one including yourself; create 2 – 3  house rules that are easy to enforce and everyone follows, even you.
  • In social and online life – learn as much as you can about the nature of your child’s relationships, whether romantic or social. Support them if they distress your child. Can they remove themselves from a toxic relationship? or cope effectively with anxiety? Can you help them address bullying at school or online?
  • Biological health – Sleep, Exercise, Diet.  Limit screen time at night because blue light inhibits sleep.  Pay attention to digestive health, which affects mental health. These are some natural approaches.
  • Psychological health – Ask a school counselor about your child.  Seek a working diagnosis and mental health treatment.  Help your child find outlets for personal self-expression:  journaling, music, art, poetry, or a website such as this one, where teens help teens.  Mind Your Mind is an excellent example.

What if my child attempted suicide?

He or she is still very fragile, even if in treatment!  They have taken the action, they’ve been there, and have the option for taking it again—a high percentage try againSuicide attempts are long-term emergencies. You need to be on alert in the following days, weeks, months, and possibly years.  In addition to intensive mental and physical health treatment, ensure your child gets regular deep sleep, exercise, and a good diet.  Ask them if they’ve had suicidal thoughts if you sense something is wrong.  Don’t be shy about checking in.

Pay attention to events that trigger suicide.

Check-in with your child when something traumatic happens or might happen, especially if someone he or she knows attempted or committed suicide, or a suicide was in a TV drama or covered in the news.  Triggers are an emergency, act immediately.

You have the power to prevent a child’s suicide.
Be strong. You can do this. 

Take care of yourself.

–Margaret

Faith can help, and harm, a family’s mental health

Faith can help, and harm, a family’s mental health

When faith helps

Most of the time, people can heal and find peace and self-acceptance through faith. All the world’s great faiths, those that have lasted centuries, are kept alive for this reason. All have common themes of healing and service to others. When things go poorly, meditation and prayer, with others or in private, lead to connection and wholeness. Faith reveals that things are better, and will be better, than they seem.

When families are in crisis because of their troubled child, parents tell me they depend on faith, even parents who don’t profess a faith practice. They say it’s their only source of strength. Most families with a child who is sick, disabled, or mentally ill will go through dark times, when a parent’s world is simply too overwhelming. Most often, no answers are forthcoming, nor any rescue. The only choice is to hand over their burden to a “higher power,” God, the Buddha, Allah, the Great Spirit… This act of “handing over” is a foundation of healing in Alcoholics Anonymous, Narcotics Anonymous, and dialectical behavioral therapy (DBT).

Few things help a family more than a supportive community of believers.  There will be one person who listens to a frightened parent on the phone, and another person who takes a traumatized sibling on an outing, and another person who provides hugs and cookies. If a mentally ill child continues to decline, a good faith-based support network will stay on. The child may not thrive, but the family does, and has the strength and forbearance to handle the years’ long task of supporting their mentally ill loved one.

Science shows that faith results in better lifetime outcomes for a child

This writer typically trusts science, but in the depths of my family’s despair, only faith and the prayers of others kept me from falling apart.

There are scientists among the faithful who have asked the question: does faith really help the mentally ill? In another blog post, Spirituality and mental health, some research are summaries of research going back 36 years.  (Follow this link for the research citations.)  The answer?  Yes, faith makes a real and measurable difference in improving mental health.

More recent scientific research shows clear evidence from brain scans that meditation and prayer change brain electrical activity, from anxious or agitated to serene and grounded.  The person actually feels and behaves better.  This article has more information on this, Yoga – Safe and effective for depression and anxiety.

Like prayer, “talk therapy” or psychotherapy also shows improvement on brain scans. Imagine, just talking with someone improves the physical brain. According to the article appended below, “When God Is Part of Therapy,” many prefer therapists who respect and encourage their faith. It just makes sense.

When faith harms

This section is a personal appeal to faith communities who have unconscionably failed families and their children with mental disorders.

Faith communities depend on people, and people have biases and foibles.  Many of ‘the faithful’ hold negative beliefs about others, right or wrong.  Children who suffer, and their families, are identified as possessed, of evil character, disbelievers, victims of abuse, or cruelest:  those who are paying for their sins. Families are repeatedly told these very things today.

“Sometimes, people hide from the Bible. That is, they use the Christian holy book as an authority and excuse for biases that have nothing to do with God.”
–Leonard Pitts Jr., Miami Herald

Stigmatization from a faith community is a cruel betrayal.

A child’s inappropriate behavior is not a choice, it is a verifiable medical illness, one with a higher mortality rate than cancer:  Mental illness more deadly than cancer for teens, young adults.  Families with sick children need support; our sense of loss is devastating.

Testimonials

Mother with five children, one with bipolar disorder:

“We were members of our church since we were first married, all our daughters grew up here, but when my youngest spiraled down, I was told the sins of the father are visited on the sons. Or we weren’t praying enough. I knew they thought (Dad) had done something bad to her. We left and went church shopping until we found a pastor who understood and supported us.”

Mother of two children, one with acute pervasive development disorder:

“I wish we had a “special needs” church. We’re so afraid our kid is going to say something and we’re not going to be accepted. We haven’t gone to church for years because of this. They just turned their backs on us, it happened to another family with a deaf child. They avoid parents in pain. Deep down in my heart I believe in the Lord, but there are days when I wonder “where is God?” People call out to pray for a job, or a kid’s grades, but we wouldn’t dare ask for us, no one would get it, we’d be told we were bad parents or didn’t punish him enough.”

Mother of two children, one with schizoaffective disorder:

“When I went up to the front to light a candle and ask for a prayer for my daughter, I expected people would come up afterward and give a hug or something, just like with other families with cancer and such. But it didn’t happen. No one even looked at me. I left alone and decided never to go back.”

Some good news

FaithNet

The National Alliance on Mental Illness (NAMI) has recognized the need for the mentally ill to be part of faith communities, and the negative experiences most face when they attempt to participate in a religious community. NAMI started FaithNet to encourage and equip NAMI members to engage with and share their story and NAMI resources with local faith groups, and appeal for their acceptance.

Key Ministry

Key Ministry: Welcoming Youth and Their Families at Church
Stephen Grcevich, M.D., president, Key Ministry and child & adolescent psychiatry in private practice, Chagrin Falls, Ohio

“Key Ministry believes it is not okay for youth living with mental illness and their families to face barriers to participation in worship services, educational programming and service opportunities available through local churches.”

Churches in American culture lack understanding of the causes and the needs of families impacted by mental illness, which poses a significant barrier to full inclusion.

“A study published recently by investigators at Baylor University examined the relationship between mental illness and family stressors, strengths and faith practices among nearly 5,900 adults in 24 churches representing four Protestant denominations. The presence of mental illness in a family member has a significant negative impact on both church attendance and the frequency of engagement in spiritual practices.” When asked what help the church could offer these families, they ranked “support for mental illness” 2nd out of 47 possibilities. Among unaffected families, support for mental illness ranked 42nd.

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When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.

When children are hospitalized with other ailments, the family draws sympathy and support from others.  But because of mental health stigma, most families like ours don’t when our child is hospitalized.  If not blame, we are second-guessed, or as bad, met with silence or a change of subject.