New York Association of New York Association of School PsychologistsSchool Psychologists

& New York State& New York State

Office of Mental HealthOffice of Mental Health

PresentPresentDepression in Young Children: Depression in Young Children:

A Workshop for Adults Who CareA Workshop for Adults Who Care

The New York State Office of Mental Health has The New York State Office of Mental Health has initiated the SPEAK public information campaign to initiated the SPEAK public information campaign to

raise awareness about suicide. raise awareness about suicide.

The New York Association of School Psychologists is The New York Association of School Psychologists is partnering with OMH to develop and present partnering with OMH to develop and present

workshops on suicide prevention for children.workshops on suicide prevention for children.

Workshop OverviewWorkshop Overview

Understanding depression in young Understanding depression in young childrenchildren

Fact versus fiction about depression and Fact versus fiction about depression and suicidesuicide

Risk and protective factorsRisk and protective factors Recognizing warning signs and taking Recognizing warning signs and taking

actionaction Suicide prevention resourcesSuicide prevention resources

Understanding Depression in Understanding Depression in Young Children Young Children

Facts about depression Facts about depression

Children of all ages can become depressedChildren of all ages can become depressed

Estimates suggest about 3% of preadolescents Estimates suggest about 3% of preadolescents have depression have depression

Rates of depression increase with ageRates of depression increase with age

Among children, boys and girls are equally Among children, boys and girls are equally affected by depressionaffected by depression

Developmental Differences in Developmental Differences in Understanding Death & SuicideUnderstanding Death & Suicide

Young children have difficulty Young children have difficulty understanding that death is not reversibleunderstanding that death is not reversible

Young children tend to show regressive Young children tend to show regressive tendencies in their behaviortendencies in their behavior

Young children tend to withdraw into playYoung children tend to withdraw into play Young children tend to act out what they Young children tend to act out what they

are feeling, difficulty verbalizing feelingsare feeling, difficulty verbalizing feelings

Symptoms of depressionSymptoms of depression

Persistent sadness, crying, or bad mood Persistent sadness, crying, or bad mood

Loss of interest in activitiesLoss of interest in activities

Feelings of being worthless or guilty Feelings of being worthless or guilty

Frequent thoughts about deathFrequent thoughts about death

Symptoms of depressionSymptoms of depression

Changes in appetite and/or weightChanges in appetite and/or weight

Difficulty sleeping OR excessive sleepingDifficulty sleeping OR excessive sleeping

Loss of energy OR physical agitationLoss of energy OR physical agitation

Difficulty concentratingDifficulty concentrating

How depression is expressed in How depression is expressed in children children

Rather than sadness, children may have high Rather than sadness, children may have high levels of anger, irritability or hostilitylevels of anger, irritability or hostility

Lack of interest in playing with friends or chronic Lack of interest in playing with friends or chronic boredomboredom

Feelings of rejection or sensitivity to failureFeelings of rejection or sensitivity to failure

Agitation may show up as frequent outbursts of Agitation may show up as frequent outbursts of shouting, crying, or complainingshouting, crying, or complaining

How depression is expressed in How depression is expressed in childrenchildren

Physical symptoms , such as headache, Physical symptoms , such as headache, stomachache, or muscle aches are commonstomachache, or muscle aches are common

Concentration difficulties are common to both Concentration difficulties are common to both adults and childrenadults and children

Changes in weight are not as common, but Changes in weight are not as common, but children may lose their appetite. children may lose their appetite.

Sleep problems can include difficulty falling Sleep problems can include difficulty falling asleep or waking at night due to bad dreams.asleep or waking at night due to bad dreams.

How depression is expressed in How depression is expressed in childrenchildren

Poor school attendance may indicate lack of Poor school attendance may indicate lack of interest or lack of sleepinterest or lack of sleep

Death thoughts may take the form of bad Death thoughts may take the form of bad dreams about dying or preoccupation with play dreams about dying or preoccupation with play that involves deaththat involves death

Some children are fearful that they are going die.Some children are fearful that they are going die.

Fact or fiction?Fact or fiction?

Children are too young to take their Children are too young to take their own lives.own lives.

Young children can take their own lives. Young children can take their own lives.

Suicides among children ages 10-14 are Suicides among children ages 10-14 are estimated at 1.5 deaths per 100,000 kidsestimated at 1.5 deaths per 100,000 kids

FICTION!FICTION!THE FACT IS THAT:THE FACT IS THAT:

Fact or fiction?Fact or fiction?

Children plan out their suicides.Children plan out their suicides.

Children in elementary school can plan Children in elementary school can plan and carry out a suicide.and carry out a suicide.

Fortunately, the younger the child, the Fortunately, the younger the child, the more likely they are to choose a method more likely they are to choose a method that is not lethal.that is not lethal.

FACT:FACT:

Fact or fiction?Fact or fiction?

Most children complete suicide Most children complete suicide

by poisoning themselves.by poisoning themselves.

Drug overdoses are the most common Drug overdoses are the most common method of suicide method of suicide attempts…attempts…

But guns are the most frequent method But guns are the most frequent method used to complete suicide (60% of deaths)used to complete suicide (60% of deaths)

FICTION!FICTION!

Fact or fiction?Fact or fiction?

Children’s suicides can be predicted Children’s suicides can be predicted based on prior behavior.based on prior behavior.

Most children’s suicides can be linked to Most children’s suicides can be linked to upsetting events or circumstances in their upsetting events or circumstances in their lives. lives.

Thus we can monitor the reactions of Thus we can monitor the reactions of children to such events to minimize risk of children to such events to minimize risk of suicide. suicide.

FACT :FACT :

Risk factors for suicideRisk factors for suicide

Risk factors for major depression Risk factors for major depression and suicide in children and suicide in children

History of child abuse or domestic violenceHistory of child abuse or domestic violence

Family stresses, such as parental divorce or Family stresses, such as parental divorce or separation, or serious illness in the family.separation, or serious illness in the family.

Significant loss, such as death of a family Significant loss, such as death of a family membermember

Family history of depression or psychiatric Family history of depression or psychiatric disorders disorders

Risk factors for major depression Risk factors for major depression and suicide in childrenand suicide in children

Significant oppositional or conduct problemsSignificant oppositional or conduct problems

History of aggressive and impulsive behaviorsHistory of aggressive and impulsive behaviors

Drug and alcohol useDrug and alcohol use

Conflict with or punishment by parentsConflict with or punishment by parents

Protective factorsProtective factors

Protective factors to reduce the Protective factors to reduce the risk of children’s suiciderisk of children’s suicide

Good skills in solving problems of Good skills in solving problems of everyday livingeveryday living

Ability to handle anger appropriatelyAbility to handle anger appropriately

Strong connections to family, teachers, Strong connections to family, teachers, and communityand community

Protective factors to reduce the risk Protective factors to reduce the risk of children’s suicideof children’s suicide

Access to mental health servicesAccess to mental health services

Restricted access to lethal means of Restricted access to lethal means of committing suicidecommitting suicide

Religious and cultural taboos against Religious and cultural taboos against suicidesuicide

Warning signs of possible Warning signs of possible suicidesuicide

Warning signs: The FACTSWarning signs: The FACTS

FFeelingseelings

AActionsctions

CChangehange

TThreatshreats

Warning Signs: FeelingsWarning Signs: Feelings Hopelessness (“It will never get any better”)Hopelessness (“It will never get any better”)

Helplessness (“No one cares about me”) Helplessness (“No one cares about me”)

Overwhelming guilt, shame, and self-hatredOverwhelming guilt, shame, and self-hatred

Persistent sadness or angerPersistent sadness or anger

Fear of losing control, going crazy, or hurting self Fear of losing control, going crazy, or hurting self or othersor others

Warning Signs: Actions Warning Signs: Actions Writing or drawing about death and dying Writing or drawing about death and dying

Cutting, biting, or scratching oneselfCutting, biting, or scratching oneself

Talking about deathTalking about death

Withdrawal or isolation from family and friendsWithdrawal or isolation from family and friends

Agitation or restlessnessAgitation or restlessness

Reckless or risky behavior that endangers the child’s Reckless or risky behavior that endangers the child’s own safety or that of others own safety or that of others

Warning Signs: ChangesWarning Signs: Changes Personality – more withdrawn, apathetic, Personality – more withdrawn, apathetic,

indecisive or more talkative and boisterousindecisive or more talkative and boisterous

Sleep – insomnia, often with early wakingSleep – insomnia, often with early waking

Eating- loss of appetite and weight dropEating- loss of appetite and weight drop

Self-Care - decline or regression in groomingSelf-Care - decline or regression in grooming

Sudden improvement after low moodSudden improvement after low mood

Warning Signs: ThreatsWarning Signs: Threats

Giving away possessionsGiving away possessions

Making out a will or talking about funeral Making out a will or talking about funeral arrangementsarrangements

Indirect threats (“I won’t be around much longer”, “I Indirect threats (“I won’t be around much longer”, “I want to go to heaven with daddy”)want to go to heaven with daddy”)

Writing or telling another of plans for suicideWriting or telling another of plans for suicide

Suicide attempts, such as cutting wrists Suicide attempts, such as cutting wrists

What You Can Do: ListenWhat You Can Do: Listen Be willing to listen, even to a child’s feelings that may Be willing to listen, even to a child’s feelings that may

upset or frighten you upset or frighten you

Be direct and open in talking about depression and Be direct and open in talking about depression and suicidesuicide

Don’t convey feelings of shock or surprise.Don’t convey feelings of shock or surprise.

Be non-judgmental in your responsesBe non-judgmental in your responses. .

Parent’s perception of symptoms may be different than Parent’s perception of symptoms may be different than child’schild’s

What You Can Do: Be AvailableWhat You Can Do: Be Available

Seek out the suicidal child if another child shares Seek out the suicidal child if another child shares information about threats.information about threats.

Remind children they did the right thing to tell.Remind children they did the right thing to tell.

Make an immediate response your first priority Make an immediate response your first priority

Don’t leave the child alone if he or she seems Don’t leave the child alone if he or she seems suicidalsuicidal

What You Can Do: Take ActionWhat You Can Do: Take Action

Don’t agree to keep a secretDon’t agree to keep a secret

Offer hope that alternatives are availableOffer hope that alternatives are available

Remove the means for lethal action, such a Remove the means for lethal action, such a guns or stockpiled pills or poisonsguns or stockpiled pills or poisons

Get help immediately from a mental health Get help immediately from a mental health professional. Call 911 if the child is in danger.professional. Call 911 if the child is in danger.

Resources in your community Resources in your community regarding suicideregarding suicide

Suicide Prevention Resource CenterSuicide Prevention Resource Center www.sprc.orgwww.sprc.org

National Association of School Psychologists National Association of School Psychologists www.nasponline.orgwww.nasponline.org

Centers for Disease Control Centers for Disease Control www.cdc.gov/ncipc/factsheetswww.cdc.gov/ncipc/factsheets