Children’s Mental Health: Dr. Cory D. Saunders, C.Psych. Developmental Neuropsychology Windsor Regional Children’s Centre Depression

 Muscular Dystrophy:1/6000  Cystic Fibrosis1/4000  Childhood Cancers1/500  Diabetes Mellitus3/100  Autistic Disorder2-3/500 1/881/50

 FTE  Social Workers  Child & Youth Workers  Psychologists  Psychometrists  Medical Consultants & Child Psychiatrists  Number of Children Seen 2011/12: 2725  Number of Visits 2011/12: 10,145

 What are the most common mental health issues in school aged children?  Where do they come from?  Is there a common denominator?  What is the purpose of the student’s behavior?

 5 or more symptoms for at least 2 weeks:  Depressed mood  Markedly diminished interest or pleasure  Significant weight loss or gain  Insomnia or hypersomnia  Psychomotor agitation or retardation  Fatigue or loss of energy  Feelings of worthlessness or inappropriate guilt  Diminished concentration or indecisiveness  Recurrent thoughts of death or suicide

 Family history  An imbalance of chemicals in the brain  Difficult life events  Traumatic events in childhood  abuse  neglect  divorce  family violence  Gender  Increased stress  Chronic illness

 Four different categories: emotional signs, cognitive signs, physical complaints, and behavioral changes  Not every child who is depressed experiences every symptom

 Typical moods or emotions experienced:  Sadness  Loss of pleasure or interest  Anxiety  Anger or Irritability

 A depressive mood can bring on negative, self-defeating thoughts  The signs to look for are:  Difficulty organizing thoughts  Negative view  Worthlessness and guilt  Helplessness and hopelessness  Feelings of isolation  Suicidal Thoughts

 Depression is not just an illness of the mind - it also causes physical changes  Changes in appetite or weight  Sleep disturbances  Sluggishness  Agitation

 These signs will be the most obvious and easy for your detect  Avoidance and withdrawal  Clinging and demanding  Activities in excess  Restlessness  Self-Harm

 Most symptoms are similar to those in adulthood  Depression can be difficult to diagnose in teens because adults may expect teens to act moody  Adolescents do not always understand or express their feelings well - they may not be aware of the symptoms and may not seek help

 These symptoms may indicate depression:  Poor performance in school  Withdrawal from friends and activities  Sadness and hopelessness  Lack of enthusiasm, energy or motivation  Anger and rage  Overreaction to criticism  Feelings of being unable to satisfy ideals  Poor self-esteem or guilt  Indecision, lack of concentration or forgetfulness  Restlessness and agitation  Changes in eating or sleeping patterns  Substance abuse  Problems with authority  Suicidal thoughts or actions

 Teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression  Teens also may express their depression through hostile, aggressive, and/or risk-taking behavior  Such behaviors often lead to new problems, deeper levels of depression, and destroyed relationships

 Four out of five teens who attempt suicide have given clear warnings:  Suicide threats, direct and indirect  Obsession with death  Poems, essays, and drawings that refer to death  Giving away belongings  Dramatic change in personality or appearance  Irrational, bizarre behavior  Overwhelming sense of guilt, shame or rejection  Changed eating or sleeping patterns  Severe drop in school performance

 Children  Young children –medication with some simple cognitive behavior therapy if appropriate  Older children – Cognitive behavior therapy and medication (SSRI)  Adolescents  Cognitive behavior therapy  Medication (SSRI)  If SSRI used an initial period of monitoring

 Immediate Risk:  Proceed to the ED at WRH Met campus  Urgent Care:  Walk In Clinic: Monday, Tuesday, Thursday 12-6pm.  Referrals for Service  Windsor Regional Children’s Centre (aged 6-18)  Maryvale Adolescent and Family Services (aged 13-18)

 Coordinated Access  HelpLink, Intake, Service Coordination  Children’s Crisis Services  Walk In Clinic, ERCR  Children's Treatment Services  Clinic Services  Youth Justice Services  Probation Diversion, Adolescent Sex Offender, Youth Mental Health Court Worker (pre-charge diversion)  Intensive Family Services  Milieu Continuum (Residential through Day Treatment)  Assessment and Consultation Services  Developmental Services, Psychological Assessment, Medical Services  Child and Adolescent Mental Health Beds  Sexual Assault Domestic Violence Treatment/SAFE Kids