Parenting Sad and Depressed Children and Youth

Community Education Service
in collaboration with
Child and Adolescent Mental Health
Parenting
Sad and Depressed Children and Youth
Funding generously provided by Encana

Corporation and the Alberta Children’s
Hospital Foundation
Parenting Sad and Depressed Children and Youth
{ What brought you here today?

Questions
Outline
{ What is Depression?
{ Stressors for Children & Adolescents
{ Protective Factors Against Depression
{ Signs and Symptoms
{ Caregiver Interventions
{ Helping Your Child Through Depression
{ Helping Your Adolescent Through Depression
{ Suicide Risk
{ Resources
1
What Is Depression?
Depression
Depression is more than feeling down in the dumps
once in a while. It’s a:
{ Mood disorder involving sadness, despair,

hopelessness, that lasts for weeks, months, or
even longer.
{ Clinical depression interferes with a person’s ability to

participate in normal activities.
Sadness vs. Clinical Depression

Sadness
o ”feeling down”
o associated with events that affect a person’s mood at
the time (i.e., poor grades, break up with a boyfriend,
etc)
o does not usually last longer than several days
o does not severely interfere with day-to-day activities

(i.e., individual is still able to get up and go to school)
o does not require therapy or medication to resolve
2
Clinical Depression
o results from an inability to solve the problem caused by

the event
o debilitating feelings of dejection, sadness, and despair
o loss of interest in others, withdrawal, and preoccupation

with self
o lasts two weeks or longer

Clinical Depression (cont’d)
o interferes with the ability to perform day-to-day

tasks
o use of unhealthy coping mechanisms (i.e., guilt,

self-blame, alcohol or drug use)
o often requires therapy and/or medication to help

overcome such feelings
What Causes Depression?

{ There is no single cause for depression. Many factors play
a role, including genetics, medical conditions, life events,
and certain thinking patterns that affect a person’s reaction
to events.
{ An imbalance of neuro-transmitters in the brain that

regulate mood may make a person prone to depression.
{ Children are more likely to become depressed if they have

a parent who has been depressed.
{ Children under the age of 5, even infants, can be

depressed.
3
What Causes Depression?
Adapted from: Bilsker, D., Gilbert, M., Worling, D., & Garland, J., Child & Youth Mental Health Branch, Ministry of Children & Family
Development
Situation
Thoughts
•Loss of relationship
•Negative thinking habits
•Loneliness
•Unfair self-criticism
•Arguing & conflict
•Poor school performance
Emotions
Actions •Sadness
•Withdrawal from others •Despair
•Reduced activity •Emptiness
•Poor self-care •Anxiety
Physical State
•Poor sleep
•Low energy
•Changes in appetite
•Nervous system changes
Parenting Sad & Depressed Children and Youth
Stressors for Children & Adolescents
Stress (Risk) Factors for Children and Adolescents
Common stressors (risks) are:
1. Death of a loved one

2. Separation/divorce of parents
3. Change in residence and/or school
4. Bullying
5. Break-up of a significant relationship
6. Sexual identity concerns
4
Protective Factors Against Depression
Common Protective Factors are:
1. High self-esteem
2. Good coping skills
3. School achievement
4. Involvement in extra-curricular activities
5. Positive relationships with parents, peers, and
adults outside the family context
Signs and Symptoms
Physical Symptoms
{ Upset stomach
{ Increase or decrease in appetite
{ Weight gain or loss
{ Headaches and other body aches or pains
{ Change in sleep (a lot more or a lot less)
{ Tiredness due to lack of sleep or insomnia
{ Lack of energy
{ Fidgety or restlessness
5
Behavioural Symptoms
Behaviour
o Poor personal hygiene
o Lack of care in physical appearance
o Enuresis (wetting oneself)
o ’Dark’ themes in writing or choice of music
o Self-medicating with alcohol or street drugs
o Talking about death or suicide
o Increase in risk-taking
Behavioural Symptoms (cont’d)

Behaviour...Cont’d
o Decline in grades at school
o Defiant and oppositional
o Cutting and other self-harming behaviours
o Social isolation/withdrawal from family and

friends
o Lack of participation in activities once found
pleasurable
o Poor school attendance
Emotional Symptoms
Typically there are themes of Anxiety, Anger,
Irritability, as reflected in the following:
{ Flat affect (i.e., unexpressive/unemotional)

{ Cries easily (tearfulness)
{ Easily irritated or upset
{ Long-lasting sadness
{ Feeling guilty
{ Feeling worthless and/or unlovable
6
Emotional Symptoms (cont’d)
{ Feeling helpless
{ Feeling hopeless
{ Feeling angry; angry outbursts
{ Feeling anxious
{ Feeling irritable or restless
{ Exaggerated need for perfection
Cognitive Symptoms
{ Inability to concentrate
{ Indecisiveness
{ Poor memory
{ Loss/change in personal belief system
{ Unable to see a future any better than present
Cognitive Symptoms (cont’d)
{ Belief that self is worthless, useless, and/or unlovable
{ Belief that self is a burden to others (e.g. “they’d be

better off if I wasn’t around”)
{ May have auditory/visual hallucinations
{ Suicidal Ideation
7
Caregiver Interventions
If you suspect a child/adolescent is depressed:
1. Respect and validate the child’s feelings
o Listen without judging

(no response needed, just validate)
o Try to put yourself in your child’s shoes
2. Maintain open communication
o Don’t be afraid to ask your child how s/he is

feeling
o Let your child know she or he can come and

talk to you at any time
o Be patient. Teens especially will let you in and

then push you away
8
Communication.... Cont’d
o Be available when your child comes to talk to you.

Don’t try to multi-task at the same time
o Ask children about their friends (i.e. being bullied)
o Use a rating scale (1-10) to understand how child is

feeling (children don’t have the language to
express feelings)
Caregiver Interventions (cont’d)

3. Help the child to label and/or identify his/her feelings
4. If a possibility for self-harm exists, remove the

following items, to the best of your ability:
o sharp objects
o any means of strangulation
o any means of suffocation
o medications (prescription and over-the-counter
products)
o poisonous household products
Caregiver Interventions (cont’d)
5. Encourage parents to find out if there are additional

supports within the school system.
6. Consider seeking professional help (therapy

and/or medication)
o The combination of a medication with therapy

has been found to be the best treatment for
clinical depression.
9
Medication
{ Therapy is the first choice of treatment
{ Research has shown that Cognitive Behavioural

Therapy (CBT) and medication is most effective
{ SSRI’s are the first choice of medication for children

and adolescents
{ Medications are normally prescribed in gradual doses

in order to reach most effective dose. Mantra is “go
low, go slow.”
SSRI’s NDRI SNRI
Prozac® (fluoxetine) Wellbutrin® Effexor®

Luvox® (fluvoxamine) (bupropion) (venlafaxine)
Zoloft® (sertraline)
Celexa® (citalopram)
Paxil® (paroxetine)
Helping Your Child Through Depression

*Drawn from: Filial Therapy: Strengthening Parent-Child Relationships Through Play, VanFleet (1994)
*These activities are not meant to be a replacement for treatment where this is needed. If expert
assistance or treatment is needed, the services of a competent professional should be sought
10
How Does A Parent Help?
o Parents are the most significant adults in
children’s lives and are likely to have the greatest
impact on their health, including their emotional
health
o When parents learn more ways of interacting with
and helping their children, the results are likely to
be more positive, profound, and longer lasting.
Play is a primary, natural, and healthy way of
interacting.
Why Play?
{ Play is a child’s language. It is how children
communicate and is crucial to their healthy
development
{ Through play, children:

express their feelings
master new skills
integrate new experiences
develop social judgment
fine-tune their problem-solving and coping
abilities
Playing With Our Children

{ Enables children to recognize and express their
feelings fully and constructively
{ Gives children the opportunity to be heard
{ Helps children develop effective problem-solving,

social judgement, and coping skills
{ Increases children’s self-confidence and self-esteem
{ Children come to know, accept, and respect

themselves
11
Playing...(cont’d)
{ Helps to increases trust and confidence
{ Helps to reduce or eliminate negative behaviours, and

increase self-control and self-direction
{ Helps children develop appropriate behaviours
{ Promotes a healthy family environment which, in turn,

fosters healthy and balanced child development in all
areas: social, emotional, intellectual, behavioural,
physical, and spiritual
Child-Centred Play
{ The child is in charge of the play, with the parent
engaging only when the child requests it
{ The child selects the toys to play with and the

manner of play, parents demonstrate empathic
listening and acceptance of child’s actions/feelings
{ Empathic listening to show acceptance of the child’s

actions and feelings
{ Few rules (other than safety-related) to create an

open atmosphere in which the child feels comfortable
expressing his or her true feelings
Child-Centred Play (cont’d)
{ Limits are enforced in a defined, effective manner so

that the child understands the boundaries and learns
to take responsibility for his or her actions
{ Sessions are of relatively short duration using toys set

aside for this sole purpose only, and are not to be
interrupted by others except in case of emergency.
12
What To Do
Child-Centered Imaginary Play
{ Preparing:
• Determine when, how often, and where sessions will

occur, and Assemble a box of “session-only” toys
• Meet with your child and set the rules/limits and

consequences for negative behaviour, remembering that
limits are only for the child’s safety, the safety of others,
or the protection of valuable toys or property, and that,
when parents routinely threaten their children with
consequences which they fail to carry out, they may erode
that child’s trust
• Arrange child care for siblings, if necessary.
What To Do
{ Setting the Stage:
• Make sure others are aware of the session and to not
interrupt unless it is an emergency
• Unplug/turn off the phones, T.V., computers,
Blackberries, etc. and let the doorbell ring!
• Set up the play area with a rug or blanket to define the
floor space and set out all of the toys in full view
• Invite the child into the play space and quickly review
the rules, boundaries, and consequences
What To Do
{ Play(!):
Let your child choose the toys and method of play while
you:
demonstrate empathic listening
• provide undivided attention
• use your own words to name the feelings expressed
Example: Child: “Look at my drawing - isn’t it great?”
Parent: “You’re really proud of your drawing!”
maintain agreed-upon limits and apply consequences as
necessary.
13
What To Do (cont’d)
Empathic Listening
o Provide undivided attention
o Use your own words to rephrase aloud the main
feelings the child expresses
Example: Child: “Look at my drawing, isn’t it great?

Parent: “You’re really proud of your drawing”
Limit Setting
o Provides children with boundaries which are

essential to their sense of security
o When determining limits, it is important to consider

whether the limit is necessary for the child’s
safety, the safety of others, or the protection of
valuable toys or property
o When parents routinely threaten their children with

consequences which they fail to carry out, they
may be eroding the trust children place in them.
Limit Setting (cont’d)
o Helps children learn that they are responsible for

what happens to them
o During play sessions, limits should be kept to a
minimum.
o Limits need to be stated and enforced as
consistently as possible
Examples of Common Limits:

o No throwing anything at windows or mirrors
o Crayons should not be used on the walls, furniture,
or blackboards
14
Examples (cont’d)
o Sharp objects should not be poked, thrown, or
kicked
o Play guns should not be pointed or shot at people

when they are loaded
o Valuable items should not be destroyed and there

should not be a mass destruction of toys
o Personal limits should be set to a minimum (i.e., no

jumping on Mommy’s back, etc)
Challenges to limits
o When a limit is about to be broken, state the

limit
o Tone of voice should be pleasant, but firm and

forceful
o Use the child’s name, reflect the child’s desire

to engage in the prohibited behaviour, then
state the limit again
Challenges ... (cont’d)
o Help the child re-direct his or her play
Example:
“Johnny, you would like to colour on the wall.

Remember, I said I’d let you know if there’s
something you may not do? One of the things
you may not do here is colour on the wall. You
can colour on the paper or in the colouring
book.”
15
Challenges ... (cont’d)
o Giving a Warning:
Restate the limit and then tell the child what

will happen if the child breaks it again (i.e.,
leave the play session); then redirect the play
Example:
“Jane, remember that I told you that you may not
colour on the walls? If you colour on the walls
again, I will end the play time for today. You may
colour on the paper or in the colouring book”.
Challenges... (cont’d)
o Enforcing the Consequence:
Restate the limit and then carry out the
consequence given in the warning
A pleasant but firm tone of voice is used
Example:
“Johnny, remember I told you if you colour on
the walls we would leave the play time? Since
you chose to colour on the wall, we must leave.
Right now.”
Helping Your Adolescent Through Depression

* Adapted from: Bilsker, D., Gilbert, M., Worling, D., & Garland, J., Child & Youth Mental Health Branch, Ministry
of Children & Family Development
*These activities are not meant to be a replacement for treatment where this is needed. If expert
assistance or treatment is needed, the services of a competent professional should be sought
16
Helping Your Adolescent...
Three skills to help your adolescent:
1. Realistic Thinking
2. Problem-Solving
3. Goal Setting

1. Realistic Thinking
o Spot depressive thoughts
o Help your teen to notice how depressive

thoughts affect his or her moods
o Challenge depressive thoughts and replace them

with realistic ones (Help child understand what is
good enough – perfectionism is not realistic)
o Learn about the triggers

Realistic Thinking (cont’d)
Identify depressive thoughts, which fall into one or more of
the following categories:
All or nothing Mind-reading
Filtering
Overgeneralizing
Hopelessness (“It doesn’t

Labelling matter what I do”)
Exaggerating Perfectionism
17
o Help your teen to notice how depressive thoughts
affect his or her mood
Write down any depressive thoughts that go along

with your negative moods (seeing your thoughts
on paper makes it easier to look at them clearly)
Remind the teen that these are just thoughts, NOT

a reality
Don’t allow the teen to criticize him or herself for

having these thoughts. They are normal, but they
do not have to determine one’s feelings and
behaviour!

o Example:
Situation Depressive Realistic Thoughts

Thoughts
A friend doesn’t call Everyone hates Maybe she was just
you. me. busy and will call
later.

o Challenge depressive thoughts - replace them with
realistic ones. Use a chart to record situations and
depressive thoughts, then replace the depressive
thoughts with ones that are realistic
Situation Depressive Realistic Thoughts

Thoughts
18
o Learn about the triggers
o Certain situations can trigger depressive thoughts.

Start noticing what went on just prior to feeling
depressed. Start writing these situations and
experiences down so that they can be used to
practice realistic thinking in the future.

2. Problem Solving
A person who is already depressed will have

difficulties solving problems. She or he might:
o See the problem as more difficult than it truly is.

o Have trouble finding solutions for the problem
o Get stuck in one way of dealing with the problem
even though it isn’t working
o Find it hard to put a plan into action.

Problem Solving (cont’d)
Steps to take:
o Identify the problem and potential actions to take to help solve
the problem
The Problem: - identify the problem by paying attention to
On a scale of 1-10, this is a ___ how your mood changes through the week
- focus on only one problem at a time
People who can support me: Friends, siblings, parents, other concerned
adults?
What I want to happen: -what would you like the end result to be?
3 or more things I could do - consider things that you could do

(my potential solutions): with/without the help of someone else
- it’s okay if you tried something and it didn’t
work. Reward yourself!
19
Problem Solving (cont’d)
Steps…Cont’d:
o Compare the good and bad points of the different
solutions
o Pick the best solution from your list and do it. Be
assertive and strike a balance between what you want
and what others want, stating your own view and
listening to the views of others.
o Evaluate your results. If the problem is solved,
celebrate! If not, revisit the list of solutions, add more
if you can, pick another to try, and do it. Evaluate the
result. Keep going till the problem is solved and then
celebrate your success!

3. Goal Setting
When people become depressed, they find it hard to set
goals or do them. They may:
o Lack problem solving skills – struggle for solution & deal
with the problem in one way, even if it is not working
o Lack realistic thinking
o Lack motivation
o Not feel they have the energy to carry out the goal
o Set goals that are too big – perfection not realistic

Goal Setting (cont’d)
Steps:
a. Choose a goal – SMART
(Specific, Measurable, Agreeable, Realistic, Timeline)
b. Carry out the goal
c. Evaluate the goal
d. Celebrate
20
a. Choose a goal for the next week, and make the goal:
• Specific: unclear goals are less likely to be carried out and
result in feelings of failure
• Measurable: develop a goal that is easy for you to track

your progress and success
• Agreeable: develop a goal that works for you and those

around you (e.g., your family, your counsellor)
• Realistic: goals that are too big often result in feeling

discouraged. Should be easy enough to carry out even if
you feel depressed over the next week
• Scheduled: the more exact in stating your goal, the more

likely to carry it out

b. Carry out the goal, using the problem solving steps

noted earlier
c. Evaluate your progress/success
• Recognize what has been accomplished. Parents,

often need to help with this, as it is frequently
difficult for your depressed teen to acknowledge
her or his successes.
• Give credit for trying to accomplish the goal too

and review or revise the plan as needed.

d. Celebrate
• Provide nurturing/emotional rewards, like time

with you (the parent), instead of monetary
rewards
21
Helping yourself: Practicing Self-care
Strategies:
{ Express your feelings!
{ Periodically get away from it all
{ Child benefits most when adult is happy and

comfortable
{ Take care of yourself
{ Nurture adult relationships
{ Join a parent support group
Suicide Risk
Suicide Risk Indicators

{ Withdrawal from friends
{ Talk about suicide, death, or going away
{ High risk behaviours (ie. Restricting eating, asking

about medication, drug use, putting themselves at
risk)
{ Giving away valued possessions
{ Sudden signs of happiness after prolonged sadness,

or any other sudden, visible change in mood
22
Suicide Risk Indicators...
{ Ending of relationships
{ Making final arrangements (e.g. writing a will,

drafting a suicide note)
{ Prior suicide attempt
{ Writing/talk about suicide
{ Idolize & romanticize people who have committed

suicide
What To Do
{ Suicide must always be taken seriously.
{ Ask if the child/youth is thinking about suicide. Listen

openly and without judging. Believe what he/she says
and take all threats seriously.
{ Never leave a suicidal child/youth alone.
{ Never keep someone’s suicidal feelings a secret.

Share the responsibility by getting others involved.
{ Reassure the child/youth that help is available and

that you are going to assist in getting it for him/her.
{ Remove, Monitor and/or supervise the means for

self-injury
{ Act immediately
Accompany the child or youth to the Emergency
Department of the closest hospital, to her/his
family doctor, or to a mental health professional.
23
Resources
• Access Mental Health 403- 943-1500
• Calgary Outlink: Centre for Gender

and Sexual Diversity 403-234-8973
• Crisis and Suicide Help Line 403-266-1605
• Kids Help Phone 1-800-668-6868
• Teen Help Line 403-264-TEEN
• Mental Health Help Line 1-877-303-2642
• Wood’s Community Resource Team 403-299-9699
• Distress Centre 403-266-1605
Bibliography*
Bilsker, G., Worling, & Garland (n.d). Dealing with Depression:
Antidepressant Skills for Teens. A free download from
http://www.mcf.gov.bc.ca/mental_health/teen.html.
Teens Health (1995-2008). Retrieved from

http://www.kidshealth.org/teen
VanFleet, R. (1994). Filial Therapy: Strengthening Parent-Child

Relationships Through Play. Sarasota, Florida: Professional
Resource Press
* These books can be obtained from your local library and/or by contacting
the Family and Community Resource Centre library (403-955-7745)
Bibliography*
Landreth, G.L., (1991). Play therapy: The art of the relationship.
Accelerated Development Inc. Bristol, PA p. 378
Booklet: Parents and Teachers as Allies, Recognizing Early-onset

Mental Illness in Children and Adolescents, Second Edition,
2003. NAMI, the Nation’s voice on Mental Illness. See
www.nami.org.
* These books can be obtained from your local library and/or by contacting
the Family and Community Resource Centre library (403-955-7745)
24
Online Sites
{ National institutes of Mental Health
www.nimh.nih.gov
{ PsychDirect, Dept., of Psychiatry and Behavioural Neuroscience,

McMaster University, Hamilton, ON
www.Psychdirect.com
{ Kids have stress too. The Psychology Foundation of Canada

www.kidshavestresstoo.org
{ American Academy of Child and Adolescent Psychiatry

www.aacap.org
{ The Centre for Children with Special Needs. Children’s Hospital and
Regional Medical Centre. Seattle, Washington.
www.cshcn.org, click on resources, and click A-Z list, then look for the
anxiety and depression link
Acknowledgements
We would like to acknowledge the contributions of the many clinicians
who participated in our Focus Groups and thus contributed to refreshing
the content of this presentation. As well, we would like to thank the
following clinicians who have gone the ‘extra mile’ and made significant
editorial and/or content contributions to this presentation:
Lindsay Hope-Ross, M.Sc., R. Psych.,

Clinical Supervisor, Healthy Minds/Healthy Children
Rekha Jabbal, B.SP,

Pharmacy Clinical Practice Leader, Child and Adolescent Mental Health
Blaine Munro, Family Counsellor, MSW, RSW,

Collaborative Mental Health Care (CMHC)
Billie Orr, R. Psych.,

Adolescent Day Treatment Program
Susan Ponting, M.Ed., R. Psych.,

Mental Health Education Specialist, Community Education Service
Community Education Service
To register for notification or an

upcoming education session
go to: www.fcrc.sacyhn.ca
For general CES enquiries

Email: ces@sacyhn.ca
Call: 403-955-7420
Funding generously provided by Encana

Corporation and the Alberta Children’s
Hospital Foundation
25

Parenting Sad and Depressed Children and Youth - Presentation

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Parenting Sad and Depressed Children and Youth - Presentation

Uploaded by

Copyright:

Available Formats

Community Education Service

Funding generously provided by Encana

{ What brought you here today?

{ Mood disorder involving sadness, despair,

{ Clinical depression interferes with a person’s ability to

Sadness vs. Clinical Depression

o does not usually last longer than several days

o does not severely interfere with day-to-day activities

o does not require therapy or medication to resolve

o results from an inability to solve the problem caused by

o debilitating feelings of dejection, sadness, and despair

o loss of interest in others, withdrawal, and preoccupation

o lasts two weeks or longer

Sadness vs. Clinical Depression

o interferes with the ability to perform day-to-day

o use of unhealthy coping mechanisms (i.e., guilt,

o often requires therapy and/or medication to help

What Causes Depression?

{ An imbalance of neuro-transmitters in the brain that

{ Children are more likely to become depressed if they have

{ Children under the age of 5, even infants, can be

Parenting Sad & Depressed Children and Youth

Stressors for Children & Adolescents

Stress (Risk) Factors for Children and Adolescents

Common stressors (risks) are:

1. Death of a loved one

Common Protective Factors are:

Parenting Sad and Depressed Children and Youth

Signs and Symptoms

o Lack of care in physical appearance

o Enuresis (wetting oneself)

o ’Dark’ themes in writing or choice of music

o Self-medicating with alcohol or street drugs

o Talking about death or suicide

Behavioural Symptoms (cont’d)

o Defiant and oppositional

o Cutting and other self-harming behaviours

o Social isolation/withdrawal from family and

{ Flat affect (i.e., unexpressive/unemotional)

{ Unable to see a future any better than present

Cognitive Symptoms (cont’d)

{ Belief that self is worthless, useless, and/or unlovable

{ Belief that self is a burden to others (e.g. “they’d be

{ May have auditory/visual hallucinations

1. Respect and validate the child’s feelings

o Listen without judging

o Try to put yourself in your child’s shoes

o Don’t be afraid to ask your child how s/he is

o Let your child know she or he can come and

o Be patient. Teens especially will let you in and

o Be available when your child comes to talk to you.

o Ask children about their friends (i.e. being bullied)

o Use a rating scale (1-10) to understand how child is

Caregiver Interventions (cont’d)

4. If a possibility for self-harm exists, remove the

Caregiver Interventions (cont’d)

5. Encourage parents to find out if there are additional

6. Consider seeking professional help (therapy

o The combination of a medication with therapy

{ Therapy is the first choice of treatment

{ Research has shown that Cognitive Behavioural

{ SSRI’s are the first choice of medication for children

Restate the limit and then tell the child what

All or nothing Mind-reading

Hopelessness (“It doesn’t

Write down any depressive thoughts that go along

Remind the teen that these are just thoughts, NOT

Don’t allow the teen to criticize him or herself for