1 Anxiety and depression in children and teenagers Professor Shirley Reynolds & Professor Cathy Creswell

2 What do we mean by Anxiety Depression Fear, stress, worry, nervousnessBody: Heart racing, sweaty, butterflies… Thoughts: “Something bad is going to happen” Behaviour: Flight or fight. Low mood, irritability, lack of pleasure Body: Low energy Thoughts: ‘I’m a failure’ Behaviour: Withdrawal

3 Why anxiety and depression?Both are common in under 18s Often appear together or in sequence Interfere with normal life at home and at school Share several features Genetics Environment Thinking and behaviour Treatment is similar (not identical)

4 Acquiring new skills Especially to do with social behaviour Abstract reasoning – greater focus on considering yourself from the eyes of another person Impulse control and long-term perspective taking

5 Should I worry? All children and young people (and adults) have changes in mood Being fearful is very common during childhood (strangers, animals, leaving parents, new school, public speaking) Adolescence is often a time of self consciousness, change and challenges

6 When might anxiety be a problem?Some anxiety is developmentally appropriate Possible excessive anxiety when: Fear is out of proportion to the level of threat. Fear in the absence of actual threat. Difficulty settling back to a normal state Anxiety becomes a problem when it prevents children from enjoying normal life experiences e.g. impacts on school, friendships, family life. A certain amount of anxiety is developmentally appropriate and normal fears can be accepted, such as nerves when starting a new school or becoming upset when being away from parents. However as child grows and is exposed to new experiences, fears and anxieties that are considered normal at a younger stage, may be less appropriate. Indications of excessive anxiety in a child include fear that is out of proportion to the actual threat in the environment or fear in the absence of any actual threat. Children struggling with too excessive anxiety will often have difficulties in settling back to a relaxed state. The level of interference is also an important consideration. Give examples of how anxiety may impact on school, friendships or family life (e.g missing out on clubs, reluctant to talk in class, unable to go out with friends, needing contant reasurrance). When anxiety begins to have a negative impact on these areas, sign that it is time to try and step in to help child. It is important to consider intervention early on. In primary care, may see children who do not reach clinical significane, but treatment can be effective and act as a preventative measure as well. Research suggests that once children meet the criteria for an anxiety disorder they do not recover without treatment and they are vulnerable to developing further problems, such as depression. So important to recognise and intervene as early as possible.

7 Ben, aged 12 ‘Ben’ becomes tearful each morning before school and complains of feeling sick. Although his teachers report that he is fine when he has settled in, he is most comfortable when he can meet a teaching assistant each morning when he arrives. He finds it difficult to sleep alone, frequently comes down to his parents throughout the evening and often goes to sleep in their bed during the night. If his parents go out without him he texts them frequently to check that they are OK and to find out when they will be home. He is reluctant to go out with friends or join activities after school.

8 Depression in adolescence: Aren’t all teenagers ‘moody’?Everyone has times when they feel miserable Teenagers also have to learn to cope with a number of additional challenges Grief, low mood, sadness and other negative feelings are all ‘normal’ But: Depression is not the same as being moody, sad & upset Core symptoms – low mood/irritability and/or lack of pleasure most of the day, nearly every day lasts for more than 2 weeks, Plus 4 additional symptoms, e.g. sleep problems, change in appetite, suicidal thoughts, lack of energy, feelings of worthlessness etc, and Difficulties interfere with functioning (e.g school, work, friends, family)

9 Ellie, aged 16 ‘Ellie’ is 16 years old, and at school studying for her GCSE’s. She feels down most days and cries a lot. Ellie finds it a real struggle to concentrate on homework, and even though she still goes to school and has dance classes twice a week, she feels like she isn’t enjoying anything she does. Ellie finds it hard to get to sleep, and often wakes up in the middle of the night. Ellie has lost her appetite since she started feeling low, and only eats when her mum makes her. She thinks she is a failure and things are never going to improve.

10 What predicts anxiety & depression?Biology / genetics - these difficulties run in families Environment - life events, triggers, learning Relationships - are often protective

11 ‘Lifestyle’ factors and depressionSleep Diet Activity

12 What keeps depression going?It’s a cloudy day and you are sitting on the beach. You look up to notice the weather really beginning to change.

13 ‘It’s probably going to rain’Thinking biases Negative anticipated outcome: ‘It’s probably going to rain’ Positive anticipated outcome: ‘The sun’s coming out’ Depressed or anxious young people make more negative interpretations. They see themselves as less capable, the world as more frightening & the future less hopeful

14 Information overload

15 Making rapid decisions

16 Dealing with information overloadWhat do we attend to? Speed, distance, weather, directions, lights, music, traffic announcements, detours, brake lights, hazards, children arguing? We pick out the key features Survival generally kicks in!

17 Ambiguity - What is it?

18 SINK

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20 Dealing with ambiguityThe world is not only crowded, it’s also confusing and ambiguous. Words, pictures, smells, noises etc all need to be perceived and then made sense of

21 What keeps problems going?Thoughts Feelings Behaviours

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23 What keeps problems going?That’s a dangerous dog Terrified Run away, hide

24 What keeps problems going?They think I’m stupid Sad, lonely Keep to myself

25 What keeps problems going?Thoughts and beliefs that interpret the world more negatively Behaviours that make us feel better immediately but worse in the long run (e.g. avoidance)

26 Treatment for anxiety/depressionUsually based on Cognitive Behaviour Therapy (CBT) CBT can be delivered in many different ways Parents, self help, books, internet, face to face, groups etc CBT involves Working together as a team Identifying goals for treatment Focusing on the here and now Learning how the world really works Challenging thinking & changing behaviours by undertaking ‘experiments’

27 How can you help as a parent?Pay attention – anxiety and depression are not always obvious Quality time- be available in gentle way Listen, support, acknowledge feelings and that it’s hard Healthy lifestyles – exercise/healthy eating/ sleep

28 How can you help as a parent?Create opportunities for independence Encourage curiosity to test out negative thoughts Encourage brave behaviour, activity, ‘try things out’ Provide support rather than reassurance Praise/reward effort, ‘having a go’

29 How can you help as a parent?Show them how to deal with problems and face fears (model what you want to see) Get support

30 Help yourself before you help your childBeing a parent is tough Time to redress and develop balance for you Look after your own needs

31 E-learning

32 The MindEd programme

33 Seeking help Seek help via GP/health professionalThey refer to CPE CAMHS For teenagers aged 17½ (or earlier if left school or living independently) or parents can be referred by GP or self-refer to Increasing Access to Psychological Therapies (IAPT), a.k.a. Talking Therapies

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35 Thank you Any questions?