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Blog Articles and Resources

How to Recognize Signs of Mental Illness in Children

5/31/2016

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This video was obtained from YouTube on 5/16/16.  It was published on 5/26/15 as part of a series: How to Treat Various Child Ailments. 
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Is it ADHD or Immaturity?

5/27/2016

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The following article was found on the Child Mind Institute website.  This website does a good job of providing factual, research based information for parents to help in raising kids struggling with various mental health concerns.  This particular article was written by Caroline Miller, the editorial director for the Child Mind Institute.

Is It ADHD or Immaturity?
How to avoid a misdiagnosis when a child is young for his class
Caroline Miller

Several studies in recent years have found that children who are among the youngest in their class are diagnosed with ADHD at a much higher rate than their older classmates.
This suggests that a significant percentage of kids with ADHD are being misdiagnosed just because they are less mature. It raises important questions about how kids are being diagnosed, and how to avoid misinterpreting the behavior of children who might be having trouble meeting expectations just because they are younger.
The findings in these studies of large populations of kids — in Michigan, British Columbia and (most recently) Taiwan — are consistent. The youngest children are significantly more likely to be diagnosed than the oldest in the same class: boys as much as 60 percent and girls as much as 70 percent. The Taiwan study even showed the prevalence of kids diagnosed with ADHD decreased month by month from the youngest to the oldest in the class.
What can we do to address this problem while still making sure kids get the help they need?
How to avoid misdiagnosis
Most ADHD diagnoses are the result of children struggling to meet expectations for behavior and performance in school. All young children find it challenging to sit still, pay attention, wait their turn, finish tasks and keep from interrupting. By school age most have developed skills to manage these things as expected. Those who don’t are often flagged by teachers who have a lot of experience with typical behavior and child development.
But the age range of students in a given classroom can span a whole year, which means that the developmental differences between the youngest and the oldest can be substantial. That’s why it’s important that if children are being evaluated for ADHD, their behavior should be compared with that of other children their age, not all the other children in their class.
“If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6,” explained Todd Elder, lead author of the Michigan study. “There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD.”
Here are other “best practices” that should be followed to avoid misdiagnosis:
A variety of sources: A child shouldn’t get a diagnosis of ADHD based on a teacher’s observations alone. A clinician evaluating a child should collect information from several adults, including teachers, parents and others who spend time with him.
Not just at school: For a child to be properly diagnosed with ADHD, the symptoms that are associated with the disorder — inattention, impulsivity and hyperactivity — have to be present in more than one setting. Are they noticeable at home and in social situations, as well as school? Do his parents worry that he’s so impulsive he’s a danger to himself? Does she have trouble keeping friends because she can’t follow rules, can’t wait her turn or has tantrums when she doesn’t get her way?
Rating scales: Scales that are filled out by teachers and parents should be used to collect specific information about the frequency of behaviors we associate with ADHD, and compare them with other children the same age, rather than relying on general impressions.
A thorough history: To get a good, nuanced understanding of a child’s behavior, a clinician needs to know how it’s developed over time, notes Dr. Matthew Rouse, a clinical psychologist at the Child Mind Institute. “What was she like at two or three or four? Is kindergarten the first time these issues have come up, or was she kicked out of preschool because she couldn’t behave?”
Level of impairment: The biggest difference between kids with ADHD and those who are just immature is likely to be how much their behavior impacts their lives. Are they in a negative spiral at home because they can’t seem to do what they’re asked to do, and parents are very frustrated? Are they unable to participate in sports because they can’t follow rules? Do they get excluded from play dates?
A wait and see approach
If a child is struggling because he’s immature, things could get better over time, as he adjusts to the expectations of a new classroom.
“Some children starting kindergarten might have a difficult time fitting into a new setting, adjusting to new rules,” notes Dr. Rouse. “It might be the first time the child has been in a setting with so many other kids around, and the first time taking direction from people not his parents.”
Giving kids time to adjust is one reason Dr. Rouse says that when a child presents symptoms that look like ADHD in kindergarten, when it’s his first year in school, he’ll make a provisional or “rule out” diagnosis, and reevaluate when the child is 6.
Treatment recommendations
While medication has been shown repeatedly to be the most effective at reducing symptoms of ADHD, it isn’t necessarily the go-to treatment for the youngest kids. The potential for misdiagnosis is one reason why Dr. Rouse recommends behavioral therapy for younger children with ADHD, rather than starting with stimulant medication.
Similarly, the American Association of Pediatricians recommends behavioral therapy administered by parents and teachers as the first line of treatment for children 4 to 5 years old. Stimulant medication is recommended only if the behavioral therapy doesn’t produce results, and the child continues to have moderate to severe symptoms.
Delay in brain development
One reason immaturity might be confused with ADHD is that ADHD itself has been linked to a delay in brain maturation. An older child with ADHD might present behaviors that are typical in a younger child — and the opposite could be true if your frame of reference is older children. Several important neuroimaging studies have shown delays in brain development in kids with ADHD.
In a 2006 study at the National Institutes of Mental Health, the brains of several hundred children were scanned over a 10-year period. As the brain matures, the cortex thickens and then thins again following puberty, when connections are pruned to increase the efficiency of the brain. Researchers found that what they call “cortical maturation” — the point in which the cortex reaches peak thickness — was three years later in kids with ADHD than kids in a control group: 10.5 years old, compared to 7.5. The kids with ADHD also lag behind other kids in the subsequent cortical thinning.
The researchers noted that the most delayed areas of the brain are those that “support the ability to suppress inappropriate actions and thoughts, focus attention, remember things from moment to moment, work for reward and control movement – functions often disturbed in people with ADHD.”
They also added, tantalizingly, that the only area that matured faster than usual in kids with ADHD was the motor cortex. Combine that with the late-maturing frontal cortex areas that direct it, and the mismatch, they suggested, could account for the restlessness associated with the disorder.
Then in 2013, a study using scans of brain functioning, rather than structure, also found a lag in maturity in kids with ADHD. That study, at the University of Michigan, found that children and teens with ADHD are behind others of the same age in how quickly their brains form connections within, and between, key brain networks.
Specifically, they found less-mature connections between what’s called the “default mode network,” which controls internally directed thought, and networks that focus on externally directed tasks. Researchers propose that this lag in connectivity could help explain why children with ADHD find their thoughts wandering and struggle to complete tasks and stay focused.
Maturing out of ADHD symptoms
Finally, we know that some children grow out of ADHD symptoms as they become teenagers and young adults. Hyperactive and impulsive symptoms often wane through adolescence, while inattentive symptoms may continue to be a problem into adulthood.
Regardless of whether or not a child has ADHD, if his behaviors interfere with learning, making friends and being a part of the family, then he needs help. But the behavioral therapies and medications that can work wonders for kids with ADHD aren’t appropriate for children who are struggling to meet expectations just because they are less mature than those they are being compared to.
There are also other problems that can be misread as ADHD. Anxiety and trauma, for instance, can also cause inattention and what looks like impulsivity. That’s why it’s important that kids with behavior issues be evaluated thoroughly; careful and effective diagnosis benefits everyone.
Miller, Caroline. "Is It ADHD or Immaturity?" Child Mind Institute. Child Mind Institute, 2016. Web. 13 Apr. 2016.

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Managing Problem Behavior At Home

5/24/2016

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The following article comes from the Child Mind Institute website.  This site has numerous sources on issues parents face raising children with a variety of concerns.  The site does an excellent job of providing factual information as well as interventions and ideas to try as parents. 
Managing Problem Behavior at Home
A guide to more confident, consistent and effective parenting
One of the biggest challenges parents face is managing difficult or defiant behavior on the part of children. Whether they’re refusing to put on their shoes, or throwing full-blown tantrums, you can find yourself at a loss for an effective way to respond.
For parents at their wits end, behavioral therapy techniques can provide a roadmap to calmer, more consistent ways to manage problem behaviors and offers a chance to help children develop the skills they need to regulate their own behaviors:
ABC’s of behavior management
To understand and respond effectively to problematic behavior, you have to think about what came before it, as well as what comes after it. There are three important aspects to any given behavior:
  • Antecedents: preceding factors that make a behavior more or less likely to occur. Another, more familiar term for this is triggers. Learning and anticipating andecedents is an extremely helpful tool in preventing misbehavior.
  • Behaviors: the specific actions you are trying to encourage or discourage.
  • Consequences: the results that naturally or logically follow a behavior. Consequences-positive or negative-affect the likelihood of a behavior recurring. And the more immediate the consequence, the more powerful it is.
Define behaviors
The first step in a good behavior management plan is to identify target behaviors. These behaviors should be specific (so everyone is clear on what is expected), observable, and measurable (so everyone can agree whether or not the behavior happened).
An example of poorly defined behavior is “acting up,” or “being good.” A well-defined behavior would be running around the room (bad) or or starting homework on time (good).
Antecedents, the good and the bad
Antecedents come in many forms. Some prop up bad behavior, others are helpful tools that help parents manage potentially problematic behaviors before they begin and bolster good behavior.
Antecedents to AVOID:
  • Assuming expectations are understood: Don’t assume kids know what is expected of them.- spell it out! Demands change from situation to situation and when children are unsure of what they are supposed to be doing,they’re more likely to misbehave.
  • Calling things out from a distance: Be sure to tell children important instructions face-to-face. Things yelled from a distance are less likely to be remembered and understood.
  • Transitioning without warning: Transitions can be hard for kids, especiallyin the middle of something they are enjoying. Having warning gives children the chance to find a good stopping place for an activity and makes the transition less fraught.
  • Asking rapid-fire questions, or giving a series of instructions:Firing a series of questions or instructions at children limits the likelihood that a child will hear, answer questions, remember the tasks, and do what she’s been instructed to do.
Antecedents to EMBRACE:
Here are some antecedents that can bolster good behavior:
  • Be aware of the situation:Consider and manage environmental and emotional factors-hunger, fatigue, anxiety, or distractions can all make it much more difficult for children to reign in their behavior.
  • Adjust the environment: When it’s homework time, for instance,remove distractions like video screens and toys, provide a snacks, establish an organized place for kids to work and make sure to schedule some breaks- attention isn’t infinite.
  • Make expectations clear: You’ll get better cooperation if both you and your child are clear on what’s expected. Sit down with him and present the information verbally. Even if he “should” know what is expected, clarifying expectations at the outset of a task helps head off misunderstandings down the line.
  • Provide countdowns for transitions: Whenever possible, prepare children for an upcoming transition. Let them know when there are, say, 10 minutes remaining before they must come to dinner or start their homework. Then, remind them, when there are say, 2 minutes, left. Just as important as issuing the countdown is actually making the transition at the stated time.
  • Let kids have a choice: As kids grow up, it’s important they have a say in their own scheduling. Giving a structured choice—”Do you want to take a shower after dinner or before?”—can help them feel empowered and encourage them to become more self-regulating.
Creating effective consequences
Not all consequences are created equal. Some are an excellent way to create structure and help kids understand the difference between acceptable behaviors and unacceptable behaviors while others have the potential to do more harm than good. As a parent having a strong understanding of how to intelligently and consistently use consequences can make all the difference.
Consequences to AVOID
  • Giving negative attention: Children value attention from the important adults in their life so much that any attention—positive or negative-is better than none. Negative attention, such as raising your voice or spanking—actually increases bad behavior over time. Also, responding to behaviors with criticism or yelling adversely affects children’s self-esteem.
  • Delayed consequences: The most effective consequences are immediate. Every moment that passes after a behavior, your child is less likely to link her behavior to the consequence. It becomes punishing for the sake of punishing, and it’s much less likely to actually change the behavior.
  • Disproportionate consequences: Parents understandably get very frustrated. At times, they may be so frustrated that they overreact. A huge consequence can be demoralizing for children and they may give up even trying to behave.
  • Positive consequences: When a child dawdles instead of putting on his shoes or picking up his blocks and, in frustration, you do it for him, you’re increasing the likelihood that he will dawdle again next time.
EFFECTIVE consequences:
Consequences that are more effective begin with generous attention to the behaviors you want to encourage.
  • Positive attention for positive behaviors: Giving your child positive reinforcement for being good helps maintain the ongoing good behavior. Positive attention enhances the quality of the relationship, improves self-esteem, and feels good for everyone involved. Positive attention to brave behavior can also help attenuate anxiety, and help kids become more receptive to instructions and limit-setting.
  • Ignoring actively: This should used ONLY with minor misbehaviors—NOT aggression and NOT very destructive behavior. Active ignoring involves the deliberate withdrawal of attention when a child starts to misbehave—as you ignore, you wait for positive behavior to resume. You want to give positive attention as soon as the desired behavior starts. By withholding your attention until you get positive behavior you are teaching your child what behavior gets you to engage.
  • Reward menus: Rewards are a tangible way to give children positive feedback for desired behaviors. A reward is something a child earns, an acknowledgement that she’s doing something that’s difficult for her. Rewards are most effective as motivators when the child can choose from a variety of things: extra time on the i-pad, a special treat, etc. This offers the child agency and reduces the possibility of a reward losing its appeal over time. Rewards should be linked to specific behaviors and always delivered consistently.
  • Time-Outs: Time outs are one of the most effective consequences parents can use but also one of the hardest to do correctly. Here’s a quick guide to effective time-out strategies.
  • Be clear: Establish which behaviors will result in time outs. When a child exhibits that behavior, make sure the corresponding time out is relatively brief and immediately follows a negative behavior.
  • Be consistent: Randomly administering time outs when you’re feeling frustrated undermines the system and makes it harder for the child to connect behaviors with consequences.
  • Set rules and follow them: During a time-out, there should be NO talking to the child until you are ending the time-out. Time-out should end only once the child has been calm and quiet briefly so they learn to associate the end of time out with this desired behavior.
  • Return to the task:If time-out was issued for not complying with a task, once it ends the child should be instructed to complete the original task. This way, kids won’t begin to see time-outs as an escape strategy
By bringing behavioral tools home, parents can make it a much more peaceful place to be.
"Managing Problem Behavior at Home | Child Mind Institute." Child Mind Institute. Child Mind Institute, 2016. Web. 13 Apr. 2016.

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Effectively Co-Parenting After Divorce

5/20/2016

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The above video was found on YouTube on 5/16/16 and was originally published on October 28, 2015.  It is a clip from Psychologist Kristine Turner addressing how parents can learn to effectively co-parent following divorce.
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How to Help a Stressed or Depressed Loved One

5/17/2016

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This article comes from the website PsychCentral.com which has several great articles about stress and managing stress.  Many of the articles are written by mental health professionals who specialize in helping clients deal effectively with stress and the resulting complications.
 
How To Help A Stressed Or Depressed Loved One
By Chris Green
 
I receive many emails from concerned relatives, partners and friends who are trying to help a loved one suffering the torment of a stressful or depressive episode. Sometimes, it’s easy to forget that people who love us are also affected by these illnesses and may find it difficult to understand what’s happening. They want to help, but just don’t know what to do for the best.
Having lived with a depressed partner for 3 years and suffered anxiety and depression for 5 years, I’ve experienced both sides. In this article, I’ll show you exactly what you can do – and, what you shouldn’t do – to help your loved one.
1. Please, however frustrated you feel, please never say to a depressed or stressed person: “Come on, snap out of it. What have you got to be worried or sad about anyway. People have it much worse than you.” Please understand that these illnesses cannot be “snapped out of.” You wouldn’t say this to someone with high blood pressure or pneumonia because you know it isn’t that simple. Stress, depression and anxiety are real illnesses that have specific causes. Asking someone to snap out of it makes that person feel inadequate or that they’re doing something wrong. Absolutely not so. Comparing their circumstances to people who are suffering greater hardship is no use either. I couldn’t have given two hoots about other people when I was ill because their circumstances meant nothing to me. I was struggling to solve my own problems and couldn’t see anything else. Knowing that others are starving, are terminally ill, or suffer in squalor didn’t matter a jot because they didn’t make my problems go away. One more thing about such statements: they confront the sufferer with their illness and they put pressure on them. This will cause sufferers to retreat further and further into their own world. Better is to offer love and support: “I’m always here if you need me or want to talk.” And 3 little words can mean so much: “I love you.” I didn’t hear them for 3 years and believe me, I missed them so very much.
2. As a loved one, it is totally natural to want to understand what is happening. Many loved ones conduct research into these illnesses to develop understanding. Nothing wrong with that whatsoever. However, a problem can arise if you start to impose your knowledge on the sufferer. This happens when you observe certain behaviors and habits performed by sufferers and comment on why they are behaving in such a way. For example, you hear a sufferer put themselves down, so you say “That’s a part of your illness. I’ve been reading about it and self-deprecation is one of the reasons why people become depressed. You need to stop putting yourself down.” Again, this is confrontational and puts the sufferer under pressure. All they’ll do is dismiss your comments and clam up whenever you’re around as they’ll feel they’re being scrutinised. A better way is to challenge them very gently by reminding them of a time when they did something good. For example, you hear a sufferer say: “I’m useless, I never get anything right.” You can say “Sure you do, hey, remember the time when you…”. Do you see the difference in approach? The first is more like a doctor assessing a patient, the second is just a normal, natural conversation and doesn’t mention stress, depression or anxiety. This is very, very helpful as it shifts focus from a bad event: “I’m useless…” to a good one: “remember when.” without exerting pressure.
3. Finally, you may find a resource – a book, a video, a supplement etc. – that you think will help someone to beat their illness. Perfectly natural. But there’s a problem. It confronts the sufferer with their illness and puts them under pressure to do something about it. The result of this will be resentment followed by retreat into their own world. Isolation is a part of these illnesses. Sometimes, you just can’t bear to be around people. My ex-partner used to sleep in a dark room for an entire weekend because she just couldn’t handle anyone being around her. “I bore people, I’ve nothing to say of interest and I don’t want anyone asking me how I’m feeling. I just want to be on my own.” I know, it cuts you to ribbons when you hear such words from someone you care deeply about. But please, you must resist the urge to DIRECTLY give them a resource you think will help them. For someone to emerge from these illnesses, they have to make the decision themselves. A direct offer will more often than not be refused. So, if you find something you think will help, leave it lying around somewhere your loved one will find it. The idea here is for them to CHOOSE by themselves to investigate further. Such an INDIRECT approach is more effective because once again, there is no pressure, no reminder, no confrontation. It is the sufferer who takes a willing first step towards recovery.
It is so hard to understand and reach loved ones when they’re caught up in these illnesses but please believe me, these ideas are very effective and they will help.
 
Green, Chris. "How To Help A Stressed Or Depressed Loved One." Psych Central. Chris Green by Psych Central, 2015. Web. 13 Apr. 2016.
 
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Treatment of Behavioral Problems

5/9/2016

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This video was found on youTube and features Dr. Collins Hodges, a child and adolescent psychologist.  This video was published by the Best Docs network on May 28th, 2015.
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Depression in Teens

5/3/2016

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The following article comes from the Mental Health America website.  This site has numerous articles on numerous mental health related subjects and provides resources for helping these issues across the country. 

Depression In Teens

It’s not unusual for young people to experience "the blues" or feel "down in the dumps" occasionally. Adolescence is always an unsettling time, with the many physical, emotional, psychological and social changes that accompany this stage of life.
Unrealistic academic, social, or family expectations can create a strong sense of rejection and can lead to deep disappointment. When things go wrong at school or at home, teens often overreact. Many young people feel that life is not fair or that things "never go their way." They feel "stressed out" and confused. To make matters worse, teens are bombarded by conflicting messages from parents, friends and society. Today’s teens see more of what life has to offer — both good and bad — on television, at school, in magazines and on the Internet. They are also forced to learn about the threat of AIDS, even if they are not sexually active or using drugs.
Teens need adult guidance more than ever to understand all the emotional and physical changes they are experiencing. When teens’ moods disrupt their ability to function on a day-to-day basis, it may indicate a serious emotional or mental disorder that needs attention — adolescent depression. Parents or caregivers must take action.
Dealing With Adolescent Pressures
When teens feel down, there are ways they can cope with these feelings to avoid serious depression. All of these suggestions help develop a sense of acceptance and belonging that is so important to adolescents.
  • Try to make new friends. Healthy relationships with peers are central to teens’ self-esteem and provide an important social outlet.
  • Participate in sports, job, school activities or hobbies. Staying busy helps teens focus on positive activities rather than negative feelings or behaviors.
  • Join organizations that offer programs for young people. Special programs geared to the needs of adolescents help develop additional interests.
  • Ask a trusted adult for help. When problems are too much to handle alone, teens should not be afraid to ask for help.
    But sometimes, despite everyone’s best efforts, teens become depressed. Many factors can contribute to depression. Studies show that some depressed people have too much or too little of certain brain chemicals. Also, a family history of depression may increase the risk for developing depression. Other factors that can contribute to depression are difficult life events (such as death or divorce), side-effects from some medications and negative thought patterns.
    Recognizing Adolescent Depression
    Adolescent depression is increasing at an alarming rate. Recent surveys indicate that as many as one in five teens suffers from clinical depression. This is a serious problem that calls for prompt, appropriate treatment. Depression can take several forms, including bipolar disorder (formally called manic-depression), which is a condition that alternates between periods of euphoria and depression.
    Depression can be difficult to diagnose in teens because adults may expect teens to act moody. Also, adolescents do not always understand or express their feelings very well. They may not be aware of the symptoms of depression and may not seek help.
    These symptoms may indicate depression, particularly when they last for more than two weeks:
  • 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, risk-taking behavior. But such behaviors only lead to new problems, deeper levels of depression and destroyed relationships with friends, family, law enforcement or school officials.
    Treating Adolescent Depression
    It is extremely important that depressed teens receive prompt, professional treatment.
    Depression is serious and, if left untreated, can worsen to the point of becoming life-threatening. If depressed teens refuse treatment, it may be necessary for family members or other concerned adults to seek professional advice.
    Therapy can help teens understand why they are depressed and learn how to cope with stressful situations. Depending on the situation, treatment may consist of individual, group or family counseling. Medications that can be prescribed by a psychiatrist may be necessary to help teens feel better.
    Some of the most common and effective ways to treat depression in adolescents are:
  • < > provides teens an opportunity to explore events and feelings that are painful or troubling to them. Psychotherapy also teaches them coping skills.Cognitive-behavioral therapy helps teens change negative patterns of thinking and behaving.
  • Interpersonal therapy focuses on how to develop healthier relationships at home and at school.
  • < > relieves some symptoms of depression and is often prescribed along with therapy.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
    REMEMBER!!! These warning signs should be taken seriously. Obtain help immediately. Caring and support can save a young life.
    Helping Suicidal Teens
  • Offer help and listen. Encourage depressed teens to talk about their feelings. Listen, don’t lecture.
  • Trust your instincts. If it seems that the situation may be serious, seek prompt help. Break a confidence if necessary, in order to save a life.
  • Pay attention to talk about suicide. Ask direct questions and don’t be afraid of frank discussions. Silence is deadly!
  • Seek professional help. It is essential to seek expert advice from a mental health professional who has experience helping depressed teens. Also, alert key adults in the teen’s life — family, friends and teachers.
    Looking To The Future
    When adolescents are depressed, they have a tough time believing that their outlook can improve. But professional treatment can have a dramatic impact on their lives. It can put them back on track and bring them hope for the future.
     
    "Depression In Teens." Mental Health America. Mental Health America, n.d. Web. 13 Apr. 2016.
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    Michelle Stewart-Sandusky

    I write articles based on my experience as a therapist or a training or conference attendee.  Many of these articles are written by others who are experts in their field and I share their information as resources for others.

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