Red Flags
Recognizing and Coping with
Depression in Children
Penelope Frese, Ph.D.
Amherst Parent Connection
February 12, 2008
What is Red Flags?
Comprehensive mental health awareness program for middle/ jr high
schools
Teaches signs of depression & other mental illnesses
Provides guidelines for getting help
Encourages peers to react and get help for others
Facilitates communication & support
WHAT IS DEPRESSION?
Physical illness. A mood
disorder with defined
characteristics.
Biological- unbalanced
chemicals in the brain- affect
thoughts, feelings, sleep,
appetite, behavior and overall
health.
Mental illnesses are brain disorders
Neurons
Individual brain cells send
electrical impulses which
are transmitted from cell to
cell across the synapses.
Brain fluid contains
substances
(neurotransmitters) which
permit these impulses to
be picked up by receptors
at the end of the
dendrites.
Developmental Pyramid
When one area of the
brain is slow to
develop, it can affect
the development of
other areas which
depend on it for their
development.
Minor developmental
problems can grow into
major ones without
intervention.
Neural Connectors
Nerve fibers continue to develop by extending the branch-like
dendrites. Around puberty the brain begins to prune these
connections.
Etiology of Emotional Disorders
Genetic
Prenatal, Birth, Postnatal Trauma
Viruses
Toxins
Complication
Environmental Factors
Injury
Illness
Extreme or Sustained Emotional or Physical Stress
Do kids really get
depressed?
Research suggests “YES”
1 out of 8 teenagers gets depressed each year
Suicide is the 3rd leading cause of death
in 11 – 24 year olds (Centers for Disease control, 2002)
Up to 90% of adolescents who commit suicide
have a diagnosable mental disorder (Institute of Medicine, 2002)
Can effect anyone regardless of economic
status, culture, age or gender
Top Ten Causes of Death in Youth Ages 11 – 24
(Center for Disease Control, 2000)
HIV
203 Flu & pneumonia
219
238
Cerebrovascular
270
Chronic Low Respiratory
Disease
603
Congenital Anomalies
1,174 Heart Diseases
2,146 Cancer
4,369 Suicide
5,145 Homicide
15,437 Unintentional injury
Medical Causes of Death in Youth Ages 11 – 24
(Center for Disease Control, 2000)
HIV
203
Flu & pneumonia
219 Cerebrovascular
238 Chronic Low Respiratory
Disease
270 Congenital Anomalies
603 Heart Diseases
1,174 Cancer
2,146 Suicide
4,369
more FACTS…
most mental illnesses first appear between the
ages of 15 – 25.
treatment is extremely effective
80% of depressed children do not get
diagnosed or treated.
early intervention can save a child’s life and
help them learn how to care for themselves
Untreated mental illnesses
Can lead to:
inappropriate coping (self-injury, eating
disorders), sexual promiscuity
repeat episodes of depression
impaired social development, acting out
behaviors
poor grades / low test scores
Suicide
Red Flags in Children’s Behavior
Learn
the warning signs
of depression
What are the symptoms?
Different in every child…Red Flags considers
– Academic performances
– Social and Behavioral characteristics
– Cognitive Functioning
– Emotional Behavior/ Standard
– Physical details
Academic Signs
Unexplained drop in school performance / work quality
Overly invested in achieving good grades
Loss of interest in subjects / activities
Turning in unfinished / messy work
Low tolerance for frustration / giving up easily
Unmotivated and can’t seem to finish work
Changes in attendance
Social / Behavioral Signs
Disruptive behavior / fighting / clowning
Withdrawing from social contact
Anti-social / delinquent
Bully / victim
Taking unnecessary risks
Refusing participation
Dropping out of activities
Cognitive Signs
Problems concentrating
Forgetfulness
Indecisiveness/ Confusion
Lack of confidence
Preoccupation with death
Emotional Signs
Poor self-esteem
IRRITABILITY
Generally unhappy
Feeling Guilty
Extreme reactions
Anxious / overwhelmed
Overly sensitive
Fatigued/unmotivated
Physical Signs
Change in sleeping patterns
Sudden weight loss or gain
Changes in appetite
Unexplained headaches, stomach aches,weakness, nausea
Looks/acts “hyped-up” / “slowed down”
Self-injury: Cuts/burns
Bangs head/ slaps self
Frustrated: Crying / punching
Drug / alcohol use
Tired / falls asleep in class
Changes in appearance
Parents need to know…
School is concerned and can help them
– Steer them to support systems
– Help them understand treatment options
– Connect them to community resources
Educational resources are available to them
– IEP’s
– 504’s
– School intervention plans I.e. resource rooms
POINTERS for PARENTS
learn about mental illness
be open to discussion/ encourage talk
know your family history
understand that any child may be at-risk
depression is not your fault but you can help
More POINTERS for PARENTS
be specific when asking for help
reciprocate extra effort
maintain communication w/ all concerned
recognize that many school mandates are
unfunded
find something for respite
If you have concerns
ask for school personnel input
go see a doctor…failing to evaluate/treat can have
serious consequences
provide safe supportive home/ learn coping skills
be specific in asking for help/ work with school
encourage physical activity & healthy eating/sleeping
habits
NEVER disregard suicidal/morbid thoughts or remarks
keep a paper trail
TREATMENT
Education
Life-style changes
(exercise, healthy diet and good sleep habits)
Medication
Counseling
Stress management – coping skills
Where to go for help?
family doctor
psychologist
counselor/social worker/minister
local mental health center
local mental health board
health department
Local resources
Mental health board _______________
Others _______________
National suicide hotline 1-800-782-2433
Local Suicide hotline
Services for children
CSB __________
Dept of health & human srvs ______________
“Conference on Children’s Mental Health… National Action Agenda”
2001 recommendations
1 . Promote public awareness of children’s mental health issues
and reduce stigma associated with mental illness.
2. Continue to develop, disseminate, and implement
scientifically-proven prevention and treatment services in the
field of children’s mental health.
3. Improve assessment and recognition of mental health needs
in children.
4. Eliminate racial/ethnic and socioeconomic disparities in
access to mental healthcare.
Recommendations cont’d
5. Improve the infrastructure for children’s mental health
services including support for scientifically-proven
interventions across professionals.
6. Increase access to and coordination of quality mental
healthcare services.
7. Train frontline providers to recognize and manage mental
health issues, and educate mental health providers in
scientifically proven prevention and treatment services.
8. Monitor the access to and coordination of quality mental
healthcare services.
Subcommittee on Children & Family (Final Report 2003)
Strategies for building better mental health services for children
1. Implement a comprehensive approach to Children’s mental health at
federal and State Levels
2. Finance a broad array of services and support
3. Strengthen family and youth partnerships and family support
4. Individualize care: a single plan of care for a child and family
5. Broaden the range of services and supports and build capacity
6. Strengthen Mental Health Services to children within schools
7. Screen high-risk populations (JV justice and child welfare) and link them
with services
8. Strengthen early childhood mental health intervention
9. Prevent mental health disorders
10. Build and adequate workforce
What is Red Flags?
Comprehensive mental health awareness program for middle/ jr high
schools
Teaches signs of depression & other mental illnesses
Provides guidelines for getting help
Encourages peers to react and get help for others
Facilitates communication & support
What can schools do?
Expand prevention/ early intervention approaches
Train faculty to identify depressed kids & make appropriate
referrals
Establish policy for handling depressed kids
Teach mental illness unit and promote social and emotional
well being
Provide parent/ school personnel education (yearly)
Set up supportive environment – evaluate stress factor in
school
Encourage students to assist depressed kids
Build in flexibility – give kids “wiggle room”
Work closely with parents/ encourage continuous
communication
What can teachers do?
Know symptoms
Know the school protocol
Develop Accommodation Skills
– Incorporate multiple teaching styles
– Reduce classroom stress
– Allow additional time for tests/homework
– Grade on mastery of material
– No put-downs…EVER
– Build in flexibility
Special accommodations—IEP or 504
– Provide a safe haven for respite
– Relax attendance policy
What can students do….
Learn the warning signs
Know who you can go to for help
Talk about it / don’t keep it a secret
Ask for help
Take your friend for help
Stand by your friend with depression
Why Red Flags?
motivates behavior change
makes responding easier / teamwork
makes parenting easier
encourages an outside support system
makes finding appropriate care easier
reduces classroom disruptions
fosters communication
helps students succeed academically, socially &
emotionally
Mental Health Matters….EVERYDAY!!
Penelope Frese, Ph.D.
The Mental Health Association of Summit Co., Inc
405 Tallmadge Road
Cuyahoga Falls, OH 44221
1 (800) 991-1311
www.redflags.org
Email: info@redflags.org