Lakhasly

1Unit 6 School age

Fears in shool age ?Examples Parents of infants and children with depression often report noticing the following behavior changes in the child: o Crying more often or more easily o Increased sensitivity to criticism or other negative experiences o More irritable mood than usual or compared to others their age and gender, leading to vocal or physical outbursts, defiant, destructive, angry or other acting out behaviors o Eating patterns, sleeping patterns, or significant increase or decrease in weight change, or the child fails to achieve appropriate gain weight for their age o Unexplained physical complaints (for examples, headaches or abdominal pain) o Social withdrawal, in that the youth spends more time alone, away from friends and family o Developing more "clinginess" and more dependent on certain relationships (This is not as common as social withdrawal.) o Overly pessimistic, hopeless, helpless, excessively guilty or feeling worthless o Expressing thoughts about hurting him or herself or engaging in self-injury (like cutting or burning him or herself), reckless or other potentially harmful behavior o Young children may act younger than their age or than they had before (regress). SLIDESHOW Learn to Spot Depression: Symptoms, Warning Signs, MedicationSee Slideshow Diagnosis of depression ? Extract depression from other other mental health conditions as:, ? attention deficit hyperactivity disorder (ADHD), autism-spectrum disorders, bipolar disorder, posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and anxiety disorders, ? Screen for signs and symptoms of: ? manic depression (bipolar disorder), a history of trauma, and other mental health symptoms. ? Role out medical problems, or it can be a side effect of various medications, exposure to drugs of abuse or other toxins. ? routine laboratory tests during the initial assessment to rule out other causes of symptoms. ? Diagnostic evaluation as: X-ray, scan, or other imaging study. ? Series of questions from a standardized questionnaire or self-test to help determine the risk of depression and suicide. What should parents do if they suspect that their child is depressed? ? Seeking professional medical, mental treatment for the depressed child. ? Promote good mental health by ? Encouraging him or her to have a healthy lifestyle, including ? healthy diet, including adequate water intake ? Enough sleep, ? Regular exercise ? Remain socially active ? Engage in healthy stress-management activities. What is the treatment for depression in children? ? Alleviating any medical condition that causes or worsens depression. As treat thyroid deficiecy hormone with levothyroxine (Synthroid). ? Supportive therapy: ? like lifestyle and behavioral changes, psychotherapy, complementary treatments, ? If symptoms are severe medical Rx with supportive for six months to a year to prevent a reoccurrence of symptoms. ? Psychotherapy ("talk therapy") ?o Feeling sad or blue and/or irritable or seeming that way as observed by others (for examples, tearfulness or otherwise looking persistently sad, or angry) o Significant appetite changes, with or without significant weight loss, failing to gain weight appropriately or gaining excessive weight o Change in sleep pattern: trouble sleeping or sleeping too much o Physical agitation or retardation (for example, restlessness or feeling slowed down) o Fatigue or low energy/loss of energy o Difficulty concentrating o lack of interest in daily activities o loss of energy, o Feeling worthless, excessively guilty, or tend to self-blame o Thoughts of death or suicide Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including o impaired performance of schoolwork, o persistent boredom, o quickness to anger, o frequent physical complaints, like headaches and stomachaches, o More risk-taking behaviors and/or showing less concern for their own safety.herbal supplements like St. John's wort and dietary supplements like vitamin C and B complex vitamins as remedies for depression What is the prognosis for depression in children?o Interpersonal therapy (ITP) and cognitive behavioral therapy (CBT) are the major approaches commonly used to treat childhood depression.Biologically, depression is associated with a deficient level of the neurotransmitter serotonin in the brain, a smaller size of some areas of the brain and increased activity in other parts of the brain.IPT uses two strategies to achieve those goals: o Educating the child, his or her parents, and other family members about the nature of depression: The therapist will reassure the child and his or her loved ones that depression is a common illness and that most people tend to improve with treatment.o Defining problems (such as abnormal grief or interpersonal conflicts): The therapist can help the child set realistic goals for solving problems and work with him or her and the child's family using different treatment techniques to reach these goals.o Cognitive component: This promotes identifying the thoughts and assumptions that play a role in the child's behaviors, especially those that may predispose the sufferer to being depressed.antidepressant medications o Common side effects can include dry mouth, upset stomach, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.Phobias are a type of anxiety disorder According to the DSM, specific phobias typically fall within five general categories related to objects and situations : ?Depressive disorders are characterized by pervasive mood changes that affect all aspects of an individual's daily functioning.Phobias: ?????????... ????????????????????????????????

1Unit 6
School age

Fears in shool age
➢ According to one study, 43% of children between ages 6 and 12 had many
fears and concerns.
➢ A fear of darkness, particularly being left alone in the dark, is one of the most
common fears in this age group.
➢ fear of animals, such as large barking dogs.
➢ Some children are afraid of fires, high places or thunderstorms.
➢ Others, conscious of news reports on TV and in the newspapers, are concerned
about burglars, kidnappers or nuclear war.
➢ If there has been a recent serious illness or death in the family, they may
become anxious about the health of those around them.
➢ In middle childhood, fears wax and wane.
➢ Most are mild, but even when they intensify, they generally subside on their
own after a while.
Phobias:
➢ Sometimes fears can become so extreme, persistent and focused that they
develop into phobias.
➢ Phobias Means '' strong and irrational fears'' ..word comes from the Greek
word phobos, which means fear or horror. ...
➢ It Can become persistent and debilitating, significantly influencing and
interfering with a child's usual daily activities.
➢ Phobias are a type of anxiety disorder
According to the DSM, specific phobias typically fall within five
general categories related to objects and situations :
➢ fears related to animals (spiders, dogs, insects)
➢ fears related to the natural environment (heights, thunder, darkness)
➢ fears related to blood, injury, or medical issues (injections, broken bones,
falls)
➢ fears related to specific situations (flying, riding an elevator, driving)

➢ other (choking, loud noises, drowning)
Examples of phobias
➢ 6-year-old's phobia about dogs might make him so panicky that he refuses to
go outdoors at all because there could be a dog there.
➢ 10-year-old child might become so terrified about news reports of a serial
killer that he insists on sleeping with his parents at night.
➢ Some children in this age group develop phobias about the people they meet in
their everyday lives.
➢ This severe shyness can keep them from making friends at school and relating
to most adults, especially strangers.
➢ They might consciously avoid social situations like birthday parties or
Scout meetings, and they often find it difficult to converse comfortably with
anyone except their immediate family.
➢ Separation anxiety is also common in this age group.
➢ Sometimes this fear can intensify when the family moves to a new
neighborhood or children are placed in a childcare setting where they feel
uncomfortable.
➢ These youngsters might become afraid of going to summer camp or even
attending school.
➢ Their phobias can cause physical symptoms like headaches or stomach pains
and eventually lead the children to withdraw into their own world, becoming
clinically depressed.
➢ At about age 6 or 7, as children develop an understanding about death,
another fear can arise.
➢ With the recognition that death will eventually affect everyone, and that it is
permanent and irreversible, the normal worry about the possible death of
family members – or even their own death – can intensify. In some cases, this
preoccupation with death can become disabling.
Treating Fears & Phobias:

➢ most phobias are quite treatable. Mainly , they are not a sign of serious
mental illness, but if persist as problem need professional psychological help
Treatment includes
1-Desensitization treatment as:((gradual process)
➢ Expose the child to source of fear under therapist and parents supervision ,
then child will become a little less sensitive to the source of her fear each time
she confronts it
• Firstly: exposing your child to the source of her anxiety in small,
nonthreatening doses. Under a therapist's guidance a child who is afraid of
dogs might begin by talking about this fear and by looking at photographs or a
videotape of dogs.
• Next, she might observe a live dog from behind the safety of a window.
• Then, with a parent or a therapist at her side, she might spend a few minutes
in the same room with a friendly, gentle puppy.
• Eventually she will find himself able to pet the dog, then expose herself to
situations with larger, unfamiliar dogs.
➢ Ultimately, the child will no longer feel the need to avoid the situation that has
been the basis of her phobia. While this process sounds like common sense
and easy to carry out, it should be done only under the supervision of a
professional.
2- Help children become more self-assured and less fearful.
3-Breathing and relaxation exercises
4-Medications (antidepressants, ) as a component of the treatment program, although
never as the sole therapeutic tool.

What Parents Can Do:
➢ Talk with your child about his anxieties, and be sympathetic. Explain to him
that many children have fears, but with your support he can learn to put them
behind him.
➢ Do not belittle or ridicule your child's fears, particularly in front of his peers.
➢ Do not try to coerce your youngster into being brave. It will take time for him
to confront and gradually overcome his anxieties. You can, however,
encourage (but not force) him to progressively come face-to-face with
whatever he fears.
Depression
Depression in children facts
• Depression is a condition that is more severe than normal sadness and can
significantly interfere with a child's ability to function.
• Depression affects about 2% of preschool and school-age children.
• Depression in children does not have one specific cause but rather a
number of biological, psychological, and environmental risk factors that
are part of its development.
• To diagnose depression, a health care professional will likely perform or refer
for a thorough medical assessment and physical examination and ask
standard mental health questions.
• Treatment for childhood depression may include addressing any medical
conditions that caused or worsened the condition.
• It can also involve lifestyle adjustments, psychotherapy, and, for moderate to
severe depression, medication.
• Interpersonal therapy (ITP) and cognitive behavioral therapy (CBT) are the
major approaches commonly used to treat childhood depression.
• About 60% of children who take antidepressant medication improve. It may
take up to six weeks of treatment with medication at its effective dose to start
improving.

• Childhood depression is a risk factor for developing a number of other mental
health symptoms and disorders.
• Depression is the leading cause of disability in the United States in people
over 5 years of age.
What are causes and risk factors for depression in children?
➢ Biologically, depression is associated with a deficient level of the
neurotransmitter serotonin in the brain, a smaller size of some areas of the
brain and increased activity in other parts of the brain.
✓ Girls are more likely to be given the diagnosis of depression than boys, due to,
biological differences based on gender,
✓ Teens drepressed mothers : four times more likely to also develop the
disorder.
✓ low birth weight, suffering from a physical condition, trouble sleeping, and to
having a mother younger than 18 years old at the time of their birth.
➢ Psychological contributors
✓ Low self-esteem, negative social skills, negative body image, being
excessively self-critical,
✓ attention deficit hyperactivity disorder (ADHD),
✓ clinical anxiety,
✓ cognitive or learning problems
✓ trouble engaging in social activities
✓ reaction to life stresses, like trauma, including verbal, physical, or sexual
abuse, the death of a loved one, school problems,
✓ bullying, or suffering from peer pressure.
✓ Obesity: may be? children have an increased risk of developing depression.
✓ poverty and financial difficulties in general,
✓ exposure to violence, social isolation,

✓ Parental conflict, divorce, and other causes of disruptions to family life.
Children who have limited physical activity, poor school performance, or lose
a relationship
What are the symptoms and warning signs of depression in children?
➢ Depression is an illness that involves the body, mood, and thoughts and
affects the way a person eats and sleeps, the way one feels about oneself, and
the way one thinks about things.
➢ Depressive disorders are characterized by pervasive mood changes that affect
all aspects of an individual's daily functioning. loss of interest or pleasure for
at least two weeks and having at least five clinical signs and symptoms.
• Feeling sad or blue and/or irritable or seeming that way as observed by others
(for examples, tearfulness or otherwise looking persistently sad, or angry)
• Significant appetite changes, with or without significant weight loss, failing to
gain weight appropriately or gaining excessive weight
• Change in sleep pattern: trouble sleeping or sleeping too much
• Physical agitation or retardation (for example, restlessness or feeling slowed
down)
• Fatigue or low energy/loss of energy
• Difficulty concentrating
• lack of interest in daily activities
• loss of energy,
• Feeling worthless, excessively guilty, or tend to self-blame
• Thoughts of death or suicide
Children with depression may also experience the classic symptoms but may
exhibit other symptoms as well, including
• impaired performance of schoolwork,
• persistent boredom,
• quickness to anger,
• frequent physical complaints, like headaches and stomachaches,
• More risk-taking behaviors and/or showing less concern for their own safety.

Examples of risk-taking behaviors in children include unsafe play, like climbing
excessively high or running in the street.
Examples
Parents of infants and children with depression often report noticing the following
behavior changes in the child:
• Crying more often or more easily
• Increased sensitivity to criticism or other negative experiences
• More irritable mood than usual or compared to others their age and gender,
leading to vocal or physical outbursts, defiant, destructive, angry or other
acting out behaviors
• Eating patterns, sleeping patterns, or significant increase or decrease in weight
change, or the child fails to achieve appropriate gain weight for their age
• Unexplained physical complaints (for examples, headaches or abdominal pain)
• Social withdrawal, in that the youth spends more time alone, away from
friends and family
• Developing more "clinginess" and more dependent on certain relationships
(This is not as common as social withdrawal.)
• Overly pessimistic, hopeless, helpless, excessively guilty or feeling worthless
• Expressing thoughts about hurting him or herself or engaging in self-injury
(like cutting or burning him or herself), reckless or other potentially harmful
behavior
• Young children may act younger than their age or than they had before
(regress).

SLIDESHOW
Learn to Spot Depression: Symptoms, Warning Signs, MedicationSee Slideshow
Diagnosis of depression
➢ Extract depression from other other mental health conditions as:,
✓ attention deficit hyperactivity disorder (ADHD), autism-spectrum
disorders, bipolar disorder, posttraumatic stress
disorder (PTSD), obsessive compulsive disorder (OCD),
and anxiety disorders,
➢ Screen for signs and symptoms of:
✓ manic depression (bipolar disorder), a history of trauma, and
other mental health symptoms.

➢ Role out medical problems, or it can be a side effect of various medications,
exposure to drugs of abuse or other toxins.
➢ routine laboratory tests during the initial assessment to rule out other causes
of symptoms.
➢ Diagnostic evaluation as: X-ray, scan, or other imaging study.
➢ Series of questions from a standardized questionnaire or self-test to help
determine the risk of depression and suicide.
What should parents do if they suspect that their child is depressed?
➢ Seeking professional medical, mental treatment for the depressed child.
➢ Promote good mental health by
✓ Encouraging him or her to have a healthy lifestyle, including
✓ healthy diet, including adequate water intake
✓ Enough sleep,
✓ Regular exercise
✓ Remain socially active
✓ Engage in healthy stress-management activities.
What is the treatment for depression in children?
➢ Alleviating any medical condition that causes or worsens depression. As
treat thyroid deficiecy hormone with levothyroxine (Synthroid).
➢ Supportive therapy:
✓ like lifestyle and behavioral changes, psychotherapy,
complementary treatments,
✓ If symptoms are severe medical Rx with supportive for six
months to a year to prevent a reoccurrence of symptoms.
➢ Psychotherapy ("talk therapy")
➢ is a kind of mental health counseling that entails working with a trained
therapist to figure out ways to solve problems and cope with depression. It can

be a powerfully effective intervention, even resulting in positive biochemical
changes in the brain. For babies, music therapy and infant massage are useful
interventions.
➢ Two major kinds of psychotherapy commonly treat childhood depression:
interpersonal psychotherapy and cognitive behavioral therapy.
➢ Interpersonal therapy (IPT):
➢ This form of psychotherapy seeks to alleviate depressive symptoms by helping
child with depression develop more effective skills for coping with their
emotions and relationships. IPT uses two strategies to achieve those goals:
• Educating the child, his or her parents, and other family members about the
nature of depression: The therapist will reassure the child and his or her loved
ones that depression is a common illness and that most people tend to improve
with treatment.
• Defining problems (such as abnormal grief or interpersonal conflicts): The
therapist can help the child set realistic goals for solving problems and work
with him or her and the child's family using different treatment techniques to
reach these goals.
Cognitive-behavioral therapy (CBT):
This approach to psychotherapy helps to decrease depression and the likelihood it will
come back by helping the child change his or her way of thinking about certain issues.
In CBT, the therapist uses three techniques to achieve these goals.
• Didactic component: This phase helps to establish positive expectations for
treatment and promote the child's participation in treatment.
• Cognitive component: This promotes identifying the thoughts and
assumptions that play a role in the child's behaviors, especially those that may
predispose the sufferer to being depressed.
• Behavioral component: This uses behavior-modification methods to teach the
child more effective ways of dealing with problems.

➢ Medications
➢ antidepressant medications
• Common side effects can include dry mouth, upset
stomach, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
• In rare cases, some people of all ages ( mainly teen ages)become acutely more
depressed when on the medication, even having suicidal or homicidal
thoughts, and/or attempting or completing suicide or homicide.
➢ Alternative treatments
✓ herbal supplements like St. John's wort and dietary
supplements like vitamin C and B complex vitamins as remedies
for depression
What is the prognosis for depression in children?
➢ 85% of people who have one episode of the disorder will have another one
within 15 years of the first episode.
➢ develop severe mental illness during adulthood
➢ Leading cause of disability in the United States for people over 5 years of age,
particularly for females.
➢ negative outcomes, like academic and interpersonal problems drugs and
attempting suicide and engaging in other forms of self-harm.
➢ Early treatment of childhood depression improves the prognosis, promotes a
better prognosis.
Prevention
➢ Seeks to reduce risk factors and strengthen protective factors using approaches
that are appropriate for the child's developmental level.
➢ It is advisable for family members and friends to seek mental health
assessment and treatment for the depressed child.