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Anxiety & Depression

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Tahani Hammad

on 6 December 2013

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Transcript of Anxiety & Depression

Anxiety & Depression
Anxiety disorders affect 1 in 8 children
It has genetic, environmental, and neurobiological roots
In DSM V, Generalized Anxiety Disorder is characterized as children having uncontrollable worry for more days than not and exhibiting 1 of the following :
Easily fatigued
Difficulty concentrating
Muscle tension
Sleep disturbance
There are three types of depressive illnesses

They are disorders of the brain

Depression is usually caused by a combination of genetic, biological, environmental, and psychological factors
How Do Depression and Anxiety Affect Children and Adolescents in School?
Naomi, Tahani, Zehua, Chris, & Tori
Common Forms of Anxiety in Schools: School Phobia
School Phobia Commonly Stems From :
1) Separation anxiety (generally in
children up to age 8)
2) Social anxiety (generally starts after 8)
- Marked fear of social situations, fear
of social scrutiny, social situations
are avoided
3) Fear of specific elements in school:
- Being bullied, moving to a new area,
feeling academic failure, not having
good friends

Common Forms of Anxiety in Schools: Separation Anxiety

Developmentally inappropriate and excessive fear concerning separation
Fear that something terrible will happen to a loved one
Worry that an unpredicted event will lead to permanent separation
Complain of physical symptoms
Cling to caregiver
Can interfere with education and social development

-Persistent sad, anxious or "empty" mood
-Feelings of hopelessness, pessimism
-Feelings of guilt, worthlessness, helplessness
-Loss of interest or pleasure in hobbies and activities, including sex
-Decreased energy, fatigue, feeling "slowed down"
-Difficulty concentrating, remembering, making decisions
-Insomnia, early-morning awakening, or oversleeping
-Low appetite and weight loss or overeating and weight gain
-Thoughts of death or suicide, suicide attempts
-Restlessness, irritability
-Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and pain for which no other cause can be diagnosed.
Major Depression
-Involves at least five of these symptoms for a two-week period
-Such an episode is disabling and will interfere with the ability to work, study, eat, and sleep.
-Episodes may take place spontaneously, during or after the death of a loved one, a romantic breakup, a medical illness, or other life event.
-Some people with major depression may feel that life is not worth living and some will attempt to end their lives.

-Less severe, long-term, and chronic form of depression.
-It involves the same symptoms as major depression, mainly low energy, poor appetite or overeating, and insomnia or oversleeping.
-It can manifest as stress and irritability
-People with dysthymia might be thought of as always seeing the glass as half empty.
Bipolar Disorder
-Once called manic-depression, is characterized by a mood cycle that shifts from severe highs (mania) or mild highs (hypomania) to severe lows (depression).
-During the manic phase, a person may experience abnormal or excessive elation, irritability, a decreased need for sleep, grandiose notions, increased talking, racing thoughts, increased sexual desire, markedly increased energy, poor judgment, and inappropriate social behavior.
-During the depressive phase, a person experiences the same symptoms as would a sufferer of major depression. Mood swings from manic to depressive are often gradual, although occasionally they can occur abruptly.
Anxiety at School
1. Repeated seeking of teacher's approval
2. Worry about academic and social performance
3. A strong desire for perfectionism
4. Inability to perform academically or socially
5. Difficulty transitioning from home to school
6. Refusal or reluctance to attend school
7. Avoidance of academic and peer activities (Isolates self from peers; Reluctant to participate)
8. Inability to stop the worry leads to difficulty concentrating on assignments and classroom instruction
9. Feelings easily hurt by peers or teacher; appears unmotivated socially and academically
10. Low tolerance for frustration; Giving up quickly on assignments
11. Learning disorders may co-exist and should not be overlooked in this population.
Depression at School
1. Easily get irritated by peers and teachers
2. Low self-esteem on academic success
3. Feeling like they don't have friends
4. "No one likes me"; "I don't care" attitude
5. Heightened sensitivity to perceived criticism from the teacher
6. Isolates self from rest of the class
7. Loss of interest or pleasure in previously enjoyed subjects
8. Death, suicide, negative thoughts come through in assignments such as in writing
9. Difficulty organizing, concentrating, and inability to follow through on assignments
10. Increased fights, arguments with peers or teachers, or unusual behaviors
11. Learning disorders, particularly if undiagnosed or untreated.

Anxiety Interventions
Tier 1: School-wide
School Transitional Environment Project (STEP)
Alter school ecology to be less threatening
Create easier transition to new school environment
Restructure role of the teacher to be more supportive
Create consistent support process
Stable set of peers and classmates (i.e. cohorts)

Tier 3: General
Allow students opportunity to practice and apply coping strategies
Model positive ways to prevent/manage anxiety
Set clear expectations and follow through
Organization! (materials, daily routines, class objectives, time limits)
Provide students with low-distraction work areas
Develop a supportive relationship with students
Depression Interventions
Tier 1: School-wide
Promote positive mental health awareness
Teach problem-solving/conflict resolution
Create opportunities for peer-staff mentoring
Provide professional development for staff
Include SEL into school curriculum (PBIS)
Identify local resources and partnerships
Adolescent Depression Awareness (ADAP)

3-hour long curriculum
Educates high school students, teachers, and parents about the illness of depression
Adolescents Coping with Depression Course

In-school/after-school group intervention for youth in active depressive episode
16, 2-hour group sessions over 8 week period

Tier 3: Individual

Primarily a treatment rather than prevention method
Teaches student to change thought processes in an active, problem-oriented manner to reduce negative thinking
Curriculum includes teaching of depression-lifting skills, including:
Mood monitoring
How to improve social skills, decrease anxiety and improve communication
Develop a caring relationship
Remember that these students are not choosing to be depressed
Try to identify the function of the behavior
Provide opportunities for success
Give directions in small steps. Check for understanding.
Seek help from support personnel
eeling worried?
elax and feel good.
nner thoughts.
xplore plans of action.
ice work, reward yourself.
on’t forget to practice.
tay cool!

12 session cognitive-behavioral intervention
Weekly sessions for students
Evening sessions offered for parents to learn about program and concepts
FRIENDS for Children
Positive Behavior
Support (PBS)
Enhance educational experience by reframing problem behaviors

Identify problem behavior, introduce student to more positive behaviors
Focus on teaching positive behaviors; punishment is not used with PBS (incentive programs)
Students learn coping skills to reduce problem behaviors
Tier 2: Classroom
eleasing tension,
ppreciation of self and others, e
panding feelings to other situations.

Educational component for parents, teachers, students on stress and its effects.
Integrates PMR, active imagination, self-talk and music.
Promotes openness to learning, positive self-esteem
Includes scripts, instructor guide
The Coping Koala
Adapted from The Coping Cat (Kendall, 1994)
Teaches children strategies to cope with anxiety
Student develops their own plan
gradual exposure
Facilitates learning strategies from each other that are positive, helpful and effective
Cognitive Behavioral Therapy (CBT)
Note: Primarily a treatment rather than prevention method
Emphasis on problem-solving and collaboration
Teaches student to identify/modify anxious self-talk, promotes awareness, exposure to anxiety-provoking situations, relaxation training, homework, practice skills
Utilize specific components at the targeted level
Supportive relationship
Create a system and regular schedule
Focus on and identify strengths
Teach relaxation techniques
Tier 2: Classroom/
Small Group
Use social-skills curriculum
Promote positive classroom climate
Create an organized classroom
Teach problem-solving and self-soothing strategies
Allow students time and/or space to “cool off”
Coping with Stress Course (CWS)

15, 45 minute group sessions for 9th/10th graders at increased risk of depression
Taught techniques to identify and challenge negative or irrational thoughts

Ready… Set… R.E.L.A.X
Tier 3: Individual
Tier 1: General
Peer mentoring programs
Social skills & self-esteem curriculum
Positive school environment
Character education
Teach coping strategies
Teach positive behaviors
Tier 2: General
Create a regular schedule
Check for understanding
Modify workload
Create classroom rituals
Low competition environment
Relaxation skills training
Academic skills training
Create a safe and encouraging classroom environment
Provide open-communication classroom
26-session intervention for 4th-7th graders with elevated levels of depression
Treatment includes self-control techniques, social skills, assertiveness, and relaxation training
Family component also recommended
Stark School Based Intervention for Depression
Promoting Alternative Thinking Strategies (PATHS)

Widely used SEL program
Designed to be taught three times/week for 20 min
Lessons include empathy, self-esteem and positive values and attitudes
Excessive worry
Striving to be perfect
Inability to explain worries
Inability to stop worry
Constant seeking of approval
Physical ailments

Cognitive Behavioral Therapy (CBT)
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