The VPC Seminar 2017 at Brighton Grammar School   “Mental Health and Wellbeing in the Digital Age” with Dr Glenn Melvin

Questions from the audience

In relation to antidepressants for anxiety in teens/children, once they are on them is it feasible that they will be able to come off them?
There are two phases of treating depression in adolescents, the response phase and then the maintenance phase. The response phase is getting the teenager well. Once a person has improved on antidepressants they have had a response. The maintenance phase is keeping the teen well.  For one episode of depression the maintenance phase is between 6 to 12 months depending on the side effects.  If the person has more than one episode of depression then it is longer, and the timelines are less clear.  When the person has been well for a while, during a quiet time, like school holidays it is worth gradually reducing the dose and seeing if they (1) need to remain on the antidepressant at all, and (2) if they can manage on a lower dose.
 
In addition, if teen doesn’t respond to the antidepressant, that is, it doesn’t resolve the symptoms that were targeted, the teen may come off the antidepressant or switch to another antidepressant.
 
Also note, there is much more evidence that antidepressants are a helpful treatment of teens rather than children.
 

What were the two books regarding anxious children you mentioned in your talk?
You and Your Anxious Child by Anne Marie Albano
https://www.bookdepository.com/You-and-Your-Anxious-Child/9781583334959
Helping Your Anxious Child by Ronald Rapee
https://www.bookdepository.com/Helping-Your-Anxious-Child/9781572245754
 

I have a popular, emotionally intelligent & socially engaged boy so he is not shy or introverted. Right now at age 11, he is starting to worry about what he is going to do with his life and that he isn't smart enough. He is having trouble sleeping & getting tummy aches. How can I help him besides just assure him?
While it is hard to make specific comments about a child without having met with the child and family and completing an assessment, a few general thoughts come to mind.
 
It is important to listen to your child and provide empathic responses. Show that you can see that worries are bothering him. This type of validation can be containing for children. There may be other fears underlying those that are currently being expressed and if they feeling safe and able to express himself, you may learn more and therefore be able to help more.
 
It is important to emphasise that it is normal to be unsure about one’s career choice during adolescence and particularly at 11 years. Focus on the importance of searching and exploring interests, rather than having a career determined in late childhood.
 
Boys can be a competitive bunch, so competition about who performed the best on a test or in a term isn’t unusual. However, being smart isn’t the only thing. Persistence and determination, which some have called ‘grit’ plays a very important role in achievement and being productive. Angela Duckworth’s writing in this area might be of interest https://angeladuckworth.com/
 
Sleep difficulties and tummy aches may be symptoms of anxiety.  If these persist consult your GP for advice or referral. It is better to get onto learning strategies to cope with stress or anxiety and its symptoms earlier rather than later.


What strategies can children/parents use to cover the move from school to school? (especially from small primary to large secondary) 
Changing schools is a time of increased stress for most kids and teens. Expressing that it is normal to feel some anxiety or unsettled feelings when starting at a new school may be helpful. Also pointing out that this anxiety tends to settle down in time is helpful.
 
Children may need more rest or downtime during transition to a new school, so it is important to take this into account when scheduling extra-curricular activities. Around transition time, make sure you are a bit more available for your child too, providing them with opportunities to tell you about how school is progressing and what is on their mind.  Be aware of the homework demands and ensure your child has the time and space to complete his/her tasks.

Support the development of new friendships by supporting social activities, e.g. having friends over or going to the movies, playing sport on the weekend.
If you are concerned, contact your child’s teacher earlier rather than later, to see if any issues need to be addressed. Connecting with other parents can also be helpful to gauge how your child is progressing compared to others.

Why does there appear to be so many more kids suffering from anxiety? Does the research support that this is the case?
In 2015, the Australian Government released the Second Australian Child & Adolescent Survey on Mental Health & Wellbeing. This survey found that 6.9% of Australian children and teens experienced one or more anxiety disorder in the past 12 months. Many more would experience anxiety to a lesser level that may have a lesser impact on their lives. Unfortunately, the prior national survey did not assess anxiety disorders, so we don’t have any good data to show any kind of change in child and adolescent anxiety.
 
However, there is some evidence to suggest from these national surveys that rates of mental health problems have increased slightly. It is not entirely clear why, but many theories exist. While some stigma still certainly exists around mental health, reductions in stigma are thought to be associated with increased reporting of mental health problems. Beyond this, changes to our social structure are also thought to play a role in increasing risk of mental illness.  

I think OCD should be put down as an anxiety disorder for kids/teens. I think it is one parents should be aware of as well as eating disorders.
This is an interesting nosological (classification of diseases) point! Obsessive Compulsive Disorder was thought of as an anxiety disorder up until 2013. It now sits in a new grouping of disorders called Obsessive and Related Disorders that includes hoarding disorder and skin picking disorder. I, too, think that it is an important disorder for parents to know about. I would have liked to have spoken about it but was limited by time. Eating disorders are also important for parents to be aware of, particularly in young women, while not forgetting that young men can also affected. Being aware of the warning signs of both these disorders is important. The Butterfly Foundation is a good source of Australian information about eating disorders https://thebutterflyfoundation.org.au/

How do we encourage optimistic thinking in the elderly?
According to eminent psychologist Martin Seligman, optimism can be learned. This can be achieved by modifying our responses to daily stressors and hassles and modifying how we respond to such adversity. Seligman wrote a book on this topic called Learned Optimism. It might be a useful resource.