Coping with an Anxious or Depressed Child: A CBT Guide for Parents and Children

Coping with an

Anxious or Depressed Child

A CBT guide for parents and carers

Sam Cartwright-Hatton

COPING WITH AN ANXIOUS OR DEPRESSED CHILD

Published by Oneworld Publications 2007

This ebook edition published by Oneworld Publications 2011

Copyright © Sam Cartwright-Hatton 2007

All rights reserved

Copyright under Berne Convention

A CIP record for this title is available

from the British Library

ISBN 978–1–78074–010–2

Typeset by Jayvee, Trivandrum, India

Cover design by Mungo Designs

Oneworld Publications

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Contents

Series Foreword

1   Is this book for you?

Who is this book for?

What are anxiety and depression?

What this book covers

SECTION ONE

2   Are anxiety and depression common in childhood, and will they grow out of it?

How common are anxiety and depression in childhood?

Will they grow out of it?

Are anxiety and depression harmful for my child?

What is the outlook for my child?

3   What causes anxiety and depression in children and adolescents?

Genetics and personality

Learning

Whose fault is it that my child is like this?

4   Psychological treatments for anxious and depressed children

Information on different professionals you may come across

How to get help

What sort of treatment will my child be offered?

5   Medications for anxious and depressed children

Drugs just for anxiety

Drugs that work for both depression and anxiety

What are the circumstances in which doctors can prescribe medication for my child?

What are the side effects of these medications?

What should I do when my child wants to come off medication?

Other things to note about medication

A note on herbal remedies

SECTION TWO

6   A few basics that can make all the difference

Diet

Sleep

Routines

Exercise

‘Pleasure and Mastery’

7   A stable, safe, predictable(ish) home life

The Seven Confident Thoughts

Step One – Special Time

Step Two – Happy Family Times

Step Three – Communicating well within your family

8   Boosting your child’s self-esteem and confidence

Play to your child’s strengths

Push them to try new things

Making sure your child gets a confidence boost every week

9   On their best behaviour: getting your kids to do what you want without tears and tantrums

Part One: Getting more good behaviour

Praise

Rewards and bribes

The magic of star charts

10   On their best behaviour: getting your kids to do what you want without tears and tantrums

Part Two: Getting less bad behaviour and less anxious behaviour

Ignoring

Dealing with dangerous and destructive behaviours: Time Out

Dealing with non-compliances: Consequences

11   Dealing with fears and worries

Fears

Worries

12   Facing facts

Your own state of mind

Marital discord

13   What schools and teachers can do to help

How to get school on your side

Who do I talk to?

What do I tell them?

What about bullying?

Who to talk to if school are unhelpful

A final note – how can you help school to help your child?

14   Rounding up

Appendix

Index

Series Foreword

This series is intended to provide clear, accessible, and practical information to individuals with a wide range of psychological disorders, as well as to their friends, relatives, and interested professionals. As the causes of emotional distress can be complex, books in this series are not designed purely to detail self-treatment information. Instead, each volume sets out to offer guidance on the relevant, evidence-based psychological approaches that are available for the particular condition under discussion. Where appropriate, suggestions are also given on how to apply particular aspects of those techniques that can be incorporated into self-help approaches. Equally important, readers are offered information on which forms of therapy are likely to be beneficial, enabling sufferers to make informed decisions about treatment options with their referring clinician.

Each book also considers aspects of the disorder that are likely to be relevant to each individual’s experience of receiving treatment, including the therapeutic approaches of medical professionals, the nature of diagnosis, and the myths that might surround a particular disorder. General issues that can also affect a sufferer’s quality of life, such as stigma, isolation, self-care and relationships are also covered in many of the volumes.

The books in this series are not intended to replace therapists, since many individuals will need a personal treatment programme from a qualified clinician. However, each title offers individually tailored strategies, devised by highly experienced practising clinicians, predominantly based on the latest techniques of cognitive behavioural therapy, which have been shown to be extremely effective in changing the way sufferers think about themselves and their problems. In addition, titles also include a variety of practical features such as rating scales and diary sheets, helpful case studies drawn from real life, and a wide range of up-to-date resources including self-help groups, recommended reading, and useful websites. Consequently, each book provides the necessary materials for sufferers to become active participants in their own care, enabling constructive engagement with clinical professionals when needed and, when appropriate, to take independent action.

Dr Steven Jones

Series Editor

1

Is this book for you?

Who is this book for?

This book is aimed at anyone who is bringing up a child who is anxious or depressed. It is most suited to helping children who are up to about fifteen years of age. The book gives guidance on when and how to seek assistance for your child, and advice on how you, as a parent, can help.

What are anxiety and depression?

Anxiety and depression are types of ‘emotional disorder’. It used to be believed that children and adolescents did not really suffer from these emotional disorders. However, in the past decade or so there has been a slow realisation that children can and do get these disorders, and when they do it is as unpleasant for them as it is for adults. The symptoms that an anxious or depressed child will experience will be very similar to those that adults get. However, there are one or two additional symptoms that you may see in children more than in adults.

Symptoms of anxiety and depression

The symptoms that may indicate that your child is depressed or has an anxiety disorder are many and varied. Also, every person is different and will have a slightly different set of symptoms. A child does not need to have all of the symptoms before they can get diagnosed with a disorder. Below, I have listed the sorts of symptoms that a child with a formal diagnosis of anxiety or depression will have. However, I would make two notes of caution. First, there is a lot of controversy over what symptoms are and are not required for someone to get a diagnosis of anxiety or depression. If you are worried about your child but they do not totally fit the descriptions given here, please do still go and find help for your child. Secondly, and on the other hand, just because your child seems to have a lot of the symptoms that I describe below, do not assume that they have got a serious diagnosable disorder. Most children and adolescents will show some of the symptoms at some point or other (there is some evidence to suggest that children who have no symptoms are the unusual ones!). Diagnosing these disorders is a complex skill that many highly trained and experienced professionals still struggle with. So, please don’t attempt to do any diagnosing yourself (you will only risk needless worry) and, if you are worried about your child, get them some help. Where to go for help is discussed in chapter 4. The list below is just to give you an indication of the sort of symptoms that you can expect to see if you know that you have an anxious or depressed child, and to give some reassurance that some of the bizarre and, frankly, annoying behaviours that they might display are probably part of their anxiety or depression. Remember, even if your child just has one or two symptoms, it is worth seeking help if you are worried.

Box 1.1. Symptoms of anxiety and depression in children and adolescents

Aren’t these just symptoms of teenager disease?

Show this list of symptoms to anyone familiar with teenagers and they will most likely roll their eyes and say, aren’t these just symptoms of being a teenager? Well, in a way, they have a bit of a point. Many (if not most) teenagers do go through prolonged stages of being grumpy, tired, weepy, eating non-stop, etc. So how do you tell if your child has an emotional disorder, or is simply being a teenager?

If you take your child to see a professional for help with their difficulties, they will ask a number of questions to try to work out whether they need help or not:

• Are the symptoms stopping your child from doing things that they want to do – e.g. are their symptoms stopping them from going out anywhere they like and enjoying themselves, making friends, learning new life skills?

• Are the symptoms stopping your child from doing things that they need to be doing – e.g. going to school, accessing healthcare, learning social skills?

• Are the symptoms impairing family life in any way – e.g. stopping the family from engaging in their normal activities; disrupting normal family routines substantially?

• Are the symptoms posing any physical threat to the child, or to any other person?

If the answer to any of these questions is yes, then it is likely that your child would benefit from some professional help.

Minor differences to the adult conditions

If you are familiar with the adult conditions of anxiety and depression, you may have noticed that the symptoms of the childhood/adolescent disorders are remarkably similar. Most of the symptoms that I have described are also seen in adults who are anxious or depressed. One common difference is the level of grumpiness that you see in depressed children. Depressed adults can get grumpy too, but it seems to be more common in children and adolescents, and can be very difficult for families to cope with.

So are anxious and depressed kids the same as anxious and depressed adults?

There is a lot of overlap between adult depression and anxiety, and child depression and anxiety. Unfortunately, not nearly enough research has been done on child and adolescent emotional disorders, so we don’t know much about the subtle differences that might exist between adults and children. In future, it is likely that we will begin to understand more about the differences, but for now, most people see them pretty much the same.

What this book covers

This book is divided into two sections: Section One covers the basic background information that parents with an anxious or depressed child might find helpful. Section Two gives parents some suggestions for helping their anxious or depressed child themselves.

Section One

Chapter 2 talks about how common anxiety and depression are and how likely it is that your child will grow out of it. Chapter 3 moves on to discuss all the different causes of these problems. Most parents want to get hold of some treatment for their children but are bewildered by the remarkable range of treatments (and associated jargon) that is available. Chapter 4 helps parents to navigate this maze, translates some of the jargon, and will help you to find the right person and the right psychological treatment for your child. Chapter 5 talks about medicines that can be prescribed for anxious and depressed children, and talks through the factors that you might want to take into account in deciding whether you want medication for your child. The different medications are described, and there is some information on side effects, and things to watch out for.

Section Two

Section Two of the book moves on to think about what you, as a parent, can do yourself to help your child. Chapter 6 describes some quick and easy basics, including diet and sleep, that can be changed to give your child a boost. Chapter 7 gives some ideas for boosting self-esteem. Chapters 8, 9 and 10 then move on to talk about subtle changes to family life, to the child’s environment, and to parenting that can be made to really help the anxious or depressed child to move forward. Chapter 11 focuses on techniques for dealing with your child’s worries and fears. Whilst parents are rarely to blame for their child’s emotional problems, there are