CUSD Cares

Understanding Depression in Youth

December 17, 2019 Brenda Vargas Season 1 Episode 11
CUSD Cares
Understanding Depression in Youth
Show Notes Transcript

Brenda Vargas discusses the topic of understanding depression in youth with Ryan Helton,MSC,LPC from Transcend Counseling Services LLC. 

Brenda Vargas:

Welcome parents. This is Brenda Vargas. I'm with CUSD Cares podcast . It's a joy today to have a local social worker here. No practicing counselor, I should say from our local area Ryan Helton returning to us from the Human Experience. Hey Ryan. So sorry about that.

Ryan Helton:

It's okay . We're one in the same counselors, social workers.

Brenda Vargas:

That's right. We are all doing the same work. So today's podcast parents is on the topic of depression and Ryan had joined us previously to talk about anxiety. So he's returning with us and I know that anxiety will come up as a topic in this conversation as well. But today we really want to focus on the topic of depression. And we'll start off. Ryan, if you could just kind of give parents an idea, what is depression? I know we hear the term feeling blue often and, or, you know, something to that effect. How would you define it?

Ryan Helton:

Yes, well first of all, thank you for having me. With depression, I think it's something I wanted to make sure in preparing for our conversation today, I'm going to go through kind of the diagnostic criteria that we use as clinicians because it's important I want to go through each of these symptoms and things that parents, anybody who's listening really wants to look out for because you're right, there's a difference between being sad , having a depressed mood that lasts a day, two days, that is coupled with bad grades or a breakup or a fight with family or parents or whatever. There's a difference between that which is just being human , which we've all experienced, and being clinically depressed. So based on the diagnostic criteria, what all parents who are listening need to look out for are some of these , so a major depressive episode is any of these that I'm going to go through, if you can say, yes, this is what I see at least five of these or more within a two week period or longer, most of the day, or nearly every day. So most of the day means the majority of the day and nearly every day of the week which I would say again, the majority of the week. So, four or five days a week plus if you're seeing these things. Absolutely, it's a conversation that you want to have with your child, with the counselor, with your primary care physician. So a persistent sadness, anxiousness, or what we call an empty mood. Just kind of feeling void of emotions, feeling hopelessness , pessimism, feelings of guilt, worthlessness, helplessness, hopelessness, a loss of interest or pleasure in hobbies and activities. In all of these you also have to look and realize, is this a change in their functioning level? Is this something that they u sed to enjoy, whether it's hanging out with friends or whatever hobbies or interests they have that it's a departure from what you know is to be your child. So, loss of i nterest, decreased energy, fatigue. We look at hypersomnia, which is oversleeping, i nsomnia, not able to sleep, difficulty concentrating, l ow appetite, weight loss, weight gain. Any of these symptoms that are a departure from your child's typical mood behaviors, et ce t era, i s so mething that you want to follow up with. So again, five of those or mo re, y ou definitely want to follow up with a mental health professional or your primary care physician and of course thoughts of suicide, sel f-harm, t hings like that.

Brenda Vargas:

I'm so glad you mentioned outside of their typical behavior, I'm glad you didn't use that word normal because what's normal for me may not be normal for someone else. I think parents really need to look at the lens of their child as an individual and what's different out of the list that you just named that could possibly point them in the direction of this could be happening, but really not comparing your child to someone else's child, a neighbor or their friend. I'm glad you went through those and I'm sure parents could replay it and listen to that list one more time so they could jot them down. I know that a lot of times parents first stop is really talking to that primary care doctor as a starting point a lot of times just because for most parents it's someone that they see at least yearly hopefully not too much more. But if their child is sick, they could possibly be seeing them more often than that, but i t's someone that already is involved with their family. So pointing out what specifics from that list they're concerned about when they go talk to their primary care physician is probably should be the focus of a parent that does have concerns.

Ryan Helton:

Absolutely. Luckily we've made headway in terms of being able to talk about mental health issues; we've come a long ways a nd if you go to your family physician, they should be screening if you're taking your child in annually, this is a part of their assessment now, which is great. They're go ing t o g o through anxiety and depression assessments. But, but that's once a year. That's once a year, right? So that's a start. That's gre at. B ut you know, we live in the information age, we have everything that I have available to me as a clinician, everything I went through comes from the DSM or diagnostic manuals that any clinicians use, parents all have that at your disposal. You can go online and look up what's the criteria for whether it's anxiety, whether it's depression and go, then that's a great place to start and jus t go look and if that criteria is being met, then you definitely want to t ak e it to t he next step. For us to rely on our family physicians once a year to do this assessment, it's not enough. Right? These are conversations that we need to be having with our kids on an ongoing basis. This has to be a part of our discussion and I don't care if it sounds scripted and you just go through these questions, son, daughter, I'm going to go through a list of symptoms of criteria that are related to anxiety and depression, which many of your peers go through. So let's just have a conversation really quickly. Tell me in the last two weeks or month , hav e you experienced any of these? And then you talk about them.

Brenda Vargas:

I'm so glad you're focusing on really going back to your son or daughter. Sometimes we don't focus on them as being a true problem solver as we're trying to make these determinations. Especially if it's something that can be scary to us, which I think this topic for a lot of parents and a lot of caregivers out there, it is pretty scary. But making sure that they're included in this conversation. We talk to other parents, talk to people we trust about these concerns and it's very often that the student or the their son or daughter is not part of maybe this conversation as much as it needs to be and going through that list and asking your son or daughter if they've had these experiences and what are their thoughts about this? Because they could be dismissing and, or avoiding it and having obviously no idea that what they're experiencing is something that they need to get extra help with. Possibly.

Ryan Helton:

I will say, I do see that in practice and well intention-ed parents, great parents by all accounts who really are scared to have some of these conversations with their kids. Why? because you're scared of what you're going to open up, and what that means for your child and what they might be going through. We don't like to see our kids in pain and also what that reflects back on us as parents, right? How could my kid be feeling hopeless and sad and depressed and anxious? What am I doing wrong as a parent? And what I can tell you is when we avoid the conversation, t he kids pick up on it, they feel whatever they're experiencing th ere i s now this feeling of shame or th ere's s omething wrong, which is why my parents aren't talking about it or bringing it up and now we're turning this really big, important issue into an even bigger thing than it should be, j ust by our own fear of not having the conversation and not maybe not knowing what to do, but we have to have the conversations with our kids. Because all of this stuff is happening. we can't avoid it. You either get ahead of the problem or you're goi ng to be in reactive mode and the problem will grow and then you will be at a point where it's not in your control. You can't even help your son or your daughter anymore. So the conversations have to start early. They need to be often. And if a parent doesn't know where to start with having that conversation, go pull up the diagnostic criteria on the internet, go through each item. You could read it word for word and then have a conversation with them.

Brenda Vargas:

I think it's important that parents realize that it's okay to say, this is scary for me. Or, i don't have the answers or I'm learning with you. I think there's that human element that we forget to show our sons or daughters that we're a team in this and we're doing this together and I may not have all the answers, but I'm going to find the answers and find other people that are experts that can help us. I think it's okay to say that. And it's easier said than done because I know this can be a very scary experience for a lot of parents. And I would say that unknown as to where's this gonna lead if I start this conversation or is this a bigger issue possibly that I personally as a parent am not comfortable with either because of my life experiences or those that I love and know. The fact that this opens up an unknown that is so uncertain and I just don't know what to do. So I think it's okay to tell parents to show that human aspect of not sure.

Ryan Helton:

I think along with that I see a lot of parents who try to shield and hide their own mental health issues, whether it's anxiety and something fear-based or depression , or even traumas that we've been through. And I get them all in a counseling office it's very powerful and important for our kids to see us as parents, as human and for us to impart some of our own experiences. So that they know that, number one, it's okay to talk about about some of our own fears, anxiety or depression or anything like that. Then again, the message we're sending is, it's not normal to feel or to go through that. If we do go through any of those things, don't talk about it. so that we can tap into our own story and try to connect to our kids that way. And I think it's also just important that our kids know that their parents are going to have these conversations with them. One of the things that I think I see kids struggle the most with, and I would say this is adults too; I work with teens, I work with adults and that is they want to be seen, they want to be heard, they want to be felt; they want to connect with people. As parents we have to make sure that that's our number one job, that our kids are being seen, heard, f elt. And so we have to have these conversations and they expect us to, they need us to. That's our jobs. That's our responsibility.

Brenda Vargas:

It is difficult depending on what season in life you're facing and what challenges. I know that we typically, and I know you'll discuss this a little bit further, Ryan, in regards to those adolescent years being probably more prevalent where we see signs of depression. Let's talk about prevalence and just what y ou're seeing in your experience a nd your office and what it looks like now.

Ryan Helton:

So what we know with depression is as we go along in the lifespan the older we get, what we see i s those numbers continue to go up. So for o ur elementary school kids, it's not a high number; we're looking around 4%; one to 4% of elementary school kids being able to meet the criteria for a depressive episode. Now that doesn't mean that they're not experiencing some of these symptoms that go along with the diagnosis. Those are things that as parents, we have to stay ahead of those things. So when we see that withdrawal from pleasurable activities or social events or withdrawing from friends, academic performance declining, w e see their overall mood kind of drop, these are conversations, these are things that we have to stay on top of and be connected with the school and our teachers to stay ahead of. So again just because those numbers are lower for elementary school kids doesn't mean that this isn't bubbling up and those things won't eventually turn into something like a depressive episode. But generally we see those numbers go up as our kids get into middle school, high school certainly. We know that on average the prevalence of teen depression is about 13%. It's higher for a f e m ale. S o if you have a girl against statistically one in five girls will experience a depressive episode lasting two weeks or more when they're in middle school. High school, a l i ttle bit less for boys, but still 13% of our kids that's a lot We take a look at Chandler high school. We've got about 31 3,200 kids, if my numbers are correct. That's 414 kids right now who can meet that criteria for a depressive episode. We know further than that, for the kids who meet that criteria, 70% would be deemed as severely impaired from this depressive episode. Again, whether it's two weeks, two months or longer, 70% are severely impaired. That's almost 300 students, right here, right next to us. We're at Chandler High right now. So 34%, a little more than a third reported feeling sad or hopeless almost every day for the last two weeks, one in th re e, right? Even if you don't meet the criteria for a depressive episode, it's one in three. 46% of our kids are experiencing a mental health disorder. Whether it's depression or anxiety, just something, it's almo st half half of our kids. It's definitely out there. If you'r e a pa rent listening to this, it's common. I'm a therapist, and you work in the counseling field.These are things that you cannot pretend that this might not be happening for our kids. I've got three boys and believe me, I know I've got to check in with them regu larly because this happens.

Brenda Vargas:

I want to just quickly touch upon the higher prevalence in females. I'm going to guess, and I'm no scientist, is there a direct correlation with the hormonal changes in girls experiencing puberty probably earlier than their counterparts, the males. Is there a direct correlation with that? What's attributed to that, if you can at all speak to that.

Ryan Helton:

If we think about the causes of depression, we know there's genetics, certainly. So there's chemistry, right? With hormonal changes that's absolutely a part of it. Just personality. There's life events, there's traumas that we go through. Obviously just being an adolescent is traumatic in and of itself. And I think typically if we look at the difference between boys and girls as well, it's more acceptable for girls to be emotional and for that emotion to be expressed. In boys depression can often look like anger, right? So how it's manifested is different. And I would say it's probably under- reported for boys. it may be easier to see in girls because girls are typically more verbal, more expressive, so can better articulate what they're going through versus boys.

Brenda Vargas:

Women tend to about their feelings in detail and in depth where the boy, the male is probably sitting in the principal's office dealing with the consequences regarding a behavior because they're angry and they made a poor choice. And the girl is in the counselor's office talking about their problem, trying to find a solution .

Ryan Helton:

Absolutely. And I wanted to also say we can't talk about depression without also kind of circling back and bring up anxiety. What we know of our adolescents who are being diagnosed with depression is almost 74% of them also meet the criteria for an anxiety disorder. So they go hand in hand. If you have a child who's experienced anxiety, depression, may be occurring as well, or right around the corner, if certainly their anxiety is untreated. Parents may not have interpreted past moods or behaviors as symptoms of anxiety, right? So they go hand in hand and you have to ask questions about both as well as like behavior problems, right? We know close to 50% of children and adolescents who are diagnosed with a major depressive episode or disorder, will also have behavior problems. Certainly in elementary school we may see that more so even than in middle school or high school. And that's boys especially because they lack the language. They lack the ability to articulate what they're thinking, what they're feeling, and so it manifests through behavior. A lot of times that's underlying depression or anxiety that is creating some of the behaviors.

Brenda Vargas:

So if a parent is dealing with their student making some poor choices , with having high behavior or even just at the beginning stages, they need to be asking other questions as to where is that behavior coming from? Why is that behavior being demonstrated and really looking deeper.

Ryan Helton:

I'm glad you brought that up because again, any behavior you and I have had conversations about this, but behavior oftentimes is representing the emotional world that our children are going through. Especially for younger children and even adolescents for that matter, who struggle to be able to identify what they're thinking, what they're feeling; I work with adults, adults struggle to identify where certain feelings are coming from and are a trigger. So our kids are way further behind us even as adults. So again, we have to look at , even if they can't articulate that I'm depressed, they may not know what that means. But if you can kind of go through that, some of the criteria of the diagnostic pieces that I went over and look at some of that behavior, then we have to dig in and figure out where is that coming from, what's underlying that that we need to address. And even if some of that behavior is things that we want to be mad at our kids about and we say how could they do this? Again, before we react, we have to really step back and ask those questions, why might my child be doing this or that? Just my experience working with kids for years now, it usually boils down to this: when it was depression or anxiety And that's for adults too. It's, they feel insignificant. They feel like they're not being seen, they're not being heard, they're not being felt and connected with. They feel inadequate, not good enough. They feel like they don't belong. They feel rejected. They feel like there's something wrong with them. And that's every client that I work with. That's kind of what it boils down to when we try to peel back the behaviors, the emotions, that's what the fear and the worry is, is, am I enough? Am I important? Am I unique and my special? Do I matter? Will others love me? Will I be accepted? If you're a parent out there and you're struggling with some behaviors that are big and ugly, we really have ask a lot of questions before we react or respond in any way.

Brenda Vargas:

So listening is really key. I'm a parent as well and have been at this end and understand that sometimes we don't have the answers and it's okay just to take more than one instance of listening in a conversation and allowing them to really be heard and voice whatever it is, they need a voice and helping them along the way with questions and prompts. But leaving it just open ended for them to share.

Ryan Helton:

Absolutely. I'll use assessments. You know, any clinician, any therapist uses various assessments and questionnaires to get a gauge on a child or teens, not only their mental world, what they think about themselves, what they think about the world, but their emotional world and try to understand b ehaviors. But as parents we can do the same thing. I go through the scale I'm looking at right now that I brought in here to the studio two of the things that I a sk every time of most all teenagers is on a scale of zero to 10, how significant have you felt over the past week, two weeks, a month, zero to 10. And I have them pick a number. We first define what does it mean to feel significant and important? And I put the words on here. Well, To feel significant is to feel important, to feel unique, to feel special, to feel like you matter. And wherever they put that number on the scale we talk about, well, why do you feel significant? Even if it's positive, even if it's good. Yeah, no, I feel significant. I feel important. And I say, well, why? Who makes you feel like that? For what reasons? Why do you matter? Right. Just because I want to k n ow where they're at mentally and if they're struggling with that, they feel insignificant. Unimportant. If they feel shame, doubt, if they feel inferior, if they feel like they don't matter, We talk about that, what's causing that, where is that coming from? So I asked them on that significant scale. I asked them on the love connection and belonging. Most of our adolescence is really all about we are moving away from our parents and trying to find our identity and our value and o ur worth separate from just our parents or our families. And we put that on our peers. Right? And so I like to ask, zero to 10, how loved, how connected, how much do you feel like a part of something, right? That you belong. And again, it's j ust to open up a conversation and help them identify how they're feeling. And kids will be honest. They're usually honest. They want to let you know what's going on with them. And these also give them words to be able to identify, Oh, okay, significance is what? it means that I matter. It means that I feel important. Okay. Do I feel like that? So we're also giving them words to be able to identify what's going on in their world. And that's really important. These are not tools that should be just used in a counseling office, these are tools that every parent should be able to use. If you don't know how to strike up that conversation, find me and I'll give you multiple tools and assessments, and t each you how to use them in a natural way to get a gauge on your child's emotional world.

Brenda Vargas:

I think those are great examples because they seem like really basic questions. But deconstructing that question and putting the words behind what does it mean so that they can, like a multiple choice, pick and choose and then elaborate and really allows them that time to reflect and allows us as parents to really just sit, listen, non-judgmentally to what they're saying and the parts that are missing and what they're not saying. A lot of times too, especially if you've not done this before, this hasn't been your typical conversation other than how was your day? It was great. What was the best part of your day, lunch, coming home, you know, whatever. Hanging out with my friends

Ryan Helton:

If you're a parent out there and you do suspect that your child is struggling with depression or anxiety or anything else, you can't expect to just ask your child, are you depressed? or are you anxious? That is such a loaded question that they, I can guarantee you they don't even know. And if you're asking that question, then you may not yourself as a parent, know fully what that means or what that looks like. So you really do have to just break down the ingredients and the elements of depression so that you can be much more specific in your questioning because I can promise you they won't know. Or they may say, yes, I'm depressed, but it may not be depression. It could be just a moment of sadness. Now, all of a sudden they're thinking they're depressed and there's a difference. Right? And we have to know as parents, this is just a normal, typical thing that all adolescents go through from time to time or is this real depression? And so we have to be very specific with our assessing and our questioning.

Brenda Vargas:

What are some of the treatment options, the choices that parents have if you could give them an idea of the gamut. I know you can't go into detail we're on short time and we don't want to lose anyone's attention as we want this to be informative and at least a starting point for those parents that are just trying to look for just more information and education on this. What do the treatment options look like, Ryan out there?

Ryan Helton:

The first thing I think that every parent has to get past is that this happens to the best of kids. It happens in the best of families, the most loving families, the best parents. This happens. So I think we first have to get out of our own way and realize if our kids are going through something and this is an issue that they need help with, we have to get out of the way. We can't be the one to say, well, I can't take them in for help because what would that say about me? And from there , once you've identified that there's a possible issue or problem, you have to seek help treatment because help helps. And the research shows that especially if you catch it when the issues are light to not as severe or just maybe even moderate , help helps. And the research is clear. So what does that look like going to your primary care physician to start? They'll do basic inventories or assessments. They'll refer out from there to clinicians, whether it's a psychiatrist , whether a psychologist , whether it's a licensed counselor or social worker like myself, they should be able to give you the resources and the tools to go seek treatment. Treatment for depression as well as anxiety since they are so lumped together are very effective. They're very effective. Now in psychotherapy typically what's used is cognitive therapy or cognitive behavioral therapy where we just have a client connect events to thoughts, to emotions, to behavior. When we put this whole picture together to help them understand how to kind of correct any irrational thoughts or some thinking patterns that are contributing to depression. So as far as success rate goes, with psychotherapy or counseling in and of itself, we see 50 to 75%, which I know is a big range, but 50 to 75% success rate with about eight weeks of counseling or eight sessions, which is pretty good. Really good, actually 50 to 75% medication alone yields about the same percentage of success, about 50 to 75%. If necessary, if medication is a part of the solution of t he equation, that coupled with counseling, we see the rates go up to 75 to 90% success rate. And when I say success rate, meaning they can return to that normal healthy level of functioning. So the counseling, medication treatments, if it comes to that, if that's needed, a re there, it's effective. And the other thing I would add is most of the kids who we talked about, how many kids do fall under this criteria and could be diagnosed with depression and worry, anxiety or anything like that, 60% don't get treatment at all. 60% of our kids who are going through this received no treatment at all, which is just crazy because it's out there. It shouldn't be anything to be ashamed of. We're talking eight weeks of cognitive therapy that you could see a significant increase in functioning. So it's really a shame that these kids are out there struggling and they never get identified and they never get the treatment that they need.

Brenda Vargas:

I read something recently, Ryan, that oftentimes, and this is not specific to anxiety and depression, but just in general regarding mental illness and mental health disorders, for some individuals it takes an average of 10 years before they even ever seek any treatment, which is mind blowing, right? If we had a physical limitation, we wouldn't wait 10 years to, for example, get a broken arm fixed obviously because we can't see these things, they're not on the outside. Sometimes society accepts the fact that mental health disorders or mental health illnesses, it's something that we can deal with and just kind of keep on pushing forward. Where that certainly doesn't help. And I think youth are finding other ways to cope that may be unhealthy. And hence we can probably sit here for another couple of hours and talk about the correlation with substance abuse and the fact that our youth and adults are coping with some of this through that avenue. And it's definitely not a healthy one when I think about treatment options and I couldn't agree with you more and every family has to make their own personal decision when it comes to what's the best option for their son or daughter. I know there are things outside of that treatment option and medication option that help, I mean exercise alone.

Ryan Helton:

Nutrition, exercise, spending time with friends and family, having a consistent regular sleep schedule, right ? Yes, of course. There are those things that we were all taught and that we try to teach our kids the basics of health and wellness, right? Eat well, sleep well, and get your exercise that are super important and crucial to the health of our kids. But, we still have to talk about them, we have to model that as parents. We have to model those things and make that a part of their lifestyle and their routines, whether it's going to the gym and getting the exercise or going on a walk around the block or making sure that they have their phone, their devices put down an hour before bedtime and that they have a consistent sleep schedule. Our kids need our help with enforcing some of those healthy habits.

Brenda Vargas:

It's great accountability too, because I think as adults we need that help to reminders, right? We have these restrictions for our students and it's easy to get sucked into that technology piece. I know my teen reminds me, mom, what about you? Right? And I'm like, yes, you need to do that. It's a two way street. Absolutely. I chuckle and smile as, as I say it, but that is the reality of the day that we live in in this global society. The fact that there are so many distractions. We live such busy lives and a lot of the things we do are important, but we forget that. Bring it back to the simple and the basics.

Ryan Helton:

I think that would probably be my last message and take away from this. As you know, most of us do 80 to 90% of our waking hours on autopilot. We go in and we do what we need to do at work and then we come home and then we've all got our routines that we set them and then we forget them. And the problem is oftentimes we lose connection, we lose touch with what's going on in our kid's worlds. We assume that they're going to school, we check in with them on their grades. And my ta ke a w ay, if I could impart anything to parents would just be, listen, the end of the day, our kids just want to be seen. They want to be heard, they want to be felt. And that requires us to put down our devices to get out of our autopilot modes that we all fall into and shut everything off and then look at them in the eyes and say, Hey, how are you doing? What's going on with you? And create space for them to talk. If we give them the space, they will talk. They may not initially because it's foreign, but open up that space for them. Let them be seen, he ard, let them know that you matter. We know if you're a parent listening to this, we know your kids matter to you, but they don't know that unless you put everything aside, you talk to them, you ask questions and try to understand what their world is looking like. So that's what I would say is our kids just need our presence, our attention. And that's the simplest way that we can help our kids.

Brenda Vargas:

Yes. Because we tell them every night I love you. And sometimes they need to hear all those other statements as well. And we know during moments of high stress or seasons of high stresses as we approach holidays during maybe anniversaries that maybe bring back a negative experience or things like that, we need to be just really cognizant that sometimes when we need to check back in even more so. But that that's a great takeaway Ryan, our community is blessed to have you and we're just so glad that you were able to be here and impart your expertise and share with parents real and raw, honest parent information. I always have takeaways when I talk to you, so I certainly appreciate your time Ryan and we will of course have you again. Parents, thank you so much for tuning in to CUSD cares. I hope that you've been able to learn a little bit today and are able to take even just one of these things that Ryan has shared with us and put that into effect with with your son or daughter. We're here for you. We know that every day is a new day, so thanks again for tuning in. Thank you, Ryan.

Ryan Helton:

Thank you .