THE YEAR OF FRIENDSHIP:

FOSTERING MENTAL HEALTH

THROUGH RELATIONSHIPS
Nadja N. Reilly, Ph.D.
April 6, 2016

Summary of Presentation

Anxiety and depression as distinct from stress

Symptoms of anxiety and depression across
developmental stages
Impact of anxiety and depression on learning and
emotional health
Building relationships and resilience

Distress vs. Clinical Concerns

Distress

Consistent with
developmental stage
Temporary
Context or situationspecific
Does not interfere
with functioning and
growth

Clinical Concerns

Out of context
developmentally
Pervasive
Global, persistent
Interferes with major
areas of functioning

Biopsychosocial Model
Genetics
Chemical imbalance
Other medical disorders

Biological

Psychological
Negative thoughts
Unhealthy coping skills
Lack of self-esteem

Social
Family
School
Peers
Neighborhood

Anxiety
Emotional uneasiness associated with anticipation of
danger
Among the most common forms of psychopathology
in children and adolescents
Prevalence rates range between 7%-28%
Average age of onset is 11, although may begin as
early as preschool age
Increases risk for depression
and/or substance use disorders

Symptoms of Anxiety

Shaky, restless, or tired

Shortness of breath, rapid heart rate, and/or cold
and sweaty hands
Lightheadedness, blushing, tremulousness
Stomach pains, GI distress, headaches, dizziness
Edgy or irritable, difficulty concentrating
Inability to control worries or thoughts
Screaming, crying (in anticipation of fear)
Difficulty sleeping; nighttime fears or nightmares
Excessive worrying, sense of nervousness

How is Depression Different from Stress?

mood

Typical changes in mood =

Clinical Depression =

time

Symptoms are too frequent, last too

long, and are too intense for the
person to manage

Depression

A family history of depression and exposure to stressful life

events are the most robust risk factors for depression

Average age of onset is between 11 and 14 years; after the

onset of puberty, girls have twice the risk of developing
depression than boys

By the age of 18 approximately 1525% of adolescents will

have experienced a major depressive episode

Twelve percent of children will relapse within 1 year, 40%

will relapse within 2 years, and 75% will experience a second
episode within 5 years

Symptoms

Depressed or irritable mood most of the day, nearly every

day
Markedly diminished interest or pleasure in all or almost all
activities
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death

Symptom Differences According to Age

Preschool age (2-5 years)

more severe presentation

lack of play, low energy

Younger adolescents (10-14

years)

School age (6-10 years)

high co-occurrence with

disruptive disorders
Agitated, anxious

more anxiety symptoms:

fearfulness and nervousness
clinging behaviors
physical symptoms (headaches,
stomachaches)

Older Adolescents (14 to 18

years)

loss of interest and pleasure

more negative self thoughts
increased thoughts of death
and suicide

Commonalities Across Disorders

Emotional Experience

High levels of shame

Difficulties with emotional regulation
Lack of healthy coping skills
Hopelessness, helplessness
Impact on relationships

Avoidance

RESPONDING TO THE NEED

Thoughts

Feelings

Behaviors

Relationships

Self-regulation is distinct from intelligence. High

levels of motivation and self-regulation are
associated with better outcomes independent of IQ.

The power of relationships

Our thinking and our brains suffer if we are lonely or

socially isolated (especially executive functions)

Forming friendships is critical to emotional wellness

and improving self-regulation

Among children struggling with depression, parental

support is associated with reduced depressive
symptoms, peer support is associated with higher
academic self-efficacy, and connection to teacher
support is associated with all three outcomes.

Parental Responses

Sense of safety
Self regulation for parent and child
Limits with love
Communication
Feelings are ok to have and experience
Identify triggers coping
Practice ways to tolerate distress
Mindfulness

Building Resilience

Celebrate the child

Celebrate the process and the failure
Long-term vs. short-term goals
Positive relationships with others (family, school,
community)
Agency and power
Experiences of social justice
Cultural rootedness
Spirituality meaning and purpose

What should I do if Im worried about my child?

Set up an appointment with your childs pediatrician

make sure has full medical exam as some medical
conditions have similar symptoms as depression
Talk to your child about your concerns ask how you
can be helpful.
Im concerned about you and how you feel or Ive
noticed these changes, I just wanted to check in with you.
Approach your child in a calm, empathic, non-forceful
manner and reassure him/her that you are ready to listen
whenever he/she is ready to talk.

Additional steps

Call your insurance company and find out about mental

health coverage and providers in your area

Call your childs teachers (or other adults in the school

working closely with child) and find out how he/she is
doing in school (academically, behaviorally, and socially);
share your observations and ask for teachers observations

Set up an appointment with a therapist who works with

kids its best to err on the side of caution and obtain an
evaluation rather than wait until there is a crisis.

National Suicide Prevention Hotline:

1-800-273-TALK (8255)
National Self-Injury Helpline:
1-800-DONT-CUT (366-8288)
National Eating Disorders Association Helpline:
1-800-931-2237
Alcohol & Drug Abuse Hotline
1-800- 729-6686
Rape, Abuse, and Incest National Network (RAINN)
1-800-656-HOPE
Way to find resources and treatment referrals:
William James Interface Resource and
Referral Service 617-332-3666, ext. 1411