Activities for Educators and Parents

Children consistently learn and develop new and increasingly complex cognitive skills throughout early childhood. During this period, it is not practical to use a one-and-done approach to learning and skill building. Like an athlete or artist, when it comes to social and emotional learning, children need to practice and fine-tune these skills inside and outside of school to gain mastery. It is important to remember that some children understand a skill or concept quickly while others may need additional practice before gaining mastery of those same skills or concepts.

In her book Play Therapy Activities, Melissa LaVigne, LCSW, offers 101 social and emotional learning activities for children between the ages of three and nine. The activities provided below are examples from the book that can be used in individual or group sessions. They can also serve as great suggestions to educators to use within the classroom and for family members to use at home with children.

Worry Jar

This activity is used to address feelings of anxiety or uncertainty a child may have.

• Materials needed: jar with lid, post-its, and a pen/pencil
• Directions: When a child has a worry, concern, or anxious feeling, invite the child to write it down on a post-it and place it in the jar. Explain they do not need to share it, confirm that everyone worries at times, and also talk about other ways to manage the feelings of being worried. For younger kids who do not yet write or spell, offer to write down the worry for them if they want. Once written, hand the paper back to them so they can put it in the jar.

Felt Feeling Faces

An emotional intelligence activity, this helps children think about and understand how feelings present on someone’s face.

• Materials needed: oval-shaped felt paper to represent faces, felt paper in an array of colors, and scissors (optional: glue stick to make permanent feeling faces)
• Directions: Instruct children to cut out the shapes of eyes and mouths expressing emotions such as happy, sad, mad, etc. If needed, have children use a hand mirror to see the shapes their own faces make with different facial expressions. Once cut, have the children use the oval-shaped pieces of felt with the eyes and mouth to create “feeling faces”. Have the children guess what feeling each face is making and discuss what they can do when they see someone feeling that way. Note: Pre-cut out these shapes for children too young to safely use scissors.

Feelings Play List

This activity draws on the emotional connection of music to help children identify feelings or remember fond memories.

• Materials needed: access to a music streaming device or an audio search device (e.g., Alexa)
• Directions: Begin a group discussion by asking the children to name feelings they want to talk about. If possible, encourage a balance between positive and negative feelings. Ask the children if they can think of songs they like that match a feeling. If possible, listen to the song or look up the words in the song. Ask the children why the song matches a certain feeling for them. For an added activity, make a playlist of songs that match positive feelings such as happy or calm. The song names can be written down and shared so families can make their own playlists.

Bubble Tag

This breathing and impulse control activity can be modified to accommodate individual or group work.

• Materials needed: bubble wand and bubble solution
• Directions: Introduce this activity by explaining how breath control can be used to create a sense of calm and discus how deep and steady breathing makes good bubbles. Use a bubble wand to take turns blowing bubbles while the child tries to pop the bubbles before they hit the ground. For group sessions, have one member blow the bubble while another pops it, or consider splitting the group into teams. During the bubble-blowing exercise, ask the child (or group) to think about what will make more or bigger bubbles and ask them to experiment with their breath to find out. Use positive praise when the child uses good breath control, model breath control if needed, and talk about how breathing can help manage feelings.

Enjoying the Classics

Games like red light green light, freeze dance, musical chairs, and duck-duck-goose provide children an opportunity to connect their mind to their body by listening and then acting on what they heard. This can help with building better self-regulation skills as well as their overall emotional intelligence.

References: LaVigne, M. (2020). Play therapy activities: 101 Play-Based exercises to improve behavior and strengthen the Parent-Child connection. Rockridge Press.

For our kids, disruptions caused by the COVID-19 pandemic are likely more than just that – temporary inconveniences, varying in severity, until life goes back to “normal.” Besides missing out on once-in-a-lifetime events, like graduations, birthdays and other milestones – at least in a way they would traditionally be observed – regular human interactions, part of social and emotional development, have changed. While adults may be experiencing a serious blip on the radar, children may be experiencing an interruption in brain development and/or lack the ability to fully cope in this unchartered territory.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Understanding and Meeting the Needs of Children and Adolescents at High Risk, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents.

As we think about the significance of childhood development, the following points from Magellan’s monograph provide insights:

A growing body of scientific information has confirmed the importance of the first five years of life, when the ongoing construction of brain architecture impacts youth social and emotional development, the ability to learn new behavior and skills, and how the youth evolves into adolescence.

Advances in neuroscience have contributed new understanding of adolescent development. During adolescence, the brain experiences a period of major development comparable to that of early childhood.

With much changing in our kids’ lives and environment – virtual schooling, modified in-person play arrangements with friends and reduced time with extended family – the responsibility falls on parents and caregivers, as it always does, to ensure their child’s wellbeing and adjustment. Magellan’s monograph offers the following to ponder:

While genes determine when specific brain circuits are formed, experiences actually shape their formation and are fueled by a self-initiated, inborn drive toward competence. This phenomenon depends on appropriate sensory input and stable, responsive relationships whereby adults respond to a child’s natural reaching out for interaction.

However, when parents are under unprecedented stress and often just trying to make ends meet, attending to their child’s increasing needs can understandably be overwhelming. In addition to the role of parent and full-time employee, many adults have taken on the additional roles of teacher, daycare worker and entertainer, to name a few. In some cases, however, a parent’s struggles may lead to neglect of their children. Magellan’s monograph highlights the following of child neglect:

While child abuse is more widely acknowledged and publicized, child neglect is, in fact, the most common type of child maltreatment, which frequently goes underreported. Expanding on the earlier discussion of impaired brain development, it is now understood that lack of stimulation and necessary care early in life may cause children to remain in a state of “hyperarousal” (i.e., constantly anticipating threats and/or experiencing dissociation) rather than a normal state of attentive calm. This phenomenon leads to a decreased ability to benefit from social, emotional and cognitive experiences and results in other psychosocial consequences. Together with insecure attachments, this state of hyperarousal can significantly affect normal growth and development.

Many parents are also managing their own mental health conditions and substance use disorder during the pandemic, which adds to the impact of what children and adolescents are experiencing themselves. The monograph outlines the risks for children of these parents:

There are many serious risks to children and adolescents who have a parent or both parents with mental illness. The American Academy of Child and Adolescent Psychiatry (AACAP) calls attention to the strong genetic predisposition in children for inheriting bipolar disorder, an anxiety disorder, attention deficit-hyperactivity disorder (ADHD), schizophrenia, alcoholism or other SUD, or depression. Recent studies have also demonstrated delayed brain development in young children of depressed mothers. Further, the AACAP notes the additional stress that mental illness places on a marriage and parenting abilities of the couple, and the risks that stem from an inconsistent, unpredictable family environment that can contribute to psychiatric illness and developmental delays in children.

It’s also appropriate to consider the older children and young adults who may lack the ability to cope with increased stress and instability. Magellan’s monograph calls attention to recent research:

A CDC report on mental health, substance use and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).

During these difficult times, we’re all doing the best we can. And we know that brighter days are on the horizon. Until then, and always, as we’re helping ourselves and our children through, let’s remember that “information is power,” as they say. To that effect, we encourage you to learn more in our full children’s clinical monograph here.

In light of recent events, Yagnesh Vadgama, BCBA, vice president, clinical care services, autism, Magellan Health, shared his perspective about how COVID-19 and racial and ethnic disparities may be combining to delay diagnosis and important early treatment for autism spectrum disorder in children.

 Magellan Health Insights: Yagnesh, thank you for chatting with us today. In the past there have been marked differences in the rates in which Black and Hispanic children are diagnosed with autism spectrum disorder (ASD). Why was that?

 Yagnesh Vadgama: For years, there was a disparity in the rates of ASD diagnosis of Black children versus White children – as recently as 2014 White children were 1.1 times more likely to be diagnosed with ASD by age 8. And in the 1990s, Black children were identified as having ASD later and were more likely to be diagnosed with conduct disorder or adjustment disorder than were White children. For the first time, the CDC has reported that this gap has closed as of 2016 for Black children, which is encouraging news, but was not the case in every state studied.

And, a gap still exists for Hispanic children. White and Black children were 1.2 times more likely to be identified with ASD than Hispanic children. Reasons for this difference include lack of access to healthcare services, differences in Medicaid vs. commercial insurance coverage of ASD services, parents and children speaking a primary language other than English, and potentially fear of seeking out care because of one’s immigration status. It’s still the case that Hispanic and Black children receive evaluations at a later age than White children. Often, children with Medicaid don’t get diagnosed until they begin attending school.

Magellan Health Insights: Why does age of evaluation and diagnosis matter?

 Yagnesh Vadgama: With ASD, time is of the essence. The earlier we get kids into services, the better the health outcomes are going to be. If an individual gets treatment early, there is less risk of developmental delays becoming permanent. A recent University of California San Diego study indicates children should receive ASD services as early as 18 months. During this time, the brain is able to acquire new skills at an earlier age. Also, as individuals get older, they are more likely to develop a comorbid diagnosis, so it’s important to begin services prior to the onset of other comorbidities.

 Magellan Health Insights: How might COVID-19 be affecting the age at which children are being evaluated?

 Yagnesh Vadgama: People are avoiding nonurgent care. Utilization rates of elective services have plummeted. Also, since school is the first place many children get evaluated for ASD, that may not happen with schools closed or moving to remote learning. And since many individuals’ health insurance is provided by their employers, many newly unemployed individuals may not be able to afford COBRA premiums and may lose coverage. Time is of the essence, and delays may have long-term or permanent effects.

 Magellan Health Insights: What can healthcare providers do to help ensure early, accurate diagnosis?

Yagnesh Vadgama: Healthcare providers should conduct early and frequent screenings as recommended by the American Association of Pediatrics. But, as important, providers should make appropriate recommendations for follow-up care and really help parents understand the next steps. They need to create a sense of urgency for follow-up care – encourage parents to act now, not to sit on it, see someone now. Then follow up with additional testing and screening on subsequent visits, because ASD can evolve over time. But never use a “just wait and see” approach, because time is of the essence.

Magellan Health Insights: What can parents do to help ensure a correct, early diagnosis if they have concerns?

Yagnesh Vadgama: Understand developmental milestones for your child’s age and the signs of ASD. Speak up about your concerns, especially where a child has a hearing impairment or an intellectual disability – because both situations could lead to a later ASD diagnosis. Be your child’s biggest advocate and ask about concerns and next steps.

One of the beautiful things is that in all 50 states, there is a mandate that commercial insurance carriers provide autism coverage. Covered members now have access to screenings, psychologists, developmental pediatricians and services that weren’t available when I began practicing over 16 years ago. And keep pushing until you get the care that best meets your child’s needs. Don’t wait!

Magellan Health Insights: We couldn’t agree more! Thank you, Yagnesh!

Coronavirus (COVID-19) concerns are growing, and school closures are happening in most states. While grown-ups are anxiously figuring out how to handle the impacts of these decisions, kids are observing everything and may feel just as scared and confused as adults.

Talking with children about COVID-19

Children look to parents, guardians, caregivers and other trusted adults to help them make sense of what is happening in the world. COVID-19 is the topic of conversations everywhere on social media, web news outlets and TV. Everyone is being exposed to the fear and uncertainty of this global pandemic.

Children might find it difficult to understand what they are seeing or hearing about COVID-19, so they can be particularly vulnerable to feelings of anxiety, stress and sadness. As an adult, it’s important to make yourself available to listen to children’s thoughts and communicate in an age-appropriate way that addresses children’s questions without stoking anxiety. Children react, in part, on what they see from the adults around them. When parents and caregivers deal with a stressful situation calmly and confidently, they can provide the best support for their children.

The Substance Abuse and Mental Health Services Administration provides Tips for Caregivers, Parents and Teachers During Infectious Disease Outbreaks that includes information on possible reactions and tips for talking with children and youth of different age groups.

Tips for staying at home with children during the outbreak

• Focus on the uniqueness of the moment. This situation has never happened before. How can you make the best of it? Yes, it is stressful on many levels, but for your children, it is a time they will never forget and there is an opportunity in forced togetherness to reinforce your family bonds.
• Plan for different age groups. Younger children will love being home. Young teenagers may not be as thrilled by not being able to hang out with their friends on a daily basis. High schoolers can handle themselves and may be able to help with the younger kids if you have to work.
• Bend with the wind. Meaning: be flexible with the schedule. Let children play, do a fun project together (make cookies or do a craft), eat breakfast for lunch and make room for downtime to read and hang out. Your kids may have quite a bit of time at home, so try to maintain your patience and perspective.

To learn more about what Magellan Healthcare is doing to support clients during the  COVID-19 pandemic, visit  MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

Adapted from: Stockwell, A. (2020, March 13). What to do with your kids when schools are canceled. Retrieved from https://www.vox.com/the-highlight/2020/3/13/21178234/coronavirus-covid-19-school-closures-kids-home

The following is an excerpt from the 2018 Magellan Community Impact Report.

Care is core to every service we deliver and everything we do. For Magellan, success is about so much more than profit or prestige. It’s about doing well by doing good. We’re always caring, listening, learning and using our collective insight to make a difference. When we care together, we turn hope into reality.

Caring and sharing our lived experiences

Wyoming’s High Fidelity Wraparound program is just one of many examples where Magellan team members, who have lived through similar experiences, are returning the care and concern they personally received.

High Fidelity Wraparound is a voluntary planning and care coordination process for children and youth (ages 4-20) with complex behavioral health conditions. High Fidelity Wraparound’s community based solutions and planning process bring people together from different areas of a family’s life to form a team. The team creates steps to help youth stay in their homes, schools and communities.

Through our partnership with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan serves as the Care Management Entity for the High Fidelity Wraparound program, setting the rules and providing training for everyone involved in the process.

The  Wiederspahn  family

When Magellan Care Worker Chassity Wiederspahn’s son began  to struggle behaviorally, mentally  and emotionally in first grade, she knew she needed assistance but was at a loss.  Through High Fidelity Wraparound, she was  able to build a team around her family to guide  them in their search for help. The High Fidelity  Wraparound program allowed them to build a strong  support system and learn the resources available in their  community. It gave them confidence that they could handle  the challenges that might lie ahead. As a graduate of High Fidelity Wraparound, Chassity shares her story with the families and providers  she speaks to on a daily basis.

Many of our Magellan team members have lived these  experiences. which enables them to bring a valuable  set of life skills to their daily jobs each and every day.  As employees, the job is more than just the tasks at hand, we  truly care and offer ourselves as role models of hope and success.

The Campbell family

Magellan’s Kathryn (Kat) Campbell, family support specialist, is the proud mother of four beautiful children, two of whom are adopted from Wyoming’s foster care system. Blending a family was an overwhelming process despite the research and preparation of a therapist team. The crash course in secondary trauma left Kat and her partner reeling.

The family was referred by the local crisis center to High Fidelity Wraparound. The process created a safe space for Kat’s entire family to focus on caring for themselves, and they started to feel the support of those around them who were waiting to help. High Fidelity Wraparound’s empowerment and team building strategy gave the family the skills to run their own team for the high needs their children had, long after the family graduated from the process. Kat now trains and mentors providers who work directly  with families like her own.

Wyoming’s High Fidelity Wraparound program continues to show successful outcomes for enrolled youth with complex behavioral health challenges.  Operated by Magellan Healthcare, Inc. through a collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Wyoming’s High Fidelity Wraparound demonstrates that young people are getting more needs met in their own homes and communities.

High Fidelity Wraparound, an evidenced-based non-clinical intensive care coordination program, is a national model designed to bridge gaps for youth where challenges in behavior and mental health exist. The program uses peers and lived experience in a strengths-based way, focusing on what people do well and provides alternative options in addition to therapy and other traditional methods that fit individual preferences and cultures. This team approach provides a network of support for families, allowing them to be the experts of their lives and learn to drive the process.

“When youth behavior is extreme, there is higher probability of needing to leave home or school to address their needs in a clinical, therapeutic or detention setting. We meet people where they are, use assessments like the Child and Adolescent Needs and Strengths (CANS) to identify needs and strengths, which inform the team of behaviors that should be addressed,” said Tammy Cooley, senior director of operations, Magellan Healthcare. “Youth are supported in meeting challenges like staying in school, having more positive relationships, and doing more of the things children should be doing at their age, which ultimately builds confidence and lasting positive change.”

In Wyoming’s High Fidelity Wraparound programs, CANS are administered at the beginning of a youth’s enrollment into the program and every three months until the youth successfully completes the voluntary program and transitions out.

Barbara Dunn, Director of Program Innovation and Outcomes for Magellan of Healthcare in Wyoming, said, “From July 2018 to June 2019, over 75 percent of youth enrolled in Wyoming’s High Fidelity Wraparound program experienced reduced severity of needs. The typical youth enrolls with nine treatment needs and resolves almost four while increasing strengths to maintain their gains.”

 Decreased Needs and Increased Strengths

July 2018-June 2019

Cooley said, “The evidence is powerful and shows reductions in high prevalence needs between a youth’s enrollment and discharge. Our program works when youth and families are engaged. Wyoming’s Department of Health, Division of Healthcare Financing (Medicaid) has given us a chance to deliver a quality home and community-based program through a care management entity model that gives high risk youth more access to care right where they need it most. From the results of this year’s CANS report, we show Wyoming’s High Fidelity Program is making a positive impact in the lives of our youth participants. We want all youth who qualify for this Medicaid program to see the benefits.”

 Wyoming CANS Initial Scores vs. CANS Discharge Scores in Key Intervention Areas

June 2019-July 2019

For more information about Wyoming’s High Fidelity Wraparound program, please visit www.MagellanOfWyoming.com.

About Magellan Health: Magellan Health, Inc., a Fortune 500 company, is a leader in managing the fastest growing, most complex areas of health, including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.

Children with attention deficit hyperactivity disorder (ADHD) may have difficulty in school, because their symptoms—inattention, impulsiveness, and hyperactivity—get in the way of learning.

Success in school is important for the development of healthy self-esteem and confidence.

You can help your child succeed in school by:

• Working with teachers and other school personnel.
• Educating yourself about ADHD.
• Helping your child control his or her symptoms.

How can you help your child be successful in school?

You can help your child have the greatest chance of success in school by educating yourself, building relationships, maintaining open communication, working with your child, and keeping good records. Preschool or kindergarten is the best time to start using these techniques. But it is never too late to help a child improve his or her school performance.

Education                                                          

Learning as much as you can about ADHD and your child’s education rights will help you work with the school system more effectively.

• Learn about ADHD. Use the Internet to locate national organizations, ask your doctor, or visit your local library or bookstore for information about ADHD.
• Know your child’s symptoms and treatment plan. Talk with your doctor about your child’s behaviors that may interfere with learning and about ways to control those behaviors. Develop a record of your child’s treatment plan.
• Learn about your child’s education rights. Laws exist ensuring education rights for children who have conditions that interfere with learning. These laws also stipulate that parents have a right to be informed about and participate in educational decisions concerning their child. Contact your state and local education departments for information about ADHD in the schools and your rights to educational accommodations.
• Talk with other parents of children with ADHD. Join a support group for ADHD families. Find out how others have effectively worked with school systems.

 Build relationships

A positive relationship with teachers and other school personnel will improve your child’s chances of being successful in school.

• Start early. Before a school year begins, get to know the principal and other appropriate school personnel. Find out as much as you can about the school policies and rules, especially how behavior problems are handled. Find out if there are other children with ADHD in the school and how their behavior is being handled in the classroom.
• Share what you have learned. Find out if the teachers and other personnel need information about ADHD. Look for ways to help them get that information, such as suggesting books, pamphlets, or any local educational programs.
• Get to know your child’s teacher. Before the school year begins, talk with your child’s teacher about his or her style of teaching and discipline in the classroom. Find out whether the teacher has experience teaching children who have ADHD. Share with the teacher information about your child’s symptoms and what behaviors may interfere with his or her ability to learn. You may want to share your child’s treatment plan with the teacher.
• Make a school plan. Work with the teacher to design a plan to help your child perform to his or her potential. Address how to minimize misbehavior and how to react to it. Your plan will change as your child grows and develops. You may need to work with the school to develop an individual education plan (IEP) for your child. An IEP is a tool for classroom and homework adaptations for a child with a disability. For children with milder symptoms, the school may suggest a plan that is used for medical conditions that do not meet the IEP standards (called a 504 plan).
• Ask school personnel for help when needed. Tutoring or services that help with study or organizational skills are sometimes provided through the school. If not, school personnel often have a list of local resources that can help your child.

Keep communication open

Open communication with your child’s teacher can help resolve problems that may occur throughout the school year. The following are suggestions for working and communicating with your child’s teacher:

• Understand the demands upon your child’s teacher. Most children with ADHD can be taught in a regular classroom, although adjustments are sometimes needed. Not all teachers are trained to do this. Also, teachers are stretched to their limits by large numbers of children in the classroom, making it difficult to give each child personal attention. Ask the teacher what he or she needs from you to help assimilate your child.
• Keep the teacher informed. Share with the teacher any relevant changes in your child’s treatment plan. Help facilitate the sharing of information among you, your child’s teacher, and your child’s doctor.
• Visit the classroom. If possible, volunteer for school activities and parties. This will let the teacher know that you are interested in your child’s education and willing to help.
• Request progress reports. Children with ADHD often lose or forget their assignments. Ask the teacher to complete regular progress reports of your child’s performance and behavior.
• Have a final conference. Meet with the teacher at the end of the school year to discuss your child’s overall progress and the teacher’s suggestions for the next year. Ask him or her about possible teachers for the next year and how to help your child get the best chance for success in school.

Work with your child

• Use treatment methods as recommended by your child’s doctor. This may include medicine and/or behavior management techniques. This will help your child control symptoms of ADHD at home and school.
• Keep your child involved. Let your child know that you support his or her teacher. Clearly outline your expectations and the consequences of misbehavior. Talk with your child about how the teacher will let him or her know that a behavior is becoming inappropriate.
• Link school and home. Use the same signals (such as hand signals) that the teacher uses at school to indicate when a behavior is becoming inappropriate. Also, you can reward your child with privileges for remembering to bring home school progress reports. You can further reward him or her if the report is positive. If your child fails to bring a progress report home, you may treat it as if he or she had an unsatisfactory report and withhold a privilege.
• Help your child organize. Even young children can learn to use lists, daily planners, or calendars to keep up with homework assignments, tests, and activities. A young child may need a teacher’s help in writing down assignments.
• Use learning aids, such as tape recorders or computers. Teach your child how to take notes and to underline important information. If your child seems to learn best visually, ask about books that have helpful pictures and diagrams or workbooks.
• Have short sessions. Keep homework sessions to no more than 20 minutes without a break.

Keep good records

Health and school records can help monitor your child’s academic and behavioral progress as well as help identify when treatment adjustments are needed. You should keep and update the following records:

• ADHD evaluations. Collect copies of any records that are used to evaluate your child for ADHD. These records often identify the type of ADHD that your child has, which helps with treatment.
• Evaluations for any other conditions with similar symptoms.
• History of medicines. Record all medicines that your child has taken or is taking to treat ADHD.
• School progress records. Keep copies of any school plans, daily school progress reports, and formal progress reports throughout the year. Also, keep your child’s final grades and any achievement test results. You may find them helpful as you develop school plans for the following year.
• Individual education plan. If your school developed an individual education plan (IEP) for your child, ask for a copy. You may need to share that information with the health professionals working with your child.

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What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

• Is irritable, sad, withdrawn, or bored most of the time.
• Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

• Lose or gain weight.
• Sleep too much or too little.
• Feel hopeless, worthless, or guilty.
• Have trouble concentrating, thinking, or making decisions.
• Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

• Both very young children and grade-school children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping. Often they will lose interest in friends and activities they liked before. They may complain of headaches or stomachaches. A child may be more anxious or clingy with caregivers.
• Teens may sleep a lot or move or speak more slowly than usual. Some teens and children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a milder, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:

• Stressful events, such as changing schools, going through a divorce, or losing a close family member or friend.
• Some medicines, such as steroidsor opioids for pain relief.
• Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about your child’s past health. You and your child may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how he or she thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

• Encourage your child to get regular exercise, spend time with supportive friends, eat healthy foods, and get enough sleep.
• See that your child takes any medicine as prescribed and goes to all follow-up appointments.
• Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
• Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.

• Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
  • Talking, drawing, or writing about death.
  • Giving away belongings.
  • Withdrawing from family and friends.
  • Having a plan, such as a gun or pills.
• Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
• A child may need to try several different antidepressants to find one that works. If you notice any warning signs or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child’s doctor.
• Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems

Help is available. For additional information, visit MagellanHealth.com/MYMH

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