Presentation for 7th Grade Students at Greenwich Country Day School 1/26/2021

1. 
Katherine Noble MD (“Dr. Katy”) | January 26, 2021
Mental Health for Middle Schoolers
Demystifying Depression & Anxiety
Staying Positive During COVID19

2. Here’s what I’m not talking about today
 I’m not talking at all about SEX
 I’m not talking at all about
PUBERTY
 I’m not talking much about DRUGS

3. 
Why bother having a pediatrician talk
about anxiety & depression in kids?

5. FeelingAnxious versus
Having an Anxiety Disorder
 Feeling anxious or worried is a normal
part of human existence
 Before a test
 Before a sporting event
 Watching a scary event unfold – in real
life or on the news
 Anxiety disorders develop when these
worries are so persistent or extreme
that they cause distress and disability
in everyday life

6. Types of Anxiety Disorders
 Generalized anxiety: typical onset age 7
 Social anxiety: more common in early adolescence
 Panic disorder: more common late in adolescence
 Agoraphobia: avoiding places or situations that might cause
you to panic
 Specific phobia: example  public speaking, vaccinations
 Separation anxiety: “Don’t leave me!”
 Selective mutism: kids who speak at home, not at school

7. How Common are Anxiety Disorders??
 VERY COMMON!
 The most
common
psychiatric
disorder starting
in childhood
 Affects 10-30%
of children

8. Factors in DevelopingAnxiety Disorders
 Developmental factors (infancy & toddlerhood)
 Learning factors
 Difficulty differentiating safety signs from true threats … and
focusing too much on insignificant things
 Neurobiological factors (in the brain)
 Genetic factors (inherited)
 Social and environmental factors (home environment)

10. Signs of Anxiety Disorder
 Avoidance: not going to
school, not participating in
social functions
 “Somatic symptoms”:
headaches, belly aches

11. Signs of Anxiety Disorder
 Sleeping difficulties: trouble
falling asleep, waking
 Needing excessive amounts of
reassurance
 Poor school performance:
trouble concentrating

12. Signs of Anxiety Disorder
 Eating problems: too much,
too little
 Explosive or oppositional
behavior

13. Identify and address anxiety early
 Anxiety disorders are associated with
 Poor school performance
 Increased risk of depression
 Increased risk of substance abuse
(drugs, alcohol …)
 Increased risk of suicide

14. Treatment
 Good news:
usually a good
prognosis!
 Psychotherapy
and/or medication
help

15. Developing your own tools
 Understand anxiety: “anxiety
breeds anxiety”
 You can stop the cycle by
accepting your worries and not
fighting them
 Take a moment for a “reality
check”  is this really
something I need to worry
about???
 Relaxation, meditation, exercise

17. Mindfulness Defined
Greater Good magazine
published by the Greater Good ScienceCenter (GGSC) ,University of California, Berkeley

18. Depression

19. 
Depression can come on suddenly…

20. 
Or rather quietly, insidiously …

21. Shame is part of the problem

22. Depression ... Girls vs. Boys
 Risk of major depression
for adolescent girls vs.
boys is 2:1 (similar to the
ratio in adults)
 But … the risk of
depression before the
teenage years is 60%
higher in boys than in girls
 So… puberty seems to be
a factor

23. Risk factors for depression
 Family history of depression and anxiety in close relatives
 Family dysfunction
 Exposure to early adversity (abuse, neglect)
 Psychosocial stressors (peer problems, bullying, serious
academic difficulties)

24. Risk factors for depression
 Gender uncertainty and homosexuality …. especially if there is
bullying
 Negative personal style of interpreting events and coping with
stress
 History of anxiety disorders, substance use, learning disabilities,
ADHD
 Traumatic brain injury
 Chronic illness, especially if it causes disruption in day-to-day
life

26. Signs and Symptoms
 Depressed mood or irritability
 Less interest or pleasure in doing
things
 Change in appetite or weight
 Difficulty sleeping
 Psychomotor agitation or
retardation – feeling sped up or
slowed down

27. More Serious Signs and Symptoms
 Fatigue or loss of energy
 Feeling worthless or guilty
 Difficulty concentrating
 Difficulty making decisions
 Thoughts of death or suicide –
repetitively
 Psychosis (delusions, hallucinations)

28. Depressions is serious...
Here are some consequences
 Academic failure
 Difficulty relating with family, peers, teachers
 Social withdrawal
 Negative interpretations of others and their intent
 Needing excessive reassurance

29. Worrisome associated conditions
 Anxiety disorders
 ADHD
 Disruptive behavior
disorders

30. Worrisome associated conditions
 Increased risk of eating disorders (anorexia, bulimia)

31. Worrisome associated conditions
 Substance use (drugs, alcohol… )

32. Suicide

33. What do you do if you or someone you
care about is very depressed or anxious??
 Expose the problem  talk to someone you
trust
 Parent or relative
 School counselor or teacher
 Pediatrician
 Encourage or seek professional help 
 Therapist
 Psychiatrist

34. Good common-sense recommendations
For Anyone Struggling with Anxiety or Depression
 Eat healthy foods
 Get regular exercise
 Get outside for fresh air

35. Good commonsense recommendations
for Anyone Struggling with Anxiety or Depression
 Get proper sleep!

36. Good commonsense recommendations
for Anyone Struggling with Anxiety or Depression
 Avoid isolation
Avoid too
much time
on
electronic
media
Spend time
with friends
and family
who care

37. 
How can we avoid isolation &
excessive electronic media use during COVID19??!
It’s seems impossible!

38. I’m frustrated
by these pandemic restrictions….
aren’t you, too?
Normal feelings during COVID19:
• ​​​​Feeling cut off from friends
• Feeling let down (graduations,
proms, sports seasons, special
events or vacations cancelled or
postponed)
• Feeling annoyed by daily
restrictions, including masks

39. 
Do’s & Don’ts

40. Don’t let your frustrations lead
to bad choices
 Don’t smoke, vape, or
experiment with drugs
 Don’t spend time on
electronic media in
ways that can be
harmful to you
(violent games,
connecting with
strangers, etc.)

41. 
Cell phones:
a tool that can get out of hand

43. Night-time Cell Phone Use:
A Slippery Slope

44. Suggestions
• Establish new and fun routines
with your family – make dinner
together, bake together, movie or
game night
• No video games, TV or cell phone
use during school hours – whether
you are learning remotely or in
school
• Use technology to connect with
those you care about and avoid
excessive electronic media that
isolates you

45. Suggestions
• Remain open in talking with your
parents
• Take on projects to help your
family or others in the community

46. Other Ideas….
• Spend time with friends
outdoors
• Stay active: run, jog,
hike
• Read a new book
• Research new hobbies
or skills to learn
• Create a diary or video
blog of life during the
COVID-19 outbreak