Statistics show 10 % to 15% of teen’s experience symptoms of depression, and an estimated 1 in 8 teens will be diagnosed with clinical depression. If you are a parent concerned about your teen’s psychological well-being, check out this presentation about risk factors for teen depression and how to recognize potential for self-harm. Treatment options such as cognitive behavioral therapy (CBT), and ways you can support treatment to help your teen achieve her or his goals for a bright outlook will be discussed.

1. Teen Depression
April Bickoff, PsyD, ACT
Nancy Moran, LCSW, ACT
Behavioral Health Clinicians
June 1, 2016

2. Agenda
• Statistics
• What is typical?
• Signs & symptoms
• Causes/triggers
• Cognitive Behavioral Therapy (CBT)
• Suicide Assessment/Self injury
• What can parents do?
• When to seek help?

3. Statistics
• 10-15% of children have some symptoms of depression right
now
• 1/8 adolescents have clinical depression
• Mean duration of 7 to 9 months; vast majority remit within a
few months
• Recurrence rate of 40%
• 35% Hereditability rate
Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.
Chansky, Tamar (2008). Freeing Your Child From Negative Thinking. Cambridge, MA: Da Capo Press.

4. Is this “typical” or is something wrong?
• Changes in social behaviors
• Conflicts with authority
• Increased stressors
• Changes in sleep
• Drug/Alcohol Experimentation
• It is normal to have some ups and downs with mood.

5. Diagnostic Criteria
5 or more of the following during a two week period with at least
symptom 1 or 2 present
• 1. depressed mood nearly every day
• 2. diminished interest or pleasure
• 3. weight loss or gain of more than 5% when not trying to lose or
gain weight
• 4. insomnia or hypersomnia nearly every day
• 5. psychomotor retardation or agitation
• 6. fatigue or loss of energy nearly every day
• 7. feelings of worthlessness nearly every day
• 8. diminished ability to think or concentrate
• 9. recurrent thoughts of death, recurrent suicidal ideation (with or
without plan)

6. Signs/Symptoms that may be associated with
Depression in Teens
• Frequent physical complaints (headaches and muscle
aches)
• Frequent absences from school and/or a drop in grades
• Loss of pleasure in activities
• Social isolation
• Increased outbursts of shouting or crying
• Self-Harm

7. Causes/Triggers
• Academic Pressure
• Relationship Issues (social or romantic)
• Sexuality Issues
• Peer Pressure
• Bullying/Peer Rejection
• Family history of depression

8. Causes/Triggers
• Family Conflict
• Substance Abuse
• Abuse/neglect
• Chronic illness
• Loss of a loved one

9. Suicide Assessment
Who is at risk?
• Past attempts
• Family history of mood disorders
• Exposure to family violence
• Impulsivity
• Co-morbid psychiatric disorders
• Parental history of suicide
• Limited social supports
• Substance Abuse

10. What should you do if you feel your child is at risk?
• Don’t be afraid to have an open conversation with your child.
• Ask your child about their thoughts.
• Identify if thoughts are passive versus active.
• Seek professional help.
• Seek immediate assistance if your child is actively thinking
about suicide.

11. Remember: IS PATH WARM?
Ideation- thoughts or threats of suicide
Substance abuse- excessive or increased
Purposeless- no reasons for living
Anxiety- agitation, unable to sleep/sleeping all the time
Trapped- feeling there is no way out, resistance to help
Hopelessness- about the future
Withdrawing- from friends, family, society
Anger- uncontrolled rage or seeking revenge
Recklessness- risky acts, not thinking, impulsive
Mood changes- dramatic, increased

12. Self-harm: How do I handle it?
Dos
• Respond when you’re calm
• Be willing to talk and listen
• Share your feelings (“I want you
to know that I love you, and if these are self-
inflicted wounds, I’m here to help you. I’m
not here to be angry at you. I’m not here to
punish you. I’m here for you to talk to me.”)
• Make an appointment with
a professional
Don’ts
• React before thinking it
through
• Do all the talking
• Share feelings of guilt
• Punish, threaten, or criticize

13. Cognitive-behavioral Therapy (CBT)
The Cognitive Model
Situations

14. The Cognitive Model
• The way individuals feel and behave is influenced by the
way they view and think about situations/experiences.
Image from www.pedigreedatabase.com

15. The Cognitive Model
for depression
Self
World FutureNegative

16. When Depressed
• Negative Perception of Self
– I’m a loser
– I’m a failure
– I can’t do anything right
• Negative Perception of the World
– It’s not fair
– It always happens to me
– People are better than me
• Negative Perception of the Future
– Things will never get better
– Nothing ever goes right
– Why try it always comes out the same

17. Behavioral Activation/Activity Scheduling
• Schedule pleasant activities
• Think out of the box
• Encourage planning ahead
• Give choices
• Ask how involved you should be
• Encourage your child to get out of bedroom

18. Neuroplasticity
Current understanding
of neuroplasticity is
that day to day
behaviors can have
measurable effects on
brain structure and
function. It can be
affected by life
experiences, behavior
as well as thought
patterns

19. What to Teach About Thoughts
1. We constantly have thoughts.
2. Just because we think something doesn’t
mean it’s true or not true.

20. What to Teach About Thoughts
3. We don’t always realize thoughts are going
through our mind.
• Example: Tying a shoe
4. Our thoughts lead to our feelings/actions.
• Example: Dog

21. Thoughts and Depression

22. How to Combat
Negative Thoughts
• Evidence “for” and “against” a thought.
• What is the truth?
• Coping Statements
Fox, M & Sokol, L (2011). Think Confident, Be Confident, For Teens. Oakland, CA: New Harbinger Publications.

24. Finding the Truth or Balance
Finding more helpful thoughts...
– “Even though….the truth is….”
– “It may be true that…however…”
– “Even if it does happen…”
• Even though I wasn’t invited to Jessica’s party, it does not mean
that I have no friends. I have been invited to a lot of other
parties. I will invite Jill over after practice on Friday and we can
hang out.

25. Autonomy
• Avoid “helicopter parenting”
• Allow your child/teen to make mistakes.
• Trust them to make certain decisions, even if
they are not the ones you would make (i.e. when
they should begin homework)

26. Autonomy
• Allow for self-direction vs. management when
appropriate.
• Teach the skill of self-direction
– Management: Did you put your soccer shoes, change of clothes and water bottle in
your bag?
– Self-Direction: Remember, you have practice today at 5:00.
• Without independence, teens may develop a belief about
themselves that they are inadequate or not capable.

27. How to Praise
• Offer praise accurately.
• Praise effort.
• Avoid empty praises.
– Offering empty praise too often can make it
difficult for teens to internally motivate
themselves
Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

28. How to Praise
• Empty Praise:
– (After striking out at a baseball game) You did such
a great job today! You are such a good baseball
player!
• Accurate Praise:
– You put a lot of effort into the game today. I bet if
you keep practicing the way you have been you’ll
keep improving!
Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

29. Criticize with Care
• Be Accurate!
• Avoid “permanent” and “across situation” criticism
• For example: “You never listen to anything I say,
you’ll never amount to anything!” or “I will never
trust you again.”
Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

30. Criticize with Care
• Strive for “temporary” and “one situation” criticism
– “I did not like that you cursed at me today. I was
surprised since you are typically more respectful . I
expect you won’t speak to me that way again.”
– “I felt really disappointed that you didn’t study more for
your math exam. Next time, I expect you’ll start sooner.”
Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

31. When to Seek Help
• Thoughts of suicide
• Self-harm
• Low mood most days for a month or more
• Difficulty/refusal with going to
school/activities
• If your child asks for help

33. References
If Your Adolescent Has Depression or Bipolar Disorder: An Essential Resource for Parents by
Dwight L. Evans, M.D., and Linda Wasmer Andrews
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 5th edition
Cognitive Therapy: Basics and Beyond by Judith S. Beck
102 Strategies for Working with Depressed Children & Adolescents: A Practical Resource for
Teachers, Counselors and Parents by Kaye Randall, Donna Strom, and Susan Bowman
Chansky, Tamar (2008). Freeing Your Child From Negative Thinking. Cambridge, MA: Da Capo
Press.
Fox, M & Sokol, L (2011). Think Confident, Be Confident, For Teens. Oakland, CA: New Harbinger
Publications.
http://www.about-teen-depression.com/teen-depression.html