Category: Mental Health

What to Do If Your Teen Is Talking About Suicide

Suicide is a public health issue that concerns all of us. It is one of the reasons that many pediatricians get involved in pushing for stronger gun safety laws and teach parents to store any guns that they have locked, unloaded, with the ammunition locked elsewhere.

As you will learn, “reducing access to lethal means” is one of the first things you should do if your child is talking about suicide.

Is Your Child Talking About Suicide?

Although there are many warning signs of suicide, one is that a child or teen might simply starts talking about wanting to die.

According to the National Institute of Mental Health (NIMH), they might also:

  • Talk about feeling empty, hopeless, or having no reason to live
  • Talk about great guilt or shame
  • Talk about feeling trapped or feeling that there are no solutions
  • Talk about feeling unbearable pain, both physical or emotional
  • Talk about being a burden to others
  • Talk or think about death often

And it is important to keep in mind that instead of actually ‘talking’ about any of this with you, a parent, your child might instead talk about it with their friends, text someone, or post messages on Facebook, Instagram, Snapchat, or inside a chat room of one of the games they play.

What to Do If Your Child Is Talking About Suicide

So what do you do if your child is talking about suicide?

Get help as soon as possible.

“Asking someone about suicide is not harmful. There is a common myth that asking someone about suicide can put the idea into their head. This is not true. Several studies examining this concern have demonstrated that asking people about suicidal thoughts and behavior does not induce or increase such thoughts and experiences. In fact, asking someone directly, “Are you thinking of killing yourself,” can be the best way to identify someone at risk for suicide.”

Suicide in America: Frequently Asked Questions

While getting help might start with a call to your pediatrician, the National Suicide Prevention Lifeline is always available at 1–800–273–TALK (8255). Call immediately to figure out the best way to help your child, before they have a chance to hurt themselves.

Let your kids know that there are hotlines to call if they ever need to talk to someone when they are feeling anxious or depressed.

And know that help is available.

Most importantly, don’t ignore or dismiss your child’s talk because you don’t believe them.

Talking to Your Kids About Suicide

What would your kids do if a friend texted them and said they were thinking of killing themselves? Would they come tell you?

What if their friend told them to keep it a secret?

What if they were thinking about suicide?

Since we know that talking about suicide is not harmful, is there any good reason to not talk to your kids about what to do in these situations?

Have you?

Your kids should know that they can always come talk to you and:

  • how to call the National Suicide Prevention Lifeline, 1–800–273–TALK (8255), which is available 24 hours a day for anyone who needs help
  • how to contact the crisis text line – text HOME to 741741, and text with a trained Crisis Counselor 24 hours a day
  • what to do when a friend is talking about suicide
  • about the Lean On Me anonymous peer support via text network
  • about the Trevor Project, the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth, including a hotline, chat and text help service
  • about the Disaster Distress Helpline for “24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.” Anyone can call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
  • how to report suicidal content on Facebook
  • how to report suicidal content on Twitter
  • how to report suicidal content on Instagram (tap “…” below the post and then tap “Report Inappropriate,” select “This Photo Puts People At Risk > Self-Harm”)
  • how to report suicidal content on YouTube (click “More” and then highlight and click “Report” in the drop-down menu. Click “Harmful dangerous acts,” then “Suicide or self-injury” to trigger a review)

Again, talk to your kids so that they know not to ignore any warning signs, as one day, they might be in a position to save one of their friends.

What to Know About Talking to Your Kids About Suicide

Talking and asking about suicide is a good first step in getting someone who might hurt themselves help.

More on Talking to Your Kids About Suicide

Teen Depression Screening

It is estimated that only about half of teens with depression get diagnosed and then, only about half of them get treated.

We should do better.

And we can, if we start routinely screening all teens for depression.

Teen Depression Screening

The idea of having pediatricians screen for depression isn’t new.

And it hasn’t always been just about screening kids for depression.

In 2010, the American Academy of Pediatrics began to recommend that pediatricians screen new mothers for postpartum depression using the Edinburgh Postpartum Depression Scale or a simpler 2-question screen for depression.

“The primary care pediatrician, by virtue of having a longitudinal relationship with families, has a unique opportunity to identify maternal depression and help prevent untoward developmental and mental health outcomes for the infant and family.”

AAP on Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice

Next, in 2014, the AAP began to recommend that adolescent depression screening begin routinely at 11 years of age. This recommendation was added to the 2015 Recommendations for Preventive Pediatric Health Care, a policy statement that was published by the AAP Committee on Practice and Ambulatory Medicine and the Bright Futures Periodicity Schedule Workgroup.

They also continued to recommend screening for maternal depression at 1-, 2-, 4-, and 6-month visits.

A score of 3 or higher on the PHQ-2 could be a sign that your child is depressed.
A score of 3 or higher on the PHQ-2 could be a sign that someone is depressed and needs further evaluation.

The latest recommendation is that all “adolescent patients ages 12 years and older should be screened annually for depression (MDD or depressive disorders) with a formal self-report screening tool either on paper or electronically (universal screening).”

Other depression screening tools are also available, including the:

In addition to yearly depression screening, the latest guidelines also talk about the need to establish treatment plans and safety plans for teens who are depressed.

Signs and Symptoms of Teen Depression

Let your kids know that there are hotlines to call if they ever need to talk to someone when they are feeling anxious or depressed.

Do you think your teen is depressed?

Have they been sad or angry on most days?

Does it seem like they don’t care about their usual activities anymore, aren’t sleeping well, are always tired, or have had a big change in their weight recently?

Are they doing poorly at school, seem extra sensitive to criticism, or have a lot of unexplained aches and pains?

Has your teen had thoughts of dying or suicide?

Call your pediatrician if you think that your teen is depression, or seek more immediate help if you think that your teen might hurt themselves.

Does your teen know how to TXT 4 HELP?
Does your teen know how to TXT 4 HELP?

Unfortunately, signs and symptoms of depression aren’t always easy to recognize in teens.

Hopefully, with universal depression screening, more teens will get diagnosed as early as possible.

What to Know About Depression Screening

It is recommended that pediatricians screen all teens for depression each and every year.

More on Depression Screening

What to Do About the Quillivant XR Shortage?

Does your child with ADHD take Quillivant XR?

quillivant-xr-shortage

Then you likely hopefully aware that there is a shortage of Quillivant XR because of a manufacturing delay.

What Is Quillivant XR?

Quillivant XR is another stimulant that is used to treat kids with ADHD.

Like many other ADHD medications, the main ingredient in Quillivant XR is methylphenidate – the main ingredient in Ritalin.

The big difference is that Quillivant XR is an oral suspension or liquid form of methylphenidate.

What to Do About the Quillivant XR Shortage?

So what do you do if you can’t get Quillivant XR for your child?

There are plenty of other ADHD medications

You will likely want to stay on something similar though, which will mean another long acting stimulant with methylphenidate, such as Aptensio XR, Concerta (Methylphenidate ER), Cotempla XR-ODT, Daytrana (patch), or Quillichew ER (chewable tablet). Metadate CD, Metadate ER, and Ritalin LA are other forms of methylphenidate, but they only last about 8 to 10 hours vs the 10 to 12 hours of all of those other long acting ADHD medications. Focalin XR (dexmethylphenidate) would likely be another alternative.

Unfortunately, there are no other liquid forms of methylphenidate. Except for Concerta and Metadate CD, you can open and sprinkle the contents of these capsules on applesauce if your child can’t/won’t swallow pills though.

You can also try and teach your child to swallow pills…

Best Alternatives To Quillivant XR

In reality, you probably don’t have that many options.

Your child is likely taking Quillivant XR because he couldn’t learn how to swallow pills, won’t take medications if you open and sprinkle them on things, and didn’t tolerate Daytrana (the methylphenidate patch).

That still leaves you with a couple of good options, including:

  • Quillichew ER – a chewable form of methylphenidate available in 20mg, 30mg, and 40mg chewable tablets (was under backorder, but that seems to have been resolved)
  • Cotempla XR-ODT – an oral disintegrating tablet form of methylphenidate available in 8.6mg, 17.3mg, and 25.9mg tablets

The main difference between all of the different forms of methylphenidate?

Surprisingly, it’s not only if it is a liquid, capsule, or pill. They all have different time release mechanisms that affect how your kids get the medication.

Quillivant XR, for example, uses a 20/80 time release delivery system. That means that your child gets 20% of the dose immediately and then 80% throughout the rest of the day. Ironically, because it is only available in a pill that can’t be crushed or opened, the closest medicine to that delivery system is Concerta, with its 22/78 system.

Cotempla XR-ODT is close, with a 25/75 delivery system.

Quillichew ER uses a 30/70 delivery system.

Aptensio XR uses a 40/60 system and some others, like Focalin XR use a 50/50 system.

Why does any of this matter?

If your child was doing great on Quillivant XR and you switched to another medicine using an equivalent dose of methylphenidate, they will be getting that dose delivered to them differently throughout the day. While that might be okay, it could also mean that your child is now starting the day off with either too much medicine (watch for side effects) or is getting too little medicine later (watch for decreased effectiveness). And that will mean some extra fine tuning of your child’s medication until Quillivant XR is available again.

Is your child due for a refill of his Quillivant XR? It’s probably time to look at your alternatives until the shortage is fixed.

What to Know About the Quillivant XR Shortage

Quillivant XR is a long acting form of methylphenidate that is available in a suspension form, so is easy for kids with ADHD to take if they can’t swallow pills, at least it is when there isn’t a shortage.

More About the Quillivant XR Shortage

Mindfulness for Kids and Parents

Have you ever heard of mindfulness?

These kids don't look like they need any help focusing on the present moment - having fun playing with each other!
These kids don’t look like they need any help focusing on the present moment – having fun playing with each other! Photo by Todd Fahrner

Once upon a time, you probably would not have if you weren’t Buddhist.

Mindfulness is a form of meditation.

“Most of the time, we are lost in the past or carried away by the future. When we are mindful, deeply in touch with the present moment, our understanding of what is going on deepens, and we begin to be filled with acceptance, joy, peace, and love.”

Thich Nhat Hanh on The Long Road Turns To Joy

But much like yoga, an ancient Hindu practice, mindfulness has become popular without understanding its spiritual ties.

Benefits of Mindfulness

Why practice mindfulness?

What are the benefits of mindfulness?

You can actually find some studies that have found all kinds of benefits of mindfulness, from increased immune functioning to boosting your memory and attention span.

Now, I would view any of those benefits with a lot of skepticism, but the benefits that do seem plausible include decreasing stress and anxiety and improving your sleep, etc.

“Mindfulness meditation on breath, perhaps the most well-known type, involves sitting quietly, resting or closing your eyes and bringing your attention to your breath. When your attention drifts away, which it is likely to do, simply usher your attention back to your breath without judgment.”

AAP on Just Breathe: The Importance of Meditation Breaks for Kids

The American Academy of Pediatrics even suggests that mindfulness meditation can be helpful for children, although it is a clinical report from the Section on Integrative Medicine that is examining “best-available evidence.”

Does Mindfulness Work?

Many of us would like mindfulness to work.

Stress and anxiety are big problems today, both among kids and their parents. Their pediatricians too. So should we all start reading books on mindfulness?

Or go to a mindfulness group parenting class or start mindfulness-based cognitive therapy?

“Despite existing methodological limitations within each body of literature, there is a clear convergence of findings from correlational studies, clinical intervention studies, and laboratory-based, experimental studies of mindfulness—all of which suggest that mindfulness is positively associated with psychological health, and that training in mindfulness may bring about positive psychological effects.”

Keng et al on Effects of mindfulness on psychological health: A review of empirical studies

Considering that many reviews have been critical and the one with the most praise could only find a suggestion of positive associations, although I have always liked the idea of mindfulness, I am skeptical of its use as a medical treatment.

“I think the best current summary is to consider mindfulness like yoga, or a specific form of exercise. There is evidence that doing yoga has specific health benefits. However, those benefits are likely not specific to yoga and are universal to exercise. It is therefore more accurate to say that exercise has many health benefits, and yoga is a form of exercise.”

Steven Novella on Is Mindfulness Meditation Science-Based?

Can we just say that being mindful is a way to help you relax?

And being able to relax has some health benefits?

Give mindfulness a try if you want. Just don’t expect miracles and realize that with all of the distractions that you likely have in your life, being truly mindful is going to be much more difficult than you could ever imagine.

And while you can sell mindfulness, it is now a billion dollar industry, you can’t really buy it.

You can start with turning off the TV unless you are watching a specific program. And putting your phone down when the kids are around. Basically, get away from always trying to multitask and focus on who you are with or what you are doing at any one moment.

And learn about breathing

What to Know About Mindfulness for Kids and Parents

There might not be much proof that it works, but mindfulness might be worth a try if you are just looking for a way to help you and your kids relax.

More About Mindfulness for Kids and Parents

Helping Kids Cope With Stress

Children, especially teens, often have stress in their lives.

Whether caused by the loss of a friend or loved one, a recent move, being teased or bullied, difficulties at home, or problems at school, childhood stress can lead to behavioral problems, anxiety, depression, headaches, drug use, and insomnia, among many other symptoms and medical problems.

Other symptoms of stress can include mood swings or temper tantrums in a younger child, withdrawing from friends and family, and aggression.

What Causes Kids to Have Stress?

Unfortunately, the source of stress for a child is frequently not so easy to recognize and parents are not always very good at noticing things that could be stressors, which can include things like:

  • a change at daycare for preschool age children, including attending daycare for the first time, moving to a new room, having a new teacher, or changing to a new daycare, etc.
  • having too much homework
  • being over-scheduled with sports and other extracurricular activities
  • having expectations for his performance that are unrealistic and too high or a fear of failure, despite of having good grades, having a lot of friends, etc.
  • a divorce or death in a friend’s family, which can raise fears that the same thing could happen to his own parents
  • poor self esteem
  • watching something stressful on the news, such as a school shooting, terrorist attack, or natural disaster
  • a chronic medical problem, like asthma or diabetes, or an acute medical problem, like a burn or broken leg
  • a medical problem in a family member
  • a traffic accident
  • financial problems at home

Keep in mind that common childhood transitions, such as moving to a toddler bed, starting kindergarten, going to camp, starting puberty, beginning high school, and going off to college, etc., can be very stressful for some children.

The other confusing thing about stress is that the symptoms of being stressed do not always immediately follow whatever is causing the stress and the same situations don’t cause stress in all children or even for the same child at different stages in their life.

Helping Kids Cope With Stress

Although overlooked as many parents and children look for a quick fix for their problems with stress, it is important not to overlook the importance of regular exercise, a healthy diet, and a good night’s sleep to help them cope with any problems with any stress they are having.

Other ways to help your child cope with stress can include:

  • scheduling more free time for your child, especially if being too busy is the source of her stress
  • spending quality time with your child and give them plenty of opportunities to talk about their worries and problems
  • eating dinner together each night as a family and having other routines or rituals that you stick to on a regular basis
  • helping your child set realistic expectations for himself
  • be prepared for stressful situations that you can anticipate, such as the birth of a new sibling, a move to a new city, or a parent who is going to have surgery
  • giving your child age appropriate responsibilities and allowing him to overcome simple challenges on his own without always bailing him out, which can help teach them basic problem solving skills that he will need throughout his life
  • teaching your child ways to relax, including diaphragmatic breathing, progressive muscle relaxation, visual imagery, listening to music, reading, keeping a journal, and drawing, etc.

Your pediatrician can be a good resource if your need help managing your child’s level of stress, especially if your child’s symptoms from the stress are not temporary. A mental health professional, such as a counselor, child psychologist, and/or child psychiatrist, can also be very helpful for the overly stressed child or even for a child who does not routinely handle stress well.

Sources:

American Academy of Child and Adolescent Psychiatry. Facts for Families. No. 66; Updated Feb 2013. Stress Management and Teens. Accessed May 2016.