Depression & Anxiety

• Separation anxiety (from parents, even in a safe space)
• Phobias (insects, dogs, going to the doctor)
• Social anxiety (being at school)
• General anxiety (worry about bad things happening and the future)
• Panic disorder (feeling shaky, dizzy, sweaty, trouble breathing, heart pounding) (CDC, n.d.)

• Fixation and intense worry about the safety of parents and/or caretakers

• Refusing to go to school

• Frequent physical ailments such as stomach aches

• Distress when sleeping away from home

• During separation from parents, panic or tantrums

• Sleep troubles and nightmares (AACAP, n.d.)

• Extreme fears about situations or specific things (needles, insects, dogs)

• Fears interfering with usual activities and causing significant distress (AACAP, n.d.)

• Shyness, fear of meeting new people or talking to people

• Avoiding social situations

• Few friends outside of family (AACAP, n.d.)

• Low self-esteem and a lack of self-confidence

• Worries of making mistakes or embarrassment

• Repetitive and unwanted actions (compulsions) or thoughts (obsessions)

• Constant concerns and worries about friends, family, school, or activities

• Significant worries about things before they happen (AACAP, n.d.)

• Irritability, sadness, or hopelessness
• Not engaging with fun things, either not wanting to or not enjoying.
• Eating pattern changes – either a lot more or less
• Sleep pattern changes – either a lot more or less than normal
• Changes in energy – being tense, restless, or sluggish and tired a lot of the time
• Trouble paying attention
• Feeling guilty, useless, or worthless
• Displaying self-destructive behavior or self-injury
• Acting unmotivated or making trouble, being labeled as lazy or a trouble-maker. (CDC, n.d.)

• Being bullied increases risk of depression

• Significant time on social media is associated with depression

• Having learning issues, attentional problems, conduct or anxiety disorders can increase risk of depression (AACAP, n.d.)

• Psychotherapy or talk therapy

• Cognitive behavioral therapy

• Interpersonal psychotherapy

• Use of antidepressant medication (AACAP, n.d.)

• The second leading cause of death among 10-24 year olds (CDC, n.d.)

• In 2019, 1,580 adolescents aged 12 to 17 years died by suicide, a rate of 6.3 per 100,000 (CDC, n.d.)

• 40% of adolescents who die by suicide had been treated for a mental health concern (CDC, n.d.)

• A third of all youth with suicidal ideation will develop a suicide plan, and 60% of them will attempt it (Milliam, Dwyer, & Vessey, 2021)

• Known risk factors for suicial ideation include a history of mental health issues, psychosocial stresses, family instability, sexual orientation and gender identity variance, and idealized reports and representations of suicide in the media (Milliman, Dwyer, & Vessey, 2021)

• Children and adolescents with chronic conditions have a higher risk of suicidal ideation, along with co-morbid mental health issues (Milliman, Dwyer, & Vessey, 2021)

• When pediatric patients are screened for suicial ideation in emergency departments, urgent care, pediatrician’s office, and other inpatient and outpatient settings, at-risk patients are identified and appropriate interventions can be implemented; in studies, many who screen positive for suicidal ideation did not have a known health problem, and did not present with suicidal ideation as a primary complaint. Screening is effective. (Milliam, Dwyer, & Vessey, 2021)

• The National Suicide Prevention Lifeline is 1-800-273-TALK (8255)

• The Crisis Text Line: text HELLO to 741741

• Know the signs and symptoms of anxiety and depression in children

• If concern for a child’s mental well-being is realized, consult with the teacher, and then the school’s psychologist

• Consider advocating for and/or implementing a curriculum such as The Aussie Optimism: Positive Thinking Skills Program (Rooney, et. al., 2013). Note that this program maintained positive effects at 6 months post intervention, but did not generalize beyond that point of measure.

• Consider advocating for and/or implementing a curriculum that supports the cultivation of grit and resilience (Hossain, 2021).

• Lindeblad and colleagues (2016) assessed 67 students aged 10-16 years with reading deficiencies. 21 of them were diagnosed with dyslexia.
o They used self-report on measures about depression, anxiety, and self-image.
o They note that the literature is replete with examples of dyslexic children being labeled lazy and/or stupid, and they note the cumulative negative effect this may have on self-image and inadequacy.
o They noted studies showing that an effective learning environment can negate symptoms of depression in students.
o They used the Beck Youth Inventory to assess the students’ self-image. Their results show few indications of depression, anxiety, or negative self-image when compared to a normed group. They note this may be an unexpected result.
o One explanation for this result is an increasing knowledge of dyslexia among teachers, leading to more effective teaching strategies for these students.

• Francis and colleagues (2019) reviewed 34 studies from 30 articles and found that the risk of anxiety was greater for students with reading disabilities than was the risk of depression, but that poor readers were overall at moderate risk for developing depression and anxiety as compared to typical peers.
o They note that 16% of children fall below average for reading abilities, and 5% have significantly impaired reading skills.
o They note inconsistencies in the literature regarding depression and anxiety among children and adolescents, as most studies report increased risk of depression and anxiety, but a significant number report better emotional health outcomes for students with reading disabilities as compared to typical peers.
o They cited Mugnaini and colleagues’ (2009) report noting that poor readers of all ages are at risk of depression and anxiety, that poor reading is specifically associated with depression and anxiety, and that poor readers who also have attention problems are at higher risk of depression and anxiety than poor readers who do not have attention problems.

• Wang (2020) assessed 132 Chinese children in Taiwan, 3rd-6th graders, half of which had reading disabilities.
o Female students with reading disabilities had higher anxiety levels than boys with reading disabilities, and higher than girls and boys who were average readers.
o Wang also found the depression levels of children with reading disabilities was also higher than for children who were average readers.
o Wang also found that participants who suffered higher anxiety and depression performed worse on reading tasks.

• Arnold and colleagues (2005) followed adolescents identified as having poor and typical single word reading abilities, monitoring for behavioral and emotional problems, for more than 2 years. They found that poor readers reported higher levels of depression, trait anxiety, and sleep complaints than typical readers.
o They noted that mid-to-late adolescence is a particularly anxiety-provoking time for students with reading disabilities as they contend with increasingly more difficult reading demands associated with school work, and more limited options for post-secondary school.
o They also noted that parental reports of delinquent behavior were higher for students with reading disabilities than for average readers.

• Hossain and colleagues (2021) found over a 3-year study of 163 participants that improved grit and resilience was associated with decreased anxiety and improved academic performance when measured by teachers. They also found that students experienced decreased signs of depression and improved quality of life when measured by parents. They contend that interventions to improve grit and resilience in students leads to positive emotional benefits.
o They used the Grit and Resilience Scale, adapted from the Connor-Davidson Resilience Scale and the Grit Scale. To measure anxiety, they used the School Anxiety Scale - Teacher Report, as well as the Spence Children’s Anxiety Scale. To measure depression, they used the Short Mood and Feelings Questionnaire. Quality of life was measured with the Pediatric QOL Inventory 4.0.
o The students were in specialized schools for students with reading disabilities, most of them identified as having dyslexia.
o They note that grit is associated with persistence, whereas resilience is associated with response to difficulties.
o At baseline, those with higher grit and resilience scores were more likely to have better mental health, higher levels of academic performance, and better quality of life.
o Over the study, they found that improvements in grit and resilience were associated with better mental health, reduction in anxiety and depression, improvements in academic performance, and enhanced quality of life over time.
o They conclude that interventions that aim to improve grit and resilience will have positive benefits.

American Academy of Child & Adolescent Psychiatry (2017, October). Anxiety and Children. https://www.aacap.org//AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Anxious-Child-047.aspx

Arnold, E.M., Goldston, D.B., Walsh, A.K., Reboussin, B.A., Daniel, S.S., Hickman, E., Wood, F.B. (2005). Severity of emotional and behavioral problems among poor and typical readers. Journal of Abnormal Child Psychology, 33(2), 205-217. https://doi.org/10.1007/s10802-005-1828-9

Francis, D.A., Caruana, N., Hudson, J.L., McArthur, G.M. (2019). The association between poor reading and internalizing problems: A systematic review and meta-analysis. Clinical Psychology Review, 67, 45-60. https://doi.org/10.1016/j.cpr.2018.09.002

Hossain, B., Chen, Y., Bent, S., Parenteau, C., Widjaja, F., Haft, S.L., Hoeft, F., Hendren, R.L. (2021, July 29th). The role of grit and resilience in children with reading disorder: A longitudinal cohort study. Annals of Dyslexia. https://doi.org/10.1007/s11881-021-00238-w

Lindeblad, E., Svensson, I., Gustafson, S. (2016). Self-concepts and psychological well-being assessed by Beck Youth Inventory among pupils with reading difficulties. Reading Psychology, 37, 449-469. https://doi.org/10.1080/02702711.2015.1060092

Milliman, C.C., Dwyer, P.A., Vessey, J.A. (2020). Pediatric suicide screening: A review of the evidence. Journal of Pediatric Nursing, 59, 1-9. https://doi.org/10.1016/j.pedn.2020.12.011

Mugnaini, D., Lassi, S., La Malfa, G., & Albertini, G. (2009). Internalising (sic) correlates of dyslexia. World Journal of Pediatrics, 5, 255-264. https://doi.org/10.1007/s12519-009-0049-7

Rooney, R., Hassan, S., Kane, R., Roberts, C.M., Nesa, M. (2013). Reducing depression in 9-10 year old children in low SES schools: A longitudinal universal randomized controlled trial. Behaviour Research and Therapy, 51(12), 845-854. https://doi.org/10.1016/j.brat.2013.09.005

The Center for Disease Control and Prevention (n.d.). Children’s mental health: Anxiety and depression in children. https://www.cdc.gov/childrensmentalhealth/depression.html

The Center for Disease Control and Prevention (n.d.). WISQARS: Web-based injury statistics query and reporting system. https://www.cdc.gov/injury/wisqars/index.html

Wang, L. (2020). Anxiety and depression among Chinese children with and without reading disabilities. Dyslexia, 27(3), 355-372. https://doi.org/10.1002/dys.1691