Dr. Scott Wooding's Parenting Thoughts

Antidepressants and Adolescents

Thu, 15 Apr 2004 00:39:43 GMT

There is little doubt that the incidence of depression among adolescents has been consistently rising over the past generation. At present most research studies indicate that about 5% of the adolescent population is at risk of major depressive disorder. Not only does the presence of depression in adolescents seriously limit their social life it can interfere with their academic performance and can often lead to suicide. No wonder, then, that in seeking to control depression in teenagers professionals have increasingly taken to prescribing the relatively new SSRI family of antidepressant drugs. Familiar brand names include Prozac, Zoloft, Wellbutrin, Celexa and Paxil. A recent Canadian study of teenagers in the province of Ontario indicates that about 2% of the adolescent population is presently taking these drugs to help control their depression.
    Recently, however, problems with these drugs have begun to surface. While all of these antidepressants have side effects of some type, few professionals realized that their use could possibly cause suicide in adolescents rather than preventing it. The first indicator of potential problems came from Britain late last year. On March 22, 2004 the US Food and Drug Administration concluded a review of the SSRI’s that resulted in a public health advisory being issued. Health Canada had issued a similar warning on Feb.2 of this year. This advisory asks drug manufacturers to include a warning on their product’s labels urging careful observation of those taking these drugs.
The interesting fact about the SSRI’s is that of the entire family of drugs, only Prozac is approved for use in children in the by the US FDA and the Committee on the Safety of Medicines in Britain, while none are approved by Health Canada. On the other hand, none are specifically banned by any of these regulating authorities. As a result they are prescribed “off label” by doctors who feel that these products can help their patients. While there is very little research evidence as yet to substantiate claims either for or against the efficacy of these drugs with adolescents, doctors and mental health professionals have begun to recommend them in the hope that they can help control the very serious problem of adolescent depression.
    The evidence that these drugs can lead to suicide is not strong either. Several cases in the US have occurred, but not enough to lead to any clear conclusion. It could well be that in these cases, the adolescents were suffering from the depression caused by Bipolar Disorder (manic depression), rather than from major depressive disorder. Bipolar disorder does not respond to the SSRI’s, but the symptoms are often difficult to separate from clinical depression, especially among adolescents.
     The best advice that anyone can give at this point is that the use of antidepressants in adolescents should be carefully monitored for signs of severe depression or suicidal thoughts. It has always been the recommendation of most mental health professionals that if drugs are going to be used in the treatment of depression in teenagers, that it be combined with ongoing psychotherapy. This is particularly true now that doubts about the SSRI’s have surfaced. There does not seem to be any need to panic yet. Far more research needs to be done. Instead parents of depressed teens should read the FDA advisory and ensure that its recommendations are being carried out.

For those interested these recommendations were that doctors should:

Monitor patients using these antidepressants for possible worsening of depression symptoms or suicidal thoughts or behavior, especially when drug therapy is begun or when doses are adjusted.

Carefully evaluate patients whose depression continues to worsen, or suicidality emerges quickly or severely, to consider what action should be taken next.

Be vigilant for symptoms including anxiety, agitation, restlessness, panic attacks, irritability, hostility, impulsiveness and mania.

Taper patients off drugs gradually if they are discontinued.

Screen patients thoroughly for Bipolar Disorder. Antidepressants may induce mania in these patients.

Alert patients and their families and caregivers to be alert for problematic symptoms and to report them immediately to the doctor.

Depression is Deadly

Mon, 16 Feb 2004 17:20:56 GMT

A number of recent studies have brought to our attention the fact that depression is a growing problem among today's teenagers. Of most concern was a study done at the University of Alberta that indicated that 25% of teenage girls suffer from at least one occurrence of clinical depression during their teen years. Clinical depression is the most serious form of this disorder in which the symptoms of a single episode last for at least two weeks. Other studies indicate that the incidence of teenage depression in the general teen population is actually on the rise in recent years. Given the frequency and severity of this disorder, it is vital that parents recognize the symptoms and, if they persist for more than a few days, get immediate professional help.

When most people think of depression, they visualize an overall state of sadness and diminished interest in activities. While these can also be symptoms of teen depression, they are more likely to be irritable than sad. The keys for parents to look for in adolescents, then, include at least five of the following symptoms
over the same two week period:

depressed mood (or irritablility) most of the day
lack of interest in favorite activities nearly every day
decrease in appetite (occasionally a marked increase)
noticeable change in sleep patterns (usually insomnia)
fatigue or loss of energy every day
feeelings of worthlessness or inappropriate guilt
diminished ability to concentrate or unusual indecisiveness
recurrent thought or verbalizations about death
unusual agitation or apparent anxiety with no apparent reason

If any of these symptoms are noticed, it is vital that parents sit down with their adolescents and see if they can find anything wrong in their environment that would cause the depression. Have they been dumped by their girl/boy friend, failed an important test or been in trouble with the law lately? If so then the depression has a clear cause and potential answers. If no apparent reason can be found, and if the symptoms last at least two weeks, be sure to check for suicidal thoughts. Ask them straight out if they are considering suicide and if so, do they have a plan. Do not be afraid that this will put thoughts into their heads - you have to find this information out. If the answer to any of the suicide questions is yes, then seek help immediately. If you don't know where to look, every major city has a suicide hot line. Just look up "suicide" in the telephone book.

Depression of short duration is common in teens due to the hormonal changes of puberty. These depression normally only last a day or two and parents should not overreact. However, depression of longer duration can be deadly. Look for the range of symptoms described above and take action immedaite action when necessary.

The Spanking Debate Continues

Fri, 30 Jan 2004 18:27:39 GMT

    For years the debate has raged among parenting experts about the effects of spanking on children. For every study that has shown it to be harmful to children, there is one that finds no negative results. Nevertheless, society has progressed to the point that spanking as a consequence for improper behavior is gradually fading in popularity. However, just today the Supreme Court of Canada upheld the legality of Section 43 of the Criminal Code that allows the use of reasonable force on children. Spanking has therefore been upheld as a legal consequence for misbehavior. The question now becomes “What should parents learn from this ruling?”
    In my opinion parents should not interpret this as a license to spank their children. There are many types of consequences that are just as effective in controlling negative behavior as spanking that have no connotations of violence and these should be used whenever possible. The Canadian Supreme Court was probably more worried about the effect of eliminating Section 43 on teachers and law enforcement officers than they were about parental spanking. If they removed the ability of these professionals to use reasonable force in removing a violent student or lawbreaker from a fight, crime scene or classroom, then these people would be severely restricted in their ability to perform their duties. The other concern might have been that if you remove parents’ ability to spank, you might be giving the false message that consequences of any kind should not be used in parenting.
   This latter concern has certainly been one that parenting authorities have been worried about over the past decade. Many parents seem very confused about what to do when their children misbehave and, knowing that many experts do not believe in spanking, they do nothing about the misbehavior. This is not what these authorities are saying. Children need to know what their limits are in order to feel safe and secure. Usually it is enough for parents who observe their child doing something wrong to say “No” in a firm voice. If the child persists in the behavior, then a time out for a few minutes is usually very effective. For older children, removal of privileges, such as computer or TV time or the use of the telephone are generally adequate to teach the lesson the parents want learned. When children misbehave, something has to be done to teach them the desired behavior.
    Perhaps Canadian law needs to be re-written so a separate section covers the professionals who work with children. Parents, then, would be in a different category. In any case wise parents will discipline their children with methods other than spanking, no matter what the Supreme Court says. But discipline of some form must be used. The result will be children who have stronger self-esteem and who have better self-discipline than those who are rarely disciplined at all.

Fallen Idols Make Great Conversation Starters

Fri, 09 Jan 2004 16:08:09 GMT

   The recent news about Britney Spears' New Years Eve folly of briefly marrying her long-time friend, then immediately having the marriage annulled, makes most parents nod wisely and cast disparaging remarks about the maturity of young stars. It's an "I told you so" kind of attitude, as parents are generally wary of having their young teenagers star-stuck by these glamorous young idols. They worry about their youngsters imitating these stars ways of dressing and acting and so take every opportunity to point out their flaws and foibles. Unfortunately this approach will only increase the generation gap between parents and their teens.
    Rather than taking every available chance to discourage your teenagers from idolizing Britney, JLo or Beyonce, use the stories of their follies as a conversation starter to discuss the problems of being a star and the reasons why stardom is so difficult. These stories can be utilized as "teachable moments" to discuss issues that are normally difficult to talk about. If a star gets caught using drugs, use the story to ask your teen about drug use in his or her peer group. Rather than lecturing on the evils of drugs, discuss why people use them and try to get your teens to talk about their ideas about drugs. Similarly if a famous person is caught in a sexual encounter, ask your teen their opinion of this story and use it as an entry point into a discussion about premarital sex.
    The trick is to get the teen talking about these difficult subjects rather than upsetting them by criticizing their heroes. It's a delicate balance, but if you can create situations where you and your teens can talk about any subject, using Britney -type stories as a starting point, then the teens will learn that they can talk openly to you and will come to you when they need advice in these areas.

Do You Know What Your Kids Are Watching?

Thu, 11 Dec 2003 16:43:36 GMT

A recent nation-wide study by the Canadian Teachers Federation indicates that the majority of parents do not exert any control on what television shows and movies their kids watch or what video games they play. According to this study, by Grade 7 three-quarters of the kids surveyed had watched R-rated movies on video or DVD. One-quarter of these youngsters had actually rented R-rated movies themselves. Similar figures applied to the video games they play. By grade 7 amost 75 percent of the parents did not tell their children what games they could or could not play.
Other studies provide similarly alarming results. Recent surveys by organizations such as the US Federal Trade Commision indicate that a typical American child spends an average of more than 38 hours a week using these entertainment media. That's a full working week for most adults. The FTC review indicates that the majority of research into the impact of media violence on children finds that there is a high correlation between exposure to media violence and aggressive and sometimes violent behavior. The Canadian Teacher's Federation study confirms these results as it found that half the students in Grades 7 to 10 had witnessed peers imitate a violent scene from a movie or television show or copy a dangerous stunt.
Three points are obvious from the research; children are spending a huge proportion of their time using electronic media, the media are having negative effects on our children and parents are not monitoring and controlling what is being watched and played by their children. There are major implications to these conclusions. They range from developing a generation of more aggressive, violent and sexually active children to contributing to the growing problem of obesity in children by allowing their major leisure time activities to be sedentary ones.
Parents need to set controls on what their children watch and play and how long they are using these media. That means they have to know the content of the programs and movies their children watch and of the games they are playing, then refuse to allow any that they feel are inappropriate. It takes time and effort for parents to impose these controls but if they don't it is becoming increasingly obvious that the impact on this generation of children may be disastrous.

Tue, 18 Nov 2003 01:34:40 GMT

FAMILY OUTINGS WITH TEENS

One of the most common misconceptions that parents of teenagers have is that their children no longer want to spend time with them. This idea stems partially from the rising importance of friends, as children become teenagers, and the resulting time that they want to spend with them. The concept that teens would rather not be with their parents also comes from the complaining that often occurs when parents mention an outing they are planning. Parents tend to conclude that since their kids do not want to go on this or that excursion, they then do not want to spend any time with their them.

It is vital that parents banish this misconception forever. Teens not only want to spend time with their parents, they become angry and frustrated when they can’t. The teenage years are the most insecure that children experience. They badly need the presence of their parents, both as company and as mentors. BUT – there is a difference. Now that the kids are older and as they are beginning to develop an identity of their own, they no longer accept their parent’s bidding unquestionably. They don’t like to be told where they are going and when, they want to have some input. They want the outing to be at least partially their idea. This is where the complaining often comes from. They also may already have plans with their friends for the time period you are suggesting, thus creating a conflict of interest.

The key, then, to going places with your teenagers, is to plan ahead and get their input. Instead of just telling them on Friday that the family is going for a hike in the Kananaskis on Saturday, it is much more effective to ask on Monday or Tuesday if they would like to go for a hike on the weekend. If the answer is positive, then ask which day do they prefer, and where would they like to go. Make each outing into a family planning meeting. In this case, get out the trail guides, discuss what food to bring, and review the clothing to carry in their backpacks. This planning session adds greatly to the anticipation of the event as well as allowing the teens input into the decisions.

Once you have accepted this general approach to going on outings with teenagers, it is equally important to understand what kinds of activities your particular teens enjoy. You’ll probably be surprised at how general these activities actually are. Most teens enjoy all kinds of activities with their parents, as long as they are consulted about them. For example, they like going shopping, playing golf, hiking and picnicking, going to Stampede, and walks. They don’t have to be exotic or expensive. They really do enjoy this time spent with their parents.

It is also not always necessary for the whole family to be on an outing, although this is preferable most of the time. Because kids differ so widely in their interests, sometimes one teen or another will prefer not to go. This should be allowed occasionally as it recognizes and respects individual differences. Following this train of thought, it is often a good idea for parents to plan a yearly event with just one teen. For example, if Dad and one teen share an interest in skiing, he could plan a special ski trip for the two of them alone. He could organize a separate outing with another child who happens to have different interests. These events usually become much anticipated, with months being spent on the planning.

Family outings with teenagers are definitely very different from those with younger children. They require much more planning and notice. They are however, vital to the development of the teenager and to the closeness of the family unit. Don't be fooled by the teens "I don’t care” attitude. Assume they want to do things with you and plan accordingly. Respect the plans and outings that the teens have with their friends and work around these as much as possible. If family events have been a priority from an early age children will anticipate them just as much as teenagers as they did when they were younger. If they haven’t been a priority, make them so. Teens need and want the company of their parents.

Tue, 28 Oct 2003 15:48:16 GMT

Doing The Chores

    One of the most vexing problems for parents of teenagers is trying to get them to do routine chores. Most parents realize that having duties around the house are an excellent tool for developing responsibility in their children. Unfortunately the nature of teenagers conspires against this important relationship.
    For many reasons, teenagers are very poor at doing chores. One of these reasons is that, partly due to the reorganization of brain connections that is taking place at this time of their lives, teens are generally very disorganized. They honestly have difficulty sequencing tasks. In other words they have problems knowing where to start a job and what to do next. Teenagers are also very distractible and tend to lose focus very quickly, especially when they aren't really enjoying what they are doing. These two factors conspire to keep teens from getting their chores done as, when they don't know what to do next, their minds wander. Suddenly they are lying on their beds dreaming when they are supposed to be cleaning their rooms. As a result parents become frustrated and angry scenes are often the result.
      Many parents solve this problem by simply doing the tasks themselves as this takes far less energy than having to closely supervise each chore. They often feel that the teens, seeing the parents do their jobs, will feel guilty and do it themselves the next time. Unfortunately this strategy only teaches that if you wait long enough, your parents will do your work for you. The fact is there is no easy way to get teenagers to do their chores, but there is an approach that will work in the long run.
    I call this strategy the PPH approach, which stands for Patience, Persistence and Humor. The patience is necessary because teens do not learn to become self-motivated overnight. In fact, it normally takes several years before they begin to spontaneously do chores. Persistence is required because teenagers need constant reminding to do their assigned tasks, then close supervision of the process. This needs to occur over and over again, day after day, year after year. Finally, humor is required because if you can use a light approach to this reminding and supervision, it is not seen as nagging. Teens respond very poorly to nagging (in fact so do husbands) but do not mind (as much) if parents remind in a light and breezy fashion. If you can't be humorous, at least don't get angry. Teens usually mean well but most are just not capable of remembering tasks, then following though on doing them. Anger will only make the situation worse and hard feelings will result.
    Parents should not shrink from assigning chores to their children. However, they should not expect that they will be done cheerfully and on time. The use of the PPH approach will not make the learning process any faster, but it will ensure that parents help their teens to become responsible adults, in as painless a fashion as possible.