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Episode 30: October 29


Teen Mental Health (Depression)

Dr Sally Werry is a senior lecturer in child and adolescent psychiatry, and Director of the Werry Centre. She has worked in clinical psychiatry for 15 years in community and patient settings.  She has a long-standing interest in teaching. She specialises in anxiety disorders, teen depression and early intervention. Sally and fellow Psychiatrist Leah Andrews are the authors of the book "Down Times - Teenage Depression in New Zealand".

What is the incidence of depression among teenagers?
Depression is one of the most prevalent mental health problems faced by
teenagers.  Actual figures depend on the age, gender, and the way depression
is measured and the time period that is considered.  There is a sharp
increase in prevalence between the age of 15 and 18 years and the
increase is more marked for girls than for boys.  By the age of 18 as
many as 20-24% of young people will have suffered from depression that
is serious enough to warrant intervention, but most will not have
received treatment.  It is far more common than an illness like
schizophrenia.  The other common disorder is anxiety, but it is not as
common as depression. 

Is clinical depression among teenagers on the increase?
This can be hard to ascertain as ways of measuring depression have
changed over the years and because the rates overall are so variable.
 
How hard is it to lead a normal life after suffering depression?
Are you always plagued by it/have to be careful?
A bit depends on the type of depression.  Once you have suffered from
depression there is a high risk of it recurring (70% within the next 5
years) but most people will return to a normal life.  They just need to
be careful about watching for signs that it is recurring and take steps
to address it - there are effective treatments and ways of averting a
further episode.  However some people suffer from a low-grade long term
depression and for these people there is a need to take care to deal
with the low mood on an ongoing basis.


The Werry Centre:

Provides and promotes first-class training in mental health to professionals working with children and adolescents

Conducts and promotes research of a high quality into child and adolescent mental health

Advocates for the mental health needs of children and adolescents

Supports the child and adolescent mental health workforce to provide high quality care.

The Werry Centre, named after Professor John Werry, has a national focus and is multidisciplinary, multicultural and is run in the accordance with the Treaty of Waitangi.


From Sally's Book "Down Times -Teenage depression in New Zealand".
("Down Times - Teenage Depression in NZ" by Sally Merry & Leah Andrews    Publishers: David Bateman)

The authors note that depression is written about a lot in papers and magazines, and talked about on the web, yet they feel it's discussed in a way that doesn't shed light on the topic.

What is depression?
Low moods or loss of interest in everything, which goes on for some time (usually weeks) affecting sleep, appetite, concentration.
The moods won't lift unless help is sought.

Therapies for teen depression:

Cognitive Behavioural Therapy
CBT should be offered first to teen sufferers as reduces feeling of depression -usually a 12 week period for 1 hour a week concentrating on dealing with negative thoughts by not arguing about them; note when they happen; with the therapist work out if they are accurate, then try to eliminate them.
Learn to look for the warning signs and watch for stress.

Interpersonal Psychotherapy
IPT means working through the relationship that affects the sufferer. 
Keep families informed, as it's the family who are looking after the sufferer.

Medication
Studies on adults show after 2-6 weeks a person starts to recover, yet with teens medication is often less effective. Important points about medication:
Takes 10 days to 3 weeks to take effect
The right dose is important
All medication has side effects

Medication prescribed:  SSRI's specific serotonin uptake inhibitors, new generation pills with less side effects, Prozac, Aropax, Luvox.

 

ANNABELLE'S RECIPES
CHOCOLATE MOUSSE MERINGUES

Meringues

You can either buy meringue bases or make your own.  They can be made ahead and keep well in an airtight container.

2 large egg whites (at room temperature)
120g (or about 1/2 cup) castor sugar
1/4 tsp vanilla

METHOD:
Preheat the oven to 150degC.  Line a baking tray with baking paper.  Beat egg whites until stiff peaks form, and then add sugar, a little at a time, still beating.  Beat in vanilla.  Place spoonfuls of meringue on baking tray and make an indentation for the mousse to later sit. Use the back of a spoon. 

Bake 45 mins.  Turn oven off and leave the door ajar and allow the meringues to cool completely in oven.  Store in an airtight container lined with greaseproof.

Chocolate Mousse

Make a yummy chocolate mousse by using a bottle of Tamara Chocolate Mousse.  Place the contents of the packet into a bowl and beat with electric beaters for 3 minutes, then refrigerate for at least 4 hours before use.  These instructions are on the mousse pottle. Spoon through 1/2 cup chocolate chips or grated chocolate after beating.  When ready to serve, place spoonfuls of the mousse into the indentation in the meringue, dust with cocoa and serve.

At a children's party serve bowls of low fat crisps, cheerios heated in cold water and simmered gently for a few minutes till heated through, tomato sauce, jelly parfait with fruit set in it, chocolate boats made with chocolate coconut bars and wafer sail.

Go to www.tararua.net.nz for more info


Toilet Training

With many parenting issues, it's not so much what you do but how you do it and toilet training is no different. How you encourage and speak/react to your child is really important. You want to build up their confidence, not make the whole experience a traumatic one. This will only create problems/ slow down the whole process. So be calm and enjoy the ride (go with the flow so to speak!!). And remember - let your child initiate and set the pace. It's their moment in the spotlight!

Key Messages
Children are ready to learn to use the toilet at different ages, any time between 18 months and 4 years, but 2 seems to be the magical age really for toilet training. It's around then that most children have the skills - language and physical control - to start using the potty/toilet.

Toilet training varies with the individual child. Experts advice you let the child set the pace/lead the way i.e. it's a child-led process, don't force it.

Avoid scolding or punishing your child. If you get a result, comment (yeehah, clap, get excited, hug if you want); no result, no comment

Commonly Asked Questions:

What age are children ready to learn to use the toilet?
Most children by the age of 20 to 24 months are ready to be toilet trained but you can start introducing the concept from 18 months when many children will be aware they have wet/dirtied their nappy& the brain-bladder connection though, kicks in around two.

What are the signs they're ready/ what skills do they need to have mastered?
By this age a child has developed two important skills: A) Language skills. They can tell you when they want to go, and they can understand your directions. B) Physical control. By this age your child has better control over the sphincter and abdominal muscles.

All children are different, what are some of the factors that come into play?
Personality, daycare - those who go to daycare are often a bit faster due to the routine there, seeing other children go etc, place in family - younger siblings often faster than older&

When is the right time to start?
When your child shows an interest and you're ready to take a calm, relaxed approach, start. Summer is a good time as there are fewer clothes to take off, but obviously if you have a child whose keen to try in July, don't stall till summer.

Who should drive the process, parents or child?
It is child-led - this really is the key.

What about the whole thing of holding out/putting them on the toilet when they're younger?
This is what they did in the old days, what many of our parents did and a Plunket Nurse we spoke with said she's noticing a trend back towards this e.g. sitting baby on the potty as young as 7-9 months. Says it's complete hit and miss, not toilet training, that children this young have no bladder or bowel control, all parents are doing is timing it right, catching poo and wee.

Are boys really harder to train than girls?
So they say, but perhaps this is a bit of a myth. There are so many variables (see above) e.g. personalities, daycare, place in family etc.

Which is best potty or straight onto the toilet?
Again, take the lead from your child. Either is fine, whichever they prefer. Some are happy with the big toilet, no insert. Others say their child loves their potty, becomes quite attached to it.

Once you have daytime sorted, what about nighttime?
Daytime control usually happens before nighttime control (just as most children can control their poos before their wee)& it is normal for one in ten children to be wetting their bed when they are 5 years old.

Being dry at night happens at different ages. Often bedwetting at older ages runs in the family. It's more physiological than mental i.e. it has to do with the physical ability of the bladder to hold a nighttime's worth of wee. You can help your child improve their bladder capacity by getting them to hold on a little bit longer during the day.

No need to withhold fluids at night as this helps increase bladder capacity and you're not training them by lifting them onto the toilet before you go to bed& doesn't help increase bladder capacity. It's really a matter of their nervous system kicking in and saying, hey you have a fully bladder, wake up.

What are the no-nos when it comes to toilet training?
Pushing your child too hard& becoming remotely upset if it's not happening. Children will become fearful/mystified if you get cross. If there's a result, comment/praise, if there's no result, don't comment& maybe say 'ah well try again later&" If they have an accident acknowledge how they're feeling as they'll be feeling disappointed, but don't get mad as they'll close down will begin to fear using the toilet/potty in case they upset mum and dad/ make a mistake.

What are some tips to make it easier?
Let your child watch others in the family go to the loo - they'll learn by copying them, familiarise them with potty or toilet, look for books about toilet training e.g. Princess and the Potty, introduce underpants or trainer pants when they're ready (Lee not keen on trainer pants/ pull-ups as she says it almost gives them permission to wee/poo in their nappies, best to go straight to knickers), take them to the potty/toilet at regular times, a smaller toilet seat may help, teach them to wash hands after going to the loo, etc

What if they become upset using the toilet?
Put back in nappies and wait until they initiate it again, until you are both ready to calmly and gently try again.

What if a child regresses, what should you do?
Many children start wetting again especially if something new is happening, e.g. a new baby in the house. This is normal behaviour and will come right in time. However if your child starts wetting again, doing poos in her pants etc for no apparent reason, it may help to change her in a calm manner, avoiding telling her off or punishing her. She may need to be reminded to go to the toilet. Some children become so busy playing they forget to go to the toilet. Praise her when she does go, you might want to try a star chart or buying patterned toilet paper to encourage use& some children may need to go back into nappies during the day for a while.

Other tips:

Words 
Children need appropriate toilet words so they can understand when directions are given. It doesn't matter what words you use - wee, pee, toilet, potty, poopy, urinate - so long as they understand what you are saying.

Identify your child's toilet responses e.g. jiggling up and down& Children usually have a way of indicating when they are going to the toilet. By recognising this you can quickly label what your child is doing: "Do you want to do wees?"

Put them in loose fitting pants- Loose fitting pants helps your child pull them up and down

Remember:
Be patient with yourself and your child. Some children become potty trained quickly, others take awhile. Don't overreact when your child has an accident. The quickest way to change behaviour is when people feel good about themselves. It's the same for your child.

So, no yelling, humiliating, or shaming. Be a 'potty training' coach that makes your child feel loved, valued and competent. When children feel good about themselves they learn quickly.

If you are having hassles contact your Plunket nurse or family doctor.
Research study results (US, from the internet): over a 10 year period, surveying 1170 children, research studies found 80% of children trained without pressure between the ages of two and two and a half with no more than one accident a week.


Book
A Hairy Tale, by Kathy White  (age 7 - 9)

"Kiwi Bites" is a series of chapter books by New Zealand writers, aimed at 7- 9 year olds, or perhaps slightly older reluctant readers.  They're all fun and quirky and are particularly well laid-out to encourage children to pick them up, want to read on, and then want to read more in the series.

There are lots of space still, large text, and plenty of illustration to fill out the story still further.  Kathy White's book, "A Hairy Tale", is a funny, contemporary take on the Rapunzel fairy tale.  It has goodies and baddies, heroes and heroines, and dramatic hair-raising rescue attempts, all leading up to the twist in the tale at the end.

 It's told with great humour, which is really important to keep your children hooked at this age, and would appeal to boys and girls alike.  Snappy illustrations increase the lively buzz of this tale - guaranteed enjoyment.

Website

www.zeeks.com  (5-15 yrs)

Zeeks is part of the Kaboose network which is a website for internet-savvy families, providing a fun, safe environment for kids.

The Zeeks site has the appearance of a bright and snazzy magazine with heaps of features for kids to explore.  Click on games to find categories including arcade games, sports, puzzles and mazes, art / music, brain teasers and more.  Games can be selected from the gamed guide where children can sort and select features. Feed your brain is a homework site where children have submitted information on homework topics

Journey To The Falls

The "Journey to the Falls" is for fathers and sons who wish to deepen their relationship and understanding of men's community.
It is designed for youth from 11 to 17 years and fathers (including mentors, step fathers or a significant adult male in the youth's life) who are reasonably fit, active, responsible and willing to be involved in an adventure.

As a group, they will walk for several hours through the bush to Piha, staying overnight in accommodation provided at Stedfast Park. As a group they will create a night around the fire, share food, culture, story craft, music and have the opportunity to speak of their experiences, hopes and dreams.

The Programme
The elements in this programme as the facilitator sees it are:
The environment ie the outdoors
Risk and challenge
Exploring relationships
Oratory
The sharing of food.

The above are the cornerstones of community. Therefore by taking the group on this journey which includes these interactions they hopes to sew the seeds of a good community.

ManAlive run programmes for men that cover a broad spectrum, from the purely fun to those assisting men in prison. This programme is fun. Anyone can go on it, some are families known to CYF, but many hear about it through schools, counsellors, lawyers etc.

At the very core of the programme and of any ManAlive programme is the desire not to identify men as the problem, but to engage and develop men in relationships.  The point of the Journey is developing men's awareness of the fact that they have a valuable role to perform in a community.  The Journey's aim is to establish a positive male culture, to offer men an opportunity to express themselves outside the stereotypical roles. Most men engage on the level of: "Hi, how are you mate? What do you do? Wasn't the rugby great."
By sharing the experience that culminates in the campfire the men can tell their stories, the youth can listen and both parties benefit.
The feedback they get from the participants is very positive, although no quantitative research has been undertaken.

Go to www.manalive.org.nz


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