Childhood/adolescent depression

[pnggrad79]

I need some serious help. It is only 7 weeks into the school year and I have a GT kid in my class with severe clinical depression diagnosed in 4th grade (he is in 6th). He has been hospitalized twice, is on at least 2 types of anti-depressants, is seeing a therapist, and a psychiatrist, yet comes to school almost daily sobbing, threatening to kill himself, saying he doesn't want to live. He seems drawn to me and I don't know how to help him, or what to say to him. I usually just hold him while he sobs and try to soothe him, and say gentle things to him, but I don't know if I am helping or not.

My gripping fear is that he will excuse himself to go to the restroom one day and slip into a stall and slice his wrists or try to hang himself, and I won't know it until some kid comes screaming out of there after seeing it being traumatized thereafter.

I am not a mental health professional and I don't even pretend to know how to deal with this. I know some of what he is going through, but I have no idea how to deal with it. Can someone give me some advice?

[BenL]

Png,

I'll have to leave the professional advice to the clinicians among us. Like you, I would be clueless, except to do what you're doing: hold him and tell him things will be all right. That, and as far as possible, making sure he doesn't have the means or opportunity to act on his suicidal thoughts.

I'm praying for him and for you. I'll be thinking of you both this afternoon when I see my own therapist. What a reminder this has been that my own perplexities are so mild compared with this poor child's.

God's peace be with you.

[keltic63]

You need to get the team together and devise a plan. Have you talked to the guidance counselor about this student and the daily behavior? Are the parents supportive? This sounds like a heavy burden to carry all alone.

btw, GT? I don't recognize that abbreviation.....

[u-dog]

You need to get the team together and devise a plan. Have you talked to the guidance counselor about this student and the daily behavior? Are the parents supportive? This sounds like a heavy burden to carry all alone.

btw, GT? I don't recognize that abbreviation.....

Gifted and Talented

[BrentRichards]

Simply put, you should not be expected to deal with this ... if the kid is this fragile, there should be a MAJOR treatment plan in place. While the terms and titles vary a lot from place to place, my first thought would be that this kid should have Mobile Therapy services ... around here, there is a provider called a "TSS" ... therapeutic support staff (again, titles vary from place to place) which is a mental health provider that actually accompanies the child to places like school, daycare, even at home part time. The intent is to provide support and supervision to a behaviorally/emotionally fragile child without inpatient admit ... though frankly it sounds like this kid is right on the edge of needing inpatient, if not over the edge.

I'd say go to your guidance counselor immediately, ask what kind of mobile services are available in your area (it would likely be through a mental health provider, not through the school) and ask point blank why this kid doesn't have them. I would be VERY clear with whomever you need to be clear with that this is not an acceptable situation to place you or this child in ... you cannot teach a class full of kids and care for this child at the same time. For that matter, caring for this child's mental health needs is outside of your training. Administrators hear LIABILITY issues better than anything sometimes, so I'd certainly hit that topic ... and it's a real one! It is simply unacceptable for you to be put in this spot, and unacceptable to just "hope for the best" if this kid isn't getting an appropriate level of service.

At some point (some point very soon) the school needs to talk with the parents as well, to find out what services the child is getting, why and why not, and to express the concerns about safety and appropriate care at school. They may be unaware of how things are at school, they may not know of available services, or they may be resistant to services, or ... but if this kid is consistently a chocolate mess at school, something needs to change, and pressure needs to be put on whoever is stopping it from happening. The other potential "culprit" in the way of services could be (imagine this) an insurance provider ... if the insurance has refused to pay for a higher level of services, the school might help by providing documentation of fragile behavior incidents, or even by offering to appear at a claims denial appeal or whatever ... sadly, I've had to be involved in more than one fight with an insurance company or other "powers that be" that were trying to give a child the cheapest or easiest form of treatment rather than the most appropriate.

It does NOT sound like you're doing anything to make it worse! You're doing the best you can with a bad situation ... which I hope you are successful in changing! Let us know.

[Vanessa White]

Just a couple of red flags I sense here:

I am ABSOLUTELY with keltic on this, get a team of you involved to support and hold this young person up. He needs major help and you absolutely, trained or not, should be doing that alone. It also could be your obligation as the person to whom he is disclosing his desire to kill himself. Without sounding cold about it, you can be sensitive and protect yourself at the same time. I would also caution you about any frequent physical contact with this young person. I have worked in Mental health and the child welfare field all of my professional life, and although hate the reality of it, the reality is that us holding our school kids and helping them through pure heart and compassion can sometimes come back and bite us, or put us in a situation that someone twists in their minds. Keep yourself safe; it also could give you some perspective so you aren't totally consumed by it, but keep you involved in a caring way.

GET HELP NOW! No more going this alone before something tragic happens, your fears about him going to the bathroom could be valid.......

I will say some prayers for you, and him, and your other students on this. Actually this could be a teaching moment for your whole class on issues related to depression and mental health issues. This week is Mental Health Awareness Week, and today, ironically, is National Depression Screening Day. Peace and love, :love::pray:

[keltic63]

Gifted and Talented

ok, around here it's just referred to as gifted.

[BrentRichards]

ok, around here it's just referred to as gifted.

When I was in school, we were just referred to as "Nerds"

[keltic63]

When I was in school, we were just referred to as "Nerds"

both of my older kids were identified pretty early in elementary school. they'd come home and I'd ask them "how was Geeks and Nerds class?" :lol:

[BrentRichards]

both of my older kids were identified pretty early in elementary school. they'd come home and I'd ask them "how was Geeks and Nerds class?" :lol:

Which of course reminds me of the prep school where my late brother worked. At the annual football rout by the local tough-neighborhood public school, the prep kids would follow an opposing team touchdown with chants of "That's alright, that's okay, you're gonna work for ME some day."

[pnggrad79]

Yes, he is truly gifted and talented, but feels overwhelmed. I have taught GT kids over the years and have seen more than one who has depression episodes.

This kid's parents are supportive but are frustrated because they don't know what to do with him. But I feel like I am the blind leading the blind. I went to the counselor the other day when I took him down there and she knows all about him and is aware of his problems. But I can't keep sending him down to the office everyday. He has to stay in class and learn at some point in time.

He is weepy when he gets to school, but I don't have him until noon. By that time, his meds have had time to work and he is fine, laughing, talking, joking and seems fine, but the next morning, he is back to weepy again, talking failure and death and catastrophe. Almost reminds me of bipolar, but I think it is more that his meds have not kicked in by the time he gets to school. And he is a basket case. :eek:

[Vanessa White]

I want to start off this post by stating that I don't mean to offend any of you here, who have been truly helped by psychotropic, or mental health, medications.

However, I do believe that as a society, we often believe a couple of things, that meds are what make us feel better all by themselves, and that we "become" the label or diagnosis that we have been given or given ourselves.

This young man is at the very beginning stages in his life. To think that he already believes or seems to live the fact that his mood is totally dependent on when his drugs kick in is very sad to me. Could this talented, gifted young man benefit by starting to empower himself in how he can change his thinking, and therefore change his mood?

If you have never heard of it, check out the Website for the William Glasser Institute in California. Dr. Glasser created Choice Theory, a theory of human behavior based on the premise that: we are all trying to meet a specific set of needs in our lives; sometimes we are much more effective at it than others; and if we change one aspect of our behavior, specifically our thinking or what we do, we can change our physical being and our emotions. It may empower him to take control of this a bit. And, I would say again that ANYTIME this student makes a specific or veiled threat to himself in your presence, SEND HIM TO THE OFFICE. You need to CYA on this...........:love:

[BrentRichards]

Actually the idea of his meds "kicking in" at noon doesn't really work for anti-depressants. Nearly all of this type of medication works at a "serum level" ... it takes 4-6 weeks to build up to an effective level of the medication in your system. Once that level is reached, the variations in effectiveness based on how long ago you took your last dose should be minimal. If this kid is swinging that far, it really doesn't sound like a dosage schedule issue.

Naturally, I'm not a pharmacist, nor do I have any idea what kinds of meds the kid is on, but as a mental health professional, I wouldn't be satisfied with the "He's sad in the morning cause his meds haven't kicked in yet" explanation ... I will reaffirm that you are being put in an unfair and unsafe situation. I say someone still needs to be pushed on this.

[BrentRichards]

I want to start off this post by stating that I don't mean to offend any of you here, who have been truly helped by psychotropic, or mental health, medications.

However, I do believe that as a society, we often believe a couple of things, that meds are what make us feel better all by themselves, and that we "become" the label or diagnosis that we have been given or given ourselves.

This young man is at the very beginning stages in his life. To think that he already believes or seems to live the fact that his mood is totally dependent on when his drugs kick in is very sad to me. Could this talented, gifted young man benefit by starting to empower himself in how he can change his thinking, and therefore change his mood?

If you have never heard of it, check out the Website for the William Glasser Institute in California. Dr. Glasser created Choice Theory, a theory of human behavior based on the premise that: we are all trying to meet a specific set of needs in our lives; sometimes we are much more effective at it than others; and if we change one aspect of our behavior, specifically our thinking or what we do, we can change our physical being and our emotions. It may empower him to take control of this a bit. And, I would say again that ANYTIME this student makes a specific or veiled threat to himself in your presence, SEND HIM TO THE OFFICE. You need to CYA on this...........:love:

I agree that we have gone med crazy. It is the first line (and often only line) of treatment every time, which is a bad thing. Which is exactly why other kinds of services are also needed, in addition to meds (I am a believer in the vital role of medication, just not in an exclusive role).

While I like Glasser's early work, and while my counseling style is based very strongly on choices and responsibilities, I will caution that I think Glasser has more recently gone way over the edge ... he is more or less in line with Thomas Szaz and others, denying the existence of genuine mental illness, or any role for medical treatment. I can't go there with him.

[u-dog]

Actually the idea of his meds "kicking in" at noon doesn't really work for anti-depressants. Nearly all of this type of medication works at a "serum level" ... it takes 4-6 weeks to build up to an effective level of the medication in your system. Once that level is reached, the variations in effectiveness based on how long ago you took your last dose should be minimal. If this kid is swinging that far, it really doesn't sound like a dosage schedule issue.

Naturally, I'm not a pharmacist, nor do I have any idea what kinds of meds the kid is on, but as a mental health professional, I wouldn't be satisfied with the "He's sad in the morning cause his meds haven't kicked in yet" explanation ... I will reaffirm that you are being put in an unfair and unsafe situation. I say someone still needs to be pushed on this.

I wonder if he's getting breakfast? Cuz it DOES sound like a bloodsugar pattern. Could he be diabetic as well? or hypoglycemic? Brent is right! what you need to be doing is PUSHING THE POWERS THAT BE to get to the bottom of this.

[Vanessa White]

I agree Brent, the last few years Glasser has been a bit over the edge at times. I do have great respect for his work, however, still, and am certified (not CERTIFIABLE, although some days I wonder....) in Reality Therapy. While I don't ascribe to there being no mental illness, I do believe that much of it is not what it appears to be, and it becomes a way for a person to potentially stay stuck in helplessness.

Blood sugar levels in terms of breakfast sound like a great possibility. :confused:

[BrentRichards]

I agree Brent, the last few years Glasser has been a bit over the edge at times. I do have great respect for his work, however, still, and am certified (not CERTIFIABLE, although some days I wonder....) in Reality Therapy. While I don't ascribe to there being no mental illness, I do believe that much of it is not what it appears to be, and it becomes a way for a person to potentially stay stuck in helplessness.

Blood sugar levels in terms of breakfast sound like a great possibility. :confused:

Sounds like we're of similar cloth ... Reality Therapy is great stuff. Wish he'd stayed that balanced.

[pnggrad79]

All I know is that since school started, this kid comes to school at about 7:30-8:00 and more times than I care to count is in tears, sobbing and wanting to kill himself. He is downright catastrophic. First week, we thought it was just separation anxiety. ( I thought he was a little old for separation anxiety, but...) And this pattern has continued now for 7 weeks. We are going on 8 weeks of school and he told me today that he went to see his therapist yesterday and was switched from his 40 mg of Zoloft back to Lexapro, which he insists did him no good. Then, why the hell did they put him back on it?

So I went to the Educational Diagnostician and asked her if she had anything she could help me with, and she said she had clinical depression for years and was being treated and had learned how to cope and she said if he was coming to school crying to send him to her and she would try to talk him down off the ledge. I said that was fine and good, but he didn't know her and had established that trust factor. So I agreed to come with him for the first couple of times so he could learn to establish a safe place to come if he felt like he was melting down.

Bottom line- I, as his classroom teacher, need to know what to do since I have him the majority of the time. I would simply be devastated to know if he excused himself and went to the bathroom to slice his wrists. I couldn't live with myself. I need tools. I need to know how to best help this kid and still be a good teacher to the rest of my class.

By the time he got to my class this afternoon, he was a different kid. All smiles, happy, talking and no tears. Dr. Jekyll and Mr. Hyde. I don't know but I am dreading going to school now, afraid of what is going to happen today with him.:eek:

[Alecto]

A couple things come to mind.
1)Suicide threats, in my state anyway, are grounds to have someone picked up for a psych eval and hospitalized. Any threats are serious threats, and serious threats mean that a hospital is probably the best place for someone.

2)I haven't seen this kid's history. Probably, neither have you. But it can sometimes take a LOT of "tweaking" to find meds that actually work. It's made worse by the fact that you can't really know for sure for at least a month whether something is helping or not. Also on the topic of "unknowns" are what kind of talk therapy he's been getting along with the meds. This is all stuff that can potentially affect how he's doing and his chances of success, but it's also (to be blunt) stuff that (I'm pretty sure) isn't technically (or legally) any of your business. I will just say, though, that if at the end of your push to help this kid, it looks like no one is "at fault"; that is a completely plausible situation. It might just be the doctors all trying their best, but taking awhile to get there.

3)I wish I could help more, but most of my knowledge, academic and personal, deals with people a little older. I don't know how helpful this might be to someone on "the other side", but crazyboards.org is a forum site with information and support for all different kinds of "the crazies". (I've had 'em, so I'm allowed to call 'em that).

[rainbow7]

All I know is that since school started, this kid comes to school at about 7:30-8:00 and more times than I care to count is in tears, sobbing and wanting to kill himself. He is downright catastrophic. First week, we thought it was just separation anxiety. ( I thought he was a little old for separation anxiety, but...) And this pattern has continued now for 7 weeks. We are going on 8 weeks of school and he told me today that he went to see his therapist yesterday and was switched from his 40 mg of Zoloft back to Lexapro, which he insists did him no good. Then, why the hell did they put him back on it?

So I went to the Educational Diagnostician and asked her if she had anything she could help me with, and she said she had clinical depression for years and was being treated and had learned how to cope and she said if he was coming to school crying to send him to her and she would try to talk him down off the ledge. I said that was fine and good, but he didn't know her and had established that trust factor. So I agreed to come with him for the first couple of times so he could learn to establish a safe place to come if he felt like he was melting down.

Bottom line- I, as his classroom teacher, need to know what to do since I have him the majority of the time. I would simply be devastated to know if he excused himself and went to the bathroom to slice his wrists. I couldn't live with myself. I need tools. I need to know how to best help this kid and still be a good teacher to the rest of my class.

By the time he got to my class this afternoon, he was a different kid. All smiles, happy, talking and no tears. Dr. Jekyll and Mr. Hyde. I don't know but I am dreading going to school now, afraid of what is going to happen today with him.:eek:

You are doing the best you can with a difficult situation, but you need more info in order to find the right resources. I think I would schedule a parent conference as soon as possible to hear from them what is going on. If he has a therapist, ask the parents to sign a release form so you can consult with the therapist. And what about the school counselor? I can hear your anxiety, and it seems totally appropriate.....you're trying to work without a net!

Polly

[Progo35]

pnggrad79:

First of all, I want to say that it is teachers like you that have the potential to really touch kids lives. It sounds like you are doing that, and as a student who often needed a hug when I was younger, I am so happy to here of how concerned and loving you are towards this young person.

I have a few questions:

1) You haven't mentioned what you guys have talked about when he is having depressive episodes like this. Is he being harassed at school? Has he had several losses in his life within the last couple of years? Because it sounds like something is behind all of this crying and being upset besides just a chemistry issue. Did he say WHY he wants to kill himself? What I mean is that as other people have said, meds don't necessarily fix things. I tend to have a bilateral approach to looking at these things: once medication is proscribed it is then important to examine other factors that could be contributing to or causing the situation. It could be that there is a problem at home or some sort of abuse situation that he hasn't told you about, although I hate to stress you out with the possibility.

Secondly, when you say that this child is gifted and talented, is he in a special, accellerated program? Or, do you just know this from working with him? Is he feeling like the demands of his workload are overwhelming and that he is going to fail in reaching his or other people's expectations?

Thirdly, it is possible for a child to be GT and also to have ADD, ADHD or a learning disorder. Sometimes having such disorders, particularly ADD or disabilities that make social cues difficult to interpret, can cause emotional breakdowns, because daily existence is extremely stressful and the child is putting for an inordinant amount of energy to cope with their daily demands. Moreover, because these children are so bright, their disabilities can be overlooked. Very often, when simple steps are taken to manage the workload and develop techniques for understanding nonverbal communication and peer harassment, some of the emotional stress can be alleviated. Basically, this entails what you and others are doing now, but getting him tested and hooked up with someone in academic support. He can, of course, remain in the gifted program if this is the case, he will just need some accommodations to make him more successful.

2) I would advise that you work closely with a team of people and that you remain part of that team. I would say that an important thing in this is to set boundaries for when you cannot handle something alone and stick to them, but to continue that good work you've done mentoring this boy. Although I've never gone to a mentor sobbing and threatening to kill myself, I know that it's helped me as a mentee to know when it is okay to seek out someone and when it isn't.

Meeting Time?

Going off of this, one thing that really helped me in college and also very early in elementary school was having people who I knew were available at certain times but not at other times. That way, I generally knew that on Thursdays at noon, it was okay to go and talk to my mentor in college, but that I shouldn't go and try to talk to him on Mondays in the morning because he had to do research. So, it's a matter of setting boundaries but remaining involved.

So, for instance, you could still "be there" if the student is having a meltdown by, for instance, guiding him to the counselor's office, but then make sure that you are completing all of your other duties. Then, you could set up a specific time with this student just to chat, both to give academic admonishment (such as encouraging him to remain in class to learn things, emphasizing strengths and giving advice about weaknesses) and just to "debrief" about life. Then, if he needs to cry, he can do it then with you but there is a boundry there so that you will not feel like you are the only one dealing with his feelings. And, this will help demonstrate boundaries to him: it will show that you are involving other people and setting boundaries, but that you are not "leaving" him, you're still in his life as a confident. I think that its very important for children with emotional problems (whatever the root of them might be) to see good boundaries with adults who are involved with them.

Parents

If I were you, I would ask to have a meeting with this boy's parents and ask them about some methods you have thought of for helping out. As for your part of it, you could ask them if it is okay with them for you to give their son a hug when he is feeling like that and if it is okay for you to meet with him either before, after, or during school sometime just to "debrief" together. If the parents say that that is okay, then I think that you can feel okay doing that. And, I think it's good for parents to know that someone is looking out for their kid. This provides encouragement that they are not alone in their struggle to meet their child's educational/emotional needs. When I was in school, my mom used to yearn for that and was so appreciative when she knew of someone taking the time to help.

So, in short, God bless you for your involvement and kind, loving heart. I'm praying for you and this young man. I hope that this advice is helpful.

[pnggrad79]

Progo,
I spoke with the educational diagnostician, the counselor and the assistant principal about him the other day, and told them that I was really concerned about him. I asked them about the possibility of getting his parents up to the school to have a conference so I could learn a little bit more about what is going on with him. It being so early into school, I don't know the history of why he is like this, how long it has been going on, what has happened to him in the past, etc.
The counselor called his mother yesterday and we have a conference next week. The counselor ran interference for me Friday morning and intercepted the tearful young man as he came in the door before he came to my room. I told the asst principal that I was behind on all my paperwork, lesson plans, etc because when he came into my room, he "demanded" all my attention. I didn't have the heart to send him away in his condition. I would sit there and let him sob on my shoulder.

In my estimation:

1. He wants to kill himself because:
a. he doesn't want to grow up. It was easier being younger and he sees it
becoming more difficult as he gets older
b. he doesn't want to be away from his mother. He thinks that the older he
gets the more time he has to spend away from mom. (major separation
anxiety)
2. He is the youngest child of a much older couple. He has at least one much older brother, who is married and has kids of his own, possibly this kid's age. So this kid is an uncle to nephews his own age. His parents had him when they were much older, like his mom was in her 40's or something.

3. He is identified G/T in all areas, but he finds it too challenging. Most G/T kids LOVE the challenge. He doesn't like it. I think his disorder makes it too much for his brain to handle. He is petrified he is going to fail, although, he is nowhere near failing in any subject.

4. When he was first diagnosed, according to his mother, they thought it was ADHD, so they put him on Adderal,(sp?) and she said that he spun out of control. They had to hospitalize him. Then they figured out it was depression they were dealing with and not ADHD. ADHD could play a role in all this, but to what degree I don't know.

5. By the time he comes to my class in the afternoon, he seems normal. No tears, no escalation, no talk of failure or suicide. I can call him down for talking. I can call on him in class. I can ask him where his paper is. I can tell him to stop messing around. He is a normal kid. But in the morning, he is ready for a straight jacket and he buries his head in my shoulder begging me to help him stop feeling like this. And I have no clue what to tell him. I know it is the messed up chemicals and hormones jumbling up his thoughts, and I have no clue how to combat that. He has no control over it and neither do I. If it was a situation, I could logically think it through with him. This is a foreign thing to me. All I know is I have a sobbing kid who is begging for my help and I feel so utterly helpless. How do you logically battle chemicals and hormones that are screwed up? It's like trying to talk logically and sensibly to Andrea Yates, or Jeffrey Dahmer!!!

(Let me digress a little here-how can we logically throw the book at someone so messed up like Andrea Yates, who CLEARLY was psychotic, and hold her responsible for what she did? She is/was MESSED UP!!! The poor woman needs HELP! not more legalistic crap thrown at her! Come on!) and this is my point with this kid, I am trying my best to be logical and sensible with chemical imbalance and that is like trying to make orange juice out of apples.


6. The educational diag told me that she has struggled with depression since childhood and with meds she has learned how to cope with it and she offered to sit down with him and me and teach both of us how to cope with this. She said the same thing all of you are saying, that I don't need to do this by myself.

Bottom line-I covet your prayers and advice. Thanks for everything. I will keep you posted. The kid's name is Travis.

[Progo35]

Hey, Pnggrad79,

Yes, please do keep us posted. I actually showed your thread to the head of academic support at my school and asked her if she has any advice. So, when she gets back to me I will send you that. I would say that you have done just what this young man needs: he just needs someone to say its going to be okay, and I think that you can still do that by setting up a time to chat with him regularly, so he still feels like you're involved but more on a weekly basis. And then, stick to that.

Still praying and blessings on you,
-Meghan

[Alecto]

I just wanted to say that, yes, there are most likely some kinds of causes behind this, but at the same time...if he doesn't bring those up, I think it's NOT your job to "get to" those. That is what a trained talk therapist is for. If he wants to talk, by all means listen (when you can; boundaries are definitely necessary), but I don't think it's doing anyone any good to pry. It can make him feel worse before he feels better, and it's going to make YOU feel worse, and it's not something you're likely equipped to deal with.

As for reasoning with chemicals: it's really, REALLY difficult but somewhat possible. But there's a catch: it's somewhat possible FOR HIM. And it's really difficult FOR HIM. The most basic breakdown of Cognitive Behavioral Therapy (which I'm a fan of) is identifying which situations or stimuli make you feel worse (and then trying to make those happen less and less often) and which make you feel better (and trying to maximize those). Another thing that did REALLY help me was knowing that there's a disease that makes you feel a certain way. That everything feels just friggin' AWFUL right now, but that it's not because everything really is awful. It's the disease in my head making me feel like that. SO then I can just kind of say "f you" to the disease, and go on with my day.

I'm the youngest in my family. I've never really been around little kids; I don't think I really "get" kids. I don't know how much of what I say might translate to children, but...hopefully something.

Also: try to remember to take care of YOU in all this too, right?

[Progo35]

What I would reiterate is that you should continue to mentor this boy with the boundaries. I, personally, have had experiences were mentors have just suddenly stopped mentoring me and expected me to just "know" why, when they hadn't actually articulated the need for any kind of boundary that might preserve that relationship in a healthy manner that works for them. This hurts. So, I would encourage you to set firm boundaries but not become inaccessible or back off entirely. I'm sure that you are not planning to do this, but people in my own life who I thought would never, ever do that have, so I just thought I'd mention it from the perspective of someone being mentored. So, keep boundaries but still be there. It can be done with consistency and planning.