Wellbeing and Emotional Resilience in teenagers and adolescents

1. Wellbeing and Emotional Resilience in teenagers and adolescents Dr M Sharma Consultant Psychiatrist

2. What do you think the are main issues that young people struggle with?

3. MAIN ISSUES Transition Bullying Sleep difficulty Friendship issues Gender issues Low mood / irritable Stress : difficulty to cope with the demands and pressure > cope with Anxiety – 300,000 YP have anxiety disorder Includes – fears and phobia, anxiety , panic disorder Is treatable with talking therapy and medication Recreational Drugs / alcohol Impact /Influence of Social media/ Cyber bullying Eating difficulty : problems/pressure at school/home can trigger YP being unhappy with size /shape

4. TRANSITION is hard because…. • Adjustment to a new environment • Making new friends • Academic pressure • Need additional help: • To talk about their fears • Share their feelings • Face their fears • To gain skills to manage these feelings • Pastoral support at school • Parents to understand their childs emotional difficulties • and support their well being

5. What’s worrying the child / young person?

6. What’s worrying the child / young person • At School • Performance – assessments /exams, competition • Time pressure - balancing act : studying , activities, relaxation, • social media, socialising • Concentration problems – ? noisy , ? Overwhelming • Peer relationship – friends / friendship groups / break ups • Bullying • At Home : relationship with parents / parental disharmony, medical condition, sibling issue, financial pressure, parents physical / mental health well being • Abuse • Gender identity issues

7. In their mind : • Unhappy , Sad Tearful • Stressed , angry , withdrawn , tired, sleep difficulty, lack of appetite • Reduced motivation to get up and go to school • Feel sick • Headache or Stomach ache • Anxiety : Heart race, shaky, shortness of breath • Motivation / concentration issues to complete HW or prepare for exams • School refusal • Drugs /alcohol Worry can present as ……..

8. Coping with Stress / Anxiety • Can feel alone in this; encouraging them to talk to whom they trust • Making a list of their worries in hierarchy • Breaking them down into small manageable parts – helps them think through, challenge unhelpful thoughts and deal with the big jumble in their head • Improve problem solving skills • Encourage them to relax : Taking regular breaks between studying • Listen to music, watching a film / series , warm bath • Regular exercise – helps release endorphins “ happy hormones” • Seek help : if affecting health-sleep-appetite, self harm thoughts /acts, depressed or abusing drugs /alcohol

9. Coping with Stress / Anxiety • Make a list of strategies to use when stressed, visit them from time to time • Most of the peers are feeling the pressure • Deal with one thing /issue at a time • If distressed by stress , time to make a change • Share the worries, seek support

10. Challenging unhelpful thoughts • The best mate question • The last time question • The is it so bad question • The hard time question • The time travel question • The tunnel vision question

11. Some Conversation Tips • General • How are you feeling today • What would you like to talk about • Tell me one good bit and one not so good bit from today • Did something make you happy and/ or sad today • Serious • Looks like you’ve had a difficult day, do you want to talk about your problem • Do you want to talk about whats going on • How can I support you through this issue • I am there for you : is there anything that you need me for • space / time / do some fun things together

12. Communication tips • FUN STUFF • Lets hear your favourite song • Is there a film that you are looking forward to watch • What do you like about school and why • If your life was a movie, which one would it be • If you were granted 2wishes, what would they be • ENCOURAGERS • Making the YP feel good about themselves • I /we love you unconditionally / not dependent on your results • I / We are there for you, come and talk anytime • If you come and talk, will try our best to help you • Even if I do not understand, just know that I do want to • If you want to talk to someone else, that’s fine too • We are going to get through this together

13. Activities • Play a board / game : that they like • Go for a walk – create a space for your child to talk about what they have on their mind • Bake / cook / decorate pizza topping– take time out to enjoy the product together • Put on your dancing shoes – ask them to pick their favourite number / come up with dance moves together • Drive together – listening to their favourite music • Sing it – singing in the car /serenading in the kitchen • Coffee shop date – treat them to their fav drink • Create a boredom jar – write an activity your child / you can do when bored • like watching a fav film, craft , baking etc • Draw cartoons of each other : without lifting the pen • Encourage them to meet up with friend ……..have time for fun • Join a youth club or activity group • Have a hobby or play a sport, spend time with a pet • Read / write a diary about mood and feelings

14. Sleep problems • CAUSES • Life events - stress, anxiety, low mood • Thinking styles- tendency to catastrophise and worry about the consequences- vicious cycle • Unhealthy bedtime habits- inability to relax, gadgets, environmental aspects • Consumption of caffeine • WHAT KEEPS A SLEEP PROBLEM GOING • Predicting poor sleep, poor bedtime routine, checking time, worrying about consequences, napping and disturbing sleep pattern

15. Sleep problems • HELPFUL SUGGESTIONS Encourage them to: • Have a healthy sleep routine • Regular exercise • Encourage relaxation : reading a book • Distraction: visual imagery ( being in a pleasant safe comfortable environment ) : count backwards : focus on breathing • Avoid usage of technology in the bedroom

17. Pathway • If your child shares with you that they are struggling • Thank them for sharing with you • Ask them if they have any idea of how they would • like you to help them • Can call up parents helpline for a chat • Discuss pastoral support with school • Talk to your GP re: referral into CAMHS (Child • and Adolescent Mental Health Service to assess and • treat emotional behavioural and mental health issues )

18. CAMHS • Multi disciplinary team • Psychiatrists ( doctors) • Psychologists • Nurses Therapists Support workers • Information on services offered on CAMHS website • Self referral – on line • Most CAMHS services work with the family as a • whole to support the child /Young persons needs • Improve emotional resilience and well being

19. Eating Difficulties • Restrictive eating • Poor body image, low calorie intake • Can lead to • Anorexia • Exercising more than usual/ calorie counting to lose weight • fear of putting on weight, avoid food as guilty - lose a lot of weight • Do not like the way you look • Irregular periods • The thinner they get, fatter they feel • Wear loose clothes to hide weight loss • Physical and mental health can be compromised • Binging and Purging • Eat a lot of food quickly- Binge • Feel ashamed, try to get rid of the food by being sick /using laxatives • Not much change in weight however take a lot of time and energy

20. Encouragement and reassurance Guilt free • There will be good and bad days • Differences between being flexible vs giving in • Errors are a learning opportunity:see what works • Eating is normal - Everybody deserves to eat • Remind child of successes • Remind child of a time pre-illness where eating was OK • Letting go of guilt that your child has an eating disorder • Stay calm and avoid criticism and blame • Help your child manage and tolerate distress

21. Eating Difficulties • How to help: • Recognition of symptoms • If serious - self referral / referral by school nurse / parents or via GP to specialist services • Psychoeducation • Weight restoration • Family therapy • Cognitive Behaviour Therapy

22. Gender dysphoria • Gender dysphoria (GD) is a condition in which a person experiences discomfort or distress because there is a mismatch between their biological sex and their gender identity. • Increasing numbers of adolescents are seeking treatment at gender identity services • Acceptance and support is key • Gender Identity Clinic

23. REFERENCES • RCPsych : Royal College of Psychiatrists • MOOD JUICE • YOUNG MINDS • BARNARDO’S • MERMAIDS UK ( supporting gender diverse / transgender) • BEAT ( beateatingdisorder.org.uk) • AQUARIUS ( Bham ) and SIAS ( Solihull Integrated addiction service)

25. Child use of social media…. • 72% of 12-15’s have a social media profile • The majority of 12-15 year olds prefer (watch more) YouTube to TV • 9% of 11-15s are using social media at 10pm, 2% at midnight • Much communication is positive (e.g. homework groups) but also some less positive uses (plus there is a fine line between banter and bullying). • 30% have got involved in civic activity (petitions, shared news stories, etc) • 90% said they have been given information about staying safe online • 19% say they have seen something worrying or nasty online in the last year (8% contacted by someone they don’t know, 4% something sexual online, 34% ‘hate speech’ • 13% say bullied online in last 12 months Ofcom report 2016

26. Survey of Y7 Sept 2018

29. There are positives to social media Social media is not inherently ‘evil’: • Useful skills for modern working environments, ‘personal branding’ and jobs (e.g. LinkedIn) - is increasingly how younger people network with each other • Most common use among school-age pupils is finding out about homework • Positive support (e.g. bereavement support, gender identity, etc.) • Mastering ettiquettes/social rules/technology while in a supportive/supervised environment (i.e. not suddenly expected to cope with it at university) so they can ‘hit the ground running’.

30. Common issues associated with social media…. • Lack of sleep (impacts large numbers of pupils) • Fear of missing out (if I turn it off, I’ll miss something important / commit ‘social suicide’) • Expectation of rapid reply/comment over considered response (a bad habit to develop for work/relationships in the future) [A Pavlovian trap? - you ping me, I respond, so you have to too….] • Distorted view of the world / lack of BALANCE • Bullying, • loss of self-esteem (12 ‘selfies’ taken for every one posted), • negative social pressures impacts smaller numbers but can have big impact • Waste of time / opportunity cost - consumes large amounts of time • Important to have a whole range of interests, friendship groups, etc. - i.e. have ‘balance’ not exclusive focus on one aspect of life. • Which is better for health/balance - sitting inside on a computer or going for a walk in the sunshine? It should be possible to do both, but often isn’t… • A ‘time diary’ may be a useful tool in helping people realise how much time is wasted (+ there are ‘apps’ that will do it too…..

31. Over-reading is easy with social networking…. ...and can lead to social misunderstandings Emphasise the importance of real world conversation / real relationships….

32. We need to think about what we are modelling too….

33. You can control their access… This is Google but similar exists for Apple. ... but there are always ways round it (and they are generally good at finding them if they want to) so it’s better to develop trust / sensible ‘rules’ that they agree to.

36. Lots of sensible advice. Twitter feed,etc! https://twitter.com/search?q=national%20online%20safety&src=typd Great on specific things to look for with different applications. Parental login link: https://lms.nationalonlinesafety.com/school/KEVICamp

37. Inside school Staff, governors and many parents have completed online safety training using NOS (see previous slide). Mobile phones are currently banned from use in school Most forms of social media are blocked on school computers (YouTube is permitted) All computers are monitored by a system that automatically ‘reads’ screens to look for signs of problems. Algorithms identify inappropriate language, potential bullying, etc., and flags it up to senior staff. This applies to any use of school computers, not just email.

38. Suggestions • Agree to leave phones downstairs at night (suggestion that usage before bedtime impacts sleep quality). • Move chargers downstairs to ‘nudge’ this idea? • Adults/other family members to promote/model positive phone usage themselves • Discourage phone use in ‘family’ time - encourage idea that ‘real’ interactions should always take precedence over ‘social media’/phone. • Model good behaviour - make sure your phone fits round your life, not the other way round! • Encourage use of apps that monitor/summarise phone use to make them aware where their time is going - some can even let them/you allocate time as work time/family time/social time and selectively block accordingly. (Also great for exam revision time!) • It encourages them to take ownership of the problem • Encourage ‘efficient’ use of time (e.g. can still use social media but reduce the frequency of checking it/reduce dependence). • Encourage daydreaming/unstructured time (e.g. when waiting for a bus, observe what’s around rather than ‘plugging in’ - also important for personal safety; on a journey look out of the window!).

39. https://safeguarde.com/cell-phone-etiquette-rules-parent-should-teach-child/https://safeguarde.com/cell-phone-etiquette-rules-parent-should-teach-child/

40. Final messages: A blanket ban probably doesn’t help to develop resilience and may socially isolate a child BUT • developing/demonstrating that life doesn’t revolve around phones does help to keep social media in perspective. • Ensure that they have various channels of communication open - you may have arguments with teens or may forbid things but there must always be a way for them to communicate a problem. • Talk to them - don’t allow the virtual world to dominate and help them to develop real world interpersonal skills alongside their virtual interpersonal ones • Develop resilience by ensuring a range of social alternatives - encourage real contact with friends, participation in clubs, real life hobbies/interests, etc.