By Camille Garceau, B.Sc.

Suicide is the second leading cause of death in Canadian adolescents and young adults (Statistics Canada, 2022). In 2021, approximately 18% of Ontario students grades 7-12 reported seriously thinking about suicide in the past year (Boak, Elton-Marshall, & Hamilton, 2022). Tragically, suicide rates are 6 times higher in First Nations youth and 24 times higher in Inuit youth than in non-indigenous youth (Statistics Canada, 2019).

How do you know if your teen is at risk for suicide? Suicide is sometimes an impulsive act, and attempts can be difficult to predict. The strongest predictor of a future suicide attempt is a past suicide attempt; other risk factors include difficult life events, social isolation, past trauma, mental illness, debilitating physical illness, and availability of means (e.g. firearms) (Bilsen, 2018). Although there is no one way to accurately determine the likelihood of someone dying by suicide, there are several warning signs that are worth monitoring. These include threats to end one’s life, getting the means to end one’s life (e.g. firearm, pills), having a suicide plan, talking or writing about wanting to end one’s life, expressing hopelessness and/or a lack of purpose in life, dramatic changes in mood, reckless behaviour, sleep problems, and increased substance use (see youthsuicidewarningsigns.org). 

As a parent, you are likely (and understandably!) disturbed and frightened by the idea of your child being at risk for suicide. This may make you hesitant to discuss the topic with them. You may wonder: will talking about suicide with my child “put the idea in their head”? Could it make them more likely to attempt? These fears, although normal, are thankfully unfounded. It is a widespread misconception that talking to someone about suicide will induce or exacerbate suicidal thoughts or urges (Dazzi et al., 2014). In reality, asking your teen direct questions shows them that you want to hear about their experience — no matter how distressing — rather than hide your head in the sand. Examples include “Do you have suicidal thoughts?”, “How often do you think about suicide?”, and “Do you have a plan to kill yourself?”. By opening the dialogue in a clear, honest, and courageous manner, you invite your teen to respond in kind. 

Fearing that your teen could take their own life can be terrifying, overwhelming, and isolating. If this is your experience, do not delay in seeking mental health care from a qualified professional for both your teen and yourself. A therapist can help you manage your emotions and help you support your teen during this difficult time.

All Canadians can access the 24-7 Suicide Crisis Helpline by calling or texting 9-8-8.   

Camille Garceau, B.Sc., is a practicum student at the Centre for Interpersonal Relationships in Ottawa under the supervision of Dr. Nalini Iype, C. Psych. She is currently completing her doctoral degree in clinical psychology at the University of Ottawa. She works with adolescents and adults in both assessment and therapy contexts. 

References

Bilsen, J. (2018). Suicide and youth: Risk factors. Frontiers in Psychiatry, 9, 540. DOI: 10.3389/fpsyt.2018.00540

Boak, A., Elton-Marshall, T., & Hamilton, H. A. (2022). The well-being of Ontario students: Findings from the 2021 Ontario Student Drug Use and Health Survey (OSDUHS). Centre for Addiction and Mental Health. https://www.camh.ca/-/media/files/pdf—osduhs/2021-osduhs-report-pdf.pdf

Dazzi, T., Gribble, R., Wessely, S., & Fear. N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44, 3361–3363. DOI: 10.1017/S0033291714001299 

Kumar, M. B., & Tjepkema, M. (2019, June 28). Suicide among First Nations people, Métis

and Inuit (2011-2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC). Statistics Canada. https://www150.statcan.gc.ca/n1/pub/99-011-x/99-011-x2019001-eng.htm

Statistics Canada. (2020). Leading causes of death, total population, by age group. https://doi.org/10.25318/1310039401-eng

What do they entail and why would I consider getting one for my child?

Psychoeducational assessments for children and adolescents are comprehensive evaluations aimed at understanding cognitive, academic, as well as emotional and behavioral functioning:

1-Cognitive skills: These are mental abilities involved in thinking, learning, and problem-solving. They include things like memory, attention, processing speed, reasoning, and language skills. Cognitive skills are essential for understanding information, making decisions, and adapting to new situations.

2-Academic functioning: This refers to a person’s performance and abilities in educational settings. It includes skills such as reading, writing, math, and comprehension. Academic functioning also involves factors like study habits, learning strategies, and the ability to apply knowledge in different subjects.

3-Emotional and behavioral functioning: This encompasses how individuals regulate their emotions, interact with others, and manage their behavior. It involves understanding and expressing emotions appropriately, coping with stress and challenges, and forming healthy relationships. Behavioral functioning includes actions, reactions, and habits that affect social interactions and daily functioning.

Assessments involve a range of standardized tests, observations, and interviews conducted by qualified psychologists, psychometrists, or other specialists. They delve into areas such as intellectual abilities, learning styles, memory, attention, executive functioning, and socio-emotional well-being. By examining these factors, psychoeducational assessments provide valuable insights into a child’s strengths and weaknesses, learning needs, and overall developmental profile. 

Parents, educators, and healthcare professionals typically seek these assessments to gain a deeper understanding of a child’s learning and behavioral challenges, identify any underlying issues such as learning disabilities, ADHD, or emotional disorders, and formulate tailored intervention plans. Ultimately, psychoeducational assessments empower individuals with knowledge about the child’s unique characteristics, enabling them to make informed decisions regarding educational placement, accommodations, and support services, thus fostering academic success and emotional well-being.

Jean-Phylippe Provencher, M.A.,is a psychometrist supervised by Dr. Nalini Iype, C. Psych., at the Centre for Interpersonal Relationships (CFIR). Using a personable and engaging approach, Mr. Provencher provides psychological services to families by conducting psychoeducational assessments. Beyond determining the presence or absence of diagnoses, the purpose is to determine the best ways in which parents and teachers can support children to reach their full academic potential and thrive in their personal and family lives.

School can be difficult for children of any age, with academic and social pressures increasing with every new grade. Children who struggle in school can be at risk for a host of negative experiences such as anxiety, depression, low self-esteem, and behavioural and social issues. As time goes on and workloads increase, struggling children may find that the strategies that have helped them in the past are no longer working effectively and it takes more time and even more effort just to maintain the level at which they are currently performing. When difficulties are left unaddressed, children can often feel lost, unsupported, and hopeless about the future. Fortunately, there are ways to identify children’s difficulties and how to better support them both in school and at home. One such way is a psychoeducational assessment, conducted by a psychologist and their relevant team.  

What is a Psychoeducational Assessment?     

A psychoeducational assessment helps children in many ways. It can help:    

• Identify areas of strength along with areas of difficulty 
• Determine the presence of learning disabilities, and/or disorders such as ADHD and ASD. 
• Determine the presence of giftedness       

The aim of this kind of assessment is to provide a better understanding of your child’s development relative to other children their age and can help get your child the supports they need at school. The report received from this assessment can be provided to your child’s school to inform them of the types of supports or accommodations your child is likely to benefit from so that they can perform to the best of their ability (e.g., extra time, one-on-one support). It can even act as a basis to monitor progress and change over time, throughout your child’s academic career (in the case of multiple assessments).  

A psychoeducational assessment can provide you and your child with a better understanding of themselves, their abilities, and can set them up to learn strategies to help them succeed both in and outside of school.  

If you believe a psychoeducational assessment may be helpful for your child, our CFIR-CPRI clinicians are ready to support you in this process. Contact us via admin@cfir.ca and a member of our team will be happy to assist you.

Massimo Di Domenico, M.A.,is a therapist working under the supervision of Dr. Nalini Iype, C.Psych. and is also working towards the completion of his PhD in Clinical Developmental Psychology. He provides both treatment and assessment services to individuals of all ages – children, adolescents, and adults. Working with an integrative framework, he treats those suffering from depression and anxiety, difficulties in social relationships, and concerns related to parenting and family dynamics. For those seeking answers on how they, or their child, learn or work best, he also provides assessment services for learning disorders and ADHD.

It may come as no surprise to any parent to hear that anxiety is the number one mental health difficulty children and adolescents face today. There are a myriad of different factors that contribute to the stress that children and adolescents experience, such as school, social, and familial expectations. Youth can be excellent at hiding their anxious symptoms not only from their parents but even from themselves! Some symptoms are easier to see while others take a keener eye to spot and may take more effort to uncover. 

Look for Physical Signs…

• Tenseness
• Jitteriness
• Restlessness
• Fidgeting
• Sweating
• Complaining of aches and pains (e.g., stomach, chest, or head aches)
• Trouble breathing

It’s important to remember that any of these physical signs of anxiety can occur during everyday events. Any one of these occurring on their own, or with others, can be felt by every person at one point or another for both positive and negative experiences. When these physical signs occur frequently and are consistently displayed before or during a specific situation, there is likely something anxiety provoking about that situation. 

… And Subtle Signs

Less easy to notice are actions, behaviours, and thoughts that can fly under the radar. Notice what it is your child is doing and when they are doing it. Are they often late to leave for school? Do they procrastinate on difficult subjects but not on easier ones? Do they check things repeatedly, like locked doors, before doing something else? It’s just as important to notice what your child is not doing. Are they not studying, doing homework, going out with friends, or attending extra-curricular activities? Refusal to do something can be a subtle way to avoid situations that provoke anxiety. If you suspect your child is experiencing anxiety, talk to them about it to better understand what they are thinking. Listening to what they say and understanding their perspective can help uncover what they are worried about. Anxiety can grow when left unchecked and your child needs your support to cope with it. 

Massimo Di Domenico, M.A., is a therapist working under the supervision of Dr. Nalini Iype, C.Psych. and is also working towards the completion of his PhD in Clinical Developmental Psychology. He provides both treatment and assessment services to individuals of all ages – children, adolescents, and adults. Working with an integrative framework, he treats those suffering from depression and anxiety, difficulties in social relationships, and concerns related to parenting and family dynamics. For those seeking answers on how they, or their child, learn or work best, he also provides assessment services for learning disorders and ADHD.

(originally posted via National Initiative for Eating Disorders (NIED))

I started the National Initiative for Eating Disorders (NIED) back in 2012. At the time, our daughter had been suffering from anorexia and bulimia for two decades – it still feels impossible to reconcile the amount of time it’s had a grasp on her life. 

The life of a caregiver supporting someone living with a mental illness is a series of never-ending harsh realities. Here is mine: 

Twenty years ago, the word “caregiver” was not in my vocabulary. When you hear “caregiver,” most people think of seniors being looked after and cared for by their adult children – who may even be seniors themselves. I come from an entirely different caregiver population – (though I’m a senior myself!)

My caregiving journey began in 1999. Little did I know that our youngest daughter, [who was] almost 16 at the time, was struggling with self-esteem and anxiety issues. An eating disorder was about to become a devastating bomb dropped on her and the rest of our family.

When she first got sick in high school, her friend came to tell me that she was throwing away her school lunch. Around the same time, she became a vegetarian, started making and requesting ‘funny foods,’ and began exhibiting strange kitchen behaviours. Her overall attitude also started to change. 

“Where do we go from here?” I remember asking myself.

Our first thought was to speak with her pediatrician. At the time, we were so naïve and didn’t know we were about to get caught in the whirlwind of an unknown illness. We had no idea where we were heading.

I still remember my husband frantically charging through downtown Toronto to the National Eating Disorder Information Centre (NEDIC) to gather names of therapists, doctors, dieticians, nutritionists – anyone we could call or reach out to for help. There was no Google at that time, and the internet was in its infancy.

At the beginning of our daughter’s illness, I waited anxiously to attend a weekly peer support group for mothers – a life-saving program. 

I vividly remember sitting in this group and watching the facilitator ask those in the room to share how sick their daughters were and for how long. Some said three years, others said five years, and some even said ten years.

“Yeah, right, we will be done with this in a year,” I remember thinking. Unfortunately, this was not my reality, and I became one of those mothers. 

We tried everything to help her, from tough love to unconditional love, from having her living at home to refusing her living at home. From a publically televised intervention, to her residence in safe houses, renting basements, incarceration, inpatient and outpatient programs – the list goes on. Being an Eating Disorder caregiver is no easy feat.

Never in our wildest dreams (or nightmares) did we think we would be taken down these dark roads with our daughter who had everything a kid could want. We were loving parents doing everything we possibly could within reason for her and her older siblings. We even uprooted our lives and moved houses in the hopes of making our lives’ better’ and giving her privacy in our basement.

In 2016, I took her to the E.R. to be rehydrated – over 20 times. I would drop her outside and let her call me when she was done. I was getting to the end of my rope.

During that time, my only respite was that I knew she was safe in the hospital. She was too sick to run out with people watching over her. I was ‘free’ for a few hours – imagine having to think like this.

To this day, our hearts sink whenever we receive texts or telephone messages from her and have had to create an alert system so our own stress levels are lessened.

One significant lifestyle change we have made, with her agreement, is placing locks on the fridge and freezer. The only groceries in the kitchen are spices and seasonings. The rest are locked away. My grandkids are accustomed to asking “for the key to get a snack.” These adaptations are still realities in our lives.

Having an Eating Disorder is not a choice. Some people believe Eating Disorders are just a rich, vain teenage girl’s sickness. Nothing could be further from the truth.

Eating Disorders affect all genders, racial, ethnic, and religious identities, sexual orientations, and socio-economic backgrounds.

No one can condense twenty years of a living nightmare into a short blog post. But it is enough to paint a dark picture of the life my family and I have had to live with, affecting us all both emotionally and financially.

There is good news, though. After 19 years, our daughter has finally started her ascent up the mountain of recovery. She is driving again after 12 years of not being allowed to; she’s gained weight and is content. It feels like we have our daughter back.

We are finally starting to feel that all of her strength, love, and will to lead a quality life suppresses the voices stemming from her mental illness.

Although the stress and worries of being a caregiver will never leave us alone, we have remade our lives as a couple and continue living and are committed to enjoying our lives (which we do!) I count my blessings every day.

About the Guest Blogger: Wendy Preskow is the President and Founder of the National Initiative for Eating Disorders (NIED).  NIED is a not-for-profit coalition of health care professionals, counsellors and parents with children suffering from Eating Disorders. NIED’s team aims to help bring about positive change in both the availability and quality of treatment of Eating Disorders in Canada.

Children are often more perceptive than most adults may give them credit for; they may be wondering why their mom and/or dad are home more, why they aren’t in school or why their routine has changed, or why they can’t go see their friends or even leave the house. It’s essential to tackle these questions head-on and in a manner that satisfies their curiosity and helps to put their mind at ease. 

Self-Reflect

Talking to your children may require that you self-reflect about your concerns and feelings. Be aware that you also may be projecting your insecurities or anxieties on to your children and recognize that you may also need additional support or guidance during this time. Also, make sure that you do your research first so that you can adequately answer any questions that may come up. 

Listen and Teach

Ask your child what they already know or have heard about the virus. Be sure to dispel any myths and elaborate on critical pieces of information like the importance of handwashing. It’s also important to talk to your children in a manner that is appropriate for their age/ level of development. Also, try putting things in terms that they can relate to or understand. It’s important to teach but not to overwhelm. 

Validate Their Feelings

Your child may be confused, scared, or anxious about the changes they are experiencing. It’s important not to dismiss their feelings and to reassure them during this time that what they are feeling is very reasonable. Don’t overcommit or overpromise on things that you may not have control over to solely help them feel better – it’s important to be reassuring but also realistic. 

Create a New Routine, and then keep it Consistent 

Children thrive on stability and knowing what to expect. Help give them that consistency by developing a new routine for them. For example, create a daily schedule that outlines their activities for the day. Setting up a plan in case things suddenly change or take longer than expected can also help provide them with further assurance moving forward. Have your child get involved in the planning process so they can feel empowered and confident moving forward. 

Many people are feeling stress and anxiety during this uncertain time, and children are no exception. The mental health experts at CFIR can help you navigate how to have these meaningful discussions with your children. Clinicians at CFIR are offering secure video and teletherapy sessions during this time to ensure continuity of care. Please reach out if you would like to have a safe, confidential session from the comfort of your own home.

Dr. Brianna Jaris, C.Psych. is a clinical psychologist at CFIR. She has extensive experience in psychological assessment and diagnosis and the treatment of a wide range of psychological issues, including trauma, depression, anxiety. She is currently the head of CFIR’s Trauma and PTSD service. 

by: Ali Goldfield, M.A., via Therapy Stew (www.therapystew.com), on Sept. 21st, 2013   

It’s always difficult as a parent to know how much to share with your child and how much to shield them from the tragedies that happen in the world around them. While it may seem like a good idea, at times, to try and protect them from all the bad things, depending on their age, it’s not always possible. Children pick up information from other kids at school, from the television and from social media. Talking to your child about a tragedy can help her understand what’s happened and actually help them begin to process the events and feel a bit safer.

It’s a personal decision whether or not to talk to your kids or not. It also depends on their age, their level of maturity and how closely they are affected by the tragedy. Every parent knows best for their own child. If you’re struggling with how to start, here are some ways to help:

Let Your Child Be The Guide

Find out what questions or concerns your child might have. Let your child’s answers guide your discussion. Let your child know that you will always be there to listen and to answer them. Try to make your child feel comfortable asking questions and discussing what happened but don’t force your child to talk if they aren’t ready.

Tell The Truth – In Moderation

When talking to your child about a tragedy, tell the truth. You can focus on the basics but it’s not necessary to share all the unnecessary and gory details. Try no to exaggerate or speculate about what happened and avoid dwelling on the magnitude of the tragedy. Listen closely to your child for any misinformation, misconceptions or underlying fears. Take time to provide accurate information. Share your own thoughts and remind your child that you’re there for him. Your child’s age will play a major role in how he or she processes information about a tragedy.

Talk to Them at Their Level

Talk in a way that’s appropriate to their age and level of understanding. But don’t overload the child with too much information. Elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Middle school children will be more vocal in asking questions about whether they truly are safe and what is being done at their school.  They may need assistance separating reality from fantasy. High school students will have strong and varying opinions about the causes of violence and threats to safety in schools, community and society.  They may share concrete suggestions about how to prevent tragedies in society. They will also be more committed to doing something to help the victims and affected communities.

Be Ready to Have More Than One Conversation

Some information can be very confusing and hard to accept so asking the same question over and over may be a way for your child to find reassurance. Try to be consistent and reassuring, but don’t make unrealistic promises that nothing bad could ever happen.

Acknowledge and support your child’s concerns

Explain that all feelings are okay when a tragedy occurs.  Let children talk about their feelings and help put them into perspective.  Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately. Let your child know that all his feelings, reactions and questions relating to the tragedy are important.

Limit Media Exposure

Don’t allow young children to repeatedly see or hear coverage of a tragedy. Even if your young child appears to be engrossed in play, he or she is likely aware of what you’re watching or listening to — and might become confused or upset. Older children might want to learn more about a particular tragedy by reading or watching TV. However, constant exposure to coverage of a tragedy can heighten anxiety.

Monitor your own stress level

Don’t ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members or mental health counselors can help. It is okay to let your children know that you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise. Kids learn from watching the grown-ups in their lives and want to know how you respond to events.

We have all awoken to disasters before, whether natural, manmade, accidental and terrorist-induced and it’s inevitable that we will wake to them again in the future. What you say to your kids and how you say it will change as they get older but the one thing that shouldn’t change is your validation of your child’s feelings and the fact that you will always love them and do your best to keep them safe. 

Read more about CFIR’s Child, Adolescent & Family Psychology Service & the Trauma Psychology & PTSD Treatment Service.

Originally posted by Ali Goldfield, M.A. on TherapyStew (www.therapystew.com) – August 2013

Lots of kids (and parents) have mixed feelings about the start of the school year. It can be really exciting getting ready for school: getting school supplies, new clothes and looking forward to seeing their friends. However, it can also cause a lot of anxiety for many kids, whether they’re starting a new school or not. Taking the time to talk through their anxieties and fears is the few weeks before school starts could make all the difference. Finding out what they’re nervous about – whether it’s meeting the new teacher, making new friends or finding the bathroom when needed, it’s all important to them.

Try the following tips to further ease back to school anxiety:

Make a Plan

If your child is starting a new school, a tour around the campus can be a simple way to ease the first-day jitters. Make sure they know where their classroom is, their locker and especially the bathroom. If you get a class list before school starts, arrange a get together with one of the kids in the class before school starts — first-day jitters are less jittery if there’s a familiar face in class. Teaching anxious middle-schoolers how to use their lock, talk about whether they will be buying lunches or brown bagging it, even sending your child’s teacher an email introducing yourself and your child can help.

Remind Your Child of the Fun They Had Last Year

Point out the positive aspects of starting school: It will be fun. They will see old friends and meet new ones. Try to refresh their memory about previous years, when they may have returned home after the first day with high spirits because they had a good time,

Address the Anxiety at Home

Talking about the different things that are causing them some worries and even role play out some of the potentially stressful scenarios your child may encounter at a new school — making friends, encountering older kids and encounters with strangers — may help ease their fears.

Get Back Into Routine

Anxious kids can feel soothed by a familiar routine. Prepare kids for a new routine by organizing your house in a back-to-school way. Get their school supplies ready, talk about what they want for lunch on the first day, help them decide what to wear on the first day. If possible, start the back-to-school routine a week or two before school starts. Make sure your back-to-school routine includes plenty of sleep and help your child get back on track with an earlier bedtime and wake-up time.

Read more about our Child, Adolescent & Family Psychology Service.

Do you have an anxious child?

Childhood fears are a part of normal growing up. Fears of the dark, monsters under the bed, starting at a new daycare or school – all of these may be part of typical child development. Anxiety is also a signal to help all of us protect ourselves from situations that are dangerous- a warning signal about a lack of safety in your child’s world. Under normal circumstances, anxiety diminishes when a child’s sense of security and safety is restored—anxious thoughts and feelings subside.

When is your child’s anxiety something you should be concerned about?

Anxiety is considered a disorder not based on what a child is worrying about, but rather how that worry is impacting a child’s functioning. The content may be ‘normal’ but reach out for help for your child under the following circumstances:

1. when your child is experiencing too much worry or suffering immensely over what may appear to be insignificant situations;
2. when worry and avoidance become your child’s automatic response to many situations;
3. when your child feels continuously keyed up, or,
4. when coaxing or reassurance is ineffective in helping your child through his or her anxious thoughts and feelings.

Under these circumstances, anxiety is not a signal that tells them to protect themselves but instead prevents them from fully participating in typical activities of daily life-school, friendships, and academic performance.

What to look for:

If your child is showing any of the following it may be time to seek help from a qualified professional:

• Anticipatory anxiety, worrying hours, days, weeks ahead
• Asking repetitive reassurance questions, “what if” concerns, inconsolable, won’t respond to logical arguments
• Headaches, stomachaches, regularly too sick to go to school
• Disruptions of sleep with difficulty falling asleep, frequent nightmares, trouble sleeping alone
• Perfectionism, self-critical, very high standards that make nothing good enough
• Overly-responsible, people pleasing, an excessive concern that others are upset with him or her, unnecessary apologizing
• Easily distressed, or agitated when in a stressful situation

A child, adolescent and family psychologist at CFIR can help you and your child to diminish unhealthy anxiety. A thorough assessment of your child will provide you and your child with valuable information about the sources of your child’s anxiety, and evidence-based psychological treatment will be employed to help your child deal with his or her anxiety symptoms.

(This post was originally written by Dr. Rebecca Moore C.Psych.)