James Donaldson on Mental Health - Kids With Multiple Diagnoses

Why many children have more than one mental health or learning disorder

Photo by samer daboul on Pexels.com

Writer: Caroline Miller

Clinical Experts: Paul Mitrani, MD, PhD , Megan Ice, PhD

Key Takeaways

- Many children have more than one mental health or learning disorder, not because they are “sicker,” but because their symptoms can’t be fully explained by a single diagnosis.
- Co-occurring disorders are common because many conditions share underlying brain systems, and one disorder can often lead to another over time.
- Treatment usually begins with focusing on the disorder causing the most impairment, and monitoring the impact on the other, adapting medication or therapy as needed.
- Why are multiple diagnoses common in kids?
- What are common co-occurring disorders?
- How do you treat co-occurring disorders?
- Treating multiple disorders with medication
- Therapy and co-occurring disorders

When you have a child diagnosed with a mental health or learning disorder, it’s not unusual to find out that they also meet the criteria for another diagnosis. Your teen with ADHD might also have anxiety. Your first grader with autism might also have ADHD.

Sometimes multiple diagnoses — also known as “co-occurring” or “comorbid” disorders — are made at the same time. A child who is struggling might be evaluated and diagnosed with anxiety and depression, for example. But often a child is first diagnosed with one thing and anotherdiagnosis is added later.

“Families can feel overwhelmed hearing that their child has multiple diagnoses,” notes Megan Ice, PhD, a clinical psychologist at the Child Mind Institute. “There can be the perception that the more diagnoses, the sicker the child is.”

But that’s not necessarily the case. When a child has multiple diagnoses, it means they have symptoms that can’t all be attributed to or treated by one diagnosis. “By identifying multiple diagnoses, we’re able to open up paths for the treatments that will be effective for more of the symptoms,” Dr. Ice explains.

Why are multiple diagnoses common in kids?

In one widely cited study of 10,000 adolescents, 40 percent of those who had one mental health disorder met the criteria for another. But there are a variety of reasons why mental health and learning disorders so often occur together.

Multiple diagnoses, same brain system

Some disorders are linked to the same brain systems. “If you’re diagnosed with one anxiety disorder, like selective mutism, the likelihood is high that you’re going to have another anxiety disorder, like specific phobia, generalized anxiety disorder, or social anxiety,” says Paul Mitrani, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute. “It makes sense because it’s the same brain system that’s affected, just presenting in several different ways. So that that’s very common.”

Several different disorders can be linked to the same neurotransmitters — chemicals like dopamine and serotonin that are used to send messages in the brain. For instance, the serotonin system is involved in both anxiety and depression. “When the pathways related to serotonin in the brain are not working as well,” says Dr. Mitrani, “you’re at a higher risk for anxiety, as well as depression and OCD. ”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

One disorder can lead to another

But it’s also common for a child’s struggles with one disorder to lead to another. For instance, a child with ADHD whose impulsivity leads to a lot of conflict with their parents can develop a behavior disorder. Kids with autism might develop anxiety because the world feels unpredictable and overwhelming. Or children with learning disorders who are struggling in school may develop anxiety or depression.

“It can be really hard to have ADHD or autism, or to struggle with learning, so it makes sense that you might have difficulty regulating your emotions and behavior or that you might develop anxiety or depression,” notes Dr. Ice.

Different diagnoses from different clinicians

Sometimes, children with several diagnoses have been seen, over the years, by different clinicians, who may have evaluated them differently and added a diagnosis without withdrawing an earlier one.

“The more interactions somebody has with the mental health system, the increased likelihood that they’ll have multiple diagnoses because of different providers seeing and hearing different things at different times,” notes Dr. Ice. A child can end up with a list of diagnoses that they’ve had in the past, but they don’t meet the criteria for anymore, she adds.

What are common co-occurring disorders?

A study of adolescents with co-occurring disorders found that slightly more than half (61 percent) had two disorders from one larger class of disorders, such as mood, anxiety, attention, or behavior disorders. Another quarter (25 percent) had disorders from two different classes, and 11 percent were affected by three different classes of disorders.

Some of the common combinations include:

- ADHD + Anxiety: Difficulty focusing, restlessness, and irritability can appear in both disorders, which can result in misdiagnosis — but many children also have both. Academic struggles, social difficulties, and consistent negative feedback can cause chronic stress, leading to anxiety over time.
- ADHD + Oppositional Defiant Disorder (ODD): Kids with ADHD may be easily frustrated and have difficulty complying or following instructions from parents and other adults, which can lead tooppositional or defiant behavior.
- ADHD + Depression: As the academic and social impact of ADHD builds up over time, kids can develop low self-esteem and depression.
- Anxiety + Depression: It’s very common for kids who experience chronic worries to develop sadness, a loss of interest in things they enjoy, and other symptoms of depression.
- Autism + ADHD: A study of more than 4,000 children with autism found that 40 percent also had ADHD. Sometimes ADHD symptoms are recognized first, and autism is diagnosed later — or vice versa. Autism and ADHD both run in families and havegenetic factors in common.
- Anxiety + OCD: OCD is an anxiety disorder, but it can appear with other anxiety types, like generalized anxiety or social anxiety.Kids may struggle with intense fears and compulsive rituals as well as general worry or panic.
- Trauma-Related Disorders + ADHD, Anxiety, Depression, or ODD: Trauma can impact a child’s mood, behavior, attention, and emotional regulation, leading to symptoms in all those areas. A trauma-informed approach is essential for accurate diagnosis and effective treatment. Trauma-informed assessments can help identify the root cause of symptoms.
- Learning Disorders + Anxiety or Depression: Children who have an extra hard time with learning often struggle with frustration and low self-esteem, which can cause them to develop anxiety or depression.
- Tic disorders + ADHD or OCD: More than three-quarters of children with Tourette’s disorder have at least one other disorder, with ADHD and anxiety being the most common.

How do you treat co-occurring disorders?

When a child has more than one disorder, how do you decide what to treat first? Whichever one seems primary, says Dr. Ice. “What is the thing that’s actually leading to the most problems? What is interfering with the child’s functioning the most — we want to figure out a plan for treating that first.”

If a child with ADHD is not paying attention in class, is hyperactive, and is getting into a lot of trouble, these difficulties could result in anxiety. “So, you treat the ADHD first, then you reassess to see if the anxiety gets better,” says Dr. Mitrani. “If it gets better, then you probably don’t need to use a medication or intervene for the anxiety. But if it doesn’t get better? Then we need to figure out how to treat the anxiety.”

Sometimes you can work on more than one disorder at the same time. A child with a learning disorder who becomes depressed should get support for their learning issues as well as treatment for depression.

But if you’re starting treatment with medication, Dr. Mitrani stresses, medicines should always be introduced one at a time. “You don’t start with two medicines at the same time because if something gets better or worse, you won’t know what the cause is,” he explains. For instance, for a child who has ADHD and anxiety, “if you start a stimulant and antidepressant at the same time and all of a sudden the child’s not sleeping, what’s causing that?”

Treating multiple disorders with medication

When treatment involves medication, the prescribing doctor needs to consider how medication for one might exacerbate or affect symptoms for another. For instance, stimulant medication for ADHD can worsen anxiety. “If a child has both, we may start with treatment for ADHD, but if the stimulant makes the anxiety worse, then we have to reassess and think about other options,” says Dr. Mitrani.

Medications for one disorder can also affect how another medication for a co-occuring disorder is metabolized — limiting its effectiveness or increasing the side effects. “Anytime you combine medications, you want to make sure there are no interactions that can worsen or compound side effects,” says Dr. Mitrani.

One of the risks when children have several mental health disorders is that they will be prescribed multiple medications without clarity on what each is intended to do and whether it is working. “The risk is that in layering medicine on medicine, you lose track of the underlying problems, and how well each medication is being tolerated,” said Dr. Mitrani.

“You can use any of these medicines in combination,” he notes, “but they need to be combined carefully to get an accurate picture of their effectiveness and manage side effects, especially when you’re dealing with meds that have more concerning side effects, like antipsychotics.”

Therapy and co-occurring disorders

One disorder could also make it more difficult for a child to participate successfully in therapy for another disorder. For instance, if a child has social anxiety and depression, the social anxiety could interfere with their ability to engage in therapy for depression that includes participation in a group, such as DBT (dialectical behavior therapy). If a child has ADHD and anxiety, the ADHD can interfere with their ability to follow through with a step-by-step treatment for anxiety like exposure and response prevention (ERP).

Kids with several mental health challenges may require more tailored treatment. “This involves adapting typical treatment for one of the diagnoses to include what is beneficial for the other diagnosis as well,” says Dr. Ice. For instance, the standardcognitive behavior therapy treatment for anxiety, Coping Cat, has been customized for autistic kids with anxiety, resulting in a treatment called BIACA (Behavioral Interventions for Anxiety in Children with Autism).

Dr. Mitrani stresses the importance of making sure to educate parents on all their options. “What’s possible with medicine? What’s possible with therapy? Where is parent work important? Where is working with the schools important? Since medications can come with concerning side effects, we want to make sure we’re setting specific goals for treatment interventions, carefully monitoring those interventions for effectiveness, and adjust things or bring in other approaches as needed.”

Frequently Asked Questions

What does it mean if my child has multiple diagnoses?

When a child is diagnosed with multiple mental health disorders, it means they have symptoms that can’t all be explained by one condition. Identifying each diagnosis helps clinicians choose treatments that address more of your child’s challenges — it doesn’t mean your child is “sicker.”

Is it common for kids to have more than one diagnosis?

Can one treatment plan address multiple diagnoses?

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/james-donaldson-on-mental-health-kids-with-multiple-diagnoses/

Why many children have more than one mental health or learning disorder

Photo by samer daboul on Pexels.com

Writer: Caroline Miller

Clinical Experts: Paul Mitrani, MD, PhD , Megan Ice, PhD

Key Takeaways

- Many children have more than one mental health or learning disorder, not because they are “sicker,” but because their symptoms can’t be fully explained by a single diagnosis.

- Co-occurring disorders are common because many conditions share underlying brain systems, and one disorder can often lead to another over time.

- Treatment usually begins with focusing on the disorder causing the most impairment, and monitoring the impact on the other, adapting medication or therapy as needed.

- Why are multiple diagnoses common in kids?

- What are common co-occurring disorders?

- How do you treat co-occurring disorders?

- Treating multiple disorders with medication

- Therapy and co-occurring disorders

When you have a child diagnosed with a mental health or learning disorder, it’s not unusual to find out that they also meet the criteria for another diagnosis. Your teen with ADHD might also have anxiety. Your first grader with autism might also have ADHD.

Sometimes multiple diagnoses — also known as “co-occurring” or “comorbid” disorders — are made at the same time. A child who is struggling might be evaluated and diagnosed with anxiety and depression, for example. But often a child is first diagnosed with one thing and anotherdiagnosis is added later.

“Families can feel overwhelmed hearing that their child has multiple diagnoses,” notes Megan Ice, PhD, a clinical psychologist at the Child Mind Institute. “There can be the perception that the more diagnoses, the sicker the child is.”

But that’s not necessarily the case. When a child has multiple diagnoses, it means they have symptoms that can’t all be attributed to or treated by one diagnosis. “By identifying multiple diagnoses, we’re able to open up paths for the treatments that will be effective for more of the symptoms,” Dr. Ice explains.

Why are multiple diagnoses common in kids?

In one widely cited study of 10,000 adolescents, 40 percent of those who had one mental health disorder met the criteria for another. But there are a variety of reasons why mental health and learning disorders so often occur together.

Multiple diagnoses, same brain system

Some disorders are linked to the same brain systems. “If you’re diagnosed with one anxiety disorder, like selective mutism, the likelihood is high that you’re going to have another anxiety disorder, like specific phobia, generalized anxiety disorder, or social anxiety,” says Paul Mitrani, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute. “It makes sense because it’s the same brain system that’s affected, just presenting in several different ways. So that that’s very common.”

Several different disorders can be linked to the same neurotransmitters — chemicals like dopamine and serotonin that are used to send messages in the brain. For instance, the serotonin system is involved in both anxiety and depression. “When the pathways related to serotonin in the brain are not working as well,” says Dr. Mitrani, “you’re at a higher risk for anxiety, as well as depression and OCD. ”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

One disorder can lead to another

But it’s also common for a child’s struggles with one disorder to lead to another. For instance, a child with ADHD whose impulsivity leads to a lot of conflict with their parents can develop a behavior disorder. Kids with autism might develop anxiety because the world feels unpredictable and overwhelming. Or children with learning disorders who are struggling in school may develop anxiety or depression.

“It can be really hard to have ADHD or autism, or to struggle with learning, so it makes sense that you might have difficulty regulating your emotions and behavior or that you might develop anxiety or depression,” notes Dr. Ice.

Different diagnoses from different clinicians

Sometimes, children with several diagnoses have been seen, over the years, by different clinicians, who may have evaluated them differently and added a diagnosis without withdrawing an earlier one.

“The more interactions somebody has with the mental health system, the increased likelihood that they’ll have multiple diagnoses because of different providers seeing and hearing different things at different times,” notes Dr. Ice. A child can end up with a list of diagnoses that they’ve had in the past, but they don’t meet the criteria for anymore, she adds.

What are common co-occurring disorders?

A study of adolescents with co-occurring disorders found that slightly more than half (61 percent) had two disorders from one larger class of disorders, such as mood, anxiety, attention, or behavior disorders. Another quarter (25 percent) had disorders from two different classes, and 11 percent were affected by three different classes of disorders.

Some of the common combinations include:

- ADHD + Anxiety: Difficulty focusing, restlessness, and irritability can appear in both disorders, which can result in misdiagnosis — but many children also have both. Academic struggles, social difficulties, and consistent negative feedback can cause chronic stress, leading to anxiety over time.

- ADHD + Oppositional Defiant Disorder (ODD): Kids with ADHD may be easily frustrated and have difficulty complying or following instructions from parents and other adults, which can lead tooppositional or defiant behavior.

- ADHD + Depression: As the academic and social impact of ADHD builds up over time, kids can develop low self-esteem and depression.

- Anxiety + Depression: It’s very common for kids who experience chronic worries to develop sadness, a loss of interest in things they enjoy, and other symptoms of depression.

- Autism + ADHD: A study of more than 4,000 children with autism found that 40 percent also had ADHD. Sometimes ADHD symptoms are recognized first, and autism is diagnosed later — or vice versa. Autism and ADHD both run in families and havegenetic factors in common.

- Anxiety + OCD: OCD is an anxiety disorder, but it can appear with other anxiety types, like generalized anxiety or social anxiety.Kids may struggle with intense fears and compulsive rituals as well as general worry or panic.

- Trauma-Related Disorders + ADHD, Anxiety, Depression, or ODD: Trauma can impact a child’s mood, behavior, attention, and emotional regulation, leading to symptoms in all those areas. A trauma-informed approach is essential for accurate diagnosis and effective treatment. Trauma-informed assessments can help identify the root cause of symptoms.

- Learning Disorders + Anxiety or Depression: Children who have an extra hard time with learning often struggle with frustration and low self-esteem, which can cause them to develop anxiety or depression.

- Tic disorders + ADHD or OCD: More than three-quarters of children with Tourette’s disorder have at least one other disorder, with ADHD and anxiety being the most common.

How do you treat co-occurring disorders?

When a child has more than one disorder, how do you decide what to treat first? Whichever one seems primary, says Dr. Ice. “What is the thing that’s actually leading to the most problems? What is interfering with the child’s functioning the most — we want to figure out a plan for treating that first.”

If a child with ADHD is not paying attention in class, is hyperactive, and is getting into a lot of trouble, these difficulties could result in anxiety. “So, you treat the ADHD first, then you reassess to see if the anxiety gets better,” says Dr. Mitrani. “If it gets better, then you probably don’t need to use a medication or intervene for the anxiety. But if it doesn’t get better? Then we need to figure out how to treat the anxiety.”

Sometimes you can work on more than one disorder at the same time. A child with a learning disorder who becomes depressed should get support for their learning issues as well as treatment for depression.

But if you’re starting treatment with medication, Dr. Mitrani stresses, medicines should always be introduced one at a time. “You don’t start with two medicines at the same time because if something gets better or worse, you won’t know what the cause is,” he explains. For instance, for a child who has ADHD and anxiety, “if you start a stimulant and antidepressant at the same time and all of a sudden the child’s not sleeping, what’s causing that?”

Treating multiple disorders with medication

When treatment involves medication, the prescribing doctor needs to consider how medication for one might exacerbate or affect symptoms for another. For instance, stimulant medication for ADHD can worsen anxiety. “If a child has both, we may start with treatment for ADHD, but if the stimulant makes the anxiety worse, then we have to reassess and think about other options,” says Dr. Mitrani.

Medications for one disorder can also affect how another medication for a co-occuring disorder is metabolized — limiting its effectiveness or increasing the side effects. “Anytime you combine medications, you want to make sure there are no interactions that can worsen or compound side effects,” says Dr. Mitrani.

One of the risks when children have several mental health disorders is that they will be prescribed multiple medications without clarity on what each is intended to do and whether it is working. “The risk is that in layering medicine on medicine, you lose track of the underlying problems, and how well each medication is being tolerated,” said Dr. Mitrani.

“You can use any of these medicines in combination,” he notes, “but they need to be combined carefully to get an accurate picture of their effectiveness and manage side effects, especially when you’re dealing with meds that have more concerning side effects, like antipsychotics.”

Therapy and co-occurring disorders

One disorder could also make it more difficult for a child to participate successfully in therapy for another disorder. For instance, if a child has social anxiety and depression, the social anxiety could interfere with their ability to engage in therapy for depression that includes participation in a group, such as DBT (dialectical behavior therapy). If a child has ADHD and anxiety, the ADHD can interfere with their ability to follow through with a step-by-step treatment for anxiety like exposure and response prevention (ERP).

Kids with several mental health challenges may require more tailored treatment. “This involves adapting typical treatment for one of the diagnoses to include what is beneficial for the other diagnosis as well,” says Dr. Ice. For instance, the standardcognitive behavior therapy treatment for anxiety, Coping Cat, has been customized for autistic kids with anxiety, resulting in a treatment called BIACA (Behavioral Interventions for Anxiety in Children with Autism).

Dr. Mitrani stresses the importance of making sure to educate parents on all their options. “What’s possible with medicine? What’s possible with therapy? Where is parent work important? Where is working with the schools important? Since medications can come with concerning side effects, we want to make sure we’re setting specific goals for treatment interventions, carefully monitoring those interventions for effectiveness, and adjust things or bring in other approaches as needed.”

Frequently Asked Questions

What does it mean if my child has multiple diagnoses?

When a child is diagnosed with multiple mental health disorders, it means they have symptoms that can’t all be explained by one condition. Identifying each diagnosis helps clinicians choose treatments that address more of your child’s challenges — it doesn’t mean your child is “sicker.”

Is it common for kids to have more than one diagnosis?

Can one treatment plan address multiple diagnoses?

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/?p=16425

James Donaldson on Mental Health - Learning Disabilities and Depression

Why kids with LDs often develop depression, and need emotional support, too

Writer: Molly Hagan

Clinical Experts: Laura Phillips, PsyD, ABPdN , Helene Omansky, LCSW

https://www.youtube.com/watch?v=4uIAhuvwFIk

What You'll Learn

- Why are kids with LDs more likely to be depressed?
- How does school affect a child's self-esteem?
- How can parents and teachers emotionally support kids with learning disabilities?
- Quick Read
- Full Article
- School and self-worth
- Academic challenges get tougher
- Comparisons with peers
- Hiding the signs
- A vicious cycle — how depression impacts learning
- Classroom safety
- Combining academic and emotional supports
- Learning Disabilities and Depression
- How Depression Affects Kids in School

Quick Read

Research shows that children with learning disabilities run a higher risk of developing depression than other kids — and that this risk increases as they get older.

Depression comes from feelings of hopelessness and low self-worth. And the struggles kids have at school play a big role in how good or bad they feel about themselves. These challenges include more difficult work in the classroom as kids get older but also social problems.

When kids turn 8 or 9, they begin to compare themselves to their friends and peers. Kids with LDs might feel embarrassed by their learning challenges and want to hide them. Some kids will act out. Others, including many girls, will withdraw at school, and from friends  — which makes it much harder for parents and teachers to know that they have a learning disorder in the first place.

Dealing with undiagnosed learning disabilities can make kids anxious and depressed. And depression and anxiety, in turn, can affect the brain, making it harder to remember things and concentrate. Because being anxious or depressed makes it hard to learn, schools are beginning to teach social and emotional learning (SEL) skills to kids with LDs, to help them cope with difficult feelings. Learning support by itself is not enough to help kids succeed.

But while SEL skills are very helpful, kids showing signs of depression — like being tired all the time, seeming sad, or losing interest in things they usually enjoy — should see a medical professional for treatment.

We think of learning disabilities as affecting kids in school, but challenges in skills like reading, writing, math, and language affect all aspects of life, not just academic performance. We are using them all the time — reading street signs, counting change, playing games, and following conversations with friends.

Struggling with skills that appear to come easily to others, inside the classroom or out, can take an emotional toll starting at an early age. Research shows that children with learning disorders are at higher risk for developing depression. This risk increases as children enter their teenage years.

“Kids spend the majority of their waking hours in school,” says Laura Phillips, PhD, a neuropsychologist. “When you spend eight hours a day engaged in something that’s challenging for you it has a very significant impact on your self-concept — meaning your idea about who you are as a person — and your ability to feel successful.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

School and self-worth

Depression can manifest in different ways:

- Appearing sad or irritable
- Trouble sleeping
- Losing interest in things you once enjoyed 
- Being tired all the time
- Gaining or losing a lot of weight

But at its root are feelings of hopelessness and low self-worth. Studies show that for kids with learning disorders, the school environment can contribute to and breed these feelings.

A child with an undiagnosed learning disability is particularly at risk for depression because they don’t understand why they struggle with things that others don’t. Frustration and failure create a sense that something must be wrong with them. A diagnosis can be reassuring and offer them the support they need — but success will still be a struggle. When it comes to a child’s emotions, an LD diagnosis is not a magic bullet.

??“It doesn’t always feel better right away,” notes Helene Omansky, LCSW, a senior social worker at the Child Mind Institute. “It will get better, but newly diagnosed kids need time to adjust to their support system, and to develop confidence in skills that they may have lacked.”

If you think your child might be depressed, consult a medical professional for help — but know there are ways parents and teachers can offer support, too.

Academic challenges get tougher

The requirements of school change as you get older, and there’s one shift that can be particularly tough for kids, especially those with reading and language deficits. “From kindergarten through second grade, you’re learning how to read,” Dr. Phillips explains. “By third grade, the emphasis shifts to reading to learn.”

In other words, reading becomes incorporated into every class. Kids who struggled in language arts classes but prided themselves on their math skills are suddenly confronted with math word problems. “And then they lose that confidence in the thing that might’ve been maintaining their sense of self and self-esteem,” Dr. Phillips explains.

This change is the first of many. Kids will continue to wrestle with their challenges in unexpected ways, and this can be discouraging.

“The impact of alearning disorder becomes more widespread as you move through school,” Dr. Phillips says.

It’s important for parents to understand the depth of frustration a child may be feeling and acknowledge it, says Omansky. We’re naturally inclined to dispel negativity with encouragement — “You’re so smart!” — but this can make a child feel isolated and unheard. If a child is saying they feel dumb because they can’t figure out how to solve a word problem, Omansky says, “It’s okay to validate that by saying something like, ‘I can see how frustrating this is for you.’”

Comparisons with peers

Around 8 or 9 years old, kids become less self-focused and begin to understand themselves in the context of — and in comparison, to — their peers. Where before school was merely frustrating, now kids may wonder why certain things appear to come easily to others. They may feel like they’re working twice as hard as those around them, and understandably, they may think this is unfair.

Kids also become more self-conscious at this age and might feel like their deficits are on display. This can look like a kid who doesn’t want to raise their hand in class, but it can also look like a kid who plays by themselves at recess. When a child can’t solve a math problem or gets called out for not finishing an assignment, it’s easy for them to go from “I feel dumb” to “Nobody is going to like me,” Omansky notes.

Kids with learning challenges can also struggle with social skills, such as following the thread of a conversation or finding the right words to respond. They sometimes fumble social cues, and given enough negative feedback, might avoid socializing altogether.

Some kids draw attention away from their challenges by acting out. Being perceived as funny or rebellious might even bolster your self-esteem. But avoiding your challenges doesn’t make you feel any better about them, it just makes you more determined to hide them.

Hiding the signs

Rates of learning disorders are not significantly different among genders, but boys are more likely to be diagnosed because of their tendency to be disruptive in class — an obvious red flag. Girls, meanwhile, tend to withdraw, making identification harder.

“Girls are much more likely to quietly sit in the back of the class and try to sink into the ground,” Dr. Phillips says.

This translates to girls not receiving a learning disorder diagnosis or being diagnosed late. When LDs are overlooked, a child’s anxiety or depression can be the first recognized signs that they need help. “They might become highly anxious or more academically demoralized,” says Dr Phillips. “So, it might be the anxiety or depression that first brings them to clinical attention.”

It’s important for adults to empathize with this experience, too. “Well-intended parents and teachers don’t want to put a spotlight on a kid unnecessarily, but they may not be asking the right questions that would allow for further intervention or exploration,” says Omansky. When a child is anxious, unmotivated, or depressed, the adults in their lives should investigate if they might be struggling, she adds. “Kids don’t always have the skillset to know how to self-advocate and say, ‘I don’t understand.’”

A vicious cycle — how depression impacts learning

Depression can actually impact cognitive functions, making learning challenges more acute.

Research shows that depression can:

- Slow information processing
- Slow memory consolidation, or how your brain transforms the things you learn into long-term memories
- Make it harder to pay attention and concentrate
- Interfere with sleep, which can also be bad for your brain

It’s a vicious cycle — learning challenges contributing to depression, contributing to more challenges — but there are ways to interrupt it.

Classroom safety

How a child relates to their school environment can also affect how they learn and how they see themselves. This is a particularly important factor for Black children and other children of color, especially if they attend predominantly white schools. “If there’s a difference in skin color between kids and their teachers, they might enter the classroom with a different level of anxious arousal that they have to overcome in order to be fully engaged,” Dr. Phillips says.

If the school environment already makes you anxious, you’re more likely to shut down if learning is also a challenge. You might even develop a fear of going to school at all. Teachers should be aware that kids don’t experience school in a vacuum. They should understand the racial, cultural, demographic factors that impact kids, so kids feel safe enough to learn and ask for help if they need it.

Combining academic and emotional supports

Schools are beginning to embrace emotional supports for children with learning disorders. When kids feel defeated by their challenges, and resist learning because it makes them feel bad about themselves, academic support alone is not enough.

Increasingly, schools are using  social and emotional learning (SEL) techniques to help kids develop an awareness of the emotions that drive their behaviors — whether they are acting out, trying to disappear, or simply avoiding the tasks that are most difficult for them.

Kids can be taught strategies to manage big emotions around learning. Take kids with math learning disorders, who become anxious when asked to solve math problems. They tend to engage in negative self-talk — “I’m so bad at math. I’m going to fail this math test. I’m so stupid, I’m not going to get into college.”

The negative self-talk interferes with problem solving. “It taxes your working memory to the point where you can’t effectively problem solve,” explains Dr. Phillips. “So, you do poorly and then you see yourself as a bad math student.”

But kids can interrupt the cycle with a simple trick: saying the steps of the math problem as they do them. “If you’re verbally working through the steps, you can’t engage in negative self-talk and so you can’t tax the working memory system,” she adds.  “It’s very effective.”

The ability to embrace this kind of creative problem-solving is the secret weapon of having a learning disorder — but when a child shows signs of depression, it’s important to seek professional treatment. Understanding that emotional challenges and learning challenges are intertwined can help parents get kids the support they need.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-learning-disabilities-and-depression-2/

Why kids with LDs often develop depression, and need emotional support, too

Writer: Molly Hagan

Clinical Experts: Laura Phillips, PsyD, ABPdN , Helene Omansky, LCSW

https://www.youtube.com/watch?v=4uIAhuvwFIk

What You'll Learn

- Why are kids with LDs more likely to be depressed?

- How does school affect a child's self-esteem?

- How can parents and teachers emotionally support kids with learning disabilities?

- Quick Read

- Full Article

- School and self-worth

- Academic challenges get tougher

- Comparisons with peers

- Hiding the signs

- A vicious cycle — how depression impacts learning

- Classroom safety

- Combining academic and emotional supports

- Learning Disabilities and Depression

- How Depression Affects Kids in School

Quick Read

Research shows that children with learning disabilities run a higher risk of developing depression than other kids — and that this risk increases as they get older.

Depression comes from feelings of hopelessness and low self-worth. And the struggles kids have at school play a big role in how good or bad they feel about themselves. These challenges include more difficult work in the classroom as kids get older but also social problems.

When kids turn 8 or 9, they begin to compare themselves to their friends and peers. Kids with LDs might feel embarrassed by their learning challenges and want to hide them. Some kids will act out. Others, including many girls, will withdraw at school, and from friends  — which makes it much harder for parents and teachers to know that they have a learning disorder in the first place.

Dealing with undiagnosed learning disabilities can make kids anxious and depressed. And depression and anxiety, in turn, can affect the brain, making it harder to remember things and concentrate. Because being anxious or depressed makes it hard to learn, schools are beginning to teach social and emotional learning (SEL) skills to kids with LDs, to help them cope with difficult feelings. Learning support by itself is not enough to help kids succeed.

But while SEL skills are very helpful, kids showing signs of depression — like being tired all the time, seeming sad, or losing interest in things they usually enjoy — should see a medical professional for treatment.

We think of learning disabilities as affecting kids in school, but challenges in skills like reading, writing, math, and language affect all aspects of life, not just academic performance. We are using them all the time — reading street signs, counting change, playing games, and following conversations with friends.

Struggling with skills that appear to come easily to others, inside the classroom or out, can take an emotional toll starting at an early age. Research shows that children with learning disorders are at higher risk for developing depression. This risk increases as children enter their teenage years.

“Kids spend the majority of their waking hours in school,” says Laura Phillips, PhD, a neuropsychologist. “When you spend eight hours a day engaged in something that’s challenging for you it has a very significant impact on your self-concept — meaning your idea about who you are as a person — and your ability to feel successful.”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

School and self-worth

Depression can manifest in different ways:

- Appearing sad or irritable

- Trouble sleeping

- Losing interest in things you once enjoyed 

- Being tired all the time

- Gaining or losing a lot of weight

But at its root are feelings of hopelessness and low self-worth. Studies show that for kids with learning disorders, the school environment can contribute to and breed these feelings.

A child with an undiagnosed learning disability is particularly at risk for depression because they don’t understand why they struggle with things that others don’t. Frustration and failure create a sense that something must be wrong with them. A diagnosis can be reassuring and offer them the support they need — but success will still be a struggle. When it comes to a child’s emotions, an LD diagnosis is not a magic bullet.

??“It doesn’t always feel better right away,” notes Helene Omansky, LCSW, a senior social worker at the Child Mind Institute. “It will get better, but newly diagnosed kids need time to adjust to their support system, and to develop confidence in skills that they may have lacked.”

If you think your child might be depressed, consult a medical professional for help — but know there are ways parents and teachers can offer support, too.

Academic challenges get tougher

The requirements of school change as you get older, and there’s one shift that can be particularly tough for kids, especially those with reading and language deficits. “From kindergarten through second grade, you’re learning how to read,” Dr. Phillips explains. “By third grade, the emphasis shifts to reading to learn.”

In other words, reading becomes incorporated into every class. Kids who struggled in language arts classes but prided themselves on their math skills are suddenly confronted with math word problems. “And then they lose that confidence in the thing that might’ve been maintaining their sense of self and self-esteem,” Dr. Phillips explains.

This change is the first of many. Kids will continue to wrestle with their challenges in unexpected ways, and this can be discouraging.

“The impact of alearning disorder becomes more widespread as you move through school,” Dr. Phillips says.

It’s important for parents to understand the depth of frustration a child may be feeling and acknowledge it, says Omansky. We’re naturally inclined to dispel negativity with encouragement — “You’re so smart!” — but this can make a child feel isolated and unheard. If a child is saying they feel dumb because they can’t figure out how to solve a word problem, Omansky says, “It’s okay to validate that by saying something like, ‘I can see how frustrating this is for you.’”

Comparisons with peers

Around 8 or 9 years old, kids become less self-focused and begin to understand themselves in the context of — and in comparison, to — their peers. Where before school was merely frustrating, now kids may wonder why certain things appear to come easily to others. They may feel like they’re working twice as hard as those around them, and understandably, they may think this is unfair.

Kids also become more self-conscious at this age and might feel like their deficits are on display. This can look like a kid who doesn’t want to raise their hand in class, but it can also look like a kid who plays by themselves at recess. When a child can’t solve a math problem or gets called out for not finishing an assignment, it’s easy for them to go from “I feel dumb” to “Nobody is going to like me,” Omansky notes.

Kids with learning challenges can also struggle with social skills, such as following the thread of a conversation or finding the right words to respond. They sometimes fumble social cues, and given enough negative feedback, might avoid socializing altogether.

Some kids draw attention away from their challenges by acting out. Being perceived as funny or rebellious might even bolster your self-esteem. But avoiding your challenges doesn’t make you feel any better about them, it just makes you more determined to hide them.

Hiding the signs

Rates of learning disorders are not significantly different among genders, but boys are more likely to be diagnosed because of their tendency to be disruptive in class — an obvious red flag. Girls, meanwhile, tend to withdraw, making identification harder.

“Girls are much more likely to quietly sit in the back of the class and try to sink into the ground,” Dr. Phillips says.

This translates to girls not receiving a learning disorder diagnosis or being diagnosed late. When LDs are overlooked, a child’s anxiety or depression can be the first recognized signs that they need help. “They might become highly anxious or more academically demoralized,” says Dr Phillips. “So, it might be the anxiety or depression that first brings them to clinical attention.”

It’s important for adults to empathize with this experience, too. “Well-intended parents and teachers don’t want to put a spotlight on a kid unnecessarily, but they may not be asking the right questions that would allow for further intervention or exploration,” says Omansky. When a child is anxious, unmotivated, or depressed, the adults in their lives should investigate if they might be struggling, she adds. “Kids don’t always have the skillset to know how to self-advocate and say, ‘I don’t understand.’”

A vicious cycle — how depression impacts learning

Depression can actually impact cognitive functions, making learning challenges more acute.

Research shows that depression can:

- Slow information processing

- Slow memory consolidation, or how your brain transforms the things you learn into long-term memories

- Make it harder to pay attention and concentrate

- Interfere with sleep, which can also be bad for your brain

It’s a vicious cycle — learning challenges contributing to depression, contributing to more challenges — but there are ways to interrupt it.

Classroom safety

How a child relates to their school environment can also affect how they learn and how they see themselves. This is a particularly important factor for Black children and other children of color, especially if they attend predominantly white schools. “If there’s a difference in skin color between kids and their teachers, they might enter the classroom with a different level of anxious arousal that they have to overcome in order to be fully engaged,” Dr. Phillips says.

If the school environment already makes you anxious, you’re more likely to shut down if learning is also a challenge. You might even develop a fear of going to school at all. Teachers should be aware that kids don’t experience school in a vacuum. They should understand the racial, cultural, demographic factors that impact kids, so kids feel safe enough to learn and ask for help if they need it.

Combining academic and emotional supports

Schools are beginning to embrace emotional supports for children with learning disorders. When kids feel defeated by their challenges, and resist learning because it makes them feel bad about themselves, academic support alone is not enough.

Increasingly, schools are using  social and emotional learning (SEL) techniques to help kids develop an awareness of the emotions that drive their behaviors — whether they are acting out, trying to disappear, or simply avoiding the tasks that are most difficult for them.

Kids can be taught strategies to manage big emotions around learning. Take kids with math learning disorders, who become anxious when asked to solve math problems. They tend to engage in negative self-talk — “I’m so bad at math. I’m going to fail this math test. I’m so stupid, I’m not going to get into college.”

The negative self-talk interferes with problem solving. “It taxes your working memory to the point where you can’t effectively problem solve,” explains Dr. Phillips. “So, you do poorly and then you see yourself as a bad math student.”

But kids can interrupt the cycle with a simple trick: saying the steps of the math problem as they do them. “If you’re verbally working through the steps, you can’t engage in negative self-talk and so you can’t tax the working memory system,” she adds.  “It’s very effective.”

The ability to embrace this kind of creative problem-solving is the secret weapon of having a learning disorder — but when a child shows signs of depression, it’s important to seek professional treatment. Understanding that emotional challenges and learning challenges are intertwined can help parents get kids the support they need. https://standingabovethecrowd.com/?p=16422

Understanding suicide, identity, and collective loss in sport.

Tess M. Kilwein PhD, ABPP, CMPC

Reviewed by Jessica Schrader

THE BASICS

- Suicide Risk Factors and Signs

- Take our Depression Test

- Find a therapist near me

Key points

- Grief in sport settings affects identity, performance, and psychological safety.

- Athlete suicide risk is shaped by pressure, identity foreclosure, injury, and barriers to care.

- Teams need proactive suicide response protocols before a crisis occurs.

When a death occurs in a sport environment, particularly a death by suicide, its impact can ripple through entire organizations. Athletes, coaches, and sport staff, including those tasked with supporting organizations through crises (e.g., sport psychologists, athletic counselors), often experience collective waves of shock, grief, and unanswered questions.

This reality was central to a recent conversation with professional soccer player for RC Strasbourg Sierra Enge and adolescent mental health and suicide expert Dr. Kimberly O’Brien. Together, Sierra and O’Brien bring both lived and professional experience to the intersection of grief, suicide prevention, and athlete mental health. Throughout our discussion, their perspectives underscored a critical truth: we still do not fully understand the weight or complexity of grief and loss within sport environments, especially when that loss is due to suicide.

Athlete Identity and the Pressure to Perform

For many athletes, sport is not just something they do. Over time, it becomes central to who they are. Sierra described growing up excelling in soccer and receiving external reinforcement that her value was directly tied to performance. Social media, increased visibility, and constant evaluation intensified this dynamic over time. She continues to navigate these same pressures as a professional athlete today.

When performance declines, injury occurs, or life circumstances disrupt sport participation, many athletes experience a significant rupture in identity. In these moments, the internal message can quickly become, “If I am not performing, I am not valuable.” This belief can fuel social and emotional challenges, including anxiety, withdrawal from sport, and social isolation.

With time, peer and professional support, and meaningful shifts in perspective, Sierra learned that she functions best when she invests in multiple parts of herself, not solely soccer. While she continues to train intensely and care deeply about her sport, the difference is that performance alone no longer determines her self-worth.

O’Brien observes this same pattern in her work with athletes across the lifespan, particularly adolescents and young adults. She emphasized that overidentification with sport can limit coping flexibility when adversity hits. To support both mental health and long-term performance, athletes need identities that extend beyond their role on the field.

Why Today’s Athletes Are Carrying More

Athletes today are navigating higher stakes and broader demands than many prior generations. Dr. O’Brien emphasized the convergence of academic and athletic pressures, while Sierra highlighted the growing expectations tied to NIL deals, public scrutiny, and constant social media comparison.

A recent systematic review examining suicide risk among college student-athletes identified several contributors, including the convergence of academic and athletic pressures, toxic or psychologically unsafe team cultures, barriers to accessing confidential mental health services, identity foreclosure tied to sport, and injury-related stressors (Anton-Lotruglio & O’Brien, 2025). These factors accumulate over time, increasing vulnerability when coping resources are already strained.

Evidence suggests that this stress exposure begins well before college. One study of high school athletes revealed that 91% reported experiencing sport-related stress, with 27% endorsing moderate to extreme levels of stress associated with athletic participation (Ward et al., 2023). This chronic stress becomes normalized long before youth athletes enter elite or collegiate sport environments.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Remembering Katie Meyer

The reality of grief in sport is best understood through the experiences of those most closely impacted. Sierra and Katie Meyer were best friends, teammates, and co-captains at Stanford University. Katie’s death by suicide in 2022 shook the college sport world and brought renewed attention to athlete mental health.

When I asked Sierra what she would say to Katie now, her message was simple and urgent: Tell someone. Make one call. Hold on a little longer. Even one trusted person can change the trajectory of a life.

At the same time, Sierra acknowledged how difficult this can be for student-athletes who are taught to be tough from a young age. “It’s not going to be an easy road,” she shared, “but if you open up to one person, maybe they can walk with you.”

Sierra speaks openly about her own mental health and her use of therapy, encouraging others to do the same. She reflected that while she had developed many independent coping skills over the years, she came to recognize how essential asking for help became as she worked through the loss of Katie.

O’Brien emphasized that suicidal crises distort perception. Emotional pain overwhelms the brain’s ability to generate alternatives. In moments of extreme distress, suicide can feel like the only option, not because others do not exist, but because the brain under intense stress cannot access them. This is why both O’Brien and Sierra emphasize the importance of social connection and accessing support before distress reaches a critical point.

Both also stress that therapy should not be a last resort for athletes. Instead, it should be treated as a protective resource. Building a relationship with a mental health professional when life feels stable creates a safety net for when it does not. “It can’t hurt,” Sierra emphasized.

Supporting Teams After Suicide

When a suicide affects a sports team, grief becomes collective, carried through the hallways, fields, and offices of athletic departments. O’Brien’s work centers on restoring psychological safety so teams and organizations can function, communicate, and ultimately heal.

This includes psychoeducation about suicide-specific grief, facilitating conversations about support needs, and helping teams navigate decisions related to memorials, daily routines, and returning to play. O’Brien emphasizes that there is no single correct response. Athletes grieve differently, and flexibility within structure is essential.

Sierra echoed this sentiment, noting that returning to structure supported her healing, while pressure to adhere to that structure when more time was needed to process caused long-term harm for one of her teammates.

Both Sierra and O’Brien emphasized that external consultants are often critical in moments of tragedy, particularly when loss involves suicide. Internal staff and coaches are grieving as well. Outside support offers containment, neutrality, and guidance at times when decision-making feels overwhelming or impossible for those closest to the loss.

Why Institutions Must Prepare in Advance

One of the clearest takeaways from my discussion with Sierra and O’Brien is that sport systems too often wait until tragedy strikes to develop a response. Suicide response protocols must exist before they are needed, especially when emotional resources are limited and decision-making capacity is compromised.

Effective institutional responses include:

- Clear suicide and crisis response protocols.

- Flexible attendance and training expectations without retaliation.

- Multiple layers of support for athletes, coaches, and staff.

- Centering survivors and respecting varied grief timelines.

Routine with flexibility allows athletes to re-engage at their own pace. “If you can come, come. If you cannot, do not,” stated Sierra.

Carrying Forward What Matters

At the end of our conversation, Sierra reflected on her friend Katie Meyer’s capacity to love deeply and consistently show up for others. Her legacy challenges sport communities to do the same. “Soccer is a sport. It’s not that serious,” Sierra shared. She expressed hope that it will not take another loss for teams to recognize this truth.

Grief and loss will continue to enter sport spaces. The critical question is whether those environments are prepared to meet it with humanity, structure, and care. Mental health support for athletes is not only a performance asset. In moments of profound loss, it is life-saving.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory. https://standingabovethecrowd.com/?p=16419

James Donaldson on Mental Health - When Grief Enters the Locker Room

Understanding suicide, identity, and collective loss in sport.

Tess M. Kilwein PhD, ABPP, CMPC

Reviewed by Jessica Schrader

THE BASICS

- Suicide Risk Factors and Signs
- Take our Depression Test
- Find a therapist near me
Key points
- Grief in sport settings affects identity, performance, and psychological safety.
- Athlete suicide risk is shaped by pressure, identity foreclosure, injury, and barriers to care.
- Teams need proactive suicide response protocols before a crisis occurs.

When a death occurs in a sport environment, particularly a death by suicide, its impact can ripple through entire organizations. Athletes, coaches, and sport staff, including those tasked with supporting organizations through crises (e.g., sport psychologists, athletic counselors), often experience collective waves of shock, grief, and unanswered questions.

This reality was central to a recent conversation with professional soccer player for RC Strasbourg Sierra Enge and adolescent mental health and suicide expert Dr. Kimberly O’Brien. Together, Sierra and O’Brien bring both lived and professional experience to the intersection of grief, suicide prevention, and athlete mental health. Throughout our discussion, their perspectives underscored a critical truth: we still do not fully understand the weight or complexity of grief and loss within sport environments, especially when that loss is due to suicide.

Athlete Identity and the Pressure to Perform

For many athletes, sport is not just something they do. Over time, it becomes central to who they are. Sierra described growing up excelling in soccer and receiving external reinforcement that her value was directly tied to performance. Social media, increased visibility, and constant evaluation intensified this dynamic over time. She continues to navigate these same pressures as a professional athlete today.

When performance declines, injury occurs, or life circumstances disrupt sport participation, many athletes experience a significant rupture in identity. In these moments, the internal message can quickly become, “If I am not performing, I am not valuable.” This belief can fuel social and emotional challenges, including anxiety, withdrawal from sport, and social isolation.

With time, peer and professional support, and meaningful shifts in perspective, Sierra learned that she functions best when she invests in multiple parts of herself, not solely soccer. While she continues to train intensely and care deeply about her sport, the difference is that performance alone no longer determines her self-worth.

O’Brien observes this same pattern in her work with athletes across the lifespan, particularly adolescents and young adults. She emphasized that overidentification with sport can limit coping flexibility when adversity hits. To support both mental health and long-term performance, athletes need identities that extend beyond their role on the field.

Why Today’s Athletes Are Carrying More

Athletes today are navigating higher stakes and broader demands than many prior generations. Dr. O’Brien emphasized the convergence of academic and athletic pressures, while Sierra highlighted the growing expectations tied to NIL deals, public scrutiny, and constant social media comparison.

A recent systematic review examining suicide risk among college student-athletes identified several contributors, including the convergence of academic and athletic pressures, toxic or psychologically unsafe team cultures, barriers to accessing confidential mental health services, identity foreclosure tied to sport, and injury-related stressors (Anton-Lotruglio & O’Brien, 2025). These factors accumulate over time, increasing vulnerability when coping resources are already strained.

Evidence suggests that this stress exposure begins well before college. One study of high school athletes revealed that 91% reported experiencing sport-related stress, with 27% endorsing moderate to extreme levels of stress associated with athletic participation (Ward et al., 2023). This chronic stress becomes normalized long before youth athletes enter elite or collegiate sport environments.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Remembering Katie Meyer

The reality of grief in sport is best understood through the experiences of those most closely impacted. Sierra and Katie Meyer were best friends, teammates, and co-captains at Stanford University. Katie’s death by suicide in 2022 shook the college sport world and brought renewed attention to athlete mental health.

When I asked Sierra what she would say to Katie now, her message was simple and urgent: Tell someone. Make one call. Hold on a little longer. Even one trusted person can change the trajectory of a life.

At the same time, Sierra acknowledged how difficult this can be for student-athletes who are taught to be tough from a young age. “It’s not going to be an easy road,” she shared, “but if you open up to one person, maybe they can walk with you.”

Sierra speaks openly about her own mental health and her use of therapy, encouraging others to do the same. She reflected that while she had developed many independent coping skills over the years, she came to recognize how essential asking for help became as she worked through the loss of Katie.

O’Brien emphasized that suicidal crises distort perception. Emotional pain overwhelms the brain’s ability to generate alternatives. In moments of extreme distress, suicide can feel like the only option, not because others do not exist, but because the brain under intense stress cannot access them. This is why both O’Brien and Sierra emphasize the importance of social connection and accessing support before distress reaches a critical point.

Both also stress that therapy should not be a last resort for athletes. Instead, it should be treated as a protective resource. Building a relationship with a mental health professional when life feels stable creates a safety net for when it does not. “It can’t hurt,” Sierra emphasized.

Supporting Teams After Suicide

When a suicide affects a sports team, grief becomes collective, carried through the hallways, fields, and offices of athletic departments. O’Brien’s work centers on restoring psychological safety so teams and organizations can function, communicate, and ultimately heal.

This includes psychoeducation about suicide-specific grief, facilitating conversations about support needs, and helping teams navigate decisions related to memorials, daily routines, and returning to play. O’Brien emphasizes that there is no single correct response. Athletes grieve differently, and flexibility within structure is essential.

Sierra echoed this sentiment, noting that returning to structure supported her healing, while pressure to adhere to that structure when more time was needed to process caused long-term harm for one of her teammates.

Both Sierra and O’Brien emphasized that external consultants are often critical in moments of tragedy, particularly when loss involves suicide. Internal staff and coaches are grieving as well. Outside support offers containment, neutrality, and guidance at times when decision-making feels overwhelming or impossible for those closest to the loss.

Why Institutions Must Prepare in Advance

One of the clearest takeaways from my discussion with Sierra and O’Brien is that sport systems too often wait until tragedy strikes to develop a response. Suicide response protocols must exist before they are needed, especially when emotional resources are limited and decision-making capacity is compromised.

Effective institutional responses include:

- Clear suicide and crisis response protocols.
- Flexible attendance and training expectations without retaliation.
- Multiple layers of support for athletes, coaches, and staff.
- Centering survivors and respecting varied grief timelines.

Routine with flexibility allows athletes to re-engage at their own pace. “If you can come, come. If you cannot, do not,” stated Sierra.

Carrying Forward What Matters

At the end of our conversation, Sierra reflected on her friend Katie Meyer’s capacity to love deeply and consistently show up for others. Her legacy challenges sport communities to do the same. “Soccer is a sport. It’s not that serious,” Sierra shared. She expressed hope that it will not take another loss for teams to recognize this truth.

Grief and loss will continue to enter sport spaces. The critical question is whether those environments are prepared to meet it with humanity, structure, and care. Mental health support for athletes is not only a performance asset. In moments of profound loss, it is life-saving.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-when-grief-enters-the-locker-room/

James Donaldson on Mental Health - Kids and Multiple Medications

A checklist of things you should know about adding and mixing medications

Writer: Caroline Miller

Clinical Expert: Ron J. Steingard, MD

- What can go wrong with multiple medications?
- Things to consider if your doctor is proposing multiple medications

When children have complex psychiatric symptoms, or aren’t responding adequately to a medication they are taking, doctors often recommend adding another medication.

Taking multiple psychoactive medications is called “polypharmacy.” And studies show that the number of children taking more than one medication is soaring. Combining medications can be effective when they’re prescribed and monitored carefully by a doctor expert in using them with children. But it’s important for parents to know the risks inherent in adding medications, and how to tell if you should be concerned about what a doctor is recommending.

What can go wrong with multiple medications?

The risk in combining medications is that they can interact in ways that increase unwanted or harmful side effects. Let’s say your child is prescribed one medication that causes mild sedation, and a second does the same thing. The result can be so much sedation that the child isn’t herself and can’t stay awake, explains Dr. Ron Steingard, a child and adolescent psychiatrist at the Child Mind Institute.

Another medication interaction that can be problematic is if two medications use the same metabolic pathway—the mechanism in the body that breaks them down and delivers them to the target. In some cases these medications, taken together, can overwhelm that pathway and create a buildup of medication, Dr. Steingard says, and that can cause the kind of side effects you’d see with a much higher dose of one of the meds.

Finally, there’s a risk that a child is prescribed multiple medications when he would benefit more from other supports, including behavioral treatments that have been shown to be effective for kids with many issues, including ADHD, anxiety and depression.

#James Donaldson notes:
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Things to consider if your doctor is proposing multiple medications

- Your clinician should have specific training and substantial experience prescribing and managing these medications in children, not just adults. That’s because children, whose nervous systems are still maturing, don’t always respond to medication the same way adults do.
- Medications for your child should not be prescribed by two different doctors, unless they are coordinating their care and communicating with each other closely. If there are two prescribing doctors on your child’s treatment team, one should take the lead in your child’s care, and the other act as consultant.
- Whenever a medication is introduced, your doctor should explain clearly what symptoms it is expected to treat, and how you will evaluate whether the medication is helping your child.
- With any new medication, your doctor should explain what side effects to watch for, as well as anything in a child’s mood or behavior that might indicate that she’s having a bad reaction.

Related: Side Effects ofADHD Medication

- If one medication isn’t working, or is barely helping, it can also be a sign that the disorder has been wrongly diagnosed. It’s important that your doctor reevaluate the diagnosis, and the treatment, before adding other medications.
- Before a child begins taking a second medication, other supports should be explored that might have lower risks and more benefit. The combination of a single medication and behavioral treatment should be carefully considered before more meds are added.
- If your child is experiencing side effects from one medication, it’s advisable to explore either cutting back on the dose or switching medications before adding another med to treat side effects.
- A child should not begin taking two or more medications at the same time. Meds should be introduced one at a time, enabling you and your doctor to monitor any side effects that occur, and to measure the effects on your child’s mood and behavior.
- If your child is taking more than one medication, dosages should be changed one at a time. It’s impossible to evaluate the effect of each change if more than one is altered.
- New medications should be added and dosage changes made when your child’s life and routine are as stable as possible. You want to avoid times like the start of a new school year, vacation, a move to a new home, or a medical illness.
- When you change or add medications, it’s important to let everyone on your child’s team know—including her teachers and other caregivers—and check in to find out how she is doing.
- When you evaluate the effects of a medication, it’s important to not assume that any change, for better or worse, is a result of the medication. Pay attention to other changes in your child’s life at home and at school that might affect her emotions and behavior.
https://standingabovethecrowd.com/james-donaldson-on-mental-health-kids-and-multiple-medications/