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CHILDHOOD ANXIETY IN THE CLASSROOM Strategies for identifying and managing anxiety disorders in children and adolescents February 22nd, 2014 Jennifer Welbel, LPC Clinical Program Fellow Anxiety and CBT The Family Institute at Northwestern University OVERVIEW Prevalence of anxiety disorders in children and adolescents Who is the anxious child Developmental factors to consider Overview of common childhood anxiety disorders The impact of anxiety in the classroom How to talk to parents about it Classroom support strategies DEVELOPMENTALLY APPROPRIATE ANXIETY What is anxiety? Normal response to perceived danger, like a warning signal. Experienced as a general feeling of discomfort, distress, or a sense of danger Normal part of childhood development – as many as 70% of children worry about a number of things Typically occurs when children confront novel experiences and situations that they have not yet mastered NORMAL DEVELOPMENTAL FEARS Infancy (birth-8 months) •Stranger anxiety •Loud noises •Unexpected objects or people Toddlerhood (1 – 3) •Separation anxiety •Fears of thunder, lightening, fire, water, darkness, and nightmares Early Childhood (4-5) •Separation anxiety •Fear of death or dead people •Fears of ghosts, spiders, the dark, storms, monsters) Elementary School (5-7) Middle and High School (12-18) •Fear of natural disasters •Fears of serious illness •Fear of specific objects •Performance fears •Peer rejection and exclusion •Concerns about academic performance PREVALENCE OF ANXIETY DISORDERS IN CHILDREN & ADOLESCENTS 20% have an anxiety disorder by the time they turn 18 75% have onset before 21 Average age of onset: 11 PREVALENCE OF ANXIETY DISORDERS IN CHILDREN & ADOLESCENTS Insert graph with prevalance of chidlhood anxiety disorders THE IMPACT OF ANXIETY IN THE CLASSROOM Social Social isolation Fewer friends May be the target of peer ridicule Less friends Academic Performance Decrease in classroom participation May result in school refusal and/or school absences Difficulty concentrating May avoid writing on the board or asking questions in class Lower grades WHO IS THE ANXIOUS CHILD? Transitory anxiety becomes problematic anxiety when… It is excessive and out of proportion to the situation It begins to interfere in the child’s social, family, and academic functioning WHO IS THE ANXIOUS CHILD? Thoughts Physical Symptoms Feelings Behaviors WHO IS THE ANXIOUS CHILD? Thoughts •Overestimate danger •Underestimate ability to cope •Misinterpretation of cues •Future-oriented WHO IS THE ANXIOUS CHILD? Feelings •Fear •Anger •Anxiety •Irritability WHO IS THE ANXIOUS CHILD? Behaviors •Avoidance •Reassurance seeking •Need for control •Decrease in risk taking WHO IS THE ANXIOUS CHILD? Physical Symptoms •Stomachache •Headache •Muscle tension •Loss of sleep •Perspiration •Dizziness COMMON CHILDHOOD ANXIETY DISORDERS Social Anxiety Disorder Excessive fear of one or more social or performance situations, in which the child fears being judged or embarrassed COMMON CHILDHOOD ANXIETY DISORDERS Separation Anxiety Disorder Unrealistic and excessive anxiety upon separation from major attachment figures Excessive worry about potential harm to oneself and/or major attachment figures Common worries: Getting kidnapped, death, becoming ill COMMON CHILDHOOD ANXIETY DISORDERS Selective Mutism COMMON CHILDHOOD ANXIETY DISORDERS Generalized Anxiety Disorder Excessive, unrealistic, and uncontrollable worries about day to day activities “What if” concerns that span far into the future Child needs to know the details about every situation Believes that worry prevents bad things from happening COMMON CHILDHOOD ANXIETY DISORDERS Obsessive Compulsive Disorder Common Obsessions Common Compulsions • Contamination or germs • Symmetry or order • Good, bad, and magical numbers • “Just right” feeling • Fear that harm, illness, or death will befall oneself or others • Repeatedly washing • Avoiding touching “dirty” objects • Counting behavior • Rearranging items to be in a certain order • Erasing words and rewriting • Checking behavior