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Building a Healthy Future
Thursday, 21 February, 13
Anxiety – What is it?
• Anxiety - a feeling of worry or unease.
Everyone experiences it. Anxiety helps
you prepare. It’s a good thing.
• Anxiety Disorder – When the level of
anxiety is great enough to interfere with
a child’s every day activities.
Thursday, 21 February, 13
How common?
• 3 to 8% of children experience some
type of anxiety disorder at some time in
their development that is serious
enough to require treatment.
• In a class of 20 children odds are that
one is struggling with anxiety.
Thursday, 21 February, 13
How long will anxiety last?
• Without treatment, some anxiety
disorders can last a lifetime. Anxiety can
lead to depression.
Thursday, 21 February, 13
What causes anxiety
• Anxiety disorders have multiple
complex origins. It’s likely that genes
play a role in causing anxiety. However,
the home, the neighbourhood, and
other settings can contribute.
Thursday, 21 February, 13
Anxiety Misunderstood
• The behaviour of children who have
anxiety is often misunderstood.
• Children will often use avoidance
• They may be viewed as angry, defiant,
rude, ADHD, or unmotivated.
Thursday, 21 February, 13
Types-Social Phobia
• Social Phobia (Social Anxiety
• Persistent fear of social or performance
situations in which the child is exposed
to unfamiliar people or scrutiny by
• Fear that they will act in a way that is
humiliating or embarrassing.
• May show up as crying, tantrums,
freezing, or shrinking from social
Thursday, 21 February, 13
Types- Social Phobia cont.
• People with this disorder usually try to
control their symptoms by avoiding the
situations they fear.
• They are overly sensitive to criticism
and have trouble standing up for
• They may suffer from low self-esteem,
be easily embarrassed, and be very shy
and self-conscious.
Thursday, 21 February, 13
Types-Separation Anxiety
• Separation Anxiety Disorder
• Anxiety concerning separation from
home or from loved one.
• Worry about harm to loved one, getting
lost or kidnapped, being alone,
reluctance to sleep without caregivers.
• May refuse to go to school.
• May have nightmares, headaches, or
stomach aches.
Thursday, 21 February, 13
Type-Specific Phobia
• Specific Phobia
• Persistent fear of a specific object or
situation that is excessive or
• Types: animal type, blood-injectioninjury type, situational type (elevators
for example).
• May show up as crying, tantrums,
freezing or clinging in children.
Thursday, 21 February, 13
Types-Generalized Anxiety
• Generalized Anxiety Disorder
• Excessive anxiety and worry about a
number of events or activities. Many
• May have physical symptoms like tense
muscles, a restless feeling, becoming
tired easily, problems concentrating,
trouble sleeping.
• Often try to do things perfectly and feel a
need for approval.
Thursday, 21 February, 13
Compulsive Disorder
• Obsessive Compulsive Disorder
• Obsessions -Repetitive, senseless,
intrusive thoughts, images or impulses
that cause distress
• Compulsions -Deliberate, repetitive,
excessive behaviours to counteract
the obsessions.
Thursday, 21 February, 13
Compulsive Disorder cont.
• These are unpleasant to the individual
and they find it very difficult if not
impossible to stop when asked.
• The obsessions and compulsions can
take up so much time that the young
person can’t lead a normal life.
Thursday, 21 February, 13
Types-Posttraumatic Stress
Disorder (PTSD)
• Posttraumatic Stress Disorder
• The child has been exposed to a
traumatic event in which they
experienced or witnessed an event that
involved death or serious injury to self
or others.
• The response was intense fear,
helplessness or horror.
Thursday, 21 February, 13
Type –Selective Mutism
• Selective Mutism
• A consistent failure to speak in specific
social situations despite speaking in
other situations.
• Up to 2% of school aged children.
• May look down, point, use gestures, or
whisper if they have to speak.
Thursday, 21 February, 13
Types-Panic Attack
• Panic Attack
• All of these disorders can lead to panic
attacks, which look and feel like a heart
attack with shortness of breath, chest
pain, dizziness, shakiness and
sweating. They can be very frightening
but they only last a short time and are
not life threatening.
Thursday, 21 February, 13
Types- Panic Disorder
• Panic Disorder
• Recurrent panic attacks, i.e. unexpected
physical reaction where they feel very
scared and have a hard time breathing,
shaking, sweating, trembling, heart
• Persistent worry about another attack
• Behaviour changes related to fear of
another attack occurring. May not want to
leave the house.
Thursday, 21 February, 13
Anxiety at school
What does it look like in school?
Thursday, 21 February, 13
Students might be
Overestimation of danger and threat
Expectation of worst outcome
Sense of uncontrollability
Responsibility for negative outcomes
Underestimation of coping ability
Need for certainty
Thursday, 21 February, 13
Students might be exhibiting:
Physical Arousal:
Tense, jittery, nervous
Butterflies in tummy
Nausea, vomiting, diarrhea
Heart pounding, palms sweating
Trouble breathing
Trouble sleeping, nightmares
On the lookout for danger
Thursday, 21 February, 13
Students might be exhibiting:
Checking to make sure things are safe
Reassurance-seeking –Will it be okay?
Escape- leaving the situation
Avoidance – Staying away
Thursday, 21 February, 13
You may notice students
• Extreme shyness
• May isolate themselves
• Extremely uncomfortable being the
centre of attention
• Lack self-confidence
• Seem very unsure of themselves
• Avoid doing school work because they
are worried they will make a mistake
Thursday, 21 February, 13
You may notice students
• Phone home frequently from school
• Absent from school due to stomach
• Require frequent reassurance from the
• Perfectionist
• Expect catastrophes in normal
Thursday, 21 February, 13
You may notice students
• Wiggle, jitter, shaky, high-strung, tense,
unable to relax
• Excessively worry about hurting others
• Become easily and frequently irritable
Thursday, 21 February, 13
• Anxiety is not fatal.
• It is transient (comes and goes).
• The fear is real for the child. Validate
the fear, don’t try to dismiss it or
convince them otherwise. (I can see this
is hard for you…)
• Teach coping strategies at a time when
the child is less anxious
Thursday, 21 February, 13
• Avoidance strengthens anxiety. Respect
the fear that the child has without
permitting intentional avoidance of it
(avoiding will reinforce the problem and
is never helpful).
• Exposure weakens fear.
• Anticipatory anxiety is often the worst
• Bad things generally don’t happen.
Thursday, 21 February, 13
General Strategies:
• Find a way to increase the positives into
your relationship with the child.
• Celebrate often what the child is good at.
• Give the environment more predictability
and structure.
• Talk to the child about the fear. “Naming”
the fear can be helpful.
• Teach the child about anxiety and how it is
normal but can be a “false-alarm”.
• Encourage a peaceful environment.
Thursday, 21 February, 13
General Strategies
• Make a personal connection as much as
possible. Smile, nod, make eye contact, show
interest in what they do.
• When in crisis it’s important for the adult to
decrease their own anxiety level first before
trying to help.
Thursday, 21 February, 13
Develop a toolkit that includes:
Calm Breathing strategies.
Coping Cards.
Progressive Muscle Relaxation
• Realistic Thinking strategies
Thursday, 21 February, 13
• Ask the child to:
• Keep a chart to log anxiety daily and
see if there is a trigger, pattern,
protective factors.
• Trap worry in a “worry box” and let it out
when they are ready and armed to deal
with it.
• Find the “Off Switch”
• Allocate worry time.
• Draw anxiety.
Thursday, 21 February, 13
• Use Visualization
• Try to imagine a “Special Place”, with
it’s sights, sounds, feelings, smells and
tastes. Imagine a special place where
the worry is not allowed to visit.
Thursday, 21 February, 13
Remind the student that:
Anxiety passes away and is harmless
Avoidance strengthens fear
Exposure weakens fear
Anticipatory anxiety is often the worst
Bad things generally don’t happen.
Thursday, 21 February, 13
• Staff at SHPMH for sharing all their
• AMHB pamphlet
• Offord Centre for Child Studies
Thursday, 21 February, 13