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Anxiety
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.
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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.
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How long will anxiety last?
• Without treatment, some anxiety
disorders can last a lifetime. Anxiety can
lead to depression.
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What causes anxiety
disorders?
• 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.
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Anxiety Misunderstood
• The behaviour of children who have
anxiety is often misunderstood.
• Children will often use avoidance
strategies.
• They may be viewed as angry, defiant,
rude, ADHD, or unmotivated.
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Types-Social Phobia
• Social Phobia (Social Anxiety
Disorder)
• Persistent fear of social or performance
situations in which the child is exposed
to unfamiliar people or scrutiny by
others.
• Fear that they will act in a way that is
humiliating or embarrassing.
• May show up as crying, tantrums,
freezing, or shrinking from social
situations.
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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
themselves.
• They may suffer from low self-esteem,
be easily embarrassed, and be very shy
and self-conscious.
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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.
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Type-Specific Phobia
• Specific Phobia
• Persistent fear of a specific object or
situation that is excessive or
unreasonable.
• Types: animal type, blood-injectioninjury type, situational type (elevators
for example).
• May show up as crying, tantrums,
freezing or clinging in children.
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Types-Generalized Anxiety
Disorder
• Generalized Anxiety Disorder
• Excessive anxiety and worry about a
number of events or activities. Many
worries.
• 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.
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Types-Obsessive
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.
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Types-Obsessive
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.
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Types-Posttraumatic Stress
Disorder (PTSD)
• Posttraumatic Stress Disorder
(PTSD)
• 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.
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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.
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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.
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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
pounding.
• Persistent worry about another attack
happening.
• Behaviour changes related to fear of
another attack occurring. May not want to
leave the house.
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Anxiety at school
What does it look like in school?
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Students might be
experiencing:
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Thoughts:
Overestimation of danger and threat
Expectation of worst outcome
Sense of uncontrollability
Responsibility for negative outcomes
Underestimation of coping ability
Need for certainty
Perfectionism
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Students might be exhibiting:
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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
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Students might be exhibiting:
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Behaviours:
Checking to make sure things are safe
Reassurance-seeking –Will it be okay?
Escape- leaving the situation
Avoidance – Staying away
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You may notice students
exhibit:
• 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
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You may notice students
exhibit:
• Phone home frequently from school
• Absent from school due to stomach
problems
• Require frequent reassurance from the
teacher
• Perfectionist
• Expect catastrophes in normal
situations
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You may notice students
exhibit:
• Wiggle, jitter, shaky, high-strung, tense,
unable to relax
• Excessively worry about hurting others
feelings
• Become easily and frequently irritable
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Remember:
• 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
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Remember:
• 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.
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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.
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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.
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Interventions
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Develop a toolkit that includes:
Calm Breathing strategies.
Coping Cards.
Progressive Muscle Relaxation
strategies.
• Realistic Thinking strategies
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Interventions
• 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.
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Interventions:
• 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.
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Interventions
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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.
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Credits
• Staff at SHPMH for sharing all their
resources.
• Anxietybc.com
• AMHB pamphlet
• Offord Centre for Child Studies
pamphlet.
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