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Building a Healthy Future 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. 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 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. Thursday, 21 February, 13 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. Thursday, 21 February, 13 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. 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 themselves. • 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 unreasonable. • 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 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. Thursday, 21 February, 13 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. Thursday, 21 February, 13 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. Thursday, 21 February, 13 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. 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 pounding. • Persistent worry about another attack happening. • 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 experiencing: • • • • • • • • 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 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: • • • • • Behaviours: 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 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 Thursday, 21 February, 13 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 Thursday, 21 February, 13 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 Thursday, 21 February, 13 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 Thursday, 21 February, 13 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. 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 Interventions • • • • Develop a toolkit that includes: Calm Breathing strategies. Coping Cards. Progressive Muscle Relaxation strategies. • Realistic Thinking strategies Thursday, 21 February, 13 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. Thursday, 21 February, 13 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. Thursday, 21 February, 13 Interventions • • • • • • 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 Credits • Staff at SHPMH for sharing all their resources. • Anxietybc.com • AMHB pamphlet • Offord Centre for Child Studies pamphlet. Thursday, 21 February, 13