Download Anxiety

Anxiety
INFORMATION FOR PARENTS
Agenda
What is Anxiety?
How is Anxiety Maintained?
Common Types of Anxiety
Anxiety Disorders
Anxiety Coping Strategies
What is Anxiety?
Anxiety is Normal
Everyone experiences anxiety from time to time. It alerts us to threats, protects
us from danger, and helps us reach important goals. When we’re anxious it
affects our thoughts, body, and behaviors. When faced with real danger, you will
have worrisome thoughts focused on the danger, your body will rev up to help
you deal with
the danger, and
you will
take action
either to get
away from
or fight the
danger.
Anxiety is Not Dangerous
Although anxiety feels uncomfortable, it is temporary and will decrease. The
sensations we experience in an anxious situation are designed to alert and
activate us. They are normal and part of our body’s natural response
mechanism. Our body is smart enough to know when to “amp up” and when to
“calm down.”
Anxiety is Adaptive
Anxiety helps us prepare for real danger. It can also help us perform at our best
and motivate us. When we experience anxiety, it triggers our “fight, flight,
freeze” response and prepares our body to react. Without it, we would not
survive.
Fight, Flight, Freeze
The Fight, Flight, Freeze response is our body’s automatic, built-in response
designed to protect us from threat or danger.
The response is critical to our survival from danger. Anxiety can also trigger this
system into action when we believe there is danger even if there is not.
Symptoms of Anxiety
There are both physical and emotional symptoms of anxiety. A person may
experience some or all of these symptoms in varying levels of intensity.
Physical symptoms of anxiety may include:
Racing or pounding of the heart
Shortness of breath and/or
difficulty breathing
Rubbery or jelly legs
Lump in the throat
Feeling like you are choking
Pain or tightness in the chest
Trembling or shaking
Tense, tight muscles
Butterflies or stomach discomfort
Sweating/ hot flashes
Symptoms of Anxiety
Emotional symptoms of anxiety may include:
Nervous, frightened, or scared
Worrying about things
Feeling tense, nervous, or on edge
Feeling stressed
Thoughts that something frightening will happen
Feeling alarmed or in danger
Feeling insecure
Developmental Anxiety
Anxiety is a typical developmental pattern that is exhibited as children grow
older. Anxiety is generally first seen at about 7 months of age. Common fears,
seen in children between the ages of 7 months and 4 years, include:
Separation
Darkness
Animals
Strangers
Sudden movements
Loud noises/ Noises at night
Developmental Anxiety
In pre-school and early childhood, children tend to experience global and
externalized fears. As children grow older, these fears become more abstract
and more internalized. Common fears, in children between the ages of 5 and 8
years of age, include:
Separation
Animals
Darkness
Staying alone
The supernatural
Bodily harm/ injury
Developmental Anxiety
Life Stage
Anxiety
Infancy
Strangers
Toddler
Separation
Loud Noises
Pre-School/ Kindergarten
Loud Noises
The Dark
Imaginary Creatures
Elementary School
World Dangers
Middle School
Death
Natural Dangers
Academic/ Social Issues
High School
Moral Issues
The Future
Relationship Issues
Anxiety in Children
Anxiety is often unrecognized and sometimes misdiagnosed in children because
it can present as anger outbursts or defiance.
ADHD is the most common misdiagnosis.
What Causes Anxiety?
What Causes Anxiety
Some early life experiences are correlated with increased feelings of anxiety.
This may include:
Parental rejection
Harsh discipline
 Anxious childrearing
 Modelling of dysfunctional and drug-abusing behavior
 Child abuse (emotional, physical and sexual)
What Causes Anxiety
Other factors linked with anxiety include:
Personal temperament
Poor coping skills / poor use of coping skills
Underlying medical conditions
Anxiety Fuel
Once anxiety occurs, there are several factors that can exacerbate the intensity
and duration of the emotional experience.
Genetics, temperament, and major life stressors can not always be changed but
there are factors that can be changed which is the basis for most treatments.
The Cycle of Avoidance
Habituation
Situational Anxiety
ANTICIPATORY ANXIETY, REASSURANCE SEEKING, AND SCHOOL
AVOIDANCE
Anticipatory Anxiety
Just like us children experience anticipatory anxiety, which is the body’s normal
response to perceived future threats. In the days and hours leading up to an
important event a person may be anxious. Although this system is critical to our
survival when there is actual threat or danger, it's a problem when there isn’t.
Common areas of anticipatory anxiety include:
Athletic, musical, or other performances
Going to a party
Joining a club, team, or sport
Starting school
Tests, projects, and oral reports
Anticipatory Anxiety
Helping children address anticipatory anxiety is important.
Provide a reasonable amount of notice about upcoming events.
 Avoid giving weeks of warning but also avoid springing the news on him or her an
hour before the event.
Remind them about the positive and fun aspects of the event.
Help them to see that worry is causing them to focus only on the scary aspects
and forget all about the fun ones.
Validate that the event might be scary/difficult for him/her, but there are
positive aspects as well.
Reassurance Seeking
Children look to their parents, teachers, and trusted adults for information
about the world around them, enabling them to reach expected milestones and
mature into adulthood. However, for some children knowledge is insufficient:
they also want reassurance and comfort that feared outcomes will not occur.
Furthermore, they’re dissatisfied with simple reassurances and seem to need
unending examples, promises, and guarantees. This is called reassurance
seeking.
Most parents and teachers know that giving reassurance over and over again is
not only exhausting but also doesn’t work.
Reassurance Seeking
Anxiety experts have determined 2 methods for reducing reassurance seeking
that can work for many families: 1) the all-at-once method; and 2) the gradual
method.
1. All at Once
This method is also known as the “cold turkey” route. This works best for
reassurance seeking that has not been occurring for long or only occurs in a few
small areas.
2. Gradual
This method works best for reassurance that has been a longstanding problem
and occurs in more than one area, or for youth that find the idea of a “cold
turkey” approach too hard.
Reassurance Seeking
When you first stop giving reassurance, the child will probably be very anxious.
This is normal. It is important that if you have decided NOT to give reassurance,
that you stick with it! Children often get very angry when they do not get the
reassurance that they have come to expect. If you keep at it, and stick to the
plan, the child will stop seeking reassurance from you and start managing
anxiety in more healthy ways.
During this early phase it is important that you give the child as much attention
and support as possible in other ways.
School Refusal
Children can have difficulty attending school due to a variety of factors. When these difficulties
are fleeting, resulting in minor complaints or a rare day off from school, most families can cope
without intervention. However, some children struggle to attend school on a more consistent
basis. These youth typically refuse, or attempt to refuse, school for four distinct reasons:
To escape from school situations that cause distress
To escape from unpleasant social or performance situations
To get attention from others
To pursue fun activities outside of school
More than ¼ of all children will engage in some degree of school refusal during their schooling
years, ranging from complaints and threats to avoid school, to missing school for months or even
years at a time.
School Refusal
Regardless of the reasons, school refusal can significantly interfere with or limit a child’s life.
Children who refuse school can fall behind or fail to meet academic milestones, have difficulty
developing and maintaining friendships, become isolated from peers, and miss opportunities to
learn new things and engage in fun activities.
School refusal peaks at several points of development, including with entry into Kindergarten,
between ages 7-9, and again with entry into Middle or High School.
It is important that prompt attention is given to understanding why a child is struggling, and that
we provide tools to help him/her adapt. The longer school refusal persists, the more entrenched
the behaviors become, and as expected, the more difficult they are to correct.
Habituation
Anxiety Disorders
An Anxiety Disorder
When feelings of anxiety become excessive (beyond what’s expected for the circumstance and
the child’s age), problems may occur.
When Does Anxiety Become a Disorder?
Excessive, unreasonable anxiety that is well out of proportion to the situation.
The child is unable to stop or control
Anxiety interferes substantially with the child’s ability to function normally.
Unable to accomplish daily routines (e.g., go to school)
Child is distraught and easily upset
Anxiety is burdensome causing overall unhappiness for the child
A significant level of anxiety, consistent over a period of time (typically 1 month)
Anxiety Disorder
Typical Anxiety
Problem Anxiety
Reasonable
Excessive
Productive
Detrimental
Manageable
Uncontrollable
Specific
Pervasive
Time Limited
Chronic
Age Appropriate
Age Mismatched
Types of Anxiety Disorders
Panic Disorder
 Attacks occur without warning and are accompanied by sudden feelings of terror
 Physical symptoms are severe and may be similar to experiencing a heart attack
Agoraphobia
 Occurs when a person avoids situations that he or she fears may cause a panic
attack.
Specific Phobias
 People who experience phobias are overwhelmed by unreasonable fears which they
are unable to control, even if they recognize that their fears are illogical.
Types of Anxiety Disorders
Social Anxiety Disorder
 Involves a paralyzing, irrational self-consciousness about social situations.
 People may have an intense fear of being observed or of making a mistake in
front of others.
Generalized Anxiety Disorder
 Characterized by repeated, exaggerated worry about routine life events and
activities.
Anxiety Management
Anxiety Management
Encourage the child to share his or her fears
Ask open-ended rather than leading questions
 Encourage the child to talk to you about their feelings but try not to ask leading questions such as “are
you worried about the science fair?”. Ask open ended questions like “how are you feeling about the
science fair?.”
Problem-solve and plan
 Encourage the child to think of ways to solve his or her problem. This gives the opportunity to coach the
child on how to cope with (and interpret) both real and imagined scary situations. You will also be giving
the child the tools he or she needs to cope with an unexpected situation that might arise.
Role-play with the child
 Sometimes role-playing a certain situation with the child can help him or her make a plan, and feel more
confident that he or she will be able to handle the situation.
Anxiety Management
Focus on the positive aspects
 Encourage the child to re-direct attention away from the worries, and towards the
positives. Most children can think of something good, even if it's just eating a special
snack or going home at the end of the day.
Pay attention to your own behavior
 Children take cues from adults, so the more confidence and comfort you can model,
the more the child will understand there is no reason to be afraid. Be supportive yet
firm.
Anxiety Management
Establish a routine. Set specific times for meals, homework, quiet time, and bed
time.
Be active. Regular exercise can have a positive impact on both emotional and
physical health.
Eat healthy.
Get a good night’s sleep.
Anxiety Management
Make sure the child understands and agrees with the plan.
Be consistent: If you give in to the child’s demand for reassurance even once,
the child has learned a powerful lesson.
Use rewards: It can be hard for the child to tolerate a reduction and eventual
elimination of reassurance, so providing the child with some extra motivation
can help.
Express positive but realistic expectations
Anxiety Management
Calm breathing
 Calm breathing is a technique that teaches a child to slow down his or her breathing
when feeling stressed or anxious.
Progressive Muscle Relaxation
Cognitive coping cards
 Cognitive coping cards can be small index cards with short sentences of some of the
coping skills a child can use when experiencing anxiety (e.g. A reminder that physical
symptoms (e.g., sweaty palms, stomach-aches) are just anxiety; A reminder that
anxiety is not dangerous and doesn’t last forever; Positive coaching statements; A
reminder to use some coping skills; etc.).
Things to Avoid
Rescuing the child
Overprotecting
Trying to reason with the child when he/she is in emotional distress.
References
Anxiety BC – amazing website with information about many topics related to anxiety for parents and
teachers as well as treatment strategies for parents, teachers, and students
Anxiety Disorder Association of Canada (ADAC) – basic information about anxiety and anxiety disorders
as well as basic information about treatment
Canadian Mental Health Association (CMHA) – general information about anxiety and anxiety disorders
Center for Addiction and Mental Health (CAMH) – center based in Canada; general information about
anxiety and anxiety disorders
National Association of School Psychologists (NASP) – website with information about anxiety and
anxiety disorders as well as other mental health problems and illnesses
Worry Wise Kids – non-Canadian website with information about anxiety, information about anxiety
treatments, and links to blogs (etc.)
Questions?
THANK YOU!