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Transcript
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!