ANXIETY IN CHILDREN AND ADOLESCENTS Toronto Catholic District School Board –Psychology Department Welcome Grace Labao, M.A. C. Psych. Assoc. School and Counselling Psychology
REVIEW � What is anxiety? � What does anxiety look like – the signs and symptoms � What factors contribute to anxiety? � What treatments are available? � How can I help?
CASE STUDY
ANXIETY ANXIETY � Anxiety is a normal reaction to many stressful, novel or threatening situations or to uncertainties in life – e.g., first date, major exam � Normal anxiety is a good thing, because it prepares the body to handle a situation that may be more stressful or require more concentration
ANXIETY THAT IMPAIRS � ANXIETY DISORDER: excessive or inappropriate feelings of anxiety so severe they interfere significantly with daily functioning (e.g., with school, home, relationships). � Anxiety Disorder is the most prevalent mental health disorder – affecting up to 10 to 12% of the population, second to depression (5-8%)
CO-MORBIDITY � 75 to 80% of children and adolescents with an anxiety disorder suffer from another psychiatric disorder � Combinations of anxiety and depression most common (Wagner, 2002) � Children of parents with anxiety disorder are 7 times more likely to have an anxiety disorder (Manassis et al, 1995) � Contributing Factors: Stressors, Genetics, Experiential
SIGNS OF ANXIETY � Constant worry � Muscle tension � Panic attacks � Extra sensitive � Extreme need for reassurance � Various physical symptoms � Easily embarrassed � Clingy behaviour
SIGNS OF ANXIETY � Extreme sensitivity to rejection or failure � Hypervigilance � Perfectionism � Physical symptoms – blushing, shaky voice, nervousness, sweating prior to or during social situation
BEHAVIOURS CHARACTERISTIC OF ANXIETY � Poor academic achievement � Difficulties socializing, getting along with peers; Social isolation/withdrawal � Irritability or outbursts of anger � Reluctant to do group work or speak out in class; not handing in work � Quiet behavioral cues – nail biting, finger picking, hair twirling
BEHAVIORS CHARACTERISTIC OF ANXIETY � Avoidant behaviours – situations, places, people � Restlessness or feeling on edge � Difficulty maintaining relationships � Easily fatigued; Shy, quiet � Difficulty concentrating � Difficulty falling or staying asleep � Alcohol and/or drug use � Drop out of activities
EXCESSIVE WORRIES/FEARS SEPARATION ANXIETY GENERALIZED ANXIETY POST-TRAUMATIC STRESS OBSESSIVE-COMPULSIVE SOCIAL ANXIETY SPECIFIC PHOBIA PANIC DISORDER AGORAPHOBIA
STATEMENTS FROM ANXIOUS ADOLESCENTS � “ I can’t seem to stop worrying” � “What if I can’t do it?” � “I can’t go to school because students will make fun of me” � “I can’t go to the school dance because everyone will notice that I’m nervous” � “I might get sick and die” � “I can’t seem to relax, I’m always tense and uptight about something
Continuation….. � “I can’t present to the class because I will freeze up and won’t talk; everyone will laugh” � “I’m afraid I’ll do something embarrassing in front of my friends & my face will get bright red” � “I will fail the test” � “Things are not going to work out” � “They don’t like me” � “They will think I am stupid”
TREATMENTS: � Cognitive Behavioural Therapy � Behavioural Therapy � Medication � Relaxation Techniques
HOW TO HELP � Know the signs and triggers � Provide support, understanding, rather than avoidance � Model effective coping strategies � Changing worried/fearful thoughts � Consult with a mental health professional - learn all you can about the disorder � Communicate your concerns to teachers/administrators; work closely with your child’s teacher, & school team.
Continuation….. � Consult with school psychologist/Social Worker via administrators � Encourage physical exercise to reduce anxiety � Encourage writing, drawing, painting to alleviate fears � Encourage “coping” behavior and discourage avoidance. Create a “coping’ book – e.g. ways to relax, tasks that distract from anxiety � Weekly planning to manage school work
Continuation….. � A supportive adult (CYW, Guidance, Chaplin, teacher, administrator) can be provided at the school level. � Encourage group social activities � Remind children/youths of their past successes � Role-play � Don’t compare your child to siblings or other kids. � Acknowledge and provide praise and positive reinforcement for all efforts/success
SNAKES ENJOY FRIENDLY DRINK BOAT FANGS DANGER TREAT DEATH RAIN ACCIDENT TEACH GAME PHOTO INTEREST FEAR
Resources � Centre for Addiction and Mental Health (CAMH) � Hospital for Sick Children (HSC) � Anxiety Disorders Association of Ontario (www.anxietydisordersontario.ca) � Anxiety Disorders Association of Canada (www.anxietycanada.ca) � Canadian Network for Mood and Anxiety Disorders (www.canmat.org) � www.anxieties.com
Resources � Helping Your Anxious Child: A step-by=step guide for parents. Ronald Rappe, New Harbinger Publications, 2000 � If Your Adolescent Has an Anxiety Disorder: An essential resource for parents. Edna B. Foa and Linda Andrews, Oxford University Press, U.S., 2006 � Freeing Your Child from Anxiety: Powerful, practical solutions to overcome your child’s fears, worries, and phobias. Tamar E. Chansky, Broadway 2004
Resources � Help for Worried Kids: How your child can conquer anxiety and fear. Cynthia G. Last, Guilford Press, 2005 � Your Anxious Child: How parents and teachers can relieve anxiety in children. John S. Dacey and Lisa B. Fiore, Jossey-Bass, 2001 � Keys to Parenting Your Anxious Child: Katharina Manassis,(2 nd Edition), Barron’s Educational Series, Inc., Hauppauge, NY. � What to Do When You Worry Too Much: A kid’s guide to overcoming anxiety. Dawn Huebnere, Magination Press, 2005
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