Putting the smiles back When Something’s Wr ng o · (e.g., headaches, stomach aches) Avoidance of stressful situations (e.g., tests/exams) Clingy behaviour in young children •

WhenSomething’s Wr ng

Ideas for Families

o

Putting the smiles back

Anxiety andAnxiety

Disorders

Anxiety and

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isorders

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What is the difference between “normal” anxiety or sensitivity and an anxiety disorder?

Anxiety is a normal reactionto many stressful orthreatening situations or touncertainties in life.It’s normal for a child to feelanxious about his/her firstday of school, or for anadolescent to feel anxiousabout a major exam or firstdate. And, it’s also normalfor a parent to feel anxiousfor their children, as they gothrough these experiences.Normal anxiety is a goodthing, because it preparesthe body to handle asituation that may be morestressful or may requiremore concentration thanusual.An anxiety disorder ischaracterized by havingfeelings of anxiety that areso severe they interferesignificantly with dailyliving (e.g., with school,home, and relationships).Children with anxietydisorders worry all thetime. Then they often worryabout how much theyworry, even when there isno reason to worry.Anxiety disorders arise froma complex mix of geneticand environmental factors.Anxiety runs in families, soif a parent or grandparent isvery anxious, the child maybe also. As a group, thesedisorders are the mostcommon mental disordersin youth and affect up to10% of children and

adolescents. Anxietydisorders can begin at anytime, but they commonlyappear at early school age.They can be made worse bycommon stressors. Forexample, the start ofschool, with its academicand social demands, can bevery stressful for any child,but even more so for a childwith an anxiety disorder.It is important to note thatanxiety disorders can easilygo unrecognized. Leftuntreated, they can lead toacademic and socialproblems (e.g., refusal to goto school), multiplying achild’s difficulties.Depression can also be acomplication of untreatedanxiety (see Mood Disordersin this handbook), againemphasizing the need forearly recognition andtreatment.Anxiety disorders can alsobe mistaken for languageand learning disabilities. Ifthe problem is only atschool, investigate thepossibility of a language orlearning disability with aqualified professional, suchas a speech languagepathologist or psychologist.Identifying anxiety in theclassroom may be difficult.Ask your child’s teacherabout his/her behaviour inclass. Children with anxietydisorders may appear “shy”in school, or reluctant to do

Anxiety and A

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isordersgroup work and speak outin class. They are oftenquiet, so their problemsmay not be detected by ateacher dealing withchildren who have moreobvious behaviouralproblems. Watch for quietbehavioural cues such asnail biting, finger picking, orhair twirling. Adolescentswith an anxiety disordermay socially isolatethemselves or turn to useof substances, like drugs oralcohol. Again, theseadolescents are often quiet,rather than obviouslydisruptive.Being extra sensitive orprone to anxiety is usually alifelong characteristic. Mostchildren, with the help andsupport of their parents,can learn effective self-management strategiesthat enable them to tackleincreasingly difficultsituations successfully.Learn all you can aboutanxiety disorders, and useresources like, Got IssuesMuch? Celebrity Teens ShareTheir Traumas and Triumphs(Randi Reisfeld, MarieMorreale, Scholastic, 1999).In this book, famous teensshare their mostembarrassing moments. It’sa great way to getdiscussion started oncoping strategies.Finally, expect temporarysetbacks with newsituations or stressors.

Anxiety disorders can comeat different times and withdifferent forms ofbehaviour throughout ayoung person’s life. Whenthe disorders are moderateto severe, they can lead topoor academicachievement, difficultiessocializing and gettingalong with others and,ultimately, a decreasedquality of life. Yet, effectivestrategies can provide relieffrom symptoms, improvedquality of life, and possiblyprevent the development ofother mental disorders.

Anxiety and A

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How do I distinguish between“normal” anxiety and an anxiety disorder?

As a parent, observe yourchild’s behaviour:• Frequency – How often

does your child becomeanxious? When doesanxiety occur?

• Intensity – How severe isthe anxiety, and howdifficult is it to manage?

• Duration – How long doesthe anxiety last?

Ask yourself:• “Is this problem inter-

fering with my child’slife?” If it is, what areas ofyour child’s life are beingaffected?

If you notice that there isan increase in thefrequency, intensity and/orduration of your child’ssymptoms, or that yourchild’s life is beingadversely affected byhis/her behaviour, it is agood idea to seek the helpof a qualified healthpractitioner for a properdiagnosis (see Working withYour Health Practitioner inthis handbook).

There are different types ofanxiety disorders. Sixcommon ones, listed inalphabetical order, include:

1. General AnxietyDisorder (GAD)

2. Obsessive CompulsiveDisorder (OCD)

3. Panic Disorder (PD) 4. Posttraumatic Stress

Disorder5. Separation Anxiety

Disorder 6. Social Anxiety Disorder

Each of the above anxietydisorders will be describedin the following pages. Atthe end of this section,treatment strategies arediscussed and additionalresources are listed.

Anxiety and A

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isordersGeneral Anxiety Disorder (GAD)

General Anxiety Disorderaffects about three to fiveper cent of youth and isoften found together withother anxiety disorders(e.g., social anxietydisorder) or depression.GAD often begins in earlyadolescence and occursmore frequently inintroverted children – thosewith excessive shynessand/or a tendency to showfew, if any, emotionalreactions.While most young peopledo worry about things,young people with GADworry constantly abouteveryday activities. It is theextreme, severe nature oftheir worries that interfereswith their lives. They worryabout what’s going tohappen next and that theywon’t be able to handle it.All youth who are anxiousneed reassurance andacknowledgement of thereality of their concerns.However, youth with GADrequire reassurancefrequently, the reassuranceusually only providestemporary relief, and they may requireprofessional help.

Anxiety and A

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isordersConstant worry ortensionExtreme need forreassurancePhysical symptoms (e.g., headaches,stomach aches)Avoidance of stressfulsituations (e.g.,tests/exams)Clingy behaviour inyoung children

• Early intervention is keyto managing the disorderand preventing furtherdisability.

• Get help from a qualifiedhealth practitioner,including a professionaldiagnosis. An accuratediagnosis will help toprevent any incorrect“labeling” of your child byothers.

• Obtain a second opinion ifnecessary.

• Find a support group forboth you and your child,and exchange strategies.

• Learn all you can aboutthe disorder and educateyour family and your childabout the disorder.

• Don’t compare your childto siblings or otherchildren. Treat your childas a unique individual.

• Re-evaluate and modifystrategies as necessary.Work closely with yourchild’s teacher, doctor, andschool team.

• See Managing ProblemBehaviour in Children,Working with Your HealthPractitioner, and Resourcesin this handbook for moreinformation.

• Reassurance alone maynot be sufficient toresolve an anxietycondition. Additionalstrategies will likely needto be used.

Coping StrategiesBehaviour Characteristics

Anxiety and A

nxietyD

isorders• Establish realistic

expectations andinteractions (e.g., role-playthe meeting of newpeople or taking a testwith your child).

• To generate discussion,ask your child “What’s theworst that couldhappen?” and “Then whatwould you do?” Offerpractical solutions.

• Encourage lots of physicalexercise to reduce anxiety,nutritious eating, andregular sleeping patterns(e.g., going to bed at thesame time each night).

• Create (with your child) ashort “Things To DoToday” sheet. This activitygives children an overviewof what they are capableof doing in a day andreduces the anxiety ofworking through a long,never-ending list. Preparethem for the fact theymay not get everythingcompleted on their list,and congratulate them forwhat they do accomplish.Confidence builds whenitems are completed. Startagain the next day andencourage them tomanage this process ontheir own over time.

Coping Strategies

Anxiety and A

nxietyD

isorders• Do weekly planning (with

your child) to assisthim/her to organize tasksinto small units andprepare for assignmentsand tests. This activityworks best whenplanning occurs alongwith your child’s teacher.

• Model calm behaviouryourself and assure yourchild you will always bethere for him/her.

• Create a coping journalwith your child. In it,include ideas to helphim/her deal withanxiety, step by step.Discuss rewards for eachsituation in which yourchild manages to reducehis/her anxiety, andgradually tackle moredifficult situations as yourchild becomes morecomfortable. Here aresome examples of ways toreduce anxiety:

– Take five deep breaths.– Draw pictures that

show how he/she isfeeling in differentsituations.

– Count from 50,backwards, or say themonths of the yearbackwards, slowly.

– Visualize a calm place.– Take time out, away

from a situation thatcreates anxiety (e.g.,play in the yard, stopthe activity and thinkof something fun orcalming).

Coping Strategies

Anxiety and A

nxietyD

isorders– Go for a walk with a

parent, friend or pet.– Talk to a parent or

friend about fears.– When child is away

from home, call hometo talk to someone.

– Take any doctor-prescribed medication,if required.

• Show your child how youcope with stress. Talk outloud in stressful situationsabout what you’re doingto handle the situation(e.g., you’re late, keyslocked in car, you’re lost,problem at work). Expressconfidence that you’llcope and solve theproblem.

• As a parent, do your bestto acknowledge that yourchild’s fears are real. Don’tdiminish his/her concerns.For example, don’t tellyour child to stopworrying about a test.Instead, say youunderstand it’s a toughsituation, but you haveconfidence and knowhe/she will do his/herbest, and that’s all thatmatters.

• Encourage your child tocome to you with anyproblems or concerns, atany time.

• “Check in” with your childat the end of each day.Debrief and review anysignificant events.

Coping Strategies

Anxiety and A

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isordersObsessive Compulsive Disorder (OCD)

Obsessive CompulsiveDisorder can begin inchildhood or adolescenceand affects up to three percent of the population. OCDis characterized byirrational fears andintrusive, unwanted ideasor thoughts (obsessions),and repeated rituals orbehaviours (compulsions),performed to eliminateanxiety brought on by theobsessions. Obsessions andcompulsions are highlydistressing for an OCDsufferer and can take up anexcessive amount of time(an hour a day, or more).A number of otherdisorders overlap with OCD,sharing many features incommon, so the terms“obsessive compulsivedisorders” or “obsessivecompulsive spectrumdisorders” are often used.For example, tic disorders(see Tourette Syndrome inthis handbook),trichotillomania(compulsive hair pulling),and body/dysmorphicdisorder (pre-occupationwith an imagined defect inappearance) are relateddisorders that commonlyco-occur with OCD. OCD canalso be accompanied bydepression and can lead tosignificantly reducedfunctioning and quality oflife. Many people with OCDcan live with it, however,without it having a

significant impact on theirday-to-day lives. Manysymptoms of OCD aregreatly improved withmedication or specificpsychological treatments.

Anxiety and A

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isordersPersistent perfectionism(e.g., written school workerased and rewritten tothe point of making holesin the paper)Worries are not normallyabout real-life problemsand often followparticular themes (e.g.,thoughts thatenvironment iscontaminated with“germs” or “odours” orthat self and family are indanger)Rituals that often involvechecking, washing,cleaning, and counting(e.g., excessive hand-washing or lining upobjects in a row)Constant questioning andasking for reassuranceYounger children may notrecognize that their fearsand behaviours areunrealistic and may alsotry to include theirparents in their ritualsHaving to do somethingexceedingly slowly to feelit has been done properly










Anxiety and A

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isorders• After receiving a diagnosis,

characterize the problem foryour child (e.g., a biological,brain-based illness). Helpingyour child recognize his/herOCD symptoms when theyoccur is an essential firststep in addressing them.This also helps childrenunderstand they are notbeing blamed for the OCD,and that you are one oftheir allies in helping themdeal with it. Youngerchildren may respond bestto labeling their behaviourwith a nickname, like“germy”. Adolescents areoften more comfortableusing “OCD” and maybenefit from reading furtherabout the disorder to betterunderstand it.

• Provide a warm andsupportive learningenvironment wheremistakes are viewed as anatural part of thelearning process.

• Work with your child todevelop a list of symptoms,from least to mostdistressing. Tackle the leastdistressing ones first, thenwork up to more difficultbehaviours. This strategywill help improveconfidence as he/she getsready to tackle moredistressing symptoms. Oneway to “tackle” thesebehaviours is to set timelimits on how long yourchild engages in particularcompulsive behaviours.

Coping Strategies

Anxiety and A

nxietyD

isorders• Do not criticize your child’s

obsessive behaviours. Seethem as symptoms, andnot faults, in your child.“Just stop it!” messagesare not helpful. Instead,encourage your child topersist in resisting his/hersymptoms whereverpossible.

• Use humour to help yourchild distance him/herselffrom irrational fears andbehaviours.

• Keep up normal routines.Routine and structure canhelp a child reduce therituals and encourageexposure to what mayotherwise have beenavoided.

• Try not to get involved inyour child’s rituals byresponding to an obsessiveneed for reassurance.Depending on the level ofyour child’s distress, you mayneed to begin this strategyby first selecting rituals youcan withdraw from fairlyeasily, and going from there.

• Recognize and reward evensmall improvements inbehaviour and evidence ofeffort. Encouragement isthe best reward (e.g., useof a “star chart”, especiallyfor younger children, witha small prize for achievinga certain number of stars).Spending extra time withyour child on a plannedactivity together can alsobe a reward.

Coping Strategies

Anxiety and A

nxietyD

isorders• Modify your expectations

during a stressful time.Stress, particularly whenyour child’s situation ischanging in any way, canincrease symptoms ofanxiety. Work with yourchild to prepare well inadvance for any changesin his/her routine.

• Do not take over any tasksfor your child or lethis/her brothers andsisters do them. Your childneeds to take fullresponsibility for his/herbehaviours and place inthe family.

• Children with OCD oftensuffer the added stress ofteasing, rejection, andeven bullying from peers.Encourage your child totalk about the disorderwith classmates, friendsand family, and therebyincrease acceptance of it.If your child agrees, even apresentation to his/herclass or school might help.Determine the bestapproach with theteacher and with yourchild to create awarenessand understanding ofyour child’s disorder.

Coping Strategies

Anxiety and A

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isordersPanic Disorder

Panic Disorder typicallyoccurs in later adolescence.It can affect up to five percent of youth and oftenoccurs with depression orother anxiety disorders. Thedisorder is characterized bya sudden onset of panicsensations that arisesuddenly, and withoutwarning, in situationswhere there is no danger.Attacks usually last five toten minutes, but may beaccompanied by an intensedesire to flee the location.Repeated attacks lead toanticipation anxiety (i.e.,fear of having an attack)and avoidance of locationswhere attacks haveoccurred in the past, orwhere there is no easy exit.In some cases, thiscondition can lead toagoraphobia – fear of openor public places, or ofleaving the house.

Anxiety and A

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isordersPanic attacks that canlead to a need to “escape”Avoidance of school orother locations whereattacks have occurred orwhere the adolescentfeels trappedIntense physicalsymptoms (e.g., shortnessof breath, heartpalpitations, dizziness,sweating, tingling, urgenturination during theattack)Intense fear during theattack



• Obtain a second opinion ifpossible.




• Re-evaluate and modifystrategies as necessary.Work closely with Yourchild’s teacher, doctor, andschool team.


• Since panic disordernormally occurs in thelater teen years, help yourchild to focus on the self-management of his/hercondition.


Anxiety and A

nxietyD

isorders• After receiving a

diagnosis, characterize theproblem as a part of thebrain that is so sensitive,it thinks it is beingattacked when there isnothing there. Medicinesand psychologicaltreatments can help todecrease this sensitivity.

• Use relaxation and deepbreathing techniques tohelp reduce fear andstress (e.g., visualize acalm and safe place, takefive deep breaths).

• Encourage “coping”behaviour and discourage“avoidance” behaviour.Involve your child in thedevelopment of “quickrecovery” strategies thathe/she thinks could work(e.g., return to class in 10minutes, go for a walkaround the block, splashcold water on face, calmbreathing patterns for fiveminutes).

• Create a coping journalwith your child, asoutlined in the strategiesfor General AnxietyDisorder (GAD).

• Encourage your child toreturn and facemanageable situationsthat caused panic attacks,with your support, asneeded.

• Model calm behaviour foryour child.

Coping Strategies

Anxiety and A

nxietyD

isordersPosttraumatic Stress Disorder(PTSD)

Posttraumatic StressDisorder is a condition inwhich a person has beenexposed to a traumaticevent that creates intensefear, helplessness or horror.In children, these feelingsmay be expressed in theform of disorganized oragitated behaviour. In orderfor PTSD to develop, aperson has usuallyexperienced or witnessedan event that has involvedactual or threatened deathor serious injury, or aphysical threat to self orothers. The severity,duration and closeness ofan individual’s exposure tothe event are the mostimportant factors thataffect the likelihood ofdeveloping PTSD. However,most young people exposedto such situations will notdevelop PTSD, while almosteveryone will exhibit anacute stress response thatwill gradually diminish overtime – usually in three tofour months.PTSD can occur at any age,including childhood.Remember, a child canshow symptoms similar toPTSD in reaction to smalleror temporary traumas (e.g.,severe illness in the family,frequent family conflict(without violence), divorce,re-marriage, death,moving), but thesesymptoms are usually lesssevere than with PTSD, and

are not PTSD. When anacute stress response failsto go away or when severestress symptoms beginafter a period of few or nosymptoms (sometimes aslong as six months after theevent) PTSD is said to onset.With PTSD, symptoms lastfor more than one monthand the disturbancesignificantly interferes withdaily living (e.g., withrelationships, school, workand other important areasof functioning). In general,symptoms seem to beworse in events deliberatelyinitiated by a person, as in arape or kidnapping (asopposed to an event notinitiated by a person, suchas a car crash or naturaldisaster).Depending on thepopulation sampled, PTSDis said to affect from one tofourteen per cent of thepopulation, but somestudies of at-risk individuals(e.g., victims of war, victimsof natural disasters such asvolcanic eruptions, victimsof sexual abuse or violencein the home, victims ofcriminal violence liketerrorist acts, or thosediagnosed with a life-threatening disorder) haveshown higher rates.Females are more likelythan males to developPTSD. Those who haverecently emigrated fromareas of social unrest and

Anxiety and A

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isorderscivil conflict may also havehigher rates of PTSD andmay be reluctant to talkabout experiences oftorture or trauma.There is some evidence thatsocial supports, familyhistory, childhoodexperiences (e.g., sexualabuse), personalityvariables, and pre-existingmental disorders mayinfluence the developmentof PTSD. However, thisdisorder can develop inindividuals without anypre-disposing conditions,particularly if the stressor isextreme. With PTSD, theremay also be increased riskof other disorders likeadditional anxiety disorders(e.g., obsessive compulsivedisorder), mood disorders(e.g., depression or bipolardisorder), and substancerelated disorders.Duration of symptoms ofPTSD varies, with completerecovery occurring withinthree months in about halfof the cases.

Anxiety and A

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isordersCoping StrategiesBehaviour Characteristics

Recurrent and upsettingmemories of the event,including images,thoughts, or perceptions(may describe painfulguilt feelings aboutsurviving when others didnot survive or things theyhad to do to survive); inyoung children, repetitiveplay may occur wherethemes or aspects of thetrauma are expressed(e.g., acting out a carcrash over and over withtoy cars if the childexperienced a car crash)Recurrent and upsettingdreams Acting or feeling as if theevent were happening allover again (e.g., flash-backs); young children mayact out the eventIntense psychological and physical stressexperienced when exposedto cues that resemblesomething about thetraumatic event (e.g.,seeing a gun on televisionif a victim of gun violence,being in a school ifassaulted in school, feelinganxious on the anniversaryof the traumatic event)Efforts to avoid thoughts,feelings, or conversationsassociated with thetraumaEfforts to avoid activities,places, or people thatbring out memories ofthe trauma

• Early intervention is key tomanaging the disorderand preventing furtherdisability.








• Provide support andreassurance. Somephysical contact studieshave shown that holdingyour child can be helpful.

Anxiety and A

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isordersCoping StrategiesBehaviour Characteristics

Inability to remember animportant part of thetraumaStrong decreased interestor participation in normalactivitiesFeeling of detachmentfrom others, especiallythose who are closefamily members andfriendsRestricted range ofemotions (e.g., unable tohave loving feelings)Feelings that life will becut short and that afuture is not possible(e.g., in young children,life will be too short tobecome an adult)Difficulty falling orstaying asleepIrritability or outbursts ofangerOn constant “alert” forevents going on aroundthem; individual maybelieve that he/she canforesee the futureExaggerated reactionwhen taken off guard orstartled by something(e.g., abnormal fears or“jumpiness”)Various physicalsymptoms, such asstomach aches orheadaches

• Try not to trivialize yourchild’s disorder or demandimprovement. Instead, showas much support as you can.

• Encourage your child todiscuss his/her thoughtsand fears with you, with atrusted friend, or by writingor drawing in a journal.Allow your child to share athis/her own pace, and usetechniques and strategiesrecommended by yourtherapist and/or doctor.

• Go slowly. Prepare yourselffor your child’s slowprogress, and for handlingyour own frustration,impatience, or despairingfeelings when progress isnot as quick as you wouldlike. Too much of your ownimpatience or anxiety willmake recovery slower andharder for your child.

• Go slowly, part two. Breakdifficult tasks down intosmall chunks. Congratulateyour child for successes.

• Be alert that anxiousbehaviour can show up inany stressful situation, notjust in the area related tothe original trauma.

• Keep in mind that a child’sresponse to trauma maybe related to his/herpersonality type (e.g., aquieter child might showextreme shyness orwithdrawal, while astronger-willed childmight behave with angerand aggressive behaviour).

Anxiety and A

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isordersCoping Strategies

• Stress managementtechniques may help toreduce anxiety (for bothyou and your child).Encourage your child topractice relaxationtechniques (e.g., breathingexercises, progressivemuscle relaxation,visualizing a calm or safeplace), sports activities, orreading a book. Help yourchild learn what worksbest, and participate inactivities with your child.

• Develop other avenuesand activities thatencourage your child toget involved in theenvironment aroundthem. Involvement in acharity or communityservice is a really goodway to help children feelthat their own lives areworth something, andthey have the power tocontribute to change. Thispoint is especiallyimportant for childrenwho have beentraumatized.

• When your child seemsready, with your healthpractitioner’s approval andyour child’s agreement,use small steps to “de-sensitize” your child.For example, if the traumainvolved a communityswimming pool, visit thepool parking lot severaltimes, leaving before orjust after stress sets in. Ifyou’re successful at this

Anxiety and A

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isordersCoping Strategies

stage, next visit the check-in area several times, thenthe dressing room, thepool deck, sitting at theedge of the pool, etc. Doeach step several timesand celebrate and userewards for successfulvisits. Always leave whenyour child wants to, anduse encouraging wordsabout trying again whenhe/she is ready. Stay calmand reassure your childthat this process is anatural healing and re-education process for hisor her body, brain, andheart, and that you will bewith him/her for as longas it takes.

• Monitor your child’s use ofother substances such ascaffeine, alcohol, andother drugs (includingcold and asthmamedications), since thesesubstances can makeanxiety symptoms worse.Discuss this issue withyour doctor.

• Watch for any signs ofdepression (see MoodDisorders in thishandbook).

Anxiety and A

nxietyD

isordersSeparation Anxiety Disorder

Separation Anxiety Disorderis usually seen by mid-childhood. It is characterizedby severe panic-likeepisodes that begin whenthe child is separated fromhis/her parent or caregiver.Consequently, the child hasdifficulty participating inage appropriate school andsocial activities like classpresentations, birthdayparties, sleepovers, andsummer camp. The childmay refuse to attendschool, cry or havetantrums when left atschool, or show excessive“homesickness” duringovernight stays away fromhome. Children sufferingfrom this disorder may also appear to be “cold”towards others.This type of behaviouroccurs normally in manychildren, at times, especiallyaround common activitieslike birthday parties, goingto pre-school, meeting anew babysitter, or a firsttime at overnight camp. Thebehaviour also occurs morefrequently in the earlyyears, with introvertedchildren, or after trauma. Todetermine when a child’sbehaviour has “crossedover” from normal toexcessive, the behaviourmust be viewed in terms ofits frequency, severity andduration. Please see theintroduction to this sectionfor more information.

September can be a difficultmonth for early school-aged children. One or twowho are having a difficulttime settling in can “infect”a whole classroom,resulting in several weeksof crying children at drop-off time. If this happens, tryto be positive andsupportive to your child,and give him/her time tosettle in. Then, re-evaluatethe situation more closelyin early October.

Anxiety and A

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isordersRefusal to attend schoolor other activitieswithout parent orcaregiverAvoidance of activitiesthat requireindependence Tantrums, tears, clingingwhen left at school byparent or caregiverExcessive “homesickness”during overnight staysClinging to teacher Physical symptoms suchas headaches, stomachaches, a shaky voice,fidgeting – especially onschool days or Sundays









• Try to remain calm. Parentor caregiver anxiety canmake your child’sseparation anxiety evenworse.


Anxiety and A

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isorders• Provide continual

reassurance to your child.• Prepare for your child to

have “relapses” at times,but know that theseanxieties usually decreaseover time with theappropriate strategies.

• Encourage your child’scaregiver/teacher to usedistraction techniques(e.g., involve your child inactivities to take his/hermind off your absence).

• Bring a small object fromhome to remind yourchild of you and your lovefor him/her. A small stoneor a love note tucked intoa pocket can be veryreassuring for your child.These objects aresometimes called“transitional objects.”

• Stay a little longer withyour child at a birthdayparty or at school everyday before you leave.Have your child give you a “secret signal” thatmeans he/she is ready foryou to go.

• Encourage your child toread, write, draw, or paintin a journal to help reducetheir fears. Ask them toshow you what scaresthem to help betterunderstand theiranxieties.

• Model calm behaviouryourself.

Coping Strategies

Anxiety and A

nxietyD

isorders• Encourage and reward

your child forparticipating inindependent activities.

• Leave your child for a veryshort time in a happysituation. Graduallyincrease the time withoutyou, even by a fewminutes at a time. Goslowly.

• Create a coping journalwith your child, asoutlined in the strategiesfor General AnxietyDisorder (GAD).

• Provide your child withfrequent feedback,encouragement andsupport.

• Talk about and role-playnew situations well inadvance.

• Have an exploratory visit(or two) to a new location(e.g., school, new friend’shouse) before schoolstarts or the party begins.Play in the playground,walk around the area, andnotice the environment.

Coping Strategies

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isordersSocial Anxiety Disorder

Social Anxiety Disorder, orSocial Phobia, as it issometimes called, usuallyshows up in adolescence. Itis characterized by severeanxiety (at times mixedwith panic) that occurs onlyin social situations and isoften accompanied byblushing. Extreme fear ofembarrassment or feelingunder scrutiny by others iswhat motivates thisdisorder.This disorder is the mostcommon of the anxietydisorders and may precedethe development ofdepression. Up to 30% ofyouth with social anxietydisorder develop problemswith alcohol use. Thedisorder can severely affecta young person’s ability tobehave normally and canresult in social isolation.Again, some degree of thisbehaviour is considered“normal” in manyadolescents. To determinewhen a person’s behaviourhas crossed over fromnormal to more severe, thebehaviour must be viewedin terms of its frequency,severity and duration.Please see the beginning ofthis section for moreinformation.

Anxiety and A

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isordersAvoidance, refusal orsevere reluctance toparticipate in activitiesthat will permit socialscrutiny (e.g., publicspeaking, eating ordressing in public, socialactivities, dances,gatherings in socialsettings, malls, parties).Also shows up asunwillingness to try newsports or activities, wherethey might look new oruncoordinated.Physical symptoms suchas blushing, a shakyvoice, nervousness, orsweating prior to orduring social situationsStrong fear that otherswill notice their anxiety



• Obtain a second opinion ifpossible.







Anxiety and A

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isordersRESOURCESAnxiety Disorders Association of America8730 Georgia Avenue., Suite 600Silver Spring, MD 20910Phone: (240) 485-1001Web: www.adaa.orgAnxiety Disorders Association of Canada(Ask for a referral to your provincial chapter for local resources)Toll-Free: 1-888-223-2252E-mail: [email protected]: www.anxietycanada.caAssociation for Advancement of Behavior Therapy (AABT)305 7th Avenue, 16th FloorNew York, NY 10001Phone: (212) 647-1890Web: www.aabt.orgFreedom from Fear308 Seaview AvenueStaten Island, NY 10305Phone: (718) 351-1717Web: www.freedomfromfear.comGot Issues Much? Celebrity Teens Share Their Traumas andTriumphs (Randi Reisfeld, Marie Morreale, Scholastic, 1999).National Center for PTSD116D VA Medical and Regional Office CenterWhite River Junction, VT 05009Phone: (802) 296-6300E-mail: [email protected]: www.ncptsd.orgObsessive-Compulsive Foundation, Inc.676 State StreetNew Haven, CT 06511Phone: (203) 401-2070E-mail: [email protected]: www.ocfoundation.org

Please also see Resources at the back of this handbook.

Anxiety and A

nxietyD

isorders• Gradually expose your

child to the situation thatmakes him/her anxiousthrough small groupactivities. For example,organize a small get-together in your home orwhere he/she feels mostcomfortable. Slowlygraduate to larger groupsand outside locations.

• Do not force your childinto situations that couldbe humiliating or thatcould cause extremeanxiety. Ask them whatthey are comfortablewith, and gradually buildfrom there.

• Reassure your child thathe/she is not alone infeeling embarrassed ornervous.

• Discuss and developstrategies to prepare forsocial occasions well inadvance. Assist your childto identify what he/sheworries about in socialsituations and some waysof coping. Role-play thesecoping strategies.

• Encourage relaxationtechniques, such as deepbreathing, progressivemuscle relaxation,meditation and guidedimagery. Ask your child toimagine him/herself in acalm social setting.Practice these strategiesalong with your child.

Coping Strategies

Anxiety and A

nxietyD

isorders• Where possible, work with

your child’s teacher toshare strategies that aresuccessful.

• Arrange activities with afocus on somethingspecial (e.g., a movie witha friend, or an activity athome together).Unfocused “hangingaround” in a social settingis often more difficult foryour child.

• Organize and/orencourage attendance atgroup social activitieswith a purpose (e.g.,religious, charitable,scavenger hunt, sportsgame). These types ofactivities help your childto feel that the focus isnot on him/her, but onthe purpose of theactivity.

• Encourage your child tojoin group activities likean orchestra or bandwhere everybodycontributes and no one issingled out.

Coping Strategies

Anxiety and A

nxietyD

isordersAnxiety Disorders: Treatment and Resources

TREATMENTYoung people with anxietydisorders can be helped bymedications and carefullytargeted psychotherapy,once the condition isprofessionally diagnosed.The choice of one or theother, or both, depends onthe preference of both thepatient (and patient’sfamily) and doctor, and alsoon the nature and severityof the condition. If choosinga therapist, find outwhether medications willbe available if they areneeded. Psychiatrists orother physicians canprescribe medications andthey often work closelywith psychologists, socialworkers, or counsellors whoprovide psychotherapy.Before treatment begins, acareful diagnosticevaluation is necessary todetermine whethersymptoms are due to ananxiety disorder(s), and ifso, which one(s). Not allanxiety disorders aretreated in the same way. Inaddition, any coexistingconditions present in theindividual will need to beevaluated. In some cases,conditions such as asubstance abuse disorder ordepression have such animpact that your doctormay wish to treat theseconditions at the sametime, or before treating theanxiety disorder itself.

During the assessmentphase, it’s important to giveyour doctor and/ortherapist as muchinformation as possible,such as, if your child hasbeen treated previously foran anxiety disorder, if yourchild was/still is on anyform of medication ornatural supplements, howlong any medicationwas/has been taken, and ifyour child has previouslybeen treated withpsychotherapy. These days,if one treatment doesn'twork, the odds are goodthat another one will, andnew medications andtreatments are continuallybeing developed throughresearch.As a parent, your support,participation, and positiveoutlook are crucial toenable your child to buildcoping skills. You spendmuch more time with yourchild than any therapist,teacher, or doctor. So, don’tunderestimate yourstrengths!

Putting the smiles back

For further informationor to donate, contact:

Canadian Psychiatric Research Foundation2 Carlton St., Ste. 1007Toronto, ON M5B 1J3

Phone: 416-351-7757Fax: 416-351-7765

E-mail: [email protected]: www.cprf.ca 1

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Putting the smiles back When Something’s Wr ng o · (e.g., headaches, stomach aches) Avoidance of stressful situations (e.g., tests/exams) Clingy behaviour in young children •