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Stress and Anxiety in School Aged Children

Dr. Agetina Smajlaj School Psychologist

Introduction �  Purpose of Presentation

�  Outline �  Stress �  Anxiety �  Prevalence rates in children �  Difference between stress and anxiety �  Signs and symptoms of stress and anxiety �  Common types of anxiety in children �  Diagnostic criteria �  Common types of anxiety in children �  Strategies for Parents �  Helpful resources �  Questions/discussion

�  Guidelines

What is Stress? �  Stress is a state of mental or emotional strain

resulting from adverse or demanding circumstances. It is a function of the demands placed on us and our ability to meet those demands �  Demands come from outside sources �  Demands can also come from within

�  What we think we should be doing versus what we are actually able to do

�  Stress can be intensified by other factors (e.g., hearing others talk about stress, illnesses, lack of sleep, poor nutrition)

�  Complicating factors can magnify everyday stress �  Illness, death of a loved one, divorce

***Some stress is normal and can provide the energy to tackle tests, presentations, projects, sports events

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What is Anxiety? �  Anxiety is a term used for several disorders that cause

nervousness, fear, apprehension and worrying

�  It is the process by which a person becomes scared and apprehensive of what lays ahead

�  Anxiety manifests itself in physical symptoms such as pain, dizziness and panic attacks

�  It is a response to something that is going to happen at a future date, may happen at a future date or may never actually happen at all

�  Anxiety is stress that continues even after the stressor is gone

�  It is normal to feel anxious when facing something difficult or dangerous (fight or flight response) and mild anxiety can be positive

�  Anxiety interferes with daily life

Prevalence of Anxiety in Children �  It is estimated that 1 in 8 or 12.5% of children

have an anxiety disorder

�  Types of Anxiety Disorders �  Separation Anxiety Disorder �  Selective Mutism �  Specific Phobia �  Social Anxiety Disorder �  Panic Disorder �  Agoraphobia �  Generalized Anxiety Disorder �  Substance/Medication Induced Anxiety Disorder �  Anxiety Disorder Due to Another Medical Condition �  Other Specified Anxiety Disorder �  Unspecified Anxiety Disorder

So…What is the difference between stress and anxiety?

�  With stress we know what is worrying us �  Impending deadline, upcoming event

�  Stress is associated with frustration and nervousness

�  With anxiety we are less aware of what we are anxious about in the moment and the reaction becomes the problem

�  Anxiety is associated with fear, unease and worry

�  Anxiety is a diagnosable mental disorder, stress is not

�  Stress typically goes away after the stressors disappear while anxiety lingers and can be harder to treat

�  To be diagnosed with an Anxiety Disorder “the fear, anxiety or avoidance is persistent, typically lasting 6 or more months.”

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Symptoms of Stress & Anxiety Cognitive Behavioral Physical

•  Difficulties concentrating •  Shyness •  Trembling or shaking

•  Overreaction to relatively minor events

•  Withdrawal •  Increased heart rate

•  Memory problems •  Frequently asking questions

•  Excessive perspiration

•  Worry •  Frequently seeking reassurance

•  Shortness of breath

•  Irritability •  Need for routines •  Dizziness

•  Perfectionism •  Avoidance •  Chest pain or discomfort

•  Rigid thinking •  Rapid Speech •  Flushing of skin

•  Hyper-vigilance •  Excessive talking •  Nausea, vomiting, diarrhea

•  Fear of losing control •  Restlessness, fidgeting •  Muscle tension

•  Fear of failure •  Hair pulling/twirling •  Difficulties with sleep

•  Difficulties with academic performance

•  Impulsiveness •  Change in appetite

Common Types of Anxiety in Children �  Generalized Anxiety Disorder- recurring fears and

worries that they have difficulty controlling. They worry about almost everything- sports, school, natural disasters, health, being on time, etc.

�  Separation Anxiety- intense anxiety about being away from home or from caregivers that affects their ability to function socially and in school. They often worry excessively about their parents whereabouts and well-being.

�  Social Anxiety Disorder- constant fear of social or performance situations such as speaking in class, attending parties/playdates, performance on tests, athletic performance, etc.

Diagnostic Criteria for Separation Anxiety Disorder (SAD)

�  SAD persists in individuals under 18 for at least four weeks and adults for six months or more. An individual with SAD experiences persistent anxiety at a developmentally abnormal level in response to separation or impending separation from an attachment figure as evidenced by three of the following symptoms: �  Recurrent excessive stress when anticipating or experiencing

separation from major attachment figures or home �  Persistent and excessive worry about losing major attachment figures

or harm to them

�  In response to fear of separation from an attachment figure: �  Excessive worry about experiencing a negative event (e.g., an accident

or illness, being lost or kidnapped) �  Refusal to go out, such as from home, to school, or to work �  Fear of being alone or without major attachment figures at home or in

other settings �  Reluctance or refusal to sleep away from home or to go to sleep

�  Repeated nightmares involving the theme of separation

�  Repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated

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Diagnostic Criteria for Social Anxiety Disorder �  A. Marked fear or anxiety about one or more social situations in which the individual is

exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g, giving a speech).

�  Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

�  B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating and embarrassing; will lead to rejection or offend others).

�  C. The social situations almost always provoke fear or anxiety. �  Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing,

clinging, shrinking, or failing to speak in social situations. �  D. The social situations are avoided or endured with intense fear or anxiety. �  E. The fear or anxiety is out of proportion to the actual threat posed by the social

situation and to the sociocultural context. �  F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. �  G. The fear, anxiety, or avoidance causes clinically significant distress or impairment

in social, occupational, or other important areas of functioning. �  H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a

substance (e.g., a drug of abuse, a medication) or another medical condition. �  I. The fear, anxiety, or avoidance is not better explained by the symptoms of another

mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

�  J. If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.

�  Specify if: Performance only: If the fear is restricted to speaking or performing in public.

Reducing Stress in Kids �  Parents cannot protect their children from stress, but

can help them to develop healthy ways to cope with stress �  Good rest and good nutrition boost coping skills �  Consistent but flexible routines (morning, homework,

activities, chores, bedtime) �  Spend time each day to talk, listen and play �  Be consistent with how you handle problems and

administer discipline �  Maintain realistic, attainable goals and expectations for

your child �  Accept mistakes as a normal part of growing up �  Praise and reinforce effort, even if success is less than

expected

What you can do if your child is stressed/anxious �  Notice out loud- (“It seems like you are still mad about what happened at the

park.”)

�  This is a casual observation that shows you are interested in hearing more about your child’s feeling

�  Be sympathetic and show you care

�  Listen- ask your child about how they are feeling. Try to get the whole story by asking open-ended questions (“And then what happened?”)

�  Comment briefly on the feelings you think your child is/was experiencing- (“That must have been upsetting” “That must have seemed unfair to you”)

�  Help your child think of things to do – Help your child brainstorm, but do not do all the work. Ask, “How do you think this plan will work?”

�  Limit stress when possible – it may be necessary to prioritize or limit activities

�  Be there- let your child know that you will be there when they are ready to talk. Initiate another activity that you can do together

�  Resist the urge to fix every problem- focus on helping your child become a good problem solver

�  Praise efforts to solve problems- (“I like how you came up with a few strategies”

�  Talk about your own stress- in an age-appropriate manner (“I have a project next week for work that I am working on. I am worried about finishing on time…)

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Strategies for Separation Anxiety �  Tell your child that it is normal to sometimes feel

anxious when alone or away from the caregiver.

�  Tell your child that you will give him/her some tools to help cope with anxiety and gradually face his or her fears.

�  Help your child identify some of the thoughts, feelings and behaviors related to his or her separation anxiety. (Thought-If you go something bad will happen, I might throw up; Feeling- stomachache, scared; Behavior- crying, refusing to go to school) �  Try changing the thought

Strategies for Separation Anxiety (continued)

�  Encourage your child to stop seeking reassurance (e.g., “Are you sure you will be here when I get out of school?” “What time will you be home?”) �  Tell your child that this is just anxiety talking because he/

she already knows the answer (you answered it 5 minutes ago)

�  Make a plan with your child about beating back anxiety by not giving reassurance

�  Tell your child that he or she can only ask you something once �  “What did I tell you when you asked the question 5 minutes

ago?”

�  Give your child something tangible (picture for cubby/ locker, locket with picture)

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Strategies for Performance Anxiety �  If your child is worried about an upcoming event (e.g., recital,

test, separation from parent) practice to increase confidence and decrease discomfort

�  The goal of practicing is to get the anxiety to a manageable level and not to eliminate it

�  Reinforce strategies to help with anxiety (organizing materials and time, develop short scripts for what to do and say in specific situations with others, develop short scripts to be used internally, practice relaxation strategies)

Building your child’s toolbox �  Relaxation Training

�  Deep Breathing �  I Can Relax! CD

�  Indigo Dreams CD

�  Progressive Muscle Relaxation �  I Can Relax! CD

�  Mindfulness Exercises �  Coping Cards or Calming Statements

�  Slowly facing fears

When to seek professional help

�  When a change in behavior persists

�  When stress/anxiety are interfering with everyday routines/activities

�  When behavior is causing significant problems at home or at school

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Helpful Resources �  Books for kids:

�  What to Do When You Worry Too Much

BY: Dawn Huebner �  What to Do When You Are Scared and Worried

BY: James J. Crist

�  When My Worries Get Too Big! BY: Kari Dunn Buron �  Please Explain “Anxiety” to Me!

BY: Laurie E. Zelinger and Jordan Zelinger �  Is a Worry Worrying You? BY: Ferida Wolff

�  A Boy and a Bear: The Children’s Relaxation Book BY: Lori Lite

Helpful Resources �  Books for parents:

�  Helping Your Anxious Child: A Step-By-Step Guide for Parents

�  Freeing Your Child from Anxiety

Helpful Resources �  CD’s

�  I Can Relax! By: Donna Pincus, Ph.D.

�  Indigo Dreams By: Lori Lite

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Questions/Discussion �  In order to protect your children’s confidentiality kindly

refrain from asking questions about your children or children in the school.

�  If you would like to ask a specific question about your child, please feel free to contact me to set up an appointment to meet.

Agetina Smajlaj, Psy.D., NCSP

asmajlaj@scarsdaleschools.org

914-721-2746