ANXIETY IN CHILDREN AND ADOLESCENTS

Toronto Catholic District School Board –Psychology Department

WelcomeGrace Labao, M.A. C. Psych. Assoc.School and Counselling Psychology

REVIEWWhat is anxiety?What does anxiety look like – the signs and symptomsWhat factors contribute to anxiety?What treatments are available?How can I help?

CASE STUDY

ANXIETYANXIETYAnxiety 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 IMPAIRSANXIETY 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-MORBIDITY75 to 80% of children and adolescents with an anxiety disorder suffer from another psychiatric disorderCombinations 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 ANXIETYConstant worry Muscle tensionPanic attacksExtra sensitiveExtreme need for reassuranceVarious physical symptomsEasily embarrassedClingy behaviour

SIGNS OF ANXIETYExtreme sensitivity to rejection or failureHypervigilancePerfectionismPhysical symptoms – blushing, shaky voice, nervousness, sweating prior to or during social situation

BEHAVIOURS CHARACTERISTIC

OF ANXIETYPoor academic achievement Difficulties socializing, getting along with peers; Social isolation/withdrawalIrritability or outbursts of angerReluctant to do group work or speak out in class; not handing in workQuiet behavioral cues – nail biting, finger picking, hair twirling

BEHAVIORS CHARACTERISTIC OF ANXIETY

Avoidant behaviours – situations, places, peopleRestlessness or feeling on edgeDifficulty maintaining relationshipsEasily fatigued; Shy, quietDifficulty concentrating Difficulty falling or staying asleepAlcohol and/or drug useDrop out of activities

EXCESSIVE WORRIES/FEARS

GENERALIZED ANXIETY SEPARATION ANXIETY

OBSESSIVE-COMPULSIVE

SOCIAL ANXIETY SPECIFIC PHOBIA

PANIC DISORDER AGORAPHOBIA

POST-TRAUMATIC STRESS

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 HELPKnow the signs and triggers Provide support, understanding, rather than avoidanceModel effective coping strategiesChanging worried/fearful thoughtsConsult with a mental health professional -learn all you can about the disorderCommunicate your concerns to teachers/administrators; work closely with your child’s teacher, & school team.

Continuation…..

Consult with school psychologist/Social Worker via administratorsEncourage physical exercise to reduce anxietyEncourage writing, drawing, painting to alleviate fearsEncourage “coping” behavior and discourage avoidance. Create a “coping’ book – e.g. ways to relax, tasks that distract from anxietyWeekly planning to manage school work

Continuation…..A supportive adult (CYW, Guidance, Chaplin, teacher, administrator) can be provided at the school level.Encourage group social activitiesRemind children/youths of their past successesRole-playDon’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

ResourcesCentre 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

ResourcesHelping 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., 2006Freeing Your Child from Anxiety: Powerful, practical solutions to overcome your child’s fears, worries, and phobias. Tamar E. Chansky, Broadway 2004

ResourcesHelp for Worried Kids: How your child can conquer anxiety and fear. Cynthia G. Last, Guilford Press, 2005Your 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: KatharinaManassis,(2nd 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, MaginationPress, 2005