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Understanding and Supporting the Anxious Child

Understanding and Supporting the Anxious Child. Allan Donsky MD FRCPC Psychiatry FRCPC Pediatrics Clinical Assistant Professor, Department of Psychiatry, University of Calgary Adjunct Professor, Department of Child and Youth Studies, Mount Royal University Mountain Park

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Understanding and Supporting the Anxious Child

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  1. Understanding and Supporting the Anxious Child Allan Donsky MD FRCPC Psychiatry FRCPC Pediatrics Clinical Assistant Professor, Department of Psychiatry, University of Calgary Adjunct Professor, Department of Child and Youth Studies, Mount Royal University Mountain Park November 21, 2013

  2. Learning Objectives • What is anxiety ? • Can Anxiety be “normal” ? • How does it arise ? • What does Anxiety look like ? • What can I do about it ?

  3. Common Age Related Fears Birth-6 Months Loud noise, loss of physical support, rapid position changes, rapidly moving objects 7-12 Months Strangers, looming objects, sudden unexpected objects or unfamiliar people 1-5 Years Strangers, storms, animals, dark, separation from parents, loud noise, toilet, monsters, ghosts, insects, bodily harm 6-12 Years Supernatural beings, bodily injury,disease, burglars, staying alone, failure, criticism,punishment

  4. What do children have to worry about ?

  5. School Related Fears • Separation from home • Bus • Performance anxiety • Academics • Interacting with peers or teachers • Bullied • Eating in front of others • Using the bathroom • Changing for gym

  6. The most Challenging Decade in life • Sex • Money • Future • Identity • Academics • Independence • Sexual Orientation • Social Competence

  7. General Principles • Root word : Anxious, Anger, Anguish = Torment • Anxiety can be a Symptom or a Disorder. • Synonyms : apprehension, anguish, unease, concern, nervous, misgiving, qualm, disquiet, distress, dread , distraught, threatened, uneasiness, edgy, jittery, trepidation, timid, tense, uneasy, consternation,worry. • Anxiety is apprehension, tension, or uneasiness from Anticipated danger. • Anxiety has survival value • Impairment or distress/suffering makes it a Disorder

  8. The Spectrum of Fear and Anxiety in Children Typical, developmentally appropriate Severe anxiety symptoms

  9. How common are Mental Health Disorders ? Waddell, Offord et al Can J Psychiatry 2002;47(9):825-832

  10. What about temperament ? Arousal Behavioral Inhibition J Am Acad Child Adolesc Psychiatry. 1993 Jul;32(4):814-21.

  11. How does Anxiety arise ? Psychological Temperament • Environment • Family • Insecure Attachment • Modeling • Stress • Media • School • Social • Trauma Genetics Anxiety +/- Disorder Splitters and Clumpers

  12. Response to Anxiety • Fright ( Experience) • Freeze ( “ Deer in headlights” ) • Flight (Avoidance ) • Fight ( Argue, Fuss, Oppositional ) • Faint (injury)

  13. What might Anxiety look like ? Physiological Cognitive Experiential Behavioral

  14. Physiological • Somatic symptoms • Mild Panic • Recognizable as fight or flight • Breathing • Heart rate • Muscle tension • Tummy aches • Sleep, nightmares • Tired

  15. Cognitive • Worry is a defining feature • Attention • Concern about adult matters • Catastrophic thinking • Rigid • Hard time letting go • Struggle to make choices • Unable to see success • Negative view of self and others

  16. Experiential • Dread • Sensitive • Hyper-vigilant • Low self worth • Low self esteem

  17. Behavioral • Fight • Flight ( avoidance) • Freeze • Repetitive actions • Nail biting, licking lips, pull hair, chew clothing, pacing • Obsessions (repetitive thoughts) or compulsions. • Need for reassurance, help seeking , overdependence

  18. Why is Anxiety missed ? • Awareness • Internalizing • Silence is seen as absence of problem • Tend to normalize shyness • Labeled as other things ( very unhelpful !! )

  19. Labeled as other things • Oppositional • Defiant • Manipulative • Attention seeking • Demanding • Confrontational • Sneaky • Pushes buttons • Lazy • Avoidant • Selfish • Aggravating • Annoying • Ignorant • Rude • Stubborn The real question: “What is going on ?”

  20. So what if there is Anxiety? • Academic • Attendance , Avoidance , Underachievement • Behavioral • Avoidance , oppositional • Cognitive • No risks, confidence, image • Developmental • Image, success, confidence, • Emotional • Stunted • Family • Power struggles, tired • Physical • Gym avoidance • Social • Loneliness, tobacco & alcohol use

  21. Common Beliefs About Worries: All untrue Worrying: • Motivates me • Helps find solutions to problems • Prevents negative outcomes • Protects me from negative emotions • Is a positive personality trait …it means I care Francis, K. & Dugas, M. J. (2004). Assessing positive beliefs about worry: Validation of a structured interview. Personality and Individual Differences, 37, 405-415.

  22. Pedal , Steer and Brake

  23. What can I do to help ? • Treat own Anxieties • Get Educated • Stop • Criticism • Rescuing” – Makes it worse • Dismissing their experience • Reassuring the wrong way ( “ Don’t worry”) • Start • Reassuring the right way ( “ You can handle this “) • Bravery = Support activities in spite of Anxiety • Encourage facing new situations

  24. Are Feelings Real ? “My feelings are real but they don’t always tell me the truth”

  25. Relationship is everything • Establish trust • People don’t care how much you know till they know how much you care • Be authentic …let them see your weaknesses • Stay calm….even if you do not know what to do ! • Act as a coach, not solver • Recognize patterns so they can be: • Explored • Explained • Expanded • Have proactive conversations • Use student’s ideas first and then yours

  26. How much do I push ? Breaking point Peak Rage Lose it Meltdown Freak out Over-react Performance Stress Push Back off

  27. Life is Simple, not easy Moments • Education • Relaxation • Emotional vocabulary “Pop ups” Thoughts Feelings • Coaching • Reality check • Evidence • Realistic & Constructive • Worry Thermometer • Mastery & Pleasure • Internal praise • Modeling • Social engineering • Exposure • Experiments • Problem Solving Anxiety Actions Relief Avoidance Helpful Unhelpful ( F words)

  28. Perfectionism

  29. Excellence and “ Good Enough” • Perfectionism is unattainable = set up for failure = never feel good enough = give up or burn out trying • Need to be real • Effort is most important • Honor roll is 80 % • No such thing as a mistake • what is worst thing that can happen ? • Celebrate “Not knowing” • “Own it ,fix it , Show some learning “ • Self worth is not tied to achievement

  30. Balancing Act for Adults Goldilocks Exposure Courage/Bravery Treat Parental Anxiety Gentle Firm limits Refrain from Criticism Unified & Consistent

  31. Educational • Learning Disabilities • Attentional issues can be secondary • School Modifications • Teacher/ Resource and Admin support • Time out/Quiet place • Bullying • Academic load • Homework issues • Tutoring. • Attendance

  32. But I don’t have time to do this ? Definition of Insanity……… Until you stop doing what is not working there is no space to do something different

  33. Online Resources American Academy of Child and Adolescent Psychiatry. Aacap.org Anxiety Disorders Association of America adaa.org AnxietyBC™. Anxietybc.com Canadian Paediatric Society. caringforkids.cps.ca/behaviour/fears.htm Chansky, T. (2004). Freeing your child from anxiety: Powerful, practical solutions to overcome your child’s fears, worries, and phobias. New York: Broadway Books. Cheng, M. (2006). Selective mutism: A guide for teachers.www.drcheng.ca/resources/Articles/selective_mutism-for_school.doc Cheng, Mi. (2009). Overcoming anxiety: A guide for families. www.drcheng.ca/resources/Articles/anxiety_info_for_families.doc Garland, E.J. & Clark, S.L. (2000). Taming worry dragons: A manual for children, parents,, and other coaches. Vancouver, BC: Children’s and Women’s Health Centre of British Columbia. “What to do when you worry too much; A kids guide to overcoming Anxiety” Dawn Huebner

  34. Counselling Recommendations When Dr. Donsky presented to our staff, he recommended the following people for counselling services: • Julie Brock – 220, 7370 Sierra Morena Blvd. SW 403-686-8379 • Dan Drybrough – Learning Solution 102, 7370 Sierra Morena Blvd. SW 403-685-0880 • Julie Robinson – Bonavista Medical Clinic 739 Lake Bonavista Drive SE 403-278-2434 • Leona Doig - 403–540-8773 • Doug Murdoch - 403–440-8536 ** Dan Drybrough  and Julie Robinson have come with high recommendations from our parents.

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