Supporting Students with Anxiety Disorders

1. Supporting Students with Anxiety Disorders Myque Harris, MS, LCPC Tennessee State University Loyola University, 2005 Licensed Clinical Psychotherapist, 2007 Psychiatry Clinic, Private practice, School based mental health

2. Video: In their own words... • http://www.youtube.com/watch?v=4VbxjsO9IYI&feature=colike • http://youtu.be/Rcy2jF1EXjk • Cleansing Breath • Today we will talk about Anxiety and ADHD with a primary focus on anxiety. • Discuss inattention/impulsivity and acknowledge possible root in anxiety or ADHD

3. ANXIETY • Anxiety is the most common, chronic, costly emotional disorder in the U.S. (NIHM) for both Children and Adults • 25% of Adults • Children age 8 (25.7%); Age 17 (21.4%) • Women vs. Men • More likely to affect females (Social Anxiety is equal) • Comorbid with Depression and ADHD • GAD and depression more common • Why? BOTH Nature (40%) AND Nurture (60%) play a part – 3 main ingredients Myque Harris, MS, LCPC

4. 3 Ingredients in Anxiety • Biological Sensitivity • Research in infants shows biological sensitivity from birth; Over sensitive to stimuli (sounds, odor, touch) • Temperament can be ID as early as 4 months to show which babies will be more likely to have anxiety • Stress Overload • Correlation between Stress and Anxiety • School months verses summer months • Personality Traits • People with Anxiety have similar traits – Further look…Next slide... Myque Harris, MS, LCPC

5. Anxiety Disorders – DSM-IV • General Anxiety Disorder • Separation Anxiety • Obsessive Compulsive Disorder • Obsession: intrusive thoughts or images, associated with negative feelings • Compulsion: Ritualized behavior, checking, counting, hoarding • Panic Disorder • Overanxious Disorder • Social Anxiety Disorder • Phobias • Post Traumatic Stress Disorder (PTSD) • Anxiety due to medical issues (allergies, Crohn’s) • Obsessive Personality Disorder (Personality Disorder vs. an Anxiety disorder) Myque Harris, MS, LCPC

6. What is ADHD? • The inability to maintain focus and manage internal (thoughts) and external (noise) distractions; organize, sequence and make things happen, inhibit impulses and issues in some memory function. • Types of ADHD • Predominately Inattentive (ADD) • Predominately Hyperactive-Impulsive • Combined type • ADHD NOS • 6 symptoms, 6 months, 2 or more settings • Before the age of 7 years Myque Harris, MS, LCPC

7. ADHD • There is a breakdown in the area of attention • This breakdown prevents complete and accurate processing of information, comprehension, and recall Barrie Morganstein, Ph.D. & Trey Ishee, Psy.D.

8. Differential Diagnoses Anxiety – • Stress and worry can also cause poor attention and distractibility prevents information from accurately and completely entering the brain. • Anxiety and low self-esteem can also cause children to hesitate in responding which can look like comprehension difficulties or verbal apraxia.

9. Anxiety • Anxiety can also cause breakdowns in the areas of attention and processing, but can also cause breakdowns further along the process and disrupt communication in a variety of ways

10. Brain Parts and Functions Myque Harris, MS, LCPC

11. Brain Structures Myque Harris, MS, LCPC

12. Your Brain on Anxiety Model of the brain Functions Brainstem: Connects to the spinal chord Heart rate, breathing, sleeping, eating Cortex: Multi-layered, complex Pre frontal lobes: Logic, fore thought, planning, mindful choices Fully develops in our 20s Limbic Region: Emotion, behavior, motivation, long term memory, olfaction Amygdala: Part of the limbic system Processes strong emotional, such as fear, anger, anxiety Acts as a smoke alarm Alarm System – Next slide for visual Myque Harris, MS, LCPC

13. Emotional Hijacking! Myque Harris, MS, LCPC

14. Neural Static and Imprinting • Neural Static • Brainstem and limbic system hijack the brain and body (fight, flight or freeze) and temporarily create “static” in the brain that inhibits the brain from functioning • We are not (literally) thinking clearly and using all of our resources • Imprint neural firing patterns • Similar situations, “Alarm systems” warns us, but makes errors – Values speed over accuracy • Hebbs’s axiom: Neurons that fire together wire together Myque Harris, MS, LCPC

15. Explicit and Implicit Memory • Explicit (Aware) and Implicit (Unaware) Memory • These memories affect and influence future experiences • WOMEN’S BUG STORY • Fearful memories are attached to an/a: • Informational component (“Nobody likes me!”; “I’m not smart enough to do math!”) • Energy/Emotional component (Helplessness, sadness, confusion) • Negative conclusion or message about self (“I’ll never have friends; I will fail math and there is nothing I can do about it.”) Myque Harris, MS, LCPC

16. The “Alarm System” • Jobs: • Imprints experiences in which we have felt at riskso we can be alerted to similar experiences in the future. *Note: Usually in childhood these experiences are perceived as very intense because of the vulnerability, naivety and lack of experience of children. Myque Harris, MS, LCPC

17. Personality Traits Common to Anxious Students • Looks like a model student? • Responsible • Prefers structure • Likes to please • Avoids conflict • Perfectionism • Worry • Difficulty relaxing • Low assertiveness • Positive • Cooperative • Motivated Student • Thoughtful/Reflective • Negative • Higher Stress/Anxiety levels • Personalizes – makes things about them • Easily exploited Myque Harris, MS, LCPC

18. Typical Worries, Ages 7-15 • School performance • Appearance • Social Acceptance • Peer relationships • Death of a parent • Global/Societal Issues • Violence, hunger, poverty, economy • Refer to Developmental handout Myque Harris, MS, LCPC

19. Home • Major transitions (i.e. moving) • Divorce of parents • Parents Illness • Unstable Parent (Mood, lack of presence, etc.) • Inconsistent home structure • Families create anxiety in children Myque Harris, MS, LCPC

20. School Related Anxieties • Text Anxiety – a specific phobia (Handout) • Symptoms • Excessive or unusual fear, tension, apprehension, somatic arousal. • Can occur before, during or after exam • Concentration, problem solving and creative thinking are affected. • Associated with some major concern about performance • Fear of Anxiety symptoms Myque Harris, MS, LCPC

21. Fear of Anxiety Symptoms • Students can have anxiety about have anxiety • Fear of embarrassment • Fear of losing control • “I don’t know what’s wrong!” • Teary; embarrassed • Cycle created Myque Harris, MS, LCPC

22. Somatization • Gastrointestinal (GI) Issues • Headaches • Aches and Pains • Wrist and knee braces Internalizing Anxiety These issues can be real or imagined. Many anxious students develop real health issues because of how they internalize their anxiety. Myque Harris, MS, LCPC

23. Supporting children and families dealing with anxiety… WE CAN HELP!!! Children can… Learn new patterns Develop new coping skills Understand new concepts Change patterns in thinking Myque Harris, MS, LCPC

24. Therapy: Students and Families Myque Harris, MS, LCPC

25. Counseling Techniques Counseling Other Cognitive Behavior Therapy (CBT) Rational Emotive Behavior Therapy (REBT) Talk Therapy Play Therapy Art Therapy In-Vivo (exposure) Therapy Mindfulness Medication Food restrictions Reducing caffeine Supplements Relaxation and Breathing Techniques Sleep hygiene Nutrition Myque Harris, MS, LCPC

26. How parents/teachers can help… • Recognize signs of a possibly anxious child/student • Equip that child/student with skills they can use at home or in the classroom or in social situations (Stop-Think- Reflect-Choose) • Make accommodations when needed (Tell child/students what will happen on a trip, the morning of the outing…) • Communicate with teachers/parents about observations • Help students understand how to recognize a different perspective • Integrate specific techniques into your home or classroom routine (Breathing, reflecting, relaxation) Myque Harris, MS, LCPC

27. How parents/teachers can help… FEAR THERMOMETER Parents/Teachers can… Listen to the students perspective or send them to an adult who has the time to listen MO – rate their feeling, ask why 5? Catch it early: Use techniques to calm kids before they cross over Feeling vocabulary Help kids understand where they feel their feelings in their bodies Talk therapy can be free!!!! Use it at home or in school!!! 9 – I can’t take it! 7 – I’m very uneasy 5 – I’m a little uneasy 1- I’m “A” Ok! Myque Harris, MS, LCPC

28. Techniques • 3’s – Signals, Source, Solutions/Skills • Stop-Breath-Reflect-Choose • Worry Box • Worry Time • Breathing • In and out through nose (Para sympathetic nervous system) • Managing Test Anxiety (or specific subject, Math) • Relaxation Techniques (Progressive muscle relaxation) • Redirect thinking – Mini CBT • FAFL – Face, Accept, Float, Let time pass… Myque Harris, MS, LCPC

29. RelaxationTechniques • Music • Breathing • Nostril breathing • Belly breathing • Stillness • Practice being still, increase time • Meditation, Chanting • Physical practice • Yoga Myque Harris, MS, LCPC

30. Programs • Life Skills Program for Anxiety in Kids • Reduce stress (adjust schedules, Time management Skills • Adjusting parenting and home structure • Sleep Hygiene • Feelings support work • Having reasonable goals (At School and Home) • Relaxation Techniques Myque Harris, MS, LCPC

31. Yay! Progress • More Relaxed • Less worry • Increased positive outlook • Higher self esteem • Risk tolerance is higher • Better social skills Myque Harris, MS, LCPC

32. Questions Myque Harris, MS, LCPC

33. References • Foxman, P. The Worried Child: Recognizing Anxiety in Children and Helping Them Heal, 2007 • Fralich, Terry, Cultivating Lasting Happiness: A 7-Step Guide to Mindfulness, 2007 • Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition • National Inst. Of Mental Health Myque Harris, MS, LCPC