Paula Barrett Pathways Health and Research Centre pathwayshrc.au University of Queensland

1. SUSTAINABLE RESILIENCE Allergies and Anxiety Preventative Strategies Paula Barrett Pathways Health and Research Centre www.pathwayshrc.com.au University of Queensland

2. Acknowledgments • My family: Ana, Tom, Brad and our pets • Pathways Team • All the families we have worked with

3. “Our mind can overcome almost any adversity “ Norman Doidge

4. Risk Factors: Temperament Physiological sensitivity – low thresholds for stress Neurological/brain development Life Events traumas Physical Health Protective Factors: Attachment/Affection Cognitive style Family Sleep Daily Exercise Diet School /Work Evidence Based Prevention Risk and Protective Factors for Human Development

5. What we know: • One in five adults & children suffer anxiety or depression (more prevalent than drug use, ADHD, or any other health problem) • One in five adults or children suffer from allergies and associated anxiety • Less than 5 % of cases receive effective preventative interventions

6. What we know: 90% of major emotional and psychological difficulties and allergies start before 18 years of age !

7. What we know Parents and Health Professionals do not know how to access and implement preventative Psychological Evidence Based Interventions

8. Evidence based interventions Attachment Stable, unconditionally loving relationships, Self - soothing, mirror self-worth, acceptance, safety Learning Problem solving skills Coping Behavioural Skills Positive role models Support networks Cognitive • Positive • thinking skills • about self, • others • and the environment Physiological Awareness of body clues Relaxation techniques Self-regulation Managing physical conditions

9. Australian Evidence Based Resilience Program: Friends for Life • F = Feelings (awareness and empathy) • R = Relaxation (self reg & self soothing) • I = Unhelpful vs helpful thinking • E = Problem Solving and step plans • N = Nurturing confidence • D = Don’t forget the ongoing practise • S = Stay calm, You know what is happening, You know what to do

10. “We cannot always build the future for our youth, but we can build our youth for the future”

11. Early Intervention • Preventative Interventions - Early prior to onset of a disorder • Preventative Interventions - Early developmentally in a child’s life

12. What WE CAN do: • Education rather than stigma • Prevention rather than waiting • Empowerment rather than blaming • Focus on interactions and learning skills • Focus on strengths rather than deficits • Focus on solutions rather than problems

14. “ Externalising the anxiety and allergy challenges empowers the child and the family”

15. Friedman and Morris, REVIEWJournal of Clinical Psychology in Medical Settings • There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents - these illnesses are often comorbid. • Anxiety management skills are needed for parents and children • Allergy management skills are needed for parents and children

16. Friedman and MorrisWhat can be done: • We must identify at-risk children • We must study the family history • We must conduct validated assessments for comorbid anxiety and allergies • We need to target anxious parents and to implement exposure and other CBT skills • We need to develop and evaluate treatments that reduce fear associated with the physiological symptoms of allergic reactions

17. Teufel et al, 07What can be done: It is important to acknowledge the complex interplay between body and mind: adults and children suffering from food allergy show impaired quality of life and a higher level of stress and anxiety. We need to develop strategies for an optimized management of the various types of adverse reactions to food.

18. DunnGalvin et al, 09What can be done: 1 - A developmental framework must link health related quality of life and the maturation of the immune system. 2 - It must also link psychological stress, temperament and emotion to neuro-immuno-regulation and increased risk of negative impact. 3 – It must explain both physiological and psychological phenomena and their interaction.

19. Preventative skills Be happy Nurture important relationships Have fun with children Let children be children Monitor, cohesion, consistency Spend time, interpersonal rewards Sleep, Diet, Exercise, Play

20. DunnGalvin et al, 09 Children whose parents encouraged independence and self-management were more likely to describe positive coping strategies “If there's food around, I will be careful, but otherwise I don't think about it” “I always tell people I'm food allergic…its safer that way and then you don't have to keep explaining

21. Cummings Ped All Imm 2010 Anxiety can be managed by both parents and children with positive outcomes for all independent of allergy severity and type experienced by the children.

22. Graves et al, 2010Journal of Pediatric Psychology • Summarises 70 studies doen with children with chronic illness mainly allergies • Only 50% of families with children adhere to treatment and prevention protocols • Adherence maximises long term health benefits

23. THANK YOU! WWW.PATHWAYSHRC.COM.AU “The brain that changes itself” Doidge, 07 “Allergies and Anxiety in Children and Adolescents: A Review of the Literature” Friedman and Morris, 06 “Psychological burden of food allergy” Teufel et al, 07 “Developmental Pathways in food allergy: a new theoretical framework” DunnGalvin et al, 09