Anxiety Disorder in YouthAnxiety Disorder in Youth

Necessary CompetenciesNecessary Competencies

Friendship skills ( higher predictor success in life than poverty )

Strong interpersonal skills Adaptive/flexibility problem

solving Need stress management skills

Friendship skills ( higher predictor success in life than poverty )

Strong interpersonal skills Adaptive/flexibility problem

solving Need stress management skills

Prevalency RatesPrevalency Rates

13- 20 % adolescents have mental health issues that are clinically sufficient, but only 1:6 contact mental health professionals

Of those seeking help for Mental health : 13% Anxiety disorder 10% Disruptive Behaviour disorder 10% mood disorders ( Depression ) 2% substance use disorder

13- 20 % adolescents have mental health issues that are clinically sufficient, but only 1:6 contact mental health professionals

Of those seeking help for Mental health : 13% Anxiety disorder 10% Disruptive Behaviour disorder 10% mood disorders ( Depression ) 2% substance use disorder

Some Complications of Untreated Anxiety

( Dodds, et al, 1997)

Some Complications of Untreated Anxiety

( Dodds, et al, 1997)

Diminished academic achievement Impaired relationships Subsequent depression, alcohol

abuse, Greatest predictor of suicide

Diminished academic achievement Impaired relationships Subsequent depression, alcohol

abuse, Greatest predictor of suicide

OnsetOnset

Mean age of onset 10-12 years old Often elevated IQ, teacher

pleasers Teachers are best referral resource Families often reluctant to seek

mental health support

Mean age of onset 10-12 years old Often elevated IQ, teacher

pleasers Teachers are best referral resource Families often reluctant to seek

mental health support

ANXIETY…ANXIETY… Normal human emotion for survival;

smart for evolution; helped be alert from predators, prepared ; pay attention to possible dangers

Individual differences continuum ____________________________ low normal excess

Normal human emotion for survival; smart for evolution; helped be alert from predators, prepared ; pay attention to possible dangers

Individual differences continuum ____________________________ low normal excess

Causes of AnxietyCauses of Anxiety

Inborn, inherited tendency Shy or cautious temperament Unpredictable lifestyle Stressful experiences Learning from anxious parents Habit patterns of avoidance

Inborn, inherited tendency Shy or cautious temperament Unpredictable lifestyle Stressful experiences Learning from anxious parents Habit patterns of avoidance

Anxiety is Developmental Anxiety is Developmental

Infant/Toddler: separation Preschool: animals, dark, separation School age: performance,

adaptations, family change Pre-adolescence: health, performance,

social Adolescence: social, existential, future

Infant/Toddler: separation Preschool: animals, dark, separation School age: performance,

adaptations, family change Pre-adolescence: health, performance,

social Adolescence: social, existential, future

Anxiety is Physical Anxiety is Physical

Classic “Fight or flight “ response -sweating (slippery to get away) -pupils dilate ( to take in more light and gain more sensory input in order to react quickly to danger) - arousal ( increased heart rate, shallow breathing, shaking, dizzy) -aches (tension, headaches, muscles, fatigue) -sleep (insomnia)

Classic “Fight or flight “ response -sweating (slippery to get away) -pupils dilate ( to take in more light and gain more sensory input in order to react quickly to danger) - arousal ( increased heart rate, shallow breathing, shaking, dizzy) -aches (tension, headaches, muscles, fatigue) -sleep (insomnia)

- the brain releases stress hormones, like epinephrine, and steroid hormones, like cortisol to give the body its much needed fuel to ward off the threat.

-Muscles become tense, heartbeats start accelerating, and blood sugar shoots up.

stomach ache, “scared peoples”

- the brain releases stress hormones, like epinephrine, and steroid hormones, like cortisol to give the body its much needed fuel to ward off the threat.

-Muscles become tense, heartbeats start accelerating, and blood sugar shoots up.

stomach ache, “scared peoples”

Common Associated Features

Common Associated Features

Depressed, irritable moods, cries easily

Fidgety, nervous habits ( nail biting) Sleep problems ( huge sleep rituals) Headaches and stomach aches Difficulty coping, easily overwhelmed Perserverance- difficulty shifting tasks Low frustration threshold Perfectionist don’t want to disappoint

Depressed, irritable moods, cries easily

Fidgety, nervous habits ( nail biting) Sleep problems ( huge sleep rituals) Headaches and stomach aches Difficulty coping, easily overwhelmed Perserverance- difficulty shifting tasks Low frustration threshold Perfectionist don’t want to disappoint

Frequently Overlooked Features

Frequently Overlooked Features

Angry outbursts Oppositional behaviours- refusals,

resistance Temper tantrums Aggression Attention seeking behaviours Hyperactivity, difficulty sitting still Attention and concentration skills underachieving

Angry outbursts Oppositional behaviours- refusals,

resistance Temper tantrums Aggression Attention seeking behaviours Hyperactivity, difficulty sitting still Attention and concentration skills underachieving

Normal vs. Anxiety Disorder

Normal vs. Anxiety Disorder

Anxiety is a problem if it:

- occurs too much of the time, or -is interfering with daily life

Remember: Internalized, so often doesn’t draw attention, often physical complaints

Anxiety is a problem if it:

- occurs too much of the time, or -is interfering with daily life

Remember: Internalized, so often doesn’t draw attention, often physical complaints

Common Types of Anxiety Disorders

Common Types of Anxiety Disorders

1) Separation Anxiety - age 5/6, then at 10, at 13 (usually girls)

2) Obsessive Compulsive Disorder 1- 4 % , age 8-10 onset, engage behaviours to stop negative thought patterns; usually

high intelligence (movie: “As Good As It Gets” )

1) Separation Anxiety - age 5/6, then at 10, at 13 (usually girls)

2) Obsessive Compulsive Disorder 1- 4 % , age 8-10 onset, engage behaviours to stop negative thought patterns; usually

high intelligence (movie: “As Good As It Gets” )

3. Specific Phobias3. Specific Phobias

Most people have at least one: -dogs, heights, spiders, public

speaking closed spaces, -Most common for kids is: Dogs -Most common for adult women:

Spiders -Most common for adult males: Heights

Most people have at least one: -dogs, heights, spiders, public

speaking closed spaces, -Most common for kids is: Dogs -Most common for adult women:

Spiders -Most common for adult males: Heights

4) Generalized Anxiety Disorder : -amongst most difficult to treat, not one trigger,

can have carry over to others

5) Social Anxiety Disorder: -everyone looking at me, judging me -typical adolescence - drop out of social situations 6) Panic disorder: -all at once, out of blue, - simulated heart attack (like over- excercise) -can’t tell difference, end up in ER;

4) Generalized Anxiety Disorder : -amongst most difficult to treat, not one trigger,

can have carry over to others

5) Social Anxiety Disorder: -everyone looking at me, judging me -typical adolescence - drop out of social situations 6) Panic disorder: -all at once, out of blue, - simulated heart attack (like over- excercise) -can’t tell difference, end up in ER;

7. Post-Traumatic Stress Disorder

violent home, car accident, fire.

7. Post-Traumatic Stress Disorder

violent home, car accident, fire.

Other common co-occurring

Other common co-occurring

Depression More than one anxiety ADHD LD Tourettes/ticks

Depression More than one anxiety ADHD LD Tourettes/ticks

Evidence Based treatments

Evidence Based treatments

Medications- anti-depressants (Prozac, Paxil) -benxodiozepines (Valium, Ativan) - Cognitive Behaviour Therapy (CBT)

Medications- anti-depressants (Prozac, Paxil) -benxodiozepines (Valium, Ativan) - Cognitive Behaviour Therapy (CBT)

1. Thoughts

4. Behaviour 2. Feelings

1. Thoughts

4. Behaviour 2. Feelings

3. Physical Symptoms

Cognitive Behaviour Therapy

Cognitive Behaviour Therapy

Shift thinking cognition Calming tools, lower distress 5 main steps

Shift thinking cognition Calming tools, lower distress 5 main steps

1. Teach about Anxiety1. Teach about Anxiety

Teach anxiety is normal, can be helpful, not dangerous

Talk about “talent for worrying”

Teach anxiety is normal, can be helpful, not dangerous

Talk about “talent for worrying”

2. Recognize Anxiety2. Recognize Anxiety

Teach about worrying thoughts How affects body- draw Explain fight or flight ( physical

aspects) “false alarm” set “too sensitive,” like

a fire alarm, name it - worry bug”

Teach about worrying thoughts How affects body- draw Explain fight or flight ( physical

aspects) “false alarm” set “too sensitive,” like

a fire alarm, name it - worry bug”

3. Scale It3. Scale It

1-5; what number are you feeling ? 1-5; what number are you feeling ?

4. Relaxing Tools4. Relaxing Tools

Calm Breathing ( flower/ candle ) Progressive Muscle Relaxation Visual Imagery Counting Bubbles

Calm Breathing ( flower/ candle ) Progressive Muscle Relaxation Visual Imagery Counting Bubbles

5. Stop Thought pattern5. Stop Thought pattern

Red light to Catastrophic Thought Green Light Come up with helpful brave thoughts, Write them down, draw them, over and

over One step at a time, worry box, step ladder “What’s your evidence?” “What’s the worst that can happen ?”

Red light to Catastrophic Thought Green Light Come up with helpful brave thoughts, Write them down, draw them, over and

over One step at a time, worry box, step ladder “What’s your evidence?” “What’s the worst that can happen ?”