ANXIETY DISORDERS

Presented by:

Dominique Sullivan

Mary Jo Fulmer

Michael Landau

Anxiety is the most prevalent mental health issue among children today.

Fear is a flight or fright response to an immediate stimulus whereas anxiety is fear

of what might happening the future.

20% of 12 to 16-year-olds have a mental health problem

Almost 10% of adults have an anxiety disorder

Up to 20% children are at risk of developing severe anxiety

Recent Australian study has found the prevalence of anxiety in adolescents to be around 15 percent

RANGE OF ANXIETY DISORDERS

GAD – Generalized Anxiety Disorder

OCD – Obsessive Compulsive Disorder

SAD – Social Anxiety Disorder

PTSD – Post-Traumatic Stress Disorder

Panic Disorder

School Refusal

NATURE OR NURTURE?

Genetics

Brain physiology

Temperament (Behavioural

Inhibition)

Parenting (attachment)

Environmental factors including traumatic or stressful events

Anxiety is the result of the merging of multiple influences.

One Interesting View

lack of nurturing and/or hyper stimulation of sensory channels

leads to sensory depravation and neural impairment

leads to capacity to screen out stimuli

leads to the need for a high level of stimulation or sensory isolation will occur

leading to ANXIETY

Is this why students need their iPods in order to study?

GENERALIZED ANXIETY DISORDERPossibly most prevalent anxiety

disorder

13-15% of all school-age children

Tendency for GAD to be:

hidden

misdiagnosed

chronic

Age may influence the experience and

presentation of behaviour / symptoms

Range of causal / risk factors

GAD - DIAGNOSIS

“For anxiety and uncontrollable worry

to reach diagnostic levels, at least one

physical symptom must be present…

and must occur on more days than not

for a minimum of six months and must

cause significant distress or impairment

in important areas of functioning

(school, home, peer relationships).”

from the DSM-IV

SYMPTOMS & BEHAVIOURS

Stomach-ache, Headache, Muscle Tension

Sleep difficulties, Fatigue / Restlessness

Concentration / Attention difficulties

Overly emotional / highly sensitive

Need excessive or constant reassurance

Apprehension / avoidance of school

related situations and activities

Abuse alcohol and other drugs

What a teacher might see: • shyness, undue worrying, hypervigilance• clinging, hiding, avoiding eye contact• selective mutism, freezing up in certain situations• chills, shakiness• painful self-coniousness• frequent phone calls home• extreme distress, tantrums• superstitions, obsessive behaviours• compulsions (doing things over and over)• fear of contamination• double touching, evening things out, needing

things to be ‘just right’• nervous habits, Tourette’s, trichotillomania• nothing

Anxious students often present as competent students and suffer in silence as they cope with life. This is exhausting and relentless.

INCIDENCE

Relatively early onset8.8 – 10 years of age

GAD tends to be chronicapprox 50% diagnosed children

have it 2.5 years later

35% are diagnosed 3-4 years

later with other anxiety or

major depressive disorder

Gender prevalenceequal until adolescence after

which is more common in girls

CHARACTERISTICS

Parents describe their anxiouschildren as “worriers of

everything”.

- being on time for school

- not getting into trouble

- homework completion / performance

- having enough friends

- class trips, new or substitute teacher

- personal health and of family members

- preoccupation with adult concerns

(family finances and relationships)

MORE CHARACTERISTICS

Older children more likely to have

- co-existing depression

- specific phobia diagnosis

Younger children more likely to also

be simultaneously diagnosed with

- separation anxiety

- attention deficit disorder

ALSO…

Related Feature of Anxious Children

“Presence of a cognitive processing bias towards

personal, interpersonal and physical threat.”

Are more likely than non-anxious children to

perceive and interpret situations as threatening.

WHAT CAN I DO?On the need for instinctual awareness and embodiment:

God guard me from the thoughts men thinkIn the mind alone.He that sings a lasting songThinks in a marrow bone.

William Butler Yeats

Movement, breath, awareness of sensation and emotion can be incorporated into classroom teaching and will be beneficial to all, short and long term.

CLASSROOM STRATEGIESAND INTERVENTIONS

Give lots of reassurance

and genuine specific praise

Carefully monitor students

Empathize with a student’s

Establish routines and clarify expectations

Allow for flexibility in workload

Establish curricula check-in points

Modify instruction for diverse

learning styles

Establish provisions for times when

students feel overwhelmed

Confer with school-based team, parents and outside professionals

INTERVENTION

Effective techniques for reducing risk include:

graduated exposure to fearful stimuli relaxation strategies to manage physiological arousal

cognitive strategies to help develop situational mastery

FOCUS OF COGNITIVE STRATEGIES

Positive social skills

Friendship skills

Social problem solving skills

Building social support network systems

Assistance to feel more self-confident and less isolated

COGNITIVE THERAPY

• the capacity of the brain to change or rewire connections

(using the mind to change the brain)

• children can learn to talk themselves through their fears

• ‘survival of the busiest’! ....the brain circuits that we engage

most frequently enlist the greatest number of neurons...the more we worry, the more our brains adapt to the capacity for worry. When we consciously and actively engage in utilizing healthy circuitry (positive thinking, beautiful thoughts), we build that capacity and the worry channels can fade into the background

• it helps to name the behaviour: your worry brain, the worry

bug, worry tape, the Exaggerator so a child can think critically and analytically about behaviour

The school psychologist:

• provides collaborative consultation

• may assist with pre-referral interventions

• provides psycho-educational assessments for students referred by the school-based team

• provides ongoing collaborative planning • may contribute to the design and evaluation of the IEP

• may provide in-service training in the area of assessment.

School Based Resources

PREVENTION PROGRAMS Coping With Stress Program

educational & cognitive behavioural therapy

Penn Optimism Programcognitive interventionsocial problem solving intervention

FRIENDS Programintegrates key elements from:

cognitive-behavioural perspectiveuseful strategies from both family therapy and interpersonal

approachesThe common thread of all intervention programs is the enhancement and

development of skills and competencies to face difficult situations, fears

and worries, daily challenges, and aversive or stressful life events.

FRIENDS PROGRAM

Feelings

Relax and feel good

Inner helpful thoughts

Explore plans

Nice work, reward yourself

Don’t forget to practice

Stay calm

Acronym for a sequential series of skills built upon previous skills

“FRIENDS” BACKGROUND

• Stems originally from the 1980’s research work of psychologist Phillip Kendall in USA to treat individual overanxious children

• Adapted and extended in 1991, Australia by Dr Paula Barrett to treat children with an anxiety disorder in a group format with an added family intervention component

• From 1998-99 Friends program further refined by Dr. Barrett to reflect a user-friendly early intervention and prevention format and expanded into 2 parallel age groups (7–11 yrs & 12–16 yrs)

• Redesigned to be a more teacher-friendly, school-based universal intervention and re-titled “FRIENDS for Life” to reflect the life-long benefits of the program

FRIENDS FOR LIFE

The world's leading school-based anxiety prevention program

FRIENDS for Life helps children and teenagers cope with feelings of fear, worry, and depression by building resilience and self-esteem and teaching cognitive and emotional skills in a simple, well-structured format.

Used in schools and clinics throughout the world, FRIENDS is the only childhood anxiety prevention program acknowledged by the World Health Organization for its 12 years of comprehensive evaluation and practice. It has proved effective for up to 6 years after initial exposure

Support to BC school districts from the Ministry includes training resources for the required one-day training of school personnel as well as the provision of FRIENDS manuals and workbooks for delivery of the program in schools. For more information go to the Ministry of FRIENDS webpage at Ministry Friends webpage or contact: MCF.CYMHFRIENDS@gov.bc.ca

For registration contact your local School District office.

In 2004, the BC Ministry of Children & Family Development committed to a province-wide implementation of the FRIENDS program as a risk reduction strategy for anxiety.

Delivered in cooperation with the Ministry of Education, this initiative enables school professionals to deliver FRIENDS as a classroom-based universal prevention program or as an early intervention to children who may be at higher risk for anxiety disorders.

ANXIETY POSITIVE FEEDBACK LOOP

Stress fight or

flight

Individuals feel anxious that they are

anxious

Start worrying about having a

panic attack

More stressedWorried they are are crazy, dying, or humiliated in

public

TriggerAnticipation

Getting all worked up over their fear of what might happen

“What if…”

Panic MountainOn a scale of 1-101-relaxed

10- full blown panic

Exit point

PanicAttack10

1 out of 10

3

6

9

Short term – If a child is having an anxiety attack Speak to them quietly and calmly Deal with it privately Ask them if they have a safe space at school Remind them that a panic attack lasts for about 2 mins and then

they should start feeling better Take deep breaths

Long term See a counselor- anxiety rarely gets better without treatment The most effective treatment for anxiety is Cognitive Behavioral therapy Children must learn to challenge their irrational thoughts Mindful education in the classroom benefits all children and

teaches children to regulate and observe their thoughts Get parent on board to reduce stress in the home. A child with

anxiety is sensitive to stress.

Activity from Mindup program

Brain Link – Dopamine – happy hormone Lesson 4: Mindful listening p. 56

Listen to the next piece of music and follow an instrument or voice

“A Case of You”- by Diana Krall (Joni Mitchell cover) – (Not for students)Don’t think about the words, or judge the quality of the music , if you like it or not… Just appreciate the art and be present.

You can’t stop the waves, but you can learn how to surf.

-Jon Kabat-Zinn

Handbook of Interventions That Work With Children and Adolescents: Prevention and Treatmentby Barrett, Paula M. and Ollendick, Thomas H.

(NOTE: only accessible as an ebook through VIU library online database)

RESOURCES

Teaching Kids with Mental Health Disorders in the Regular Classroomby Myles L. Cooley, Ph.D.Free Spirit Publishing Inc., 2007.

Mind Up from the Hawn Foundation

Web Resources:

BIBLIOGRAPHY

Anthony, Martin (2004); 10 Simple Solutions to Panic, New Harbinger Publications

Chilton Pearce, Joseph The Biology of Transcendance: A Blueprint of the Human Spirit

Chansky, Tamar (2004); Freeing Your Child from Anxiety, Broadway Books

Chambers Clark, Carolyn (2006); Living Well with Anxiety, Collins

Levine, Peter (1997); Waking the Tiger, North Atlantic Books