Parenting Anxious Children Youth

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					               Community Education Service
                  in collaboration with the
      Child and Adolescent Addictions & Mental Health
                           Program




 Parenting Anxious Children & Youth

                       Presented by:
                   Susan Ponting M.Ed.,
                  Registered Psychologist


                Funding generously provided by Encana
                Corporation and the Alberta Children’s
                         Hospital Foundation




Parenting Anxious Children & Youth


 What Brought You Here Today?
  Questions




                               Outline

 1.   Introduction

 2.   Anxious Behaviours Often Seen in Children

 3.   Types of Anxiety Disorders

 4.   Case Studies

 5.   Helping Your Anxious Child

 6.   Resources

 7.   Bibliography




                                                         1
        Anxiety vs. Clinical Anxiety

Common anxious situations
   E.g., Being pulled over by the traffic police
   E.g., Temporarily misplacing your wallet
Everyone feels anxiety, and on a regular basis
Anxiety is a normal response
A Fight or flight response

It is when anxiety interferes with everyday
functioning that it may be considered an
anxiety disorder.




   Parenting Anxious Children & Youth



  Anxious Behaviours in Children




     Anxious Behaviours in Children

   Extreme shyness             May be extremely
                               uncomfortable when
   May isolate                 they are the center of
   themselves in the           attention
   classroom                   May lack self-
                               confidence and seem
   May be hesitant to          very unsure of
   participate in social       themselves
   activities
                               May avoid doing
                               schoolwork because
                               they are worried that
                               they will make a
                               mistake




                                                        2
      Anxious Behaviours…(Cont’d)

o   May phone home            o   May be a perfectionist
    frequently from school        about their work
    May be absent from
    school often due to           May “blend into the
    “nervous stomach” or          wallpaper” and refuse
    headaches                     to raise hand in class
    May need frequent
    reassurance from              May spend too much
    teacher that they are         time worrying about
    doing their work              failure
    correctly




      Anxious Behaviours…(Cont’d)

    May spend too much        o   May worry excessively
    time worrying about           about upsetting others
    failure                       or hurting others
    May expect                    feelings
    catastrophes in           o   May have trouble
    normal situations             falling asleep or have
    May be wiggly, jittery,       disrupted sleep
    shaky, high-strung,       o   May experience
    tense, and just never         nightmares and/or
    seem to relax                 night terrors




      Anxious Behaviours…(Cont’d)

    May become
    frequently irritable

    Acting out




                                                           3
    When do these behaviours require
       help from a professional?

Questions to ask
o Is your child’s fear and the behaviour s/he is
  exhibiting typical for your child’s age?

o   What are the symptoms of the fear and worry,
    and how do they affect your child’s personal,
    social and academic functioning?

o   Does the fear or worry seem unreasonable in
    relation to the reality of the situation?




     Parenting Anxious Children &
                Youth



      Types of Anxiety Disorders




          Types…       Specific Phobia
Persistent fear of a        In children the anxiety
specific object or          may be expressed by
situation that is           crying, tantrums,
excessive or                freezing, or clinging
unreasonable

Fear leads to               Types of Phobias:
avoidance of objects or     - animal type: e.g.,
situations and can          spiders, dogs, etc
cause people to limit       - blood-injection-injury
their lives                 type: e.g., needles
unnecessarily               - situational type: e.g.,
                            elevators, heights, etc




                                                        4
Types…    Separation Anxiety Disorder
Developmentally                   Reluctance or refusal
inappropriate and excessive       to go to sleep without
worry or distress                 being near caregivers
concerning separation from        or to sleep away from
home or caregivers                home
Excessive worry about
losing, or about possible         Repeated nightmares
harm occurring to
caregivers
                                  Repeated complaints of
Excessive worry about             physical symptoms
getting lost or kidnapped         (e.g., headaches,
from caregivers                   stomach aches,
                                  nausea, or vomiting)
Excessively fearful to be         when separation from
alone or without caregivers
                                  caregivers occurs




             Types…      Social Phobia
 An overwhelming and              In children this may be
 disabling fear of scrutiny,      expressed by crying
 embarrassment, or                tantrums, freezing, or
 humiliation in social            shrinking from social
 situations, which leads to
                                  situations with
 avoidance of many
 potentially pleasurable and      unfamiliar people
 meaningful activities

 Examples: fear of initiating
 or maintaining
 conversations,
 participating in small
 groups, speaking to
 authority figures. Children
 may avoid trying to make
 friends. Extreme shyness.




Types…    Generalized Anxiety Disorder
 Constant, exaggerated          Physical symptoms
 worrisome thoughts             - restlessness
 and tension about              - easily tired
 everyday routine life
 events and activities          - difficulty concentrating
                                - irritability
 Almost always                  - muscle tension
 anticipating the worst         - difficulty falling
 even though there is           asleep, staying asleep, or
 little reason to expect it     unsatisfying sleep




                                                             5
              Types…      Panic Attack
     Intense fear or          Feeling dizzy, unsteady,
     discomfort               light-headed, or faint
     Pounding heart           Feeling detached from
                              oneself
     Sweating
                              Fear of losing control or
     Trembling or shaking     going crazy

     Feeling of choking       Fear of dying
                              Numbness or tingling
     Chest pain
                              sensations
     Nausea                   Chills or hot flashes




Types… Obsessive          Compulsive Disorder
  Repeated, unwanted thoughts (e.g., did I lock the
  door, turn the stove off, my hands have germs on
  them)

  Compulsive, repetitive behaviours that seem
  impossible to stop or control (e.g., repeatedly
  returning to the house to check if doors are locked,
  repeatedly washing hands to get rid of germs)




     Types… Post-Traumatic     Stress
                Disorder (PTSD)
  Experienced or witnessed      Frightening dreams
  an event that involved
                                Difficulties falling asleep
  potential death or
  serious injury                Irritability
  Reliving the event in         Difficulty concentrating
  your mind
                                Exaggerated startle
  Children may repetitively     response
  re-enact the trauma in
  their play




                                                              6
                   Case Studies

     Sam



     Walter




      Parenting Anxious Children & Youth




       Helping Your Anxious Child




 Helping…General Strategies for Parents
General strategies to help your child:
   Find a way of inserting the positive into your
   child’s life (and your family life).
      What kinds of things make you and your children
      laugh? Learn to laugh on a regular basis
   Find a way to regularly reward yourself, your
   family, your child/teen
      What are your accomplishments, creative ideas, or
      problem-solving that you are proud of? What are
      those of your family, your child, your teen?




                                                          7
               Helping…General Support
  o      Remember, the fear is real to your child

         Let your child know his/her fear is important to you
         and that you want to help them overcome it

         Respect the fear the child has without permitting
         intentional avoidance of it (avoiding will
         reinforce the problem)
         Helping your child/teen to talk with you about the
         fear helps to take some of the power out of the
         negative feeling

         Go over strategies and techniques together when
         everyone is calm




               General Strategies…(Cont’d)

      Give your household life more predictability and
      structure
      -(e.g., regular mealtimes, chore times, bedtimes,
      exercise times)
      -Encourage a peaceful home, or peaceful evenings
      (e.g., low lighting, soft voices, avoid televisions and
      music in bedrooms)

 o Check out practical resources for your child/teen
   (e.g., tutor, exercise program, school advocate)




Garland E. J. and Clark, S. (2002)




            General Strategies…(Cont’d)
 Parent self-care ... avoiding Fatigue:

      Periodically getting away from it all
      Your child benefits most when you and your partner
      are happy and comfortable
      Take care of yourself, daily
         (build into your day, 10 mins of calmness or 10 min of
         your favorite activity)

      Nurture adult relationships (e.g., call a friend, daily)
      Join a parent support group




                                                                  8
      Parent Coaching Techniques




         Parent Coaching Concepts
General Coaching Tips:

1.   Using patience and an empathic style is important
2.   Calm matter-of-fact reactions are critical
3.   Predictable routines and preparation for future
     changes are helpful
4.   Set small, achievable goals because success early
     on is critical




                 Coaching…(Cont’d)

5.   Low-key praise and/or rewards for success will
     reinforce bravery

6.   Increased physical activity, good sleep habits,
     decreased caffeine are important prevention factors

7.   Facing fears (exposure): Facing feared situations
     or events gradually and repeatedly and according
     to a plan, from easiest to hardest. “Avoiding
     anxiety makes it grow, facing anxiety makes it
     shrink”

8.   Promote the use of a Tool Kit to cope with anxiety




                                                           9
   5 Step Method to Helping Your
       Child Manage Anxiety




  5 Step Method to Helping Your Child
            Manage Anxiety

     Step 1 :Teach your child about anxiety

     Step 2 : Teach your child about the
              specific type of anxiety they are
              experiencing

     Step 3 : Build the child’s toolbox

     Step 4 : Use the toolbox

     Step 5 : Building on bravery




 5 Step Method to Help Your Child
         Manage Anxiety
Step 1: Teach your child about anxiety

o Anxiety is normal and adaptive

o Anxiety can become a problem when our body tells
  us there is danger and there is no real danger
  (False Alarm concept)




AnxietyBC™ (2007 – 2008)




                                                     10
      5 Step Method to Helping Your
          Child Manage Anxiety

Step 2: Teach child about the specific type of
  anxiety

For example:
o Generalized Anxiety Disorder: Worries are triggered by
  uncertainty. Since uncertainty is a big part of life, worrying
  becomes excessive
o Social Anxiety Disorder: Social anxiety is common.
  Anxiety is triggered by fear of embarrassment or ridicule in
  performance situations (e.g., speaking in front of peers,
  class presentations, etc).

AnxietyBC™ (2007 – 2008)




       5 Step Method to Helping Your
           Child Manage Anxiety
 Step 3: Building the child’s toolbox

 Relaxation Strategies such as:
    1) Calm Breathing
         (slow breaths through the nose to reduce anxious, fast
         breathing)

    2) Muscle Relaxation
         (tensing stressed muscles and then relaxing them)

    3) Guided Imagery / Visualization

 AnxietyBC™ (2007-2008)




       5 Step Method to Helping Your
           Child Manage Anxiety
  Step 3: …. toolbox (cont’d)

  4) Realistic Thinking and Positive Self Talk

       Understanding that anxious thoughts are not always
       realistic or factual. Searching for evidence and
       evaluating the “facts” can help challenge anxious
       thoughts

  5) Packing your favourites

       a bunch of your favourite, relaxing activities that you do
       by yourself and/or do with family members/friends, and
       put them into the tool box

  AnxietyBC™ (2007-2008)




                                                                    11
5 Step Method to Helping Your Child
          Manage Anxiety
Step 3: …. toolbox (cont’d)

6) Coping cards and cuing from adults

o Provide the child or teen with reminders to use
  strategies depicted in step 3

o Coping cards can be created for visual reminders of the
  strategies
o Parents and teachers might cue child to use strategies
  with a verbal cue or visual signal.

AnxietyBC™ (2007-2008)




  5 Step Method to Helping Your Child
            Manage Anxiety
Step 4: Use the Toolbox

  Go to the toolbox, everyday, and try out a favourite
  relaxing activity (even if only for 10 minutes)

  Try problem solving your way through non-anxious,
  then anxious, events (this one will take some practice)

  Try a variety of relaxation techniques before, during,
  and after an anxious event

  Use self talk and visualization, regularly




  5 Step Method to Helping Your Child
            Manage Anxiety

Step 4: Use the Toolbox (Cont’d)
  Relaxation

   o Deep breathing and muscle relaxation

   o Do these exercises with your child just before
     his/her bedtime

   o Encourage your child to use the exercise when in
     anxiety provoking situations (such as at school
     before a big test)

   o Adolescents can become familiar with the exercise
     and practice on their own




                                                            12
  5 Step Method to Helping Your Child
            Manage Anxiety
Step 4: Use the Toolbox (Cont’d)
  Visualization

   o    Trap the worry in a “Worry Box” and only let it out
        when you are armed and ready to deal with it

   o    Finding the “off switch”. Practice turning on and off
        the switch to prove who is in control of the worry

   o    Try to imagine a “Special Place”, with its sights,
        sounds, feelings, smells and tastes. Imagine a
        “Special Place” where the worry is not allowed to visit.

   o    ”Worry Time” and the stop sign




   5 Step Method to Helping Your Child
             Manage Anxiety
Step 4: Use the Toolbox (Cont’d)

   Draw the fear

    o   Allowing the child/teen to draw how the feared
        object looks to them, and then talking about the
        drawing, can be a powerful way of reducing
        negative feelings and preparing the child to do
        something about the fear




  5 Step Method to Helping Your Child
            Manage Anxiety
Step 5: Building on Bravery

Practice… Practice … Practice
   o Continue to practice strategies, even after
     anxiety is reduced. Strategies should become
     habitual to be most effective.




AnxietyBC™ (2007-2008)




                                                                   13
            Helping Your Adolescent




                Helping your Adolescent
     Strategies adolescents can use

      o   Take charge of their own schedule so that
          parents don’t have to nag

      o   Help keep the family schedule working

      o   Follow-through after asking parents for help

      o   Manage their anxiety so as not to have melt
          downs


*Garland E. J. and Clark, S. (2002)




      Again…When is professional help
               needed?
    Questions to ask

       Is your child’s fear and the behaviour s/he is
       exhibiting typical for your child’s age?
       What are the symptoms of the fear and worry, and
       how do they affect your child’s personal social and
       academic functioning?

       Does the fear or worry seem unreasonable in
       relation to the reality of the situation?




                                                             14
       Professional help…(Cont’d)
Professional Help can involve:

  The use of child therapy

  The use of family therapy

      family therapy often supports the work
      done in child therapy, and vice versa

  The use of medications

  Combination of therapy (or counselling) and
  medication




       Professional help…(Cont’d)
Accessing professional help:

  Family Doctor

  ACCESS Mental Health (403-943-1500)

  School Counsellor

  If you belong to a religious organization, there
  may be a counsellor available to assist you.

  Public/private agencies listed in the yellow pages
  of the telephone book




    Professional help…(Cont’d)

Medication
 Therapy is the first choice of treatment

 Research has shown that Cognitive Behavioural Therapy
 (CBT) and medication is most effective

 SSRI’s are the first choice of medication for children and
 adolescents

 Medications are normally prescribed in gradual doses in
 order to reach most effective dose. Mantra is “go low,
 go slow”.




                                                              15
   Professional help…(Cont’d)

Medication
    SSRI’s

     Prozac (fluoxetine)
     Luvox (fluvoxamine)
     Zoloft (sertraline)
     Celexa (citalopram)
     Paxil (paroxetine)




   Parenting Anxious Children & Youth




              Resources




                   Resources

 Access Mental Health         403-943–1500


 Calgary Counselling Centre   403-265-4980


 Calgary Family Services      403-269–9888

 Distress Centre              403-266-1605


 Canadian Mental Health       403-297-1700
 Association




                                             16
                        Bibliography*
    Booklet: Parents and Teachers as Allies, Recognizing Early-onset
    Mental Illness in Children and Adolescents, Second Edition, 2003.
    NAMI, the Nation’s voice on Mental Illness. See www.nami.org.

    Chansky, T. (2000). Freeing Your Child From Obsessive Compulsive
    Disorder

    Chansky, T. (2004). Freeing Your Child from Anxiety

    Garland, E. J., and Clark, S. L. (2000). Taming Worry Dragons: A
    Manual for Children, Parents, and Other Coaches. Children’s and
    Women’s Health Centre of British Columbia, British Columbia.


* These books can be obtained from your local library and/or by contacting
the Family and Community Resource Centre library (403-955-7745)




                        Bibliography*
Garland, E. J., and Clark, S. L. (2002). Worry Taming For Teens.
Media Group: University of British Columbia, British Columbia

Manassis, K. (2004). Keys to Parenting your Anxious Child

Rapee, R.M. (2000). Helping your Anxious Child: A Step-By-Step
Guide for Parents. California: New Harbinger Publications.




* These books can be obtained from your local library and/or by contacting
the Family and Community Resource Centre library (403-955-7745)




                         Online Sites
The Centre for Children with Special Needs. Children’s Hospital
and Regional Medical Centre. Seattle, Washington.
www.cshcn.org, click on resources, then click A-Z list, and look
for the anxiety and depression link
PsychDirect, Dept., of Psychiatry and Behavioural
Neuroscience, McMaster University, Hamilton, ON
www.Psychdirect.com

AnxietyBC™ (2007 – 2008). Retrieved on May 12, 2008 from
www.anxietybc.com

Kids have stress too. The Psychology Foundation of Canada
www.kidshavestresstoo.org
American Academy of Child and Adolescent Psychiatry
www.aacap.org




                                                                             17
                 Acknowledgements
We would like to acknowledge the contributions of the many
clinicians who participated in our Focus Groups and thus contributed
to refreshing the content of this presentation. As well, we would like
to thank the following clinicians who have gone the ‘extra mile’ and
made significant editorial and/or content contributions to this
presentation:

Lindsay Hope-Ross, M.Sc., R. Psych., Clinical Supervisor, Healthy
Minds/Healthy Children

Rekha Jabbal, B.SP, Pharmacy Clinical Practice Leader, Child and
Adolescent Mental Health

Susan Ponting, M.Ed., R. Psych., Mental Health Education Specialist,
Community Education Service

Annette Vance, M.Sc., R. Psych, Child and Adolescent Mental Health




  Community Education Service


        To register for notification or an
         upcoming education session
          go to: www.fcrc.sacyhn.ca

            For general CES enquiries
             Email: ces@sacyhn.ca
                Call: 403-955-7420


                    Funding generously provided by Encana
                    Corporation and the Alberta Children’s
                             Hospital Foundation




                                                                         18

				
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