ANXIETY IN CHILDREN

WHEN THERES A TIGER IN THE ROOM

SUZANNE WITT-FOLEY
JANUARY 25,2017

KEY THEMES
Understand the relationship between Stress, Anxiety and Fear

Explore the root causes for anxiety, recognize the signs and
triggers.
Discuss and explore strategies that can reduce anxiety, build
resilience and sense of safety and why relationships
connection are essential

Stress is.

Stress is simply a reaction to a stimulus that

disturbs our physical or mental equilibrium.

WHAT IS ANXIETY?
People lump together experiences of anxiety and fear

Two emotions feel similar and have similar functions

Both part of the bodys natural hardwired alarm system or fight or flight
response
Fear is a present moment emotional experience Anxiety is a future
focussed emotion

Both serve an important purpose

Factors Impacting Well Being

early
childhood

lack
education
social isolation
Family conflict

poor quality
housing
Poverty
unemployment

Violence
Discrimination
abuse

Chronic or Toxic Stress

Mental Wellbeing &

Chronic Illness
Access to care

Genetics

Coping
with
Substance
Use

What triggers stress response are threats

(or perceived threats) to our survival.

The brain responds much the same way to

threat or damage to social bonds as physical pain.

Defining Child Mental Health

Infant and early childhood mental health,
sometimes referred to as social and emotional
development, is the developing capacity of the child
from birth to five years of age:
- To form close and secure adult and peer
relationships,
- Experience, manage and express a full range of
emotions,
- Explore the environment and learn
all in the context of family, community, and
culture (Cohen, Oser & Quigley, 2012, pg. 1)

1 in 5 Ontario children and youth has a mental

health problem - that's about 500,000 kids
Childrens Mental health Ontario

ANXIETY DISORDERS

Children & adolescents with anxiety disorders typically

experience intense fear, worry, or uneasiness that can last for
long periods of time & significantly affect their lives.

Avoidance = Core Feature

HOW COMMON ARE ANXIETY DISORDERS?

Anxiety disorders are among the most common mental,
emotional, and behavioural problems to occur in childhood &
adolescence.

About 13 of every 100 children and adolescents ages 9 to 17

experience some kind of anxiety disorder; girls are affected
more than boys. (1.5 2X more prevalent)

ANXIETY DISORDERS - WHAT TO WATCH FOR:

Avoidance of school (refuses to go)

Frequent stomachaches or headaches in the morning before school

Avoidance of activities
Easily upset distress out of proportion

Expectation of threat worry, rumination, negative thoughts

You spend a lot of time comforting the child and/or urging her/him to participate in
regular activities

GENERAL SYMPTOMS OF ANXIETY

Psychological
Sense of impending doom or imminent danger
Excessive inappropriate persistent worry
Fear of dying
Decreased attention and concentration
Avoidance or procrastination

GENERAL SYMPTOMS OF ANXIETY

Psychological

Crying or loosing temper easily/frequently

Speeding or slowing of thoughts, trouble concentrating
Easily distracted, insomnia (tiredness & fatigue), vivid dreams

Irritability, impatience, anger

Withdrawal

GENERAL SYMPTOMS OF ANXIETY

Physical

Cardiovascular: palpitations, chest pain, rapid heartbeat, flushing

Respiratory: hyperventilation, shortness of breath
Neurological: dizziness, headache, sweating, tingling and numbness

GENERAL SYMPTOMS OF ANXIETY

Physical

Gastrointestinal: disruption in eating patterns, choking, dry mouth, nausea, vomiting,

stomach ache, diarhea
Musculoskeletal: muscle aches and pains (esp. neck and shoulders), restlessness,
tremors and shaking

AGE OF ONSET
There can be much overlap between the various anxiety disorders
Average ages of onset:
Animal phobias ~ 6-7 yrs
Separation anxiety d ~7-8 yrs
GAD ~ 10-12 yrs
Social anxiety d ~ 11-13 yrs

OCD ~13-15 yrs

Panic d ~ 22-24 yrs

SEPARATION ANXIETY
Child is afraid of leaving their parent(s)
They may worry that something bad will happen to the parent or to someone they love or to themselves

May refuse to go to school

May have stomachaches, headaches, or throw up if they fear separation

May refuse to go to playdates at other peoples houses

Diagnosed if it causes problems at school or socially and has been going on at least 4 weeks

GENERALIZED ANXIETY
Children with this kind of anxiety may:
Have lots of worries and fears
Have problems sleeping because of worries
Have trouble concentrating
Get tired easily or have tension headaches
Be tense or restless
Be perfectionist
Have an anxious desire for approval

SOCIAL ANXIETY/SOCIAL PHOBIA

Happens more in teens than in young children
Fear and worry about social situations
Going to school
Speaking in class
Social events including recess and lunch

Shy, self-conscious
Easily embarrassed
These kids tend to be sensitive to criticism and find it hard to be assertive

SELECTIVE MUTISM
Children may not talk to anyone who is not close to them, such as immediate family

They may look down, withdraw, turn red if required to talk

Often they whisper if they do speak in a situation where they are anxious
Up to 2% of school age children may have these symptoms

Some kids outgrow it; some go on to have social phobia

OBSESSIVE-COMPULSIVE DISORDER
OCD often begins in early childhood or adolescence. Children with this kind of anxiety
may:
Have frequent uncontrollable thoughts (obsessions)
Usually they dont like these thoughts, or they may think they dont make sense

Perform certain behaviours or rituals to try and prevent something bad from happening
(or to get rid of thoughts)
Examples are: handwashing a lot if there is a fear of germs; checking that doors are
locked; special touching rituals

POST TRAUMATIC STRESS DISORDER

Symptoms start after a physical or emotional trauma or very frightening event
Can be marked by several of
Behavioural changes
Repetitive play
Zoning out, numbing of feelings
Jumpiness and watchfulness of surroundings

Nightmares and sleep problems

Flashbacks

Not common in young children

PANIC DISORDER
Happens less often with younger children
People with this kind of anxiety have panic attacks
Feel very scared
Heart pounding, hard to breathe
May feel shaky, dizzy, or sick

May feel like they are going crazy or something really awful is going to happen
Sometimes they avoid school or want to stay in the house
Frequent panic attacks = panic disorder

28

WHAT IMPACTS/CAUSES ANXIETY IN CHILDREN?

Gender
Individual factors (biology, sensitivity, shyness, self esteem)

Family history or people with an anxious parent

Stressful life events family, school, neighbourhood
(abuse, neglect, trauma, death of family member, bullying)

Certain drugs or medications

2017-01-19

TEMPERAMENT
ORCHID & DANDELION

CHILDHOOD ADVERSITY BY CATEGORIES

(18 YEARS OR YOUNGER)

CHILDHOOD TRAUMA.

The first 5 years of life are so important for a childs brain

development. During this critical period, Children develop a blueprint of
how safe they feel based on their early experiences and how their
caregivers respond to them.
Children who grow up in stressful and unpredictable environments learn
that the world is unsafe. They learn that they cannot trust themselves
or others making them vulnerable to emotional difficulties and anxiety.
Children who grow up in a predictable, nurturing environment learn that
they can turn to others in times of trouble for security and comfort.
They learn that the world can be a safe place and do not have to live in
constant fear.

RESILIENCE = STRESS X SUPPORT

Regulation is Relationship Dependent

Factors Impacting Well Being

Neglect
Social
Isolation

Parent Mental
Illness/Addiction

abuse

Hunger
Poor Nutrition

Family conflict

violence

Loss of Parent
Divorce

Chaos
Unpredictable

Chronic or Toxic Stress

Learning, Behaviour, Brain

Development & Health
Access to care

Genetics

STILL FACE EXPERIMENT

Children can be shielded from the most damaging effects of

stress if their caregivers are taught how to respond
appropriately. One thing that is highly protective is the quality
of the relationship between the caregiver and the child
-Dr. Darcey Lowell,

Associate Clinical Professor, Yale University

WHAT YOU CAN DO:

Be patient, calm and reassuring

Be positive about their ability to manage the situation (with support)

Help your child succeed by doing small steps
Reward and praise your childs efforts as well as successes

Be a model manage your own stress and anxieties

Help the child avoid avoidance with planned gradual exposure to things they fear
Teach positive self-talk

WHAT YOU CAN DO:

Allow for a safe place or calming down place.
Encourage physical activity and lots of water.
Acknowledge somatic complaints but treat them casually.
Empathize with student anxiety
Use distraction and sense of humor
Teach them the physiological response to anxiety, that it feels strange but will pass.
Encourage them to push out worry thoughts and bring in positive thoughts. Reinforce
realistic thinking.

WHAT YOU CAN DO:

Routines and plenty of warning before change can go a long way to making the child feel
more secure and less anxious. Explain new situations in advance in a simple, friendly
manner. Try role playing to prepare for upcoming situations.
Remind the child of old fears that they overcame. This will provide the courage and
confidence to face current fears. Always praise childrens efforts and successes when
they do confront these anxieties.
Finding books and websites that might help everyone better understand what he/she is
going through.

WHAT YOU CAN DO:

Teach child basic relaxation strategies such as belly breathing and muscle relaxation
Teach child to visualize or imagine a pleasant, relaxing happy place

Keep stress low. Be calm and positive as much as possible.

Deal with external situations that require adult intervention, such as bullying
Encourage the child to discuss his/her fears with you. Children who are encouraged to talk
about their concerns and feelings will feel comforted and less alone. Suggest that the child
write a story or draw a picture of scary things, and look for clues to help you understand his
or her fears better.

DONT:
Criticize or yell at your child

Tease or make fun of your child for anxiety

Ignore the problem or wait for the child to get over it
Tell the child to toughen up

Pressure your child to do more than s/he can do

Have unrealistic expectations
Make it easy for your child to avoid anything that scares them

PREVENTION ENCOURAGE AT HOME

Make the home environment as calm and consistent as possible
Establish a regular routine: mealtimes, playtime, homework time etc.
Eat meals together as a family. Avoid negative talk at meals.
Enough sleep, physical activity, balanced meals and not too much junk food
Have frequent one-on-one time with your child

Make fun and enjoyable activities frequent and regular

Limit video game, computer and TV time
Dont pressure child or have unrealistic expectations
Dont criticize, tease, make fun of, yell or tell the child to toughen up

Suzanne Witt-Foley
Making Connections for Health
www.suzannewittfoley.com