Parenting an anxious child

Parenting an Anxious ChildWhat parents should know

Fellow Lecture SeriesMarch 9th 2011

Pallav Pareek M.D.

References

Freeing Your Child From Anxiety by Tamar E Chansky Ph.DHelping Your Anxious Child (A step by step guide for parents) Rapee et.alYour Anxious Child : John S DaceyHandbook of Clinical Family Therapy

What is anxiety? Is it abnormal? Anxiety is an expected, normal and

transient response to stress; it may be a necessary cue for adaptation, and coping

What makes it pathological?a) Autonomy: No/minimal

recognizable triggerb) Intensity: exceeds pt’s capacity to

bear c) Duration: persistent rather than

transientd) Behavior: avoidance or withdrawal

Is Anxiety = Fear

NO !!!! Anxiety (abnormal)

results from unknown internal stimulus or excessive response to the external stimulus

While Fear is sense of dread and foreboding that occurs in response to an external threatening event.

Anxiety Disorders (family of)

Simple Phobia, Social Phobia, Agoraphobia

Panic Disorder, Generalized Anxiety Disorder

Separation Anxiety Disorder

Post Traumatic Stress Disorder, OCD

Characteristics of an anxious child

Harder to calm themselves

Usually above average creativity, they can’t use this creativity in coping

Even with a good plan: get discouraged/quit easily

Fail to recognize their success

Parenting: what NOT to do?????

Too much Reassurance

Reassurance is a natural parental response to a child’s distress

No reassurance » alone & insecure Children with anxiety: ask for

reassurance far more often » VICIOUS cycle

If the heavens are falling: no amount of kisses and hugs are too much, but for an excessive unjustified fear » child learns a wrong message

Becoming Impatient

Often it feels: “They could do it only if they tried a little harder” & it’s not easy NOT to become angry or frustrated on your anxious child

Anger More fright & anxiety

Parenting : Approach #1

COPE method Calming the

nervous system Originating an

imaginative plan Persisting in the

face of obstacles Evaluating and

adjusting the plan

Calming the nervous System Stressful Situation Fight/Flight Hard wired human response We should not elicit the FF response for every

trivial situation Ways to calm the nervous sytema) Abdominal Breath Controlb) Sensory awareness :know your orangec) Personal Punching Pillow: Ventd) Know your heart Ratee) Paradoxical Paradigm (witch hairy, scary witch)f) Scale the fearsg) Link it to an ouch (rubber-band around wrist)

Inoculate Imaginative thinking Vertical vs. lateral

thinking Writing stories

(completion) Functional freedom (uses

of brick) Mindless activities (don’t

use in OCD) You be me Empty Chair Successive approximation

Persistence

Identify the problems It’s not scary after all. Glorify well intentioned

mistakes Model moderate risk

taking Negative vs Positive

thoughts (write them down)

We got your back…

Evaluating the PLAN

Plans are fluid Let them have feedback

on their own (photos/videos)

Charting success Pretest vs post test

Don’t !!!

Pass on your own fears. Letting them face challenges is better than overprotection

Leave perfectionism for your own self

ALWAYS REMEMBER Reflective listening is the

key !!!!

Parenting: Approach #2

Based on the Cool Kids Program, developed by Ronald Rapee Ph.D. and group at Macquarie University Sydney AUS.

The Detective approach

Based on Cognitive therapy principles Event “Iam waiting to be picked up from

school, mom is late” Thought : She could be dead Evidence: its been only 10 minutes, (?)

traffic, she was late twice before (never died), other kids are still there (not all parents could be dead)

Reorganized Realistic thought: She is running late, and will arrive soon

Helpful ways to handle anxiety

Rewarding Brave, non anxious behavior (no matter how small a bravery: start from there)

Ignoring behaviors you don’t want Modeling brave, non-anxious

behavior

Important principles

Be Consistent (more so for an anxious child)

Keep your emotions in check Distinguish between anxious and

naughty: even if anxious some behaviors are not pardonable

Removal of privileges Natural consequences are

sometimes the best teachers

Use Stepladders

Freeing your child from anxiety

The MASTERPLAN1) Empathize what your child is feeling2) Re-label the problems (anxieties) as

the worry brain3) Rewire, act with smarts not with

fears4) Get body on board: deactivate

alarms5) Refocus: on what we need to do6) Reinforce your child’s efforts at

fighting

Online Resources

Anxiety Disorders Association of America http://www.adaa.org/

Worry Wise Kids : http://www.worrywisekids.org/parents/parenting_child.html

The Child Anxiety Network http://www.childanxiety.net/

Cool Kids Program Sydney Australia: http://www.kidsmatter.edu.au/primary/programs-guide/cool-kids-school-version/

Resources: Local to the Lou St. Louis Behavioral medicine

Institute : 1129 Macklind Ave. Phone: 314-534-0200 http://www.slbmi.com/

Dr. Jennifer L Abel (Psychologist specializing in Anxiety disorders) 314 -721-7201 http://www.anxietystlouispsychologist.com/

Family Resource center 3rd floor in St. Louis Children’s Hospital : 314-454-2350 http://www.stlouischildrens.org/content/familyresourcecenter.htm

Center for Cognitive Behavioral Therapy, St. Louis, Inc 314-576-4900 http://site.cbt-stl.com/

QUESTIONS?

धन्यवा�द

When I was young, I admired clever people. Now that I am old, I admire kind people. ~Abraham Joshua Heschel