Understanding and Supporting the Anxious Child Allan Donsky MD FRCPC Psychiatry FRCPC Pediatrics Clinical Assistant Professor, Department of Psychiatry, University of Calgary Adjunct Professor, Department of Child and Youth Studies, Mount Royal University Mountain Park November 21, 2013
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Understanding and Supporting the
Anxious Child
Allan Donsky MD
FRCPC Psychiatry
FRCPC Pediatrics
Clinical Assistant Professor, Department of Psychiatry, University of Calgary
Adjunct Professor, Department of Child and Youth Studies, Mount Royal University
Mountain Park
November 21, 2013
Learning Objectives
• What is anxiety ?
• Can Anxiety be “normal” ?
• How does it arise ?
• What does Anxiety look like ?
• What can I do about it ?
Birth-6 Months Loud noise, loss of physical support, rapid position changes, rapidly moving objects
7-12 Months Strangers, looming objects, sudden unexpected objects or unfamiliar people
1-5 Years Strangers, storms, animals, dark, separation from parents, loud noise, toilet, monsters, ghosts, insects, bodily harm
• Separation from home • Bus • Performance anxiety • Academics • Interacting with peers or teachers • Bullied • Eating in front of others • Using the bathroom • Changing for gym
• Nail biting, licking lips, pull hair, chew clothing, pacing
• Obsessions (repetitive thoughts) or compulsions.
• Need for reassurance, help seeking , overdependence
Why is Anxiety missed ?
• Awareness
• Internalizing
• Silence is seen as absence of problem
• Tend to normalize shyness
• Labeled as other things ( very unhelpful !! )
Labeled as other things
• Oppositional
• Defiant
• Manipulative
• Attention
seeking
• Demanding
• Confrontational
• Sneaky
• Pushes buttons
•Lazy
•Avoidant
•Selfish
•Aggravating
•Annoying
•Ignorant
•Rude
•Stubborn
The real question: “What is going on ?”
So what if there is Anxiety?
Academic
Attendance , Avoidance , Underachievement
Behavioral
Avoidance , oppositional
Cognitive
No risks, confidence, image
Developmental
Image, success, confidence,
Emotional
Stunted
Family
Power struggles, tired
Physical
Gym avoidance
Social
Loneliness, tobacco & alcohol use
Common Beliefs About Worries: All untrue
Worrying:
• Motivates me
• Helps find solutions to problems
• Prevents negative outcomes
• Protects me from negative emotions
• Is a positive personality trait …it means I care
Francis, K. & Dugas, M. J. (2004). Assessing positive beliefs about worry: Validation of a structured interview. Personality and Individual Differences, 37, 405-415.
Pedal , Steer and Brake
What can I do to help ?
• Treat own Anxieties
• Get Educated
• Stop
• Criticism
• Rescuing” – Makes it worse
• Dismissing their experience
• Reassuring the wrong way ( “ Don’t worry”)
• Start
• Reassuring the right way ( “ You can handle this “)
• Bravery = Support activities in spite of Anxiety
• Encourage facing new situations
Are Feelings Real ?
“My feelings are real but they don’t always tell me the truth”
Relationship is everything
• Establish trust
• People don’t care how much you know till they know how much you care
• Perfectionism is unattainable = set up for failure = never feel good enough = give up or burn out trying
• Need to be real
• Effort is most important
• Honor roll is 80 %
• No such thing as a mistake
• what is worst thing that can happen ?
• Celebrate “Not knowing”
• “Own it ,fix it , Show some learning “
• Self worth is not tied to achievement
Balancing Act for Adults
Gentle
Firm limits
Refrain from Criticism
Exposure
Courage/Bravery
Treat Parental Anxiety
Unified &
Consistent
Goldilocks
Educational
• Learning Disabilities
• Attentional issues can be secondary
• School Modifications
• Teacher/ Resource and Admin support
• Time out/Quiet place
• Bullying
• Academic load
• Homework issues
• Tutoring.
• Attendance
But I don’t have time to do this ?
Definition of Insanity……… Until you stop doing what is not working there is no space to do something different
Online Resources
American Academy of Child and Adolescent Psychiatry. Aacap.org Anxiety Disorders Association of America adaa.org AnxietyBC™. Anxietybc.com Canadian Paediatric Society. caringforkids.cps.ca/behaviour/fears.htm Chansky, T. (2004). Freeing your child from anxiety: Powerful, practical solutions to
overcome your child’s fears, worries, and phobias. New York: Broadway Books. Cheng, M. (2006). Selective mutism: A guide for teachers.
www.drcheng.ca/resources/Articles/selective_mutism-for_school.doc Cheng, Mi. (2009). Overcoming anxiety: A guide for families.
www.drcheng.ca/resources/Articles/anxiety_info_for_families.doc Garland, E.J. & Clark, S.L. (2000). Taming worry dragons: A manual for children, parents,,
and other coaches. Vancouver, BC: Children’s and Women’s Health Centre of British Columbia.
“What to do when you worry too much; A kids guide to overcoming Anxiety” Dawn Huebner