Loud noises, loss of support, heights, strangers, separation (in the present) Animals, the dark, storms, imaginary creatures, anticipatory anxiety

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Anxiety is normal, adaptive, and protective Anxiety varies in intensity from person to person High levels of anxiety are problematic Lowering the volume, not changing the station Developmental Stage

2 Anxiety is normal, adaptive, and protective Anxiety varies in intensity from person to person High levels of anxiety are problematic Lowering the volume, not changing the station Developmental Stage Infancy Preschool School-Aged Older Children/Adolescents Common Fears/Worries Loud noises, loss of support, heights, strangers, separation (in the present) Animals, the dark, storms, imaginary creatures, anticipatory anxiety Specific realistic fears, school achievement, natural events Fear of fear (ability to think abstractly about fears), school performance, social competence, health

5 Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorder Agoraphobia Generalized Anxiety Disorder

9 Chronic excessive worry in a number of areas (e.g., school, internal standards with social interactions, family, health/safety, world events, natural disasters) & at least 1 somatic complaint

10 Discomfort or fear in one or more social settings that involves a concern about being judged or evaluated

Presence of obsessions and/or compulsions Obsessions: Recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety or distress; but are not excessive

12 Presence of obsessions and/or compulsions Obsessions: Recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety or distress; but are not excessive worries about real-life problems Compulsions: Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession in order to reduce stress or avoid feared situation

13 Anxiety is often observed among children who have experienced maltreatment and trauma (but not all youth who are anxious experienced trauma) Majority of children manifest resilience in the aftermath of trauma Traumatic stress occurs when youth are exposed to traumatic events/situations which overwhelms their ability to cope Trauma Symptoms: Hyperarousal/Reactivity (e.g., inattention, anxiety, disrupted sleep); Re-experiencing (e.g., intrusive thoughts, flashbacks); Avoidance (e.g., dissociation); Negative Alterations in Cognition/Mood (e.g., irritability, distress, anger, anxiety Impact on social-emotional functioning and lead to increased vulnerability for other psychological disorders (e.g., anxiety, depression)

Likely caused by a combination of factors Genetic Temperament behavioral

Environmental/Life stressors Long Term: More physical symptoms, worry,

Term: Relief Anxiety Increased arousal, emotionality, scanning for danger,

14 Likely caused by a combination of factors Genetic Temperament behavioral inhibition Parenting Reinforcement & Modeling Cognitive Factors Avoidance Environmental/Life stressors Long Term: More physical symptoms, worry, loss of confidence in coping ability, increased safety behaviors Short Term: Relief Anxiety Increased arousal, emotionality, scanning for danger, physical symptoms intensify, attention narrows and shifts to self Escape or Avoidance

15 American Academy of Child & Adolescent Psychiatry (2007) recommends a two-pronged approach for treating anxiety: Cognitive Behavioral Therapy (CBT) Most studied and empirically supported CBT is the first line of treatment for youth with mild-moderate anxiety Medication SSRIs (e.g., Zoloft/sertraline; Lexapro/escitalopram) CBT & Medication Acute symptom reduction in moderate severe cases Comorbid disorder Partial response to psychotherapy

16 Discomfort Exposure is the active or vital ingredient More exposure practice = better outcomes Anxiety management strategies (e.g., emotion identification, relaxation skills, cognitive strategies) Little direct evidence of added value, may not be necessary for improvement Not sufficient as a stand alone intervention Exposure and Response Prevention (ERP) for pediatric OCD 100 Avoidance 50 0

17 Practice, practice, practice!! Partnership between parents, school, therapists, etc. Each of you has a unique opportunity to observe and intervene

18 Group Treatment Helping Your Anxious Child Selective Mutism Group School Avoidance Group Individual therapy Availability at SC difficult; working to provide brief episodes of therapy List of community resources available OCD Intensive Outpatient Program (Bellevue-Overlake) 3 hours/ day, 4 days/week Must have primary diagnosis of OCD (severe or extreme) and have failed course of ERP in typical outpatient setting

Anxiety in Youth: Identification, Management, & Referral

Anxiety in Youth: Identification, Management, & Referral Martin E. Franklin, Ph.D. Associate Professor of Psychiatry University of Pennsylvania School of Medicine Prelude to the Talk: Anxiety & Its Disorders