Anxiety. A state of apprehension and fear resulting from the anticipation of a threatening event or situation.

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2 ! Anxiety! A state of apprehension and fear resulting from the anticipation of a threatening event or situation.

3 Anxiety is an evolutionary and adaptive response.

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6 SYMPTOMS OF ANXIETY IN YOUNG CHILDREN excessively nervous, fearful and overly-apprehensive (developmentally atypical in this) easily overstimulated may withdraw/isolate and show sad/removed affect (more typically depressive symptoms), but are most likely to display apprehensive hyper-vigilance in situations and avoid only those situations which elicit an anxiety response for them (i.e. can still happily enjoy other activities, which do not). clinging behaviours and difficulty attaching from caregivers (intense separation anxiety that is beyond developmentally appropriate stages) heightened anxiety and emotional upset during unstructured and unpredictable times (e.g. recess) a heightened need for knowing exactly what is coming next in routine and difficulty with transitions or changes to routine

7 SYMPTOMS OF ANXIETY IN YOUNG CHILDREN (continued) excessive need for control, order and predictability hyperactive behaviour irritability/acting out/tantrums/defiance/rigidity inability to self-regulate effectively however, also the opposite - overly compliant, approval-seeking and perfectionistic behaviours - also common in those with anxiety psychosomatic complaints - headaches, tummy aches, etc. (particularly prior to or during anxiety-provoking event) significant changes in appetite (usually less of an appetite with anxiety; often increased appetite with depression, but can go either way - notable change is the key) significant changes in sleep - insomnia, regression in sleep habits, fears of sleeping alone, bed-wetting all common (excessive sleeping more common in depression)

8 Anxiety Disorders are excessive persist beyond developmentally appropriate periods interfere with daily functioning may not present an identifiable cause typically persist for 6 months or more are not best explained by another medical condition persist and worsen if left untreated 8

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12 Good Intentions - Common Mistakes Sink or Swim approach - causes flooding. Overprotective approach - unintentionally exacerbates perception of risk as well as inability to manage situation or emotions. Increases avoidance behaviours. Too much talking; not enough doing! Behavioural work and calming central nervous system (via relaxation techniques) are critical. Over-explaining and verbal calming are often over-stimulating to a child in panic. Trying to talk child out of fears - elicit coping and calming strategies instead. Beginning exposure work before the basics - thorough medical physical, adequate and regular sleep, healthy diet free of stimulants, and daily vigorous exercise. 12

13 Cognitive Behavioural Therapy

14 Deep, Daily Relaxation Practice Deep, Belly Breathing! Progressive Muscle Relaxation Yoga Acupressure/Massage

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16 Calming Young Babies skin-to-skin contact with loving caregiver swaddling, if the baby enjoys this gentle singing to baby along with smooth, rhythmic movement. (decrease or eliminate movement if too baby overstimulated) involve extended family as support in above strategies. Do not overburden mother and/or father with implementation of all strategies introduce a transitional object (cuddle blanket, safe, age-appropriate stuffy, etc. - preferably with mother s scent on it) 16

17 Calming Toddlers and Young Children cuddling, gentle singing, and use of transitional objects appropriate for these ages as well use of cosy space (tent, small area dedicated for alone time and soothing - not punishment) distraction strategies - e.g. name every green item you can see Should be immediately available in child s environment and require just enough mental energy to drown out the ability to worry about anything else, but also be accessible and easy enough for child to avoid frustration. music - headphones (with noise control for children) are an excellent investment. Classical, soft music or children s calm favourites. Keep in good place(s) for easy access. use of power/i can! posture and gestures prior to anxiety-evoking events. Elicit emotion neurologically-connected to sense of empowerment and confidence. 17

18 Calming Toddlers and Young Children (continued) Utilize mindfulness strategies to foster emotional awareness. Help child recognize, label and develop a robust vocabulary for emotions he/she experiences. Externalize anxiety by imagining it as a character on shoulder who needs soothing, calming, and coaching. Coach child to develop a compassionate, encouraging, and brave relationship between the child and this anxiety character he/she needs to help along (appropriate for ages 6 and up). Involves, mindfulness, visualization and C.B.T. Begin exposure therapy under the guidance of a registered clinical counsellor or psychologist trained in cognitive behavioural therapy where necessary. Cognitive behavioural therapy is an ideal approach for addressing clinical levels of anxiety in children. Medication may or may not be suggested upon the clinical guidance of the child s doctor and/or psychiatrist. A doctor s involvement in anxiety treatment is always recommended and is absolutely critical in the treatment of panic disorder, P.T.S.D, O.C.D. (and for any anxiety disorder that is causing significant impairment in functioning). A thorough medical is required at the outset of any treatment for clinical levels of anxiety. 18

19 Cognitive Behavioural Therapy

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21 CBT THOUGHT RECORD THOUGHT RATE ANXIETY WHEN THINK THIS THOUGHT PROVE IT DISPROVE IT REALISTIC ALTERNATIVE THOUGHT RATE ANXIETY RE: ALTERNATIVE THOUGHT

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25 Prioritize Love and Connection

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28 Additional Anxiety-Related Resources for Parents, Caregivers, Children and Teens A superb list of resources can be found online, offered by:!! The Family Support & Resource Centre 4480 Oak St, BC Children s Hospital. Rm K2-126 (604) Local 5102.!! Anxiety_StressManagement.pdf 28