Tea and Talk Anxiety in Children

Transcription

1 Tea and Talk Anxiety in Children Penny Wardell organised a Tea and Talk session on Friday 24 th November. One of our parents, Fiona Snyder, Clinical Psychologist gave a talk entitled Anxiety in Children. The presentation was well received by parents and we hope to organise other useful talks for parents in the future. See presentation Power Point below.

2 Anxiety in Children Dr Fiona Snyder Child Clinical Psychologist (Currently working in Specialist CAMHS, Previously in neurodevelopment team assessing ASD and ADHD)

3 Topics to be covered.. What is anxiety Anxiety in children How does anxiety develop How is anxiety maintained What helps When and how to seek professional help Some resources..

4 Worries Avoiding Nerves Wobbles Jitters Stress Panic Freak-out Melt-down

5 What is anxiety? A normal and necessary reaction Fight or flight response: Sympathetic nervous system Gets the body ready for action when threatened Anxiety often runs in families At moderate levels enhances performance. At higher levels enhances survival through avoidance of danger. Becomes problematic when persistent and out of proportion to true level of threat.

6 Anxiety and the body Feeling lightheaded or dizzy because we are breathing faster and may not be using up the oxygen as fast by running or fighting and because blood is being moved away from the head to the muscles Butterflies in the stomach because blood is being pumped away from the stomach to the muscles Feeling jumpy or on edge to watch out for danger and be ready to act if we need to Feeling confused/dreamlike possibly due to preoccupation/hyperarousal Short, fast breaths to supply oxygen to the muscles Being on high alert noticing things that bother and irritate you Heart beats faster to pump blood to the muscles Feeling sick/ Being sick - Digestion is slowed down as blood is diverted away from stomach Muscles feel tense to get ready to run or fight

7 What can cause emotional difficulties Bereavement Parents having mental health problems Feeling isolated and alone Genetic factors Difficulties learning or attaining good grades Feeling unliked, unattractive or inadequate compared to others Difficulties getting on with others (high comorbidity of ASD and anxiety) Stress of any kind such as exams, relationship break-ups etc. Being bullied Domestic violence at home Strained relationships of any kind Feeling different Difficulties at home Feeling anxious because parents are worriers Money problems Learning from adults around them about having difficulties

8 Statistics There are about 396,000 young people with anxiety in the UK. That means to seat all the young people with anxiety they would need nearly twenty O2 arenas!

9 Topics for thought What are anxiety and depression Why is it important How can you know it when you see it What can be done and what is the evidence for intervention

10 Infants: fear of loud noises, strangers Toddlers: fear of the dark, monsters, separation from parents School-age: physical injury, storms, school Teenagers: social evaluation and school performance

11 Impact of Emotional Difficulties Feelings Mood changes They may be more angry/irritable with others/the world, sensitive to criticism, anxious, worried or upset. Thinking May have negative thoughts about themselves and what they are capable of May have thoughts about how frightening the world is, think they cannot cope with particular situations Behaviour Stop doing things they enjoy Isolating themselves Reckless or harming behaviours Avoiding anxiety-provoking situations

12 Physical changes Aches / pains Illness, malaise Tiredness Sweating Heart racing, hyperventilating Feeling sick/being sick Relationships Conflict Isolation Irritability / falling out with friends Affecting what you do as a family

13 What you might see..

14 Anxiety Disorders Separation anxiety Social phobia Generalized anxiety disorder Selective mutism Obsessive Compulsive Disorder Panic Disorder Phobias Post Traumatic Stress Disorder

15 Generalized Anxiety Disorder Have lots of worries and fears Have problems sleeping because of worries Have trouble concentrating Get tired easily or have tension headaches Tense or restless Perfectionist Have an anxious desire for approval

16 Separation Anxiety Disorder Child is afraid of leaving their parent(s) They may worry that something bad will happen May refuse to go to school Physical symptoms May refuse to go to playdates at other people s houses Diagnosed if it causes problems at school or socially and has been going on at least 4 weeks

17 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 Sensitive to criticism

18 Selective Mutism Children may not talk to anyone They may look down, withdraw if required to talk May whisper if they do speak in a situation where they are anxious School age children Some kids outgrow it; some go on to have social anxiety

19 Panic Disorder Panic attacks Feel very scared Heart pounding, hard to breathe May feel shaky, dizzy, or sick May feel like something really awful is going to happen Sometimes they avoid school Frequent panic attacks = panic disorder

20 Obsessive-Compulsive Disorder OCD often begins in early childhood or adolescence. Obsessions - frequent uncontrollable thoughts Usually they don t like these thoughts, or they may think they don t 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

21 Post Traumatic Stress Disorder Following a trauma or very frightening event Can be marked by several of the following Behavioural changes Avoiding Intrusive Repetitive play Zoning out, numbing of feelings Jumpiness and watchfulness of surroundings Nightmares and sleep problems Flashbacks

22 How anxiety is maintained: A Cognitive Behaviour Therapy Approach Time-limited, brief structured psychotherapy Collaborative and transparent Aims to change agreed problems If reverse maintaining processes, the problem will resolve. Scientific underpinnings throughout and evidencebased

23 Hot Cross Bun Thoughts Actions Feelings Physical Reactions

24 Vicious cycles Worrying Thoughts Feeling anxious, worried & stressed Confirms my original worrying thoughts Avoid worrying situations Feel increasingly anxious

25 Thoughts, feelings & behaviours When they tread in dog poo! What might they think?

26 Everyone / the world is out to get me That evil dog did this on purpose to annoy me!

27 The world is a dangerous place. Ahhh, I m infected by killer germs! I m going to die!

28 Balanced thinking (new attitude) Gross! But never mind it wont take long to clean off

29 Thinking Traps! 1. Mind Reading When you think you know what everyone else is thinking Example: Emily saw Sophie in the shopping centre but she didn t say hi and Emily thinks Sophie must not like me, that s why she didn t say hello 2. Fortune Tellers Think they know what is going to happen Example: Emily believed that if she got on the bus then she would have a panic attack and not be able to cope and people would laugh at her 3. Disaster Thinking Example: Tom got back his exam results and achieved high grades for 9 subjects, but because he got a slightly lower mark for one subject he thought I m so stupid, I m going to fail my exams!

30 4. Negative Glasses Only let you see the negative things that happen Example: Lauren had been off school for a while and managed to go to 4 out of 5 days school but she thought I m so rubbish, I can t even manage to go to school every day 5. Magnifying the Negative Negative events are magnified and blown up out of all proportion Example: I was asked a question in class and I got the answer wrong and the whole class was watching me and laughing at me and thinks I am stupid 6. Snowballing A single event or upset snowballs and quickly grows into a never-ending pattern of defeat Example: I m rubbish at Science, I m rubbish at Art, I m rubbish at everything!

31 The Worst Day Today was the absolute worst day ever And don't try to convince me that There's something good in every day Because, when you take a closer look, This world is a pretty evil place. Even if Some goodness does shine through once in a while Satisfaction and happiness don't last. And it's not true that It's all in the mind and heart Because True happiness can be obtained Only if one's surroundings are good It's not true that good exists I'm sure you can agree that The reality Creates My attitude It's all beyond my control And you'll never in a million years hear me say that Today was a good day Now read from the bottom to top.

32 What can you do as parents / teachers Do what you want your children to do. Lead by example and show them how to cope well with anxiety in how you do it Listen & Understand Support them in the techniques they learn, such as relaxation exercises: build into routine Routine and consistent boundaries Look after yourself Seek professional help if anxiety is debilitating and persistent Don t over-protect Challenge your own worries about your child and how they will manage

33 Some Ideas: Working with Physical Sensations

34 Relaxation Strategies: Graded muscle relaxation: Rag Doll (handout available) Guided Imagery

35 Some Ideas: Working with Thoughts Questions you can ask: Why are you worried? What is frightening you? What do you think will happen? What is it about (this situation) that is making you worried? What is the evidence/proof that your thoughts are true? Is there evidence that disproves this thought? How do you know your thoughts are true?

36 Questions you can ask cont d. What other explanations for the way you think could there be? How realistic are your thoughts (on a scale of 0-10)? Would other people (friend, sibling etc.) see it that way? If not, why not? What other ways are there to view the situation? How might you view the situation if you weren t feeling anxious? Is it helpful for you to think this way? Does it make you feel better or worse? Worry Box for child to post worries Pack of thinking error images to share with your child

37 Challenging Negative Automatic Thoughts (NATs) The best mate question What would your best mate say if I asked her/him? The last time question The last time you did this what happened? Was it ok? The is it so bad question Is it so bad if (the thing you re worried about) does happen? The hard time question Are you giving yourself a hard time here? The time travel question If we travelled into the future to see what happened, what do you think would happen? The tunnel vision question Are you seeing things through tunnel vision? Are you ignoring other information about the situation?

38 Some ideas: Working with Feelings

39 Some Ideas: Working with Behaviours

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41 What not to do: Ignore what you see Expect your child to just "snap out of it Blame your child or blame yourself. Keep it a secret. Let your own anxiety or depression impact on your child Get into power struggles. Remove all expectations Make home stressful

42 How to find a professional. 1. Through the NHS: See your GP Referral to local CAMHS (Child and Adolescent Mental Health Service) 2. Privately. Go through the British Psychological Society website to find a chartered psychologist, search by postcode Look at a professional body of psychologists working privately.

43 If you take your child to see a professional Be matter-of-fact Be honest about what you have noticed Ask what books / website you can look at Ask what you can do to help Communicate with the professional Remember your family are the most important members of the treatment team!

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46 MINDED

47 Factsheets for families Mental Health and Growing Up RCPsych For parents / professionals Worries and anxiety helping children to cope Sleep problems in childhood and adolescence Traumatic stress in children how parents can help Obsessive-compulsive disorder in children and young people For young people Worries and anxiety Positive Parenting Programme Triple P For parents - Stranger Anxiety

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