Effective Strategies for Helping Distressed / Anxious Children and Teens Webinar Handout 8/27/2010

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16 True or False Test Anxiety disorders rank first as the most common mental health issue with young people. Up to 40 million people are affected with significant anxiety. 1 in 8 children have anxiety disorders. 13% of children (9 to 17 years old) and adults are affected with an anxiety disorder in any six-month period. 75% of youth with significant anxiety go undiagnosed and untreated. Anxiety disorders are often masked by physical illness, alcohol and substance abuse, and other mental health disorders. 1 in 4 adults will have an anxiety disorder in his or her lifetime. Girls are more affected by significant anxiety than boys. About one-half of the children or teens diagnosed with an anxiety disorder also have a second behavioral disorder. 15% of preschoolers experience significant levels of anxiety and depression. 16

17 Why Are Kids So Anxious? Environmental Dangers Crime Community violence AIDS Worry about nuclear war Terrorism Family Issues Separation and divorce of parents Moving to new locations Single-parenting Being away from family members Isolation and loneliness Family dysfunction Physical and verbal abuse Constant arguing Chronic illness in the family Loss of a family member Economic Factors Parent s unemployment Poverty School Problems Poor grades Learning disabilities Peer conflicts Isolation Source: K. T. Frank, The Handbook for Helping Kids with Anxiety & Stress, Chapin, SC: Youthlight,

18 What s Going On in the Brain? Stress causes a virtual chain reaction in the brain. The thalamus processes and interprets information. Two Neural Pathways (work simultaneously) Amygdala (Fear Center) Prefrontal Cortex Emergency route Activates system over entire body (Classic fear response) Increased blood pressure, heart rate, and adrenaline rush Activates hippocampus (memory center) Learns and stores memories In-depth processing route (more circuitous) Recognizes danger and logically figures out what to do Cerebral Cortex Sends out all clear message when danger has passed Tells amygdala to stand down 18

19 The Eight Forms of Anxiety Facing Kids Today 1. Generalized Anxiety Disorder (GAD) Excessive worry about a variety of things Self-conscious and perfectionistic Seeks constant approval and reassurance Women twice as likely to be affected Affects 3.1% of U. S. population 2. Obsessive-Compulsive Disorder (OCD) Unwanted/intrusive thoughts (obsessions) Feeling compelled to repeatedly perform rituals (compulsions) to try to ease anxiety (hand washing, arranging and rearranging, counting, checking, etc.) Most children diagnosed around 10 years old Can strike as early as age 2 or 3 OCD more likely to develop in boys before puberty OCD more likely to develop in girls after adolescence Affects 2% of adolescents Children do not realize their obsessions and compulsions are excessive OCD is sometimes related to streptococcus 3. Panic Disorder and Agoraphobia Two unexpected panic or anxiety attacks for no apparent reason Followed by at least one month of concern over having another attack Six million adults affected each year Usually beginning in early adulthood Less likely in children but not unusual in adolescents Agoraphobia Avoiding public places where immediate escape is difficult such as malls, public events, etc. 4. Posttraumatic Stress Disorder (PTSD) Intense fear and anxiety Emotional numbness and irritability along with avoidance of people, places, and activities after experiencing or witnessing a traumatic or life threatening event Children most at risk: -Suffering an injury or death of a parent -Previous mental health problems -Lack of strong support system -Violence in home Affects 7.7 million adults 5. Separation Anxiety Excessive anxiety about being away from home, parents, or caregivers Refusal to go to school, camp, sleepovers, etc. Most common age for separation anxiety 7 to 9 year olds Affects 4% of children 19

20 6. Social Anxiety Disorder (Social Phobia) Intense fear of social and performance situations and activities Fear of being judged or scrutinized by others; i.e., being called on in class or starting a conversation with a peer Often occurs with feelings of powerlessness, aloneness, and shame Typical age of onset is 13 years old Affects 15 million adults 7. Specific Phobias Intense, irrational fear of a specific object Kids and teens avoid situations they fear Crying, clinging, headaches, stomachaches are common Common kids fears: insects, animals, storms, heights, water, blood, darkness, medical procedures, etc. Some phobias develop in childhood but usually occur during adolescence or early adulthood 8. Selective Mutism Refusal to speak in situations where talking is expected or necessary Behaviors: Stand motionless, expressionless, turn head, avoid eye contact, withdrawal Average diagnosis: 4 to 8 years old 20

21 Checklist for Common Characteristics of Anxiety Disorders How many do you see in your child or teen? Intense fear or discomfort with symptoms such as pounding heart, sweating, trembling, choking, chest pain, nausea, or dizziness Strong fear of dying, losing control, or going crazy Fear of being in places or situations from which escape may be difficult or embarrassing Fear of being outside of home alone; being in a crowd; being on a bridge; traveling on a bus, train or automobile Marked and persistent fear that is excessive or unreasonable cued by the anticipation or presence of a specific object or situation such as airplanes, elevators, heights, storms, water, animals, receiving an injection, seeing blood, loud noises, or costumed characters A marked and persistent fear of one or more social or performance situations in which the child or teen is exposed to unfamiliar peers or to possible scrutiny by others Anxiety that is expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people Recurrent and persistent thoughts, impulses, or images that cause marked anxiety or distress Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that are time consuming and interfere with a person s normal routine Feelings of intense fear, helplessness, or horror after one has experienced an event that involved actual or threatened death or serious injury of self or others. Disorganized or agitated behavior after a traumatic event Recurrent and intrusive distressing recollections of a traumatic event or repetitive play or reenactments of traumatic events Behaviors such as difficulty falling or staying asleep, difficulty concentrating, or hyper vigilance Long-lasting, excessive anxiety and worry Anxiety and worry associated with symptoms such as restlessness (feeling keyed up or on edge), being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance Anxiety, worry, or physical symptoms that cause distress or impairment in normal functioning in life Source: Adapted from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (1994, pp ). 21

22 Other Possible Symptoms of Ongoing Stress and Anxiety Found in Children and Adolescents Changes in eating patterns (eating more than normal or not eating at all) Sleep problems (sleeping too much or too little) Feeling restless unable to wind down Losing interest in doing normal activities Feeling worthless and thinking bad thoughts about yourself and your situation Difficulty concentrating Feeling irritable and upset Feeling fatigued or out of energy to cope Withdrawal avoiding people, places and situations Self-medicating/using alcohol and other substances Changes in school performance or poor grades Hyperactivity Regular nightmares Aggressive behavior/not obeying adults in charge Excessive worry and trying to do things perfectly Outbursts of anger Depression long-lasting sad or hopeless feelings Complaints of physical illnesses, aches, and pains Source: K. T. Frank, The Handbook for Helping Kids with Anxiety & Stress, Chapin, SC: Youthlight,

23 Screening Tools and Rating Scales Anxiety Disorders in Children: A Test for Parents - A simple 15 item screen for parents to identify symptoms of anxiety in their children ages 5-11 Anxiety Disorders in Adolescents: A Self-Test - A simple 18 item screening tool for youth to identify symptoms of anxiety Beck Anxiety Inventory (BAI) - Assesses general anxiety symptoms for ages 7 and older - 21 items filled out by parent, student and clinician Beck Anxiety Inventory for Youth (BYI) - 20 item self-report inventory for ages Reflects children s specific worries about school performance, the future, negative reactions to others, loss of control, and psychological symptoms associated with anxiety Depression and Anxiety in Youth Scales (DAYS) - Screening tools measure anxiety, depression, and social maladjustment ages Filled out by parent, teacher, and student Endler Multidimensional Anxiety Scales (EMAS) - The three EMAS scales are filled out by adolescents years old Multidimensional Anxiety Scale for Children (MASC) - 39 items for self-report assess areas of anxiety in children and adolescents ages Revised Children s Manifest Anxiety Scale (RCMAS) - Features 37 yes/no items: 28 related to anxiety; and 9 on social desirability. - Filled out by youth ages 6-19 Self-Report for Childhood Anxiety Related Disorders - Contains 41 items rated by parent and student - Measures general anxiety, separation anxiety, social phobia, school phobia, and physical symptoms of anxiety in children and adolescents 8 and older Spence Children s Anxiety Scale (SCAS) - 34 item preschool form for ages 2.5 to 6.5 years - Completed by parents - Screens for separation anxiety, social phobia, OCD, panic-agoraphobia, GAD, and fears of physical injury State-Trait Anxiety Inventory for Children (STAIC) - Measures anxiety in children ages Distinguishes between anxious behavior rooted in the personality versus a fleeting emotional state 23

24 Behavioral Therapies Prolonged exposure - Gradually confronting fear using similar, real, or imagined versions with positive self-talk, relaxation, hypnosis, or biofeedback Modeling - Children observe another person interacting effectively with a feared situation Contingency management - Rewards given for successful, increasingly bold steps Self-management - Subjective and physiological reactions are altered by teaching adaptive ways of thinking and using deep muscle relaxation 24

25 Selective Serotonin Reuptake Inhibitors (SSRI s) Medications SSRI s block the reabsorption of serotonin by certain nerve cells in the brain. This leaves more serotonin available, which improves mood. - citalopram (Celexa) - escitalopram (Lexapro) - fluoxetine (Prozac) - paroxetine (Paxil) - sertraline (Zoloft) - fluvoxamine (Luvox) Paxil approved by FDA for treatment for social anxiety disorder Zoloft approved by FDA for treatment for OCD and panic disorder Common side effects: insomnia or sleepiness weight gain Serotonin-Norepinephrine Reuptake Inhibitors (SNRI s) SNRI s increase levels of serotonin and norepinephrine by inhibiting reabsorption in cells. - duloxetine (Cymbalta) - venlafaxine (Effexor XR) - desvenlafaxine (Pristig) SNRI s are particularly good for treatment of General Anxiety Disorder (GAD) Benzodiazepines Benzodiazepines are used for short-term management of anxiety. They produce sedation, induce sleep, and relieve anxiety, muscle spasms, and seizures. Benzodiazepines promote relaxation and reduce muscular tension and other physical symptoms of anxiety. - chlordiazepoxide (Librium) - diazepam (Valium) - lorazepam (Ativan) - alprazolam (Xanax) - zolpidem (Ambien) - zaleplon (Sonata) Major side effect: Benzodiazepines can be addictive. 25

26 Brain Channels Draw a T.V. This is a B.C. T.V. (before cable) with only three channels Channel 1 Channel 2 Channel 3 Answer Key: Channel 1 Cloudy Mind; Channel 2 Sunny Mind; Channel 3 Rainbow Mind 26

27 RAS Your Feelings R A S your feelings your feelings your feelings Dream Planning Replace bad dreams with good dreams Use all your senses A habit is established in 21 days One-Minute Vacation Magic Number Desensitization Sleeping Bag Shuffle 27

28 Answer key: Recognize; Accept; Share Personal Chill Out Plan o Maintenance stress relievers o Instant stress relievers o Ideas cannot be against the rules or law and cannot hurt others o Narrow list to three to five ideas so response becomes automatic ANT Killing A N T (Instant) (Bad) (Ideas) It s just awful! I can t stand it! This is the worst. *List some of your ANTs: 28

29 Answer Key: Automatic; Negative; Thoughts 29

30 Charting My Feelings 1) Rate your feelings for the morning, afternoon, and evening. 2) Briefly describe each part of your day. 3) Average the three scores. 4) Interpret your score: 0-1 awful 2-3 poor 4-6 fair 7-8 good 9-10 excellent 5) Note any patterns and adjust behaviors to better cope. The Three R s R R R thoughts checking thoughts Answer Key: Recognize; Reality; Reframe 30

31 Summary of Magic Button Steps 1. Think of a specific feeling you want to have. Magic Button 2. Make a list of good experiences you ve had or would like to have that would help bring about the feeling you want. 3. Choose a magic button. Make sure your magic button touch or movement is the same each time. 4. Picture in your mind the good experiences you ve listed. When your pleasant feeling is strong, push your magic button. 5. Practice step four regularly. The magic button connection to your desired feelings will become automatic. 6. Use your magic button during periods of time when you are having unpleasant feelings. This will wash them away and replace them with the pleasant feeling you want. Source: K. T. Frank, The Handbook for Helping Kids with Anxiety & Stress, Chapin, SC: Youthlight, The Big Balloon Relaxation Techniques The Big Squeeze The Lemon Squeeze Anxiety Mapping Biofeedback Stress cards 31

32 No FAT Brain Diet F change to F A change to T T change to A ROCK Technique R O C K Get your mind on something good. yourself. Get busy doing something good. to your safe place or person. that you ll be OK. Stress Test T charge of your feelings. E S T something good to yourself. Focus only on the job at hand. Answer Key: No FAT Brain Diet: Feel change to Feel; Act change to Think; Think change to Act ROCK Technique Refocus; Occupy; Come; Know Stress Test Take; Exhale; Say; Task. 32