Helping Children Manage Stress and Anxiety in Schools. Kameron Dill, PsyD. Sundstrom

Transcription

1 Helping Children Manage Stress and Anxiety in Schools Kameron Dill, PsyD Psycholo Child Bu

2 Agenda Overview of anxiety/stress School factors 4 Components of managing anxiety Power of relationships Medication Questions

3 Overview

4 Anxiety Facts 18% of adults have an Anxiety Disorder 3% of children (ages 3-17) in America have an Anxiety Disorder Most people develop symptoms before age 21 Women are 60% more likely to be diagnosed than men.

5 Is it anxiety if? Constant questions: What if? Fear of embarrassment or unwanted attention Burden for repetition, order, evenness, confessing Separation from parents or fear of them getting hurt Reliving traumatic memories and experiences

6 Is it anxiety if? Expecting disasters (fire, kidnapping, robbers) Fear of throwing up, germs, or medical problems School resistance or refusal Unwanted thoughts that are out-ofcharacter Perfectionism/too much pressure on themselves

7 Is it anxiety if? Recurrent pain complaints (stomach/headaches) Sleep difficulties Inhibition or not fully participating Meltdowns and tantrums Difficulties with transitions Defiance and selfishness Sensitivity to clothing, texture, sound Toileting issues

8 Typical anxiety based categories Type of Symptom Fear of leaving mom or dad Fear of having a panic attack Fear of being the center of attention Fear of closed doors or stairways, elevators, or heights Fear of contamination, a need to perform ritual behaviors Worry about safety of parents or pets; worry about homework or keeping track of the schedule; multiple shifting worries Diagnostic Category Agoraphobia (Separation Anxiety) Panic Disorder Social Anxiety Disorder Specific Phobia Obsessive-Compulsive Disorder Generalized Anxiety Disorder

9 Typical Anxiety Triggers in School Academic Rigor o o Private vs. Public Homework vs. No HW Learning Differences Developmental Differences Learning supports and Implementation o 504 vs. Individualized Education Plan (IEP) Class size/environment Teacher Learning Style Energy/Sleep Social Dynamics

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11 Common Issues with Anxiety in School Panic attacks Fear of vomiting, diarrhea, germs Increased bathroom usage Poor test performance Recess avoidance PE avoidance Behavioral outbursts Inflexibility with changes in rules or routine I m sick statements School avoidance/refusal Quiet Withdrawl

12 Components to Treating Anxiety/Stress 1) Understanding 2) Coping tools 3) Facing it 4) Adult Support

13 Part 1: Understanding Why is my body doing this?

14 The Response to Stress Danger/Survival Instinct Autonomic Nervous System Fight Tantrums Flight Avoidance Freeze Adrenaline causes tunnel vision o Decrease in logical, intentional behavior Can control o Breathing, muscles, thought, action

15 Observe Feelings, Triggers, Response Upset thermometer o What do people do who are angry, sad, nervous? o Difference between small, med, big upsets Daily review: o Highest upset in last 24 hours o How did I respond o Don t do after upsets only

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17 Thoughts, Feelings, and Behaviors

18 Part 2: Coping

19 Evaluate a Child s General Health Is he/she getting enough sleep? Does he/she have to be woken up in the morning? Is he/she getting enough physical activity? Look at diet. Is he/she hangry? Need a snack?

20 General Calm Down Strategies Time! Relaxation muscles and breathing (good apps for this!) Distraction Humor Rewards and pleasant activities Pleasant imagery Mindfulness Special roles in classroom

21 Routine & Practice

22 Visual Cues

23 Bossing Back Worry Thoughts Worry Bully tricks and lies Worst will DEFFINITELY happen o Really it s unlikely If something happens it will be a DISASTER o Really it s a bummer Weighing the Evidence Thinking erros/traps BOSS HIM BACK!!! o Stop tricking me. I m the boss of you o Test the evidence and speak truth.

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25 Worry Time/Box 5 minutes Ignore anxious statements during other times of day Child writes fear in box where it s stuck Parent- Based Activity Try not to problem solve but empathize

26 Fighting the Lie! Determine automatic thoughts (thinking errors) occurring that most contributes to worry. Restructure thoughts to be more true and positive. Practice saying out loud often. Use positive mantras.

27 Cognitive Restructuring Example: Event Thought Emotion (Rated 0-10) Realistic Counter - Thought Emotion (rated 0-10) Class presentation My voice will shake! 8 My voice might shake but most people won t notice 6

28 Individualized Education Plan (IEP) Support Ideas Take a break at desk Take a break in hall Sensory room Rewards Study buddy Increased time on tests Sensory breaks Verbal & visual instructions Noise cancellation Headphones Fidgets Special/leader jobs Visual cues for help when upset Praise! Praise! Praise! Adult-Child Connection

29 Part 3: Exposure How can my body build a defense?

30 Anxiety Growth Cycle Trigger Relief Distress Avoid

31 Anxiety Growth Cycle Trigger Relief Distress FACE Avoid IT

32 Helping Children Face It Avoidance or rescuing grows anxiety o Try your best not to miss school! Exposure builds your bodies defense o Ex: Immunization exposes body to virus Intentionally do a piece of a smaller stressor on purpose Track the effort visually Use rewards Adults time and attention are best

33 Examples of Exposures Go to school late on purpose Ask teacher for help Do sloppy and/or incorrect work intentionally Ask a friend to play Practice being flexible with doing things out of routine

34 Example Exposures Go to part of school day before getting a chill break Go to school unless temperature, throwing up, or recurrent diarrhea Ask What if question without getting an answer Making frequent choices Food on your face or funny clothes Watch team play if can t join

35 Anxiety Hierarchy Christine has a fear of germs. She worries that if she touches something dirty she could get sick and even die! Goal: Be able to bring contaminated things inside the bedroom Situation Lie down on my bed in the same clothes I wore to school Put backpack on bus floor and then put it on my bed Put backpack on bus floor and then put it next to my bed Sit at the desk in my room in the clothes I wore to school Put backpack on bus floor and then put on the floor by my bedroom door Fear Rating Wear school clothes around the house, but don't sit on anything 3

36 We don t want kids who never struggle We want them to know they can handle the struggle

37 Part 4: Adults Role How do I help a child (rather than doing the work for him/her)?

38 Adult Role Your relationship is the leverage Lead your child through with questions (prior to or after the trigger is past) o Observe: I ve noticed what s up? o Validate: Sounds like you felt Did I get it right? o Prompt: What could you do to help yourself? o Praise ideas and action Problem Solving o Ross Greene s Collaborative and Proactive Solutions

39 Adult Role Kids take their cues from adults o Think volume, tone, and posture Observe your own reactions to a child s anxiety and whether it might contribute to the child s interpretation of the situation and subsequent emotional response. In the midst of panic, NO problem solving, allow child to calm and then praise them for doing so. Flip your lid and the limbic system

40 Let Kids Do Their Work Let them hurt, seethe, and slump Teach distress tolerance o Nothing to fear but fear itself. Don t expect kids to WANT to learn how to calm its not natural Don t give reassurance monologues Disengage from battles

41 Power of Relationships Date your children and teacher Volunteer in the classroom Teach them to be assertive Teach them to reconcile Help them take someone else s perspective Encourage friendships that fit them Place them on a team Have adults that invest and expect 2x10 theory by Raymond Wlodkowski

42 Rinse and Repeat! (Review) Understand triggers See and fight the lie Calming strategies Exposure Praise!

43 How do I know if medication is appropriate? Some kiddos are predisposed to anxiety (Do mom and dad experience it as well?)and have a chemical imbalance of serotonin in the brain If treatment is not getting us to where we really want to be, it might be time to consult a naturopathic provider or a prescriber IF they are school refusing we are much more likely to recommend medication at the onset Too difficult to implement therapy recommendations?

44 Medication Sometimes naturopathic solutions can help alleviate symptoms o Some kids take 5-HTP, GABBA, L-methylfolate o Have vitamin D, B12, iron levels checked Sometimes prescription medications are called for o Typically a Selective Serotonin Reuptake Inhibitor (SSRI) o Usually takes 2-6 weeks to take effect, start at a low dose and monitor for any side effects

45 Questions and Examples