Child and Adolescent Mental Health Anxiety in Children & Adolescents Developed by Susan Ponting M.Ed., Registered Psychologist

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Anxiety Quiz Behaviours Often Seen in Children with Anxiety Types of Anxiety Disorders Basic Strategies to Help Your Child with Anxiety Specific Strategies to Help Your Child with Anxiety Other Strategies to Help Your Child with Anxiety Resources Bibliography

Anxiety Quiz

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Anxiety Quiz {

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The following is a short quiz to test your knowledge regarding Anxiety Once completed, you will be asked to pass your paper to the person seated on your right Papers will then be collected by the facilitators You may begin the quiz now.

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How did you feel when you thought your quizzes were going to be marked and collected? Anxiety is a normal response Fight or flight response It is when anxiety interferes with everyday functioning that it may be considered an anxiety disorder

Anxiety Quiz True or False? Post-Traumatic Stress Disorder (PTSD) once referred to as shell shock or battle fatigue, is a condition that only affects war veterans. 1.

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False - Individuals (including children) who have experienced or witnessed a traumatic event or ordeal, such as a terrorist attack, a tornado, a rape or mugging, or a car accident, can be at risk for developing PTSD. Many people with this anxiety disorder repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled.

Anxiety Quiz True or False? Someone who feels compelled to spend a great deal of time doing things over and over again such as washing their hands, checking things, or counting things has an anxiety disorder. 2.

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True - A person plagued by the urgent need to engage in certain rituals, or tormented by unwelcome thoughts or images, may be suffering from an anxiety disorder called Obsessive Compulsive Disorder (OCD). This disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life. It can appear in childhood, adolescence, or adulthood, but on the average, it first shows up in the teens or early adulthood.

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Anxiety Quiz 3. a) b) c)

What is the most common mental health problem in America? Depression Schizophrenia Anxiety Disorders

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Anxiety disorders are the most common mental health problem in America. About 40 million American adults suffer from anxiety disorders, which include Panic Disorder, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, Phobias, and Generalized Anxiety Disorder.

Anxiety Quiz 4.

a) b) c) d)

Which of the following diseases/disorders are real medical illnesses? Anxiety disorders Diabetes High blood pressure All of the above

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All of the above, including Anxiety Disorders. Brain scientists have shown that anxiety disorders are often related to the biological makeup and life experiences of the individual, and they frequently run in families. Unfortunately, misconceptions about mental illnesses like anxiety disorders still exist. Because many people believe mental illness is a sign of personal weakness, the condition is often trivialized and is left untreated.

Anxiety Quiz 5.

a) b) c) d) e)

Which of the following are symptoms of an anxiety disorder known as Panic Disorder? Chest pains Dizziness Nausea or stomach problems Fear of dying All of the above

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Panic Disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. Left untreated, people with panic disorder can develop so many phobias about places or situation where panic attacks have occurred that they become housebound (Agoraphobia)

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Anxiety Quiz True or False? Anxiety disorders often occur with other illnesses. 6.

Anxiety Quiz True It is common for an anxiety disorder to accompany depression, eating disorders, substance abuse, or another anxiety disorder. Anxiety disorders can also co-exist with illnesses such as heart disease, high blood pressure, irritable bowel syndrome, thyroid conditions, and migraine headaches. It is important, before beginning any treatment, to have a thorough medical examination to determine the causes of the symptoms.

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Anxiety Quiz True or False? Most people successfully take control of the symptoms of anxiety disorders by sheer willpower and personal strength. 7.

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False. Many people misunderstand anxiety disorders and other mental illnesses and think individuals should be able to overcome the symptoms by sheer willpower. Wishing the symptoms away does not work-but there are treatments that can help. Treatment for anxiety disorders often involves medication, specific forms of psychotherapy, or a combination of the two

Behaviours Often Seen in Anxious Children

Behaviours Often Seen in Anxious Children { { { { { { { {

Extreme shyness May isolate themselves in the classroom May be hesitant to participate in social activities May be extremely uncomfortable when they are the center of attention May lack self-confidence and seem very unsure of themselves May avoid doing schoolwork because they are worried that they will make a mistake May phone home frequently from school May be absent from school often due to “nervous stomach” or headaches

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Behaviours Often Seen in Anxious Children {

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May need frequent reassurance from teacher that they are doing their work correctly May be a perfectionist about their work May “blend into the wallpaper” and refuse to raise hand in class May spend too much time worrying about failure May expect catastrophes in normal situations May be wiggly, jittery, shaky, high-strung, tense, and just never seem to relax May worry excessively about upsetting others or hurting others feelings

When do these behaviours require help from a professional? Questions to ask? { Is your child’s fear and the behaviour s/he is exhibiting typical for your child’s age? { What are the symptoms of the fear and worry, and how do they affect your child’s personal social and academic functioning? { Does the fear or worry seem unreasonable in relation to the reality of the situation?

Types of Anxiety Disorders

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Types of Anxiety Disorders: Panic Attack {

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Intense fear or discomfort Pounding heart Sweating Trembling or shaking Feeling of choking Chest pain Nausea

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Feeling dizzy, unsteady, lightheaded, or faint Feeling detached from oneself Fear of losing control or going crazy Fear of dying Numbness or tingling sensations Chills or hot flashes

Types of Anxiety Disorders: Specific Phobia {

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Persistent fear of a specific object or situation that is excessive or unreasonable Fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily

In children the anxiety may be expressed by crying, tantrums, freezing, or clinging { Types: -animal type: e.g., spiders, dogs, etc -blood-injection-injury type: e.g., needles -situational type: e.g., elevators, heights, etc {

Types of Anxiety Disorders: Social Phobia {

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An overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities Examples: fear of initiating or maintaining conversations, participating in small groups, speaking to authority figures. Children may avoid trying to make friends. Extreme shyness.

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In children this may be expressed by crying tantrums, freezing, or shrinking from social situations with unfamiliar people

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Types of Anxiety Disorders: Obsessive Compulsive Disorder (OCD) {

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Repeated, unwanted thoughts (e.g., did I lock the door, turn the stove off, my hands have germs on them) Compulsive, repetitive behaviours that seem impossible to stop or control (e.g., repeatedly returning to the house to check if doors are locked, repeatedly washing hands to get rid of germs)

Types of Anxiety Disorders: Post-Traumatic Stress Disorder (PTSD) {

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Experienced or witnessed an event that involved potential death or serious injury Reliving the event in your mind Children may repetitively reenact the trauma in their play

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Frightening dreams Difficulties falling asleep Irritability Difficulty concentrating Exaggerated startle response

Types of Anxiety Disorders: Generalized Anxiety Disorder {

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Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities Almost always anticipating the worst even though there is little reason to expect it

{ Physical symptoms -restlessness -easily tired -difficulty concentrating -irritability -muscle tension -difficulty falling asleep, staying asleep, or unsatisfying sleep

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Types of Anxiety Disorders: Separation Anxiety Disorder Developmentally inappropriate and excessive worry or distress concerning separation from home or caregivers excessive worry about losing, or about possible harm occurring to caregivers Excessive worry about getting lost or kidnapped from caregivers Excessively fearful to be alone or without caregivers

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Reluctance or refusal to go to sleep without being near caregivers or to sleep away from home Repeated nightmares Repeated complaints of physical symptoms (e.g., headaches, stomach aches, nausea, or vomiting) when separation from caregivers occurs

Basic Strategies To Help Your Child With Anxiety

Basic Strategies To Help Your Child With Anxiety 1.

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Recognize that the fear is real to your child. Being able to talk about fears helps – words often take some of the power out of the negative feeling. If you talk about it, it can become less powerful Younger children might want to draw a picture showing what the feared object looks like to them

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Basic Strategies To Help Your Child With Anxiety 2.

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Never belittle the fear as a way of forcing your child to overcome it. Telling your child, “Don’t be ridiculous! There are no monsters in your closet!” may get your child to bed, but it won’t make the fear go away.

Basic Strategies To Help Your Child With Anxiety 3. {

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Don’t cater to the fears. Helping your child avoid the fear will only reinforce that the object or situation should be feared and avoided. Provide support and gentle care.

Basic Strategies To Help Your Child With Anxiety *Garland E. J. and Clark, S. (2002) What parents can do to help -Stop nagging!! -Give the household life more structure (e.g., mealtimes) -Practical help (e.g., tutor, exercise program, advocate at school) -Manage own anxiety better {

{ What teens can do to help -Take charge of their own schedule so that parents don’t have to nag -Help keep the family schedule working -Follow-through after asking parents for help -Manage their anxiety so as not to have melt downs

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Specific Strategies To Help Your Child With Anxiety

Specific Strategies To Help Your Child With Anxiety Help Your Child to: { Listen to the worries -what do the worries look like? -draw the worries or make a list {

Listen to self-talk Situation or Trigger: Negative Self-Talk:

Specific Strategies To Help Your Child With Anxiety {

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Changing self-talk Situation or Trigger: Negative Self-Talk: Positive Self-Talk: Facing the Worries Visualization Relaxation

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Strategies To Help Your Child With Anxiety Visualization -trap the worry in a “Worry Box” and only let it out when you are armed and ready to deal with it -Finding the “off switch”. Practice turning on and off the switch to prove who is in control of the worry -Try to imagine a “Special Place”, with its smells, sounds, feelings, colours. Imagine a “Special Place” where the worry is not allowed to visit. -”Worry Time” and the stop sign

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Specific Strategies To Help Your Child With Anxiety Relaxation -deep breathing -muscle relaxation

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-do the relaxation exercise with your child before going to bed -encourage your child to use the exercise when in anxiety provoking situations (such as at school before a big test) -adolescents can become familiar with the exercise and practice on their own

Other Strategies To Help Your Child With Anxiety {

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Learning to laugh What kinds of things make you laugh? Exercise, Sleep, and Eating Right Learning to reward yourself What are your accomplishments, creative ideas, or problem-solving that you are proud of?

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Resources

Resources Access Mental Health 943-1500 { Calgary Counselling Centre 265-4980 { Calgary Family Services 269-9888 { Distress Centre 266-1605 { Canadian Mental Health Association 297-1700 {

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Garland, E. J., and Clark, S. L. (2000). Taming Worry Dragons: A Manual for Children, Parents, and Other Coaches. Children’s and Women’s Health Centre of British Columbia, British Columbia. Garland, E. J., and Clark, S. L. (2002). Worry Taming For Teens. Media Group: University of British Columbia, British Columbia.

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The Community Education Service {

To learn more about upcoming presentations offered by the Community Education Service or evaluations, go to: www.fcrc.sacyhn.ca

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Evaluation Fax: 955-2444 For upcoming education events, Distribution List or other inquiries email: [email protected] Or Call(403)955-7420

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Family & Community Resource Centre Here are some suggested resources for parents and children about:

Anxiety

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Freeing Your Child From Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias Chansky, Tamar E. 2004 E N j m

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The Worried Child: Recognizing Anxiety in Children and Helping Them Heal Foxman, Paul, 2004 E N This book is also available at over 20 libraries in Southern Alberta; inquire at your local branch.

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The Anxiety Cure for Kids: A Guide for Parents Spencer, Elizabeth DuPont, DuPont, Robert L., Dupont, Caroline M. 2003 E N

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Your Anxious Child: Raising a Healthy Child in a Frightening World Shaw, Mary Ann, 2003 E N M k

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Helping Your Anxious Child: A Step-by-step Guide for Parents Rapee, Ronald M. and others, 2000 E N 2 C j

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Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Children Dacey, John S., Fiore, Lisa B. 2000 E N I C

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Raising Your Spirited Child: A Guide for Parents Whose Child is More Intense, Sensitive, Perceptive, Persistent, Energetic Kurcinka, Mary Sheedy, 1991 E N G d f r B 2 k C ^

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Canadian Paediatric Society www.caringforkids.cps.ca/behaviour/fears.htm

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Anxiety Disorders Association of America www.adaa.org/AnxietyDisorderInfor/ChildrenAdo.cfm

10. American Academy of Child & Adolescent Psychiatry www.aacap.org/publications/factsfam/anxious.htm 11. Kids’ Health www.kidshealth.org/parent/emotions/feelings/anxiety.html Materials can be borrowed through inter-library loan

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Family & Community Resource Centre

Banff Library Bassano Library Brooks Library Canmore Library High River Library

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Hinton Library Lethbridge Library Medicine Hat Library Okotoks Library Red Deer Library

Calgary Public Library

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Taber Library Three Hills Library Trochu Library

September 2006

Disclaimer This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please contact your doctor or appropriate health care professional. For additional resources or information regarding Anxiety please call or visit: The Southern Alberta Family & Community Resource Centre Alberta Children’s Hospital 2888 Shaganappi Trail NW Calgary, AB T3B 6A8 Phone: (403) 955-FCRC(3272) For additional support in child health information needs please contact our Child Health Information Specialist at 955-7745, toll free at 1-877-943-FCRC(3272) or email [email protected]. Or you can call: HealthLink Toll Free: 1-866-408-5465 (within Alberta) Phone: (403) 955-5465 Alberta Mental Health Board Information Line Phone: 1-877-303-2642 Access Mental Health Phone: (403) 955-1500

Contributing Partners Southern Alberta Child & Youth Health Network: Healthy Minds / Healthy Children Capacity Building Project Calgary Health Region: Child & Adolescent Shared Mental Health Care Program Alberta Children's Hospital: Mood & Anxiety Clinic Pharmacy Department

All of our Information Prescriptions are available for free download at: www.sacyhn.ca/pages/publications.html