1. Welfare Guardian
Supporting Parents of Anxious Children: Primary School Years
Dr Erin Bowe
Clinical Psychologist

2. Introduction
Differentiating normal fears & worries from anxiety disorder
Common presentations in Primary School years
How to support parents though ‘peak’ anxiety times

3. Objectives Learn about common presentations in children
Learn to differentiate normal & potentially problematic worries
Support parents to help their child at home
Educate parents about how psychologists manage child anxiety

4. What’s normal? 10-20% of children will have an anxiety disorder
Many more will have anxiety symptoms BUT not have a disorder (Walkup et al, 2008)
Separation fears (40%)
Competence worries (30%)
Social acceptance (20%)
Shyness & introversion normal
Girls disclose worry content more than boys

5. Understanding the Issue

6. Differentiating normal and problematic anxieties
Is this something a child this age needs to worry about?
Is the degree of stress unwarranted given age and the feared object/event?
Does the anxiety interfere with functioning: (1) social, friendships, (2) school work, (3) family life
Ability to cope/recover when object/event not present?

7. What do Primary School kids worry about?
Change – doesn't matter if good or bad
Injury and natural events (storms, fires, earthquakes, tsunamis)
Separation and loss
Competence (school, sport, social)

8. Risk factors for anxiety disorders
Parent with an anxiety disorder (genetics + model anxious behaviours)
Persistent stressors- moves, illness, divorce, etc.
Learning difficulties
Chronic illness
Bullying (bully and victim)
Temperament (to some degree)
Social or cultural isolation

9. What does anxiety look like?
Internalised: children who are shy, fearful, and avoid new situations at 3 and 5 years are more likely to exhibit anxiety later in life (Caspi et al, 1995)
BUT:
Externalised: some children express their anxiety ‘outwards’- over-confident, talkativeness, need to be centre of attention, anger outbursts & aggressiveness or push people away

10. What does anxiety look like? cont.
Cannot expect kids to concretely articulate thoughts/feelings
Anxious ppl listen to their bodies too much
So complain of: poor sleep, upset tummy, headaches, sore muscles, ‘butterflies’, needing toilet a lot, heart goes fast, appetite changes
Anxious children & parents interpret unfamiliar situations in a negative way and underestimate their ability to manage (attribution bias)

11. What to look for
Ongoing physical complaints – usually stomach complaints
Often first thing in morning and bedtime
Sleep issues
Change in eating
Avoidance
Excessive need for reassurance
Inattention and poor school performance
Explosive outbursts – “get out of my face” type behaviours

12. What types of anxiety disorders?
The most common anxiety disorders in middle childhood are:
Separation Anxiety
Generalized Anxiety Disorder
Phobias

13. Separation anxiety Normal part of development
BUT can become problematic if it persists > 6mo
Excessive fear when separated from home/parents
Excessive worry about health/safety
Difficulty sleeping alone
Nightmares
School Refusal
Expected part of trauma and chronic illness

14. Generalised Anxiety
Excessive worry about everything and anything >6mo
About 3% of children
Confuse worrying with preparing
Over-analyse the meaning of thoughts
Over-estimate risk and danger
Can be perfectionistic and seek reassurance
Over-analyse the meaning of body sensations
Often coincides with developmental changes in cognition (awareness of death, end of magical thinking)
Over-estimate their role in family for worrying about BIG things

15. Phobias
Fear of a particular object or situation which is avoided or endured with great distress >6 mo
About 5% school-aged children
Will avoid feared object/situation
Children may not realize fear is generalized or unreasonable
Often maintained by well-meaning caregivers who ‘help’ the child to avoid their phobia (cross street to avoid dog)
Multiple phobias more common (75% of all sufferers)
‘problematic’ if the child cannot realistically avoid the fear

16. Anxiety is often learned
Children watch parents to see how to behave in situations
They will mirror their parents’ estimations of risk
Also tend to mirror their parents’ anxious behaviours- fidgeting, reassurance-seeking, & ‘safety’ behaviours
Parents jump to reassure before child has even raised the worry (‘you’ll be ok at the party’)
Balance risk assessment with facts not just feelings
‘Where is the evidence that this will go badly?’
‘Am I focussing on possibility instead of probability?’

17. Addressing the Issue Medication for child anxiety is rare
Psychological treatment focusses on:
(1) teaching kids about thoughts
(2) how to describe and communicate feelings
(3) teaching that feelings are not facts
(4) risk estimation skills (‘detective work’)
(5) how to manage physical symptoms
(6) giving parents strategies and tools

18. Working with parents Explaining anxiety curve 0-10
Explaining parent-child mirroring
Myth of avoidance: “don’t think about it”, “don’t worry”, “think of something else”
Radical acceptance & tolerance for anxiety symptoms is what helps reduce them
Coach parents in how to actively teach kids how to calm selves
Shift from child relying on parent to calm them into learning self-management skills

19. Working with parents
Parents of anxious children initially may want lots of reassurance (lots of phone calls, s, checking)
Model same skills that we are teaching their children!
Instil confidence, unfaltering belief in strategies & self-efficacy
Parents who are afraid their child will ‘never’ go to school/sleepover/party without anxiety have a hard time believing the behaviours will ever end
“With strategies, this will resolve pretty quickly”
“Yes, it’s hard now, but it’s going to get better”

20. Specific Example Jack, recently turned 7
Over summer came to question validity of Santa
Jack saw Black Saturday fires on TV
Started to become v. worried about fires
Then escalated to other ‘big’ worries about robbers, dog being stolen, Mum forgetting to pick him up
Also had smaller worries: cruelty of worms being eaten by birds, ‘crashing’ his bike on cracks in the road, & potential ‘poisoning’ from writing on hand with pens

21. Jack Worked with Jack on his thoughts: ‘worry box’
Explain fight or flight response
Detective work – where’s the evidence?
Use of ‘secret signal’ ritual for separation fears
Jack to come up with list of ‘kids’ jobs’ (“play”, “have fun”) & ‘parent jobs’ (“keep fires away”, “buy stuff”, “drink wine”)

22. Parent support
Practise limiting reassurance & praising Jack’s attempts to self-assure
If endless reassurance worked, then kids wouldn’t be anxious!
Keeping calm and confident – anxious kids often pick up on their parents’ uncertainties or doubts about themselves
Anxious kids may assume the role of worrying about adult problems
They then get ‘drunk with power’ from the self-imposed responsibility and become even more anxious – worry about grown up problems like bills, safety etc.

23. Useful resources ‘Smiling mind’ app Books:
What to do when you worry too much
What to do when you’re scared and worried
Is a worry worrying you?
What Does it Mean to be Present?

24. Summary Anxiety is a normal part of life
Problematic if it interferes with daily functioning: school, friends, family life
Being anxiety-free is not realistic for anyone
Emphasize- where is the evidence for that worry?
Feelings are not facts
Reduce repetitive reassurance- try 1 confident statement about competence (‘you CAN do it’)

25. Supervision
Do you need further support, coaching or guidance about how to manage anxiety in schools?
Just need someone external to school to bounce ideas off?
Individual supervision via Skype or at our Port Melbourne office is available