Presentation on theme: "Anxiety, when is it more than “Just a Phase”?"— Presentation transcript:
1Anxiety, when is it more than “Just a Phase”? Ruth E. Imershein, MD RMOPUS Embassy Lima
2AnxietyA state of being uneasy, apprehensive, or worried about what may happen; concern about a possible future eventIn psychiatry, anxiety is an abnormal state, characterized by feeling powerless andunable to cope with threatening events, typically imaginary, and by physical tension,as shown by such symptoms as:sweatingtrembling or shakingpalpitations or racing heart ratefeeling dizzy or unsteadydifficulty breathing or the sensation of shortness of breathfear of losing control or going crazy
3FactsAbout 13 out of every 100 children and adolescents ages 9 to 17 experiencing some kind of anxiety disorderAnxiety disorders affect more than emotional health -- they are also associated with many physical illnessesIf anxiety in children is not detected and treated early enough, other problems may develop.
4More FactsAnxiety disorders frequently co-occur with depressive disorders or substance abuse.Most people with one anxiety disorder also have another anxiety disorder.Many anxiety disorders experienced by adults actually start in childhoodNearly three-quarters of those with an anxiety disorder will have their first episode by age 21.5
5Why?A person's genetics, biochemistry, environment, history, and psychological profile all seem to contribute to the development of anxiety disorders.Most people with these disorders seem to have a biological vulnerability to stress, making them more susceptible to environmental stimuli than the rest of the population.
6Common Anxiety Disorders in Children School RefusalGeneralized AnxietyFears and PhobiasObsessive Compulsive DisorderTrichotillomaniaSelective MutismSocial PhobiaAcute Stress DisorderPost Traumatic Stress Disorder
7Separation issues or School Avoidance Separation difficulties are a normal, healthy part of a child’s developmentSeparation can be difficult if a child is young, immature or bashfulIf a child has separation difficulties, he/she may cry, throw a tantrum, cling to the parent, refuse to enter the schoolEven though these reactions might be extreme, they are normal
8Common ExplanationsMy baby’s too young…a child’s reluctance to attend school may be a reflection of a parent’s reluctance to let the child leave.My child’s stubborn…is refusing to go to school just one of many things your child won’t do? If so, then your child may be difficult or oppositional, not anxious.My child doesn’t like school…applies to most teenagers, but not most young children.My child’s too anxious…does the child become anxious at other time or display distress whenever parents leave or when left alone in the bedroom at night?
9My child is embarrassed to go to school…poor school performance often contributes to poor attendance. Children want to avoid being teased.My child hates school and claims to have no friends…shyness or underlying behavior problems should be addressed.My child is sick many mornings…physical symptoms may be a manifestation of anxiety, but a though examination is in order to determine if there is a chronic illness.My child is too tired…lack of sleep may be due to late bedtimes, but children also should be checked for physical illnesses.
10What can a parent do?Make sure that your child goes to school every dayDetermine the cause of the school avoidanceIf your child is scared, try to make things at school more familiarDecrease separation anxieties for both you and your childTry to eliminate the source of fear (the teasing, bullying, abuse, etc.)Make going to school easier and more fun than staying homeSeek professional help
11Generalized Anxiety My child worries too much has always been a worrierworries about everything, including things that are beyond his controlis always nervous and tensehas frequent headaches, stomachaches, trouble sleepingis constantly seeking reassuranceis overly sensitive to correction or criticismis easily fatigued, irritable, overwhelmed
12What to do if it is GAD Psychological treatments Behavior TherapyCognitive TherapyRelaxation TherapyPharmacological treatmentsClarify normal vs excessive worriesEstablish a stable, predictable support baseDon’t overprotect your childDon’t tease or ridicule your child
13If it isn’t Generalized Anxiety Disorder, then what could it be? Normal Childhood WorriesStress Induced AnxietyMedical DisordersPanic DisorderObsessive Compulsive DisorderOther Anxiety DisordersMr. Worry
14Fears and PhobiasResearchers have found certain fears are natural and arise at specific ages in all children, and these fears tend to disappear naturally as the child grows older.Children may develop fears from a traumatic experience (e.g. traumatic dog attack), but for some children, there is no clear precipitating eventSome children become fearful simply by watching another child acting scaredChildren's fears are often associated with avoidance, discomfort, and physical complaints, such as rapid heart rate, gi distress, sweaty palms, or trembling.
15Which fears are normal at what age? Most children, when asked, are able to report having several fears at any given age.Some research shows that 90% of children between the ages of 2-14 have at least one specific fear.If your child’s fear is not interfering with his/her daily life (e.g., sleep, school performance, social activities) , or your family’s life, then most likely your child does not need professional help.
16Common fears at specific ages INFANTS/TODDLERS (ages 0-2 years) loud noises, strangers, separation from parents, large objectsPRESCHOOLERS (3-6 years) imaginary figures (e.g., ghosts, monsters, supernatural beings), the dark, noises, sleeping alone, thunder, floodsSCHOOL AGED CHILDREN/ADOLESCENTS (7-16 years) more realistic fears (e.g., physical injury, health, school performance, death, thunderstorms, earthquakes, floods.)
17Helping a Child Outgrow Fears Recognize whether the fears are within normal range or excessiveBe sympathetic to the child, not the fearTalk about nightmaresHelp confront fears – fears often decrease and sometimes disappear completely simply when confrontedHelp overcome fears - No more Monsters in the Closet by Dr. Jeffrey Brown OR What to Do When You're Scared and Worried by James Crist and/or seek professional help
18PhobiasWhen children’s fears persist beyond the age when they are appropriate, are irrational and excessive and begin to interfere with their daily functioning, they are called phobias.
1910 Most Common Phobias Acrophobia – fear of heights Claustrophobia – fear of enclosed spacesNyctophobia – fear of dark placesOphidiophobia - fear of snakesArachnophobia – fear of spidersTrypanophobia - fear of injectionsAstraphobia – fear of thunder and lighteningNosophobia – fear of having a diseaseMysophobia or Germophobia – fear of germs/contaminationTriskaidekaphobia – fear of the number 13
20Obsessive Compulsive Disorder Essential featuresRecurrent obsessions (persistent intrusive thoughts, impulses or images that are inappropriate)Recurrent compulsions (repeated rituals or behaviors)These are experienced as either time consuming and / or cause marked anxiety, distress or significant interference with daily functioning.The person attempts to suppress or ignore these thoughts, impulses, images or behaviors without success
21Does a child have OCD?Is the child troubled by excessive worries, particularly about dirt, germs or other dangers?Does the child repeat the same questions over and over again? Or constantly seek reassurance?Does the child seem to have difficulty concentrating?Is the child washing excessively? Taking extra showers, longer showers, changing clothing more frequently?Does the child “check” repeated? Reread, erase and rewrite homework assignments?Does the child have to repeat things a certain number of times or until they are “just right”?Does the child arrange things in a certain order or become upset if something is moved or misplaced?Do the symptoms bother the child – make him or her anxious or upset?Do the worries or behaviors interfere with relationships and/or activities at home or school?
22Treatments for OCD Behavior therapy with exposure Cognitive therapy and thought blockingMedicationsParental interventions to assist with professional treatmentRecognize the behaviors as symptoms of OCDProvide support for the child but don’t come involved in the ritualsUse distraction to decrease symptomsHelp your child to avoid “avoiding”
23TrichotillomaniaIt can be a habit or a symptom of Obsessive Compulsive DisorderCompulsive hair pullingThe child feels an overwhelming urge to pull which increases in intensity until the hair is pulledIf the child tries to resist the urge, then anxiety increasesWhen the “right” hair is pulled, the child experiences a sense of relief
24Selective MutismDefinition - a consistent failure to speak in specific social situations in which there is an expectation for speaking.Children with selective mutism have the ability to both speak and understand language, but fail to use this ability in some situations.Selective mutism is not a communications disorder and is not part of a developmental disorder.Most children with selective mutism also have other anxiety disordersMost children with selective mutism function normally in other areas of their lives.By definition, selective mutism does not include children with conduct disorders, oppositional/defiant behavior, and/or attention-deficit hyperactivity disorder.
25Does a Child have Selective Mutism? Does the child consistently fail to speak in certain situation such as in the classroom or in front of strangers?Does the child’s lack of speech interfere with educational achievements and social relationships?Has the child been mute for at least one months not including the first month of school?Does the child speak normally in at least one setting, such as at home with family?What is the child’s primary language?
26Selective Mutism The extent to which a child speaks varies greatly Punishment or withholding of privileges for not speaking and communicating effectively in social settings is inappropriate.Treatment should focus on reducing anxieties, becoming more comfortable and ‘unlearning’ the silent behaviorWith early diagnosis and the right treatment , the prognosis is good
27Treatment focus for Selective Mutism Not on getting a child to speak, but ratherOn decreasing anxiety and teaching coping skills to use when confronted with anxious situations and shouldInclude approaches that gradually desensitize. andUse multiple modalities combining, but not be limited tocognitive-behavioral therapy,family therapy, play therapy, and school-based and community-based behavioral interventionsmedications
28Social Phobia or Social Anxiety Disorder Diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations.Children and adults with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them.They can worry for days or weeks before a dreaded situation.This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.Because these children do not usually display behavioral problems, their problems tend to go undetected by parents and teachers.Earlier onset of the disorder typically means a more severe and chronic course .Untreated this continues to be a lifelong problem. Most adults with social anxiety disorder indicate that it began in childhood, usually in elementary school
29Age Related Symptoms Presentation is related to a child’s age If your child is a pre-schooler, some symptoms to watch for are:fear or lack of interest in new thingscries, whines or appears irritablefreezes up or clings to parentshy around new peoplerefuses to participate or speak
30School-Aged Children with Social Anxiety Disorder Not always but often…Don’t read aloud or answer questions in classDon’t start or join a conversationDon’t write on the blackboardDon’t’ speak to adultsDon’t participate in music or athletic performances or after-school activitiesDon’t order food in a restaurantDon’t attend birthday partiesDon’t invite friends over to playDon’t sit with others at lunchDon’t want to play with others at recessDon’t seem able to stop worrying excessively about being evaluated or judgedDon’t like schoolDon’t feel comfortable being the center of attentionDon’t speak clearly but rather mumble and avoid eye contact
31Teenagers with Social Anxiety Disorder Display some or all of the aforementioned plusWatch for the following additional symptoms specific to the teenage years:skips school and/or uses drugs or alcoholfears performance situations such as public speakingdifficulties dating or problems with a jobfear of using public restroomsfear of signing name in public
32Treatment for Social Anxiety Disorder Professional helpCognitive Behavior therapyExposure therapySocial skills trainingCognitive Restructuring – positive thinking with thought blockingSymptom Management Skill training to reduce stress and symptoms of anxietyMedications – usually antidepressantsParental supportRecognize “shyness” as social anxiety disorderEncourage trying new social situationsDon’t ridicule or teaseSeek therapy early
33ResourcesAnxiety Disorders Association of America -The American Academy of Child and Adolescent Psychiatry – Facts for Families (http://aacap.org)Madison Institute of Medicine – booklets on Social Anxiety, Panic Disorder, OCD in Children, Depression, Trichotillomania, etcThe OC Foundation -
34More Resources - booksIs It Just a Phase? by Susan Swedo and Henrietta LeonardWhat to do when you are scared or worried by James CristThe Boy Who Couldn’t Stop Washing by Judith RapaportThe Boy Who Finally Stopped Washing by James B
35More Resources – online ordering Magination Press – self help books for kids and adults by the American Psychological AssociationChildsWork/ChildsPlay – resources for parents, teachers and professionals:Courage to Change – more resources available online: