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

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Presentation on theme: "Supporting Parents of Anxious Children: Primary School Years Dr Erin Bowe Clinical Psychologist Welfare Guardian."— Presentation transcript:

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

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

3 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 Objectives

4  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 What’s normal?

5 Understanding the Issue

6 1.Is this something a child this age needs to worry about? 2.Is the degree of stress unwarranted given age and the feared object/event? 3.Does the anxiety interfere with functioning: (1) social, friendships, (2) school work, (3) family life 4.Ability to cope/recover when object/event not present? Differentiating normal and problematic anxieties

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

8  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 Risk factors for anxiety disorders

9  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 What does anxiety look like?

10  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) What does anxiety look like? cont.

11  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 What to look for

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

13  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 Separation anxiety

14  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 Generalised Anxiety

15  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 Phobias

16  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?’ Anxiety is often learned

17  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 Addressing the Issue

18  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 Working with parents

19  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” Working with parents

20  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 Specific Example

21  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”) Jack

22  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. Parent support

23  ‘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? Useful resources

24  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’) Summary

25  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 Supervision


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