1. www.pspbc.ca Childhood & Adolescent Anxiety

2. Fast Facts About Anxiety in Children 2 Childhood = toddlerhood to puberty (2-12 yrs) 2

3. 3  Different anxiety disorders throughout life › e.g. Separation anxiety disorder  A common childhood anxiety disorder  Can be a precursor for other anxiety disorders and depression in adolescents and young adults  Anxiety disorder can lead to: › Poor economic, vocational, interpersonal outcomes › Increased morbidity:  comorbid anxiety disorders, major depressive disorder, and alcohol and drug abuse) and mortality (suicide)  Significant negative impact on family, social and school functioning  Chronic anxiety disorder can lead to: › Poorer physical health outcomes › Increased cardiovascular morbidity and mortality in mid-life Fast Facts About Anxiety in Children

4. 4  Adolescence = puberty to mid-twenties  Anxiety disorders affect 8-10% of young people  Most anxiety disorders begin in childhood & adolescence  Anxiety disorders are often hereditary  Many individuals with anxiety disorders experience physical symptoms that they present to their health care provider.  An individual can be affected by different anxiety disorders throughout their lifespan. › Separation anxiety disorder can be a precursor for other anxiety disorders in adolescents and young adults. › Social Anxiety Disorder; Panic Disorder = teen onset Fast Facts About Anxiety in Adolescents

5. 5  Effective treatments for most young people with an anxiety disorder can be provided by first contact health providers  Always assess parents for the presence of an anxiety disorder if a diagnosis of anxiety disorder or depression has been made in a child  If a parent has an anxiety disorder or depression, successful treatment of child will include effective treatment for the parent Fast Facts About Anxiety in Adolescents

6. 6 6 Key Steps 1.Identification of children at risk 2.Useful methods for screening and diagnosis 3.Treatment template 4.Suicide assessment 5.Safety/contingency planning 6.Referral flags Delivery of Effective Treatment for Anxiety Disorders

7. 7  Ideal position of first contact health providers  Screen usual-risk youth at routine vaccination and start of school visits I. Identification of Children & Youth At Risk

8. 8 Anxiety Disorder Identification Table

9. 9  Educate about risk  Obtain family history  “Clinical review” threshold  Standing “mental health check-up”  Confidentiality, understanding & informed consent A Child is Identified At Risk

10. 10 Screen at-risk youth every 6 months 15 minute office/clinical visits every 6 months Standing “Mental Health Check-up” Anxiety symptoms worsen: - During school year -Before first weeks of school -Should not cause severe distress or dysfunction Anxiety symptoms worsen: - During school year -Before first weeks of school -Should not cause severe distress or dysfunction Anxiety symptoms decrease: - In summer months - After first few weeks of school Anxiety symptoms decrease: - In summer months - After first few weeks of school

11. 11  Does your child worry more than other children you know?  Do you need to reassure your child excessively and about the same things over and over?  Does your child have difficulty separating from you to go to school or over to a friend’s house?  What does your child worry about?  Does worry/anxiety ever stop your child from doing something new or an activity they would enjoy?  Does your child get a lot of stomach aches and headaches? When do they occur?  Are there any events/activities/people/places that your child avoids because of fear or anxiety Additional Questions for Child Anxiety & OCD

12. 12  Ask parents, “How does your child compare to other children of similar age regarding such issues as… › Being away from parent? › Need for reassurance? › Comfort with exploring new situations? › Physical complaints?  If child shows substantially more anxiety type symptoms, assess for presence of anxiety disorder or other mental health problem. Standing “Mental Health Check-up”: Screening

13. 13 D. Standing “Mental Health Check-up” 13 Standing “Mental Health Check-up” School reports and patterns Physical complaints

14. 14  Appropriate/Adaptive Anxiety › Short duration (< a few weeks) › Resolves spontaneously, or › Ameliorated by social supported or environmental modification  Anxiety Disorder › Long duration (usually lasting many months) › Significantly interferes with functioning › Is often out of sync with magnitude of stressor › Usually require health provider intervention › Diagnosis made using DSM IV-TR criteria Differentiating Distress from Disorder

15. 15

16. 16  Psychotherapeutic Support for Teens (PST)  Kutcher Adolescent Depression Scale (KADS) › A screening tool for depression  Teen or Child Functional Assessment (TeFA; CFA) › Self-report tool (child depending) › 3 minutes to complete › Assists in evaluating four functional domains of teen mental health  School  Home  Work  Friends  Tool for Assessment of Suicide Risk (TASR-A) Useful Methods for Screening & Diagnosis

17. Use of SCARED in Assessment 17 Anxiety disorder is suspected: if score of 25 or higher 17

18. 18 Clinical Approach to Possible Child / Adolescent Anxiety Disorder Visit 1: SCARED Function Use PST & MEP as indicated and as time allows If SCARED is 25 or greater (parent and/or child) or shows decrease in function, review WRP/Stress management strategies and proceed to step 2 in 1-2 weeks. If SCARED < 25 and/or shows no decrease in function, monitor again (SCARED) in a month. Advise to call if feeling worse or any safety concerns. Visit 2: SCARED, Function. Use PST & MEP If SCARED > 25, and shows decrease in function, utilize PST strategies, review WRP and proceed to step 3 within a week. If SCARED <25 and shows no decrease in function, monitor again in a month. Advise to call if feeling worse or any safety concerns. Visit 3: SCARED, Function. Use PST & MEP If SCARED remains > 25 or shows decrease in function, proceed to diagnosis (DSM-IVTR criteria) and treatment If SCARED <25 and shows no decrease in function, monitor again (SCARED) in one month. Advise to call if feeing worse or any safety concerns.

19. 19 2nd Mental Health Checkup (1 – 2 wks following initial visit)

20. 20  Repeat SCARED › If symptoms persist review DSM-IV criteria. › Make a treatment plan for anxiety disorder  If concerns of depression persist › Treatment is best applied in a specialty mental health setting or with guidance of child psychiatrist › If depression suspected, refer to appropriate service, but start treatment for anxiety disorder. 3rd Mental Health Checkup (2 – 3 wks following 2nd visit)

21. 21 SCARED score is 25 or higher  Discuss issues/problems in the youth’s life/environment.  Teen Functional Activities Assessment (TeFA)  Supportive, non-judgmental problem solving assistance › Psychotherapeutic Support for Teens (PST) as a guide  Strongly encourage and prescribe:  Exercise  Regulated sleep  Regulated eating  Positive social activities Teen Anxiety Disorder is Suspected

22. 22  Screen for depression › Use the Kutcher Adolescent Depression Screen (KADS)  Screen for suicide risk › Use the Tool for Assessment of Suicide Risk (TASR)  Mental Health Check-ups › Second visit one week from visit  Can include TeFA and/or PST (15 – 20 mins)  If suicide or depression concerns use KADS & TASR-A › Third visit two weeks later  Repeat SCARED and other tools as indicated  Make treatment plan as indicated Teen Anxiety Disorder is Suspected

23. 23  If Panic Disorder: › Complete Panic Attack Diary › Complete DPG:TD Diary  If Social Anxiety Disorder › Complete K-GSADS-A Teen Anxiety Disorder is Suspected

24. 24 Don’t Get Overwhelmed Onset of anxiety disorder is not an emergency Onset of anxiety disorder is not an emergency

25. 25  Specific Factors › Evidence based treatments:  Structured psychotherapies (e.g. Cognitive Behavioral Therapy - CBT)  Medication  Non-specific Factors › Activities  Decrease stress, improve mood and general well-being › Supportive psychological interventions  PST in toolkit guide III. Childhood Anxiety Treatment Template

26. Enroll the Help of Others Who does the child want to help them? Family Teacher School Counselor Coach Neighbor Babysitter

27. 27  Essential for information on child’s emotional state and function  Differing opinions between child and parent › Joint discussion to clarify and appropriately plan  Ensure confidentiality throughout process Parent/Caretaker Involvement

28. 28 Psychotherapy

29. 29 Anxiety BC website www.anxietybc.com Youth anxiety/depression treatment guideline algorithm www.bcguidelines.ca/gpac/guideline_depressyouth.html#algorithm American Academy of Child and Adolescent Psychiatry www.aacap.org Teen Mental Health www.teenmentalhealth.org Suggested Websites