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

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

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

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

Understanding the Issue

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?

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)

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

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

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)

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

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

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

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

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

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?’

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

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

Working with parents Parents of anxious children initially may want lots of reassurance (lots of phone calls, emails, 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”

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

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”)

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.

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?

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’)

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