1. Anxiety in Children Galway Educate Together National School 7th February 2017@7pm
Pamela Carroll Mannion BA MSc
Cognitive Behavioural Psychotherapist

2. What to Expect this Evening
What is Anxiety and how to explain it to your child?
Treatment using Cognitive Behavioural Psychotherapy
What you can do at home to help your child
Importance of self care
Question Time

3. What is Anxiety?
Anxiety is the most common form of psychological distress in childhood and adolescence. Certain fears are more common at certain ages and stages of development.
Its effects how we think, feel and behave.
Girls tend to present with more anxiety disorders than boys
Anxiety is a normal emotion and something we all experience. Fight or flight response to perceived danger. Essential for survival.
Many types of anxiety disorders including; Generalized Anxiety, Separation Anxiety, Social Anxiety, OCD, PTSD.
Anxiety becomes a problem when it prevent individuals from enjoying normal life experiences for a long period of time. This can also lead to depression

4. What is Anxiety?
Anxiety can impact your children in the following ways
Affect: Emotionally and physically
Behaviour: What they do or how they act
Cognitively: How they think/Mentally - Worry
Dependence: relying on parents too much to problem solve or help avoid situations/people
Excess and Extreme: Anxiety is a problem if it is impacting on all areas of your child’s life
Functioning: Day to day functioning/ability to do everyday things

5. What Causes Anxiety? Main causes of Anxiety:
Genetic - genetic vulnerability manifests itself through childs temperament
Environmental - School eg need to do well in order to succeed in life, friends eg needing to fit in/not to be different, family, parenting style eg controlled parenting, observational learning eg seeing anxious parent, exposure to a traumatic event eg death/serious illness of family member
Learning difficulties eg Dyslexia, social communication difficulties, physical illness, other mental health concerns eg ADHD, Aspergers.

6. What To Look Out For
AFFECT: Children are unable to recognise their physical symptoms as anxiety so will rarely complain of feeling anxious per se
Look out for complaints such as
Sore tummy or feeling sick
Headache or feeling dizzy
Chest pain "like something is stuck"
Unable to swallow properly
Feeling hot or cold
Hard to breathe
Heart beating really fast
Panic attacks

7. What to Look out For
BEHAVIOUR: Avoidance is the most common behaviour. Refusing to go places eg school, birthday parties, social situations.
Look out for
Fear of making mistakes/wanting to be perfect
Not wanting to go to birthday parties or friends houses
Not wanting to sleep alone or in own bedroom
School Refusal
Fear of reading out loud/answering out in class
Not wanting to play team sports or extra curricular activities
Angry Outbursts

8. What to look out for
COGNITIONS: These are the worries that go though children’s minds about themselves, other people and the world around them. They can be about a current situation or about the future
Listen out for
I'm not able to do that
What if eg I fail the test, people don’t like me, I look stupid, Mum/Dad gets sick?
Are you sure you wont forget to collect me?
The other kids at school will laugh at me or leave me out

9. What to look for
DEPENDANCE: Anxious children seek reassurance from their parents/caregivers about what may seem the most normal and simple of things. By giving this constant reassurance are you keeping it going?
Are you?....
Answering the same questions over and over again to reassure your child that they are eg safe, wont get sick, wont be forgotten
Going with them to friends parties
Speaking teachers about their academic concerns eg not to ask questions, read out in class

10. What to look out for
EXCESSIVE & EXTREME: Anxious children worry about more things, more often and in more extreme ways than their peers.
Look out for:
Jumping to the worst conclusion (mind reading & fortune telling)
One problem being added to another and another (snowballing)
Inability to concentrate due to excessive worrying
Appearing sad and/or tired much of the time
Isolating themselves

11. What to look out for
FUNCTIONING: Anxious children over time will begin to withdraw from friends, social situations, recreational activities and school. They may struggle academically because they cannot concentrate due to worrying, fear getting things wrong, or because they hav’nt been sleeping properly.
Look out for
Not getting enough sleep, not eating as well as before, being sick more often
School refusal, withdrawal from friends
Getting upset or angry easily
Feeling overwhelmed when having too many tasks to do.
Wanting to spend more time with you.

12. When Anxiety is a Problem
It is important to remember that anxiety is normal at certain developmental stages and children normally grow out of their worries or learn to manage them. However if you notice that your child is becoming more anxious rather than less anxious, not engaging in school, home or with friends like they should be or used to, then their anxiety is not normal and has become a problem.
Anxiety can also happen suddenly eg one day after a bad day at school or football training but it is now causing excessive and extreme thoughts/feeling/affect/behaviour each time your child has to go to school/football training etc..

13. Talking to your child about Anxiety
Ensure you have enough time and that you wont be interrupted eg go for a drive, lunch, walk
1-1 or both parents and child.
Ensure you are feeling relaxed
Describe situation where you noticed your son/daughter seemed to be worrying or sad about something. Perhaps more quieter than usual. Is everything ok?
Talk about similiar situation that you’ve found yourself in and how you worried and how you have learned to manage it. (from childhood or adulthood)
It is important to acknowledge your child’s worries and fears. NEVER pass them off as silly or unimportant eg sure there's no need to worry about that. Whilst they may seem insignificant to an adult they mean the world to your child

14. Talking to your Child about Anxiety
Reassure your child that anxiety is a normal emotion to protect us from harm or danger, but sometimes our brain gets confused and tricks us into worring about and avoiding situations that are perfectly safe.
Reassure your child that you are going to work together as a team to get their brain working properly again and that together you are going to "boss the worry back". This will take some time.
Reassure your child that in time he/she will be managing their worries by themselves and wont need your help (but you'll be on standby just in case!!!)
There is always professional help if needed too!!

15. Treatment of Anxiety using CBT
Research has shown that CBT is one of the most effective treatments in the management of Anxiety Disorders
CBT looks at the relationship between thoughts (cognitions), feelings (affect), behaviours. You learn new ways of thinking and behaving in order to manage your feelings of anxiety better.
Its essentially a set of coping skills
Focuses on here and now
Goal orientated and working collaboratively towards achieving goals
Homework in order to practice now coping skills learned

16. What can parents do?
Take time to explain to your child about anxiety, that you want to help them manage their worries if they would like that help?
If your child is able to access their thoughts then using a "Worry Box" and having "Worry time" is helpful.
If your child is getting very upset by their worries or is acting out then having a "Calm Box" and "Calm Corner/place" is helpful
Mindfulness and Breathing Techniques useful at bedtime and to use as they face their anxiety provoking situations.
Challenging worries "Bossing Anxiety Back"
Praise, Praise, and lots of it......not matter how small the achievement.

17. "Worry Box" and "Worry time"
Make Worry Box together
Place to keep worries safe
Doesnt matter how big or small worry is as all worries are important
Have worry time each day, time limited (10-15mins max), stick to this time ie don’t change last minute as child will be waiting to talk to you.
Problem solve together...small managable steps...
Throw problems solved in bin and keep others in box until child happy that they are dealt with
If child comes to you with worry outside of worry time encourage use of worry box. (Helps with children who want to talk about worries all the time)

18. "Calm Box and Calm Corner/place"
When your child is unable to talk about their worries, or is upset and needs comfort and space then a Calm Box and Calm Corner/place is useful
Put Calm Box together - focusing on each of the five senses - Sight, Touch, Taste, Smell, Hear. Each thing of special meaning to your child.
Have dedicated space to use these
Place to relax
Ask for invitation to join or agree a time to join

19. Mindfulness Meditation and Breathing Techniques
Learning to Relax and being able to do this when feeling anxious takes practice but can be so beneficial.
Research has shown that meditating with children can help them cope with stress and anxiety as well as sleep better, improve imagination, concentration and manage distress.
Being mindful helps us to notice what comes through our senses through an activity. Thoughts and feeling are’nt ignored but rather observed without judgement.
Example Power Shield Meditation Script

20. Breathing Techniques
Ensure you are breathing properly for relaxation purposes
If sitting ensure back is straight in order for air to get to lungs. Shoulders down.
Breathing In....Smelling flowers/coffee/perfume
Breathing Out....blowing up balloon/blowing out candles
Counting slowly 1-5
Belly Breaths - Hand on tummy to ensure out when breathing in and vice versa
Chest Breaths - Anxious breaths and not breathing properly
Riding waves of anxiety

21. Challenging and Bossing Back Anxiety
What does your child’s anxiety look like to them? Does it have a name?
Something visual for them to challenge and boss back
Looking for evidence or is their brain playing tricks?
What small steps can be taken to boss back the anxiety so your child is in charge again? Is there a goal eg something they want to do that they have not been able to manage due to their anxiety. Break this into small achievable steps

22. Self Care for Parents
Parental Self care is essential in order to have the emotional batteries charged to cope with the challeges that each day brings.
Juggling work, school runs, homework, sports, music practice, playdates, housework is no easy task
Looking after yourself helps you manage the difficulties each day (and child) brings more calmly and logically.
Self Care isn’t selfish...its necessary and sensible
20mins each day for yourself…..what will you do in that time?
Eg Meditation/breathing exercise

23. "A Handful of Quiet"
Each image below embodies a particular quality relative to each of us
Imagine you are a:
Flower I feel (what image of a flower means to you) eg beautiful, fresh, open
Still Water....I feel..
Mountain.....I feel...
Space.... I feel....
Draw what each image looks like for you

24. " A Handful of Quiet" Now using Belly Breaths..eyes closed
Breathing IN...I see myself as a flower
Breathing OUT...I see myself as eg Beautiful/Fresh
Breathing IN... I see myself as a mountain
Breating OUT....I see myself as eg strong
Breathing IN.....I see myself as still water
Breathing OUT....Im eg calm
Breathing IN....I see myself as space
Breathing OUT...I feel eg at ease

25. Questions??

26. References
Graham, Philip.J (2005). Cognitive Behaviour Therapy for Children and Families, 2nd edn. Cambridge University Press.
Kluge, Dr Nicola (2014). Mindfulness for Kids I, 7 Children's Meditations & Mindfulness Practices to help kids be more focused, calm and relaxed. The Arts & Education Foundation, Houston, Texas.
Thich Nhat Hanh (2012). A Handful of Quiet, Happiness in Four Pebbles. Plum Blossom Books.