1. “We have nothing to fear but fear itself”
Anxiety and Kids:
“We have nothing to fear
but fear itself”
Touchstone Academy – Live and Learn Series, Oct. 23, 2014
“So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance” …FDR’s first inaugural address
Treating anxiety is like that. Treating this very treatable symptom and group of psychiatric illnesses is like that. Much of the what makes an anxiety problem so disabliing is the fear of the fear…the anxiety about the anxiety. A fire starts to burn and the flames get fanned.
But just like a fire can get put out so can anxiety problems/symptoms get treated
Give own Hx
The reason I like working with this “bread and butter’ of psychiatry is that they are so trreatable/ curable
Edward S. Yuzda, MD, MSc, FRCPC
Dr. Jean Craven, Clinical Psychologist
Dr. JoAnne Burt ,School Psychologist, ASD---S
Ms. Anita Hofmann, Occupational Therapist

2. As a child of the 80’s I can’t resist the simple wisdom of Calvin and Hobbes
I think one of the hardest things for me to remember when I’m talking with my kids about the trials and tribulations is that what seems like little/trivial problems to me are huge problems to them
This cartoon was especially useful to remind me to keep my perspective for my son’s sleep problems
And also reminding me of my own sleep issues when I was a kid which was a great way to normalize his difficulties (but has also become a constant source of amusement to my kids as I am reminded of them…so be careful what you ask for!)

3. Anxiety is the hand-maiden of creativity
TS Elliot
Firstly, when speaking of anxiety, we must remember that anxiety (like all emotions) is crucial for our survival as a species.
As an example, the way I contextualize sleep difficulties, is by looking at our past…Cavebear example
Anxiety drives us/compels us/motivates us…as for this talk
It is truly as the other of ‘The Love Song of J Alfred Pruffrock’ wrote, the hand-maiden of creativity

4. Anxiety - A Very Common Problem
Society’s Most Common (yet Curable) Mental Health Problem
Anxiety - A Very Common Problem
Mental Disorder
1 Year Prevalence (%)
Age = years
Any Anxiety Disorder
16.4
Any Mood Disorder
7.1
Major Depressive Disorder
5.3
Bipolar Disorder
1.1
Schizophrenia
1.3
Any Disorder 21
I would remind you that these figures are based on diagnosed anxiety disorders (in addition to other mental illlnesses)…it doesn’t include simply anxious symptoms that do not fully manifest as a diagnosable condition
So the number of people that anxiety impacts really is staggerring and we begin to get a scope of the magnitude of the problem
Despite how common these conditions are, they are often woefully mismanaged in clinical situations

5. EPIDEMIOLOGY – all anxiety disorders
WHO study
Annual prevalence – 17.7 %
Lifetime prevalence
Women – 30.5%
Men – 19.2%

6. Most Common Mental Health Issue in Children and adolescents
Overall Prevalance - 10%
Separation Anxiety Disorder – %
Selective Mutism – 0.7%
Obsessive Compulsive Disorder – 1.2%
Social Anxiety Disorder – 7%
Specific Phobia – 10%
Panic Disorder – 2-3%
Agoraphobia – 3-4%
Post Traumatic Stress Disorder – 2-3%
About 40% of adults with Panic Disorder indicated that their symptoms began in their childhood

7. “The child is the father of the Man”
William Wordsworth ( )

8. Tell me about youR childhood
Childhood experiences heavily influence us
Attitudes, rules beliefs and assumptions, maladaptive or not, govern our behavior as adults
‘And once a boy has suffered rejection, he will find rejection, even where it does not exist…or worse, will draw it forth from people simply by expecting it’
East of Eden…John Steinbeck

9. Normal Anxiety Anxiety is essential to life
A desire to reduce anxiety keeps us fed, keeps us procreating, keeps us sitting through a dead boring lecture
It compels us to carry out certain acts that forestall or prevent danger

10. PATHOLOGICAL ANXIETY Too much of a good thing Uncontrollable
Chronic & Persistent
Exaggerated
Impairs functioning (at home, in relationships)
i.e. obsessionality

11. Typical Anxiety Profile
Time

12. Prepared to Fight or Flee for Safety & Protection
What is signaling?
Brain Registers
DANGER!
DANGER!
Prepared to Fight or Flee for Safety & Protection
Initiation
of Physiologic Cascade
 Heart Rate
 Tension
 Alertness
 Perception
Sensory Perception
(Ears, Eyes, Nose, Touch, Taste)
Signaling:
Our hard-wired danger response mechanism. Every organism on the planet from an ant to a human being has a Signaling Mechanism. Without it we and all other creatures on the planet would die!
Our signaling mechanism is what allows us to jump out of the way of oncoming traffic; sharpen our senses to the slightest change in our environment when we are afraid; gets us ready to run to escape from danger or prepares us to fight to protect ourselves. It also helps us focus when we have to study to pass an exam or drive a vehicle safely during a bad storm.
When the brain senses danger from signals received from the environment through our 5 senses it reacts before we have time to THINK about it… this is an automatic ‘reflex’!... If the brain waited for us to think before we acted in danger situations we would most likely never live to know about it!!
As soon as the brain senses danger it turns an our ‘adrenaline tap’... This activates a whole cascade of reactions that results in our bodies being prepared to react and protect itself.
The Signaling Physiologic cascade is hardwired for survival
Result of the Physiologic cascade:
Increased heart rate
Sweating
Tension
Increased delivery of blood to the muscles
Sharpened sight and hearing
Inhibition of digestion
Extreme alertness
Internal Signals
(Thoughts, Emotions, Physical)

13. Signaling = “fight or flight”
This danger signaling mechanism is also called the ‘Fight or Flight’ response, and is initiated by the brain when it perceives danger from any of the five senses.
The brain then initiates a ‘physiological cascade’ in response to the perceived danger. This results in in a state of readiness characterized by ‘autonomic hyperarousal’.
This process:
Shunts blood from body organs that don’t need blood in times of stress (like the digestive tract) to our muscles, lungs, and heart
Sharpens our five senses
Super-focuses our attention away from unnecessary environmental noise to important safety and danger cues, and
Allows us to take immediate action to protect ourselves.

14. of Physiologic Cascade
What is anxiety?
No Danger
Brain Registers
DANGER!
Anxiety
Initiation
of Physiologic Cascade
 Heart Rate
 Tension
 Alertness
 Perception
Sensory Perception
(Ears, Eyes, Nose, Touch, Taste)
Dysfunction of the danger signaling mechanism can lead to triggering of the ‘physiologic cascade’ in the absence of real danger:
This is called ‘Anxiety’
Internal Signals
(Thoughts, Emotions, Physical)

15. Everyone experiences anxiety from time to time.
Normal anxiety is an expected response to stressful or dangerous situation.
But anxiety which is abnormal occurs in the absence of danger and is excessive or inappropriate to the situation.

16. Misperceiving Dangers!

17. The Rogues Gallery of Anxiety
Panic Disorder
Agoraphobia
Post-Traumatic Stress Disorder
Separation Anxiety Disorder
Generalized Anxiety Disorder (adult)
Social Anxiety Disorder
Specific Phobias
Selective Mutism

18. The Rogues Gallery of Obsessive-compulsive and related disorders
Obsessive Compulsive Disorder
Body Dysmorphic Disorder
Hoarding Disorder
Trichotillomania
Excoriation Disorder

19. The Rogues Gallery of Trauma- and Stressor-related disorders
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Post-Traumatic Stress Disorder
Acute Stress Disorder
Adjustment Disorder

20. Ooooh… the days of ones care-free youth

21. Avoidance Anxiety AVOIDANCE – The Yang to Anxiety’s Ying
Avoidance is the KEY functional symptom found in all Anxiety Disorders
Avoidance behaviours INCREASE anxiety
Not allowing Avoidance behaviours DECREASES anxiety
All successful therapeutic interventions in Anxiety Disorders MUST address Avoidance behaviours
Avoidance
Anxiety

22. Typical Anxiety Profile
Time

23. Anxiety’s Imposter -Somatization
Most people with psychological problems go to their family doctor with a physical complaint rather than recognizing that they have a form of mental distress.
Physical symptoms
Psychiatric symptoms

24. Sorrow that has no vent in tears may make other organs weep
Somatization
Sorrow that has no vent in tears may make other organs weep
Henry Maudsley ( )

25. General Management
Whether mild, moderate or severe, parents/family must play a role in helping your child
there are general strategies that can help any child who is experiencing anxiety problems
Although there are different types of anxiety problems and specific strategies aimed at helping children cope with different types of fears,

26. General Management Listen - listen to your child's thoughts
and feelings
Normalize - let your child know he/she
is not alone
Educate - anxiety is normal, harmless,
and temporary
Model it - Model facing fears and
encouragement
Praise - Don't forget to praise your child for
his or her efforts
Helpful Hints:
Listen! Make sure you take the time to listen to your child's thoughts and feelings. Simply feeling heard can be very helpful to your child.
Normalize! It is important to let your child know that he or she is not alone. Lots of children have problems with anxiety.
Educate! Let your child know that anxiety is normal, harmless, and temporary.
Model it! Model facing fears and provide support and encouragement. Motivate your child through supportive coaching. However, be careful not to push your child too far too fast. Let your child work at his or her own pace.
Avoid Giving Excessive Reassurance! Resist giving excessive reassurance, instead encourage your child to use his or her coping strategies (for example, calm breathing or challenging scary thoughts)
Praise! Don't forget to praise your child for his or her efforts! Remember, facing your fears is not easy!

27. Strategies at Home Reduce Stress Make a Routine Work Together
Give Consequences
Be Supportive
Encourage Independence
Avoid Giving Excessive Reassurance
Build Self-Confidence
Realistic Expectations
Dealing with Your Reactions
Take Risks
Avoid Avoidance
Reduce Stress! Excessive stress and tension in your home
Make a Routine! Establish a routine by setting specific times for meals, homework, quiet time, and bedtime
Work Together! It is important that you and your partner work together to help your child manage his or her anxiety.Consistency
Give Consequences! Although your child may have problems with anxiety, that does not give him or her the green light for inappropriate behavior
Be Supportive! Recognize that it is difficult for children to face their fears. It is important not to laugh at your child or minimize his or her fears
Encourage Independence! Although it is tempting to want to do things for your child, especially when he or she tends to be nervous and fearful, it is better to let kids do things for themselves
Avoid Giving Excessive Reassurance! It can be hard not to give your child reassurance, especially when he or she is scared or anxious; however, giving constant reassurance prevents your child from learning how to cope on his or her own
Build Self-Confidence! It is important to praise your child for his or her accomplishments and for facing fears
Realistic Expectations! It is important to have expectations for your child and help him or her meet those expectations; however, understand that an anxious child will have some trouble doing things, and may need to go at a slower pace.
Reactions! Although it is important to be understanding and caring, do not overreact or let anxiety trick you into thinking that something is too hard or impossible for your child
Dealing with Your Reactions! It can be very difficult dealing with an anxious child. Make sure you manage your own reactions
Take Risks! Anxious children need to try new things and take some risks, in order to build confidence and develop the necessary skills for dealing with the world
Avoid Avoidance! Anxious children tend to want to avoid things that cause them anxiety.

28. Healthy Habits for the Home
Anxious children and teens prefer to have a sense of control in their lives
They feel calmer when:
life is predictable
they know what is expected of them
they know what the consequences will be
Therefore set limits, create routines, encourage
physical activity and good nutrition

29. Cognitive Behavioral Therapy
Skill-based psychotherapy, teaching specific techniques
Targets maladaptive thoughts and behaviors
Psychoeducation about anxiety/anxiety is normal and adaptive
Learning to relax via Progressive Muscle Relaxation,
Mindfulness or Calm Breathing
Challenging anxiety inducing thoughts
Exposure Therapy - facing fears

30. Very Useful Websites
AnxietyBC.com
Teenmentalhealth.org

31. Rx?

33. Thanks!