Transcript Supporting Parents of Anxious Children: Primary School Years Dr

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
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?
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 selfassure
 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