PARENTING A CHILD WITH

ANXIETY

Dr Emily O’Leary, PhD

Director Anxiety House

ANXIETY HOUSEHawthorne Medical Centre7/171 Riding Rd HawthorneQueensland 4171 Australia

Phone (07) 3399 9480Fax (07) 3009 0338

Postal: PO Box 297, Morningside QLD 4170

www.anxietyhouse.com.au

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OVERVIEW

3 Main objectives:

a. What does anxiety look like in children?

b. What can parents do?

c. Focus on practical tips

Important :

• “Parenting practices do not cause anxiety”

• “Focus on addressing the maintenance of anxiety”

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WHY TALK ABOUT ANXIETY?

Anxiety disorders affect one in eight children.

Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.

Overall, about half of people with anxiety disorders experience their first symptoms by the age of 11 years

75% of those do not get help

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WHAT IS ANXIETY?

All of us experience anxiety at some time

Anxiety can arise from real or imagined circumstances

Triggers can be external and/or internal

Normal developmental pattern that is exhibited differently as children grow older

One common definition is apprehension or excessive fear about real or imagined circumstances

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SIGNS OF ANXIETY

COGNITIVE BEHAVIORAL PHYSICAL

Concentration difficulties Shyness Trembling/shaking

Catastrophizing events Withdrawal Increased heart rate

Worrying Frequent questions Shortness of breath

Perfectionism Frequent need for reassurance Dizziness

Memory problems Need for sameness Flushing of skin

Overreactions Excessive talking Stomach-aches or nausea

Hyper vigilant Restlessness Muscle tension

Lack of confidence Habit behaviors (biting nails, twirling hair) Sleep problems

Impulsiveness

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HOW IS ANXIETY MAINTAINED?

EXCESSIVE REASSURANCE

AVOIDANT BEHAVIOR

SELF-TALK OR “AUTOMATIC THOUGHTS”

WHAT CAN PARENTS DO?

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• Main area you can work on is tackling the maintenance of anxiety and future episodes.

• Divided the next sections into several key areas parents can focus on:

LOTS OF THINGS!!!

Modellin

g

Resu

rgence

Avoid

ance

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MODELLING

• Children watch parents to see how to behave in situations – use “approach behaviors not avoidance behaviors”

• They will mirror their parents’ estimations of risk - “are you being too cautious?”

• Also tend to mirror their parents’ anxious behaviors- fidgeting, reassurance-seeking, & ‘safety’ behaviors – be mindful of the non-verbals

• Balance risk assessment with facts not just feelings - emotional reasoning

• Where is the evidence that this will go badly?

• Am I focusing on possibility instead of probability?

• Are you being a thought detective?

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REASSURANCE “GOOD PARENT SYNDROME”

When your child is feeling anxious, he or she will probably turn to you for help in feeling better. One of the ways in which your child might do this is through reassurance seeking, which involves asking you lots of questions, or asking the same question over and over in order to hear from you that things will be okay.

SUBTLE DANCE BETWEEN RESPONDING TO THEIR EMOTIONAL NEEDS AND FEEDING THE ANXIETY

WHAT IS EXCESSIVE REASSURANCE SEEKING?

SOME EXAMPLES OF REASSURANCE SEEKING:

“ARE YOU SURE YOU LOCKED ALL THE DOORS?”

“TELL ME AGAIN THAT I’M A GOOD GIRL!”

“DID YOU WASH YOUR HANDS BEFORE YOU COOKED DINNER? ARE YOU REALLY SURE?”

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REASSURANCE “GOOD PARENT SYNDROME” (cont’d)

• Calling mom or dad over and over again on the phone from school to make sure they are okay.

• Asking parents to check homework repeatedly to make sure there are absolutely no mistakes.

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WHY IS REASSURANCE IN THIS CONTEXT NOT OUR FRIEND?

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02

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Bottomless pit

Band-Aid

Keeps your child’s anxiety alive

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AVOIDANCE COPINGAVOIDANCE BEHAVIORS, ARE THINGS THAT PEOPLE DO, OR DON'T DO, TO REDUCE ANXIETY IN

CERTAIN SITUATIONS. AVOIDANCE BEHAVIORS CAN TAKE THREE DIFFERENT FORMS

Avoidance behaviors involve the complete avoidance of the feared situation. For example, someone afraid of public speaking might drop a class in which he has to give a speech, change jobs to avoid giving presentations.

AVOIDANCE

When total avoidance is impossible, escape behaviors may be used. Escape involves leaving from a feared situation. Some examples of escape include leaving a gathering early, walking out in the middle of a speech.

ESCAPE

When neither avoidance nor escape are possible, safety behaviors may be used to reduce feelings of anxiety. Safety behaviors might include such things as avoiding eye contact, crossing your arms to hide shaking, daydreaming, or sitting in the back of a classroom.

SAFETY BEHAVIOURS

• Problem with avoidance is that it never gives the child (and the brain) the opportunity to LEARN that the feared event did not happen and they can COPE - means new neural pathways are not created and old ones NOT extinguished.

HOW DO WE FIGHT IT?

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THINGS TO START AT HOME

EXPLAIN WHAT ANXIETY IS

BEING A THOUGHT DETECTIVE

STEP PLANS

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TEACH YOUR CHILD THAT WORRY IS PERFECTLY NORMAL.

WORRY IS A PROTECTIVE MECHANISM.

WORRY RINGS AN ALARM IN OUR SYSTEM AND HELPS US SURVIVE DANGER.

EDUCATION

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FOUR IMPORTANT POINTS TO COMMUNICATE TO YOUR CHILD

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01

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Anxiety is normal. Everyone experiences anxiety at times. For example, it is normal to feel anxious when on a rollercoaster, or before a test.

Anxiety is not dangerous. Though anxiety may feel uncomfortable, it doesn’t last long, is temporary, and will eventually decrease! Also, most people cannot tell when you are anxious (except those close to you such as your parents).Anxiety is adaptive. Anxiety helps us

prepare for real danger (such as a bear confronting us in the woods) or for performing at our best (for example, it helps us get ready for a big game or speech). When we experience anxiety, it triggers our “fight-flight-freeze” response and prepares our bodies to defend themselves. Without anxiety, humans would not have survived as a species!

Anxiety can become a problem when our body reacts as if in danger in the absence of real danger. A good analogy is that it’s like the body’s smoke alarm.

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“An alarm can help protect us when there is an actual fire, but sometimes a smoke alarm is too sensitive and goes off when there isn’t really a fire (e.g. burning toast in toaster). Like a smoke alarm, anxiety is helpful when it works right. But when it goes off when there is no real danger, then we may want to fix it.”

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Once your child is calm, it’s time to figure out possible solutions.

Be a Thought Detective

EVALUATE

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the best remedy for distorted thinking is not “positive thinking”, it's ACCURATE THINKING.

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THOUGHT DETECTIVE

• Based on Cognitive therapy principles

• Event “I am waiting to be picked up from school, mom is late”

• Thought : She could be dead

• Evidence: its been only 10 minutes, (?) traffic, she was late twice before (never died), other kids are still there (not all parents could be dead)

• Reorganized Realistic thought: She is running late, and will arrive soon

* Boss back cards

Is there another way of looking at this?

What would my sister think if this happened to her?

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HELP YOUR CHILD BE A THOUGHT DETECTIVE BY GIVING “PARENTAL BOSS

BACKS”• Is that you or your worry? I am going to support you, not the anxiety

• What if you didn’t do your homework perfectly -- what would happen?

• Maybe you did make a mistake on your exam; what could you do to cope with that?

• It sounds like your anxiety is acting up. What could you do to boss it back? Could you maybe do some relaxed breathing? Are there any helpful thoughts that you can tell yourself?

• What do you think? How could you handle that?

• I guess you’ll just have to wait and find out.”

• When that happened last time, what did you do?

• What dO you think mother, father, sister, friend would do?

• What do you think action hero would do in this situation?

STEP PLANS

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EVALUATEIt is normal for children and teens to want to avoid the things they fear. However, avoidance prevents them from learning that feared situations or places are not dangerous. The process of facing fears is called EXPOSURE. Exposure involves having your child repeatedly go into feared situations until he or she feels less anxious.

Exposure is not dangerous and will not make the fear worse. After awhile, the anxiety will naturally lessen. Starting with situations that are less scary, children and teens work their way up to facing things that cause them a great deal of anxiety. Over time, they build up confidence in those situations and may come to enjoy them. This process often happens naturally.

A child or teen who is afraid of the water takes swimming lessons every week and practices putting feet and legs in the water, then the whole body and, finally, diving underwater. Children and teens with a fear of water can learn to love swimming. The same process occurs when children and teens learn to ride a bike, skate, or drive a car.

Exposure is one of the most effective ways of overcoming fears. However, it takes some planning, encouragement, modelling and rewards.

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DOG FEARSGOAL: TO BE ABLE TO BE NEAR DOGS WITHOUT EXCESSIVE

FEARS

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DOG FEARS (cont’d)

RATING

12. Petting a larger dog off leash 10

11. Petting a larger dog off leash 10

10. Holding a puppy 9

9. Petting a puppy that someone is holding 88. Standing beside, but not touching, a dog on a leash 77. Standing 4 feet away from a dog on a leash 6

6. Standing 8 feet away from a dog on a leash 5

5. Standing 8 feet away from a dog on a leash 5

4 Looking at a dog across a park through binoculars 3

3. Looking at a dog through a window 3

2. Watching a film with dogs in it 2

1. Looking at photos of dogs 2

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NEEDLE FEARS GOAL: TO TOLERATE GETTING AN INJECTION (IN THIS CASE, THE

GOAL IS NOT TO FEEL COMPLETELY COMFORTABLE GETTING NEEDLES - AS MOST PEOPLE AREN’T -- BUT TO BE ABLE TO

TOLERATE THEM)

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NEEDLE FEARS (cont’d)

RATING

11. Having blood drawn from a vein 1010. Getting a shot in the upper arm or fleshy part of leg 99. Slightly pricking one’s skin with a needle 8

8. Watching someone else get a needle 7

7. Resting needle against vein 7

6. Resting the needle against one’s skin 6

5. Rubbing an alcohol swab against one’s skin 5

4. Holding a needle 4

3. Watching an apple being injected 3

2. Watching video clips of someone getting a needle

GIVE A PRESENTATIO

N

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PUBLIC SPEAKING

PR

AC

TIC

E M

Y S

PEEC

H

In my living room where my mom can hear me

In front of my family

With a friend over the phone

With a friend over a video call

In front of my friend at home

With a friend at the local coffee shop

By myself in the lecture hall

In front of a friend in the lecture hall

In front of group of friends

In front of the teacher

Give the presentation

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ONE LAST THING!

ENGAGING THE RELUCTANT CHILD: MOTIVATING

• Appeal to your child’s pride. E.g. Worriers tend to be bright and imaginative. This has lead to an ability to see the most unexpected dangers. Need to turn this into a talent for taming/trapping the worries.

• Make a list with your child about the ways anxiety is interfering with her life. Anxiety causes fear, sadness, crying and fighting. It stops her from participating in school, parties, sleepovers, sports etc.

• Then make a positive list of the feelings and things she can do when she is the boss of anxiety.

• Be Playful.

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THE MASTERPLAN

Empathize what your child is feeling but avoid the reassurance trap

Label the problems (anxieties) as the worry brain or nickname

Get body on board: deactivate alarms

Refocus: on what we need to do: Step Plans

Reinforce your child’s efforts at fighting

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REFERENCES - BOOKSTORE

Freeing Your Child From Anxiety by Tamar E Chansky Ph.D.

Helping Your Anxious Child (A step by step guide for parents) Rapee et.al

Your Anxious Child : John S Dacey

Handbook of Clinical Family Therapy