Childhood Anxiety

• Dr John Callary– Child & Adolescent Psychiatrist– Father of 4

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Case vignettes

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Books: The Panic Book & The Secret Problem

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Books: Living with Fear & The Hidden Gifts of The Introverted Child

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Childhood Anxiety

• Phenomena – healthy vs unhealthy• Developmental and systemic considerations• Sensitization & Desensitization• Childhood Anxiety Disorders - prev 8-10%• Management

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Anxiety

• Perceived threat > Perceived capacity to cope

• Fight or Flight response

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Normal age-related fears

Everyone has worries and fears. They are part of living. Children of all ages have fears and their typical fears differ at different ages:

Infants and toddlers -loud noises, separation, strangers

Preschoolers -animals, especially dogs, the dark, ghosts and monsters

School age -snakes and spiders, fear of failure and rejection, the news and TV shows,blood, injury, and sickness, being home alone, robbers, death, parent’s well-being

Most children will grow out of these fears.

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So why are some children more anxious? Why does their anxiety persist/worsen?

Genetic factors - Anxiety seems to run in familiesParents remark their child is like they were at that age... Anxious children are often temperamentally intense and sensitive children.

Modelling - Anxious parents can unknowingly model anxious behaviourscommunicates to children that there is something to be scared about.

Parental reaction to the child’s anxiety - to reassureSometimes reassuring children can accidentally reinforce anxious behavioursChildren may gain a lot of attention or may escape from a feared event by

continuing to be anxious.

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So when is anxiety a problem?

• Degree of distress

• Disruption to participating in everyday activities and routines

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Anxiety-Response

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Imagined Anxiety

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Avoidance - Sensitization

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Face the Fear – Graded Desensitization

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Dynamic and Diagnostic Formulation

• Why this child in this way @ this point in time?

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Bio Psycho Social Cultural

Predisposing

Precipitating

Perpetuating

Protective

Systemic Aspects

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Family

School – peers, teachers, studies

Community

Family of 6 = 15 relationships!

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What does an Anxiety Disorder look like?

• Unrealistic /excessive worries• Physiological• Constitutional• Avoidance (Social)• Behavioural

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Anxiety Disorders - DSM

Separation Anxiety Over-anxiety Disorder of Childhood Social Phobia Selective Mutism Obsessive Compulsive Disorder Panic Disorder +/- Agoraphobia

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Comorbidity

Attachment Disorder Learning difficulties Depression ADHD Intellectual Disability Asperger’s Syndrome

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Management

• Psycho-education

• Intervention vs No intervention

• Address co-morbidities & systemic

• Parental anxiety

• CBT, Relaxation therapy, Hypnotherapy, Social skills, Other therapies or activities

• Medication

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What can parents/carers do to help?1. Find out what the problem is. Listening to how they feel in a

sympathetic but calm way.

2. Teach them calming techniques, such as slowing their breathing, and relaxation techniques.

3. Encourage your child to generate suggestions on how they can cope with the anxiety; what your child can do to make themselves feel better. It is an important step for them to try to reduce their anxiety.

4. Summarise the options your child has in the situation. They can continue to feel upset and anxious and behave in an anxious manner or they can choose to do something that reduces their anxiety and lets them feel better. (e.g. relaxation techniques, realistic thinking)

....

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What can parents/carers do to help?

5. Go through the options with your child and ask, “What would happen if you did this?” Don’t allow them to use avoidance as a solution.

6. Resist the temptation to use excessive reassurance (e.g “its fine I am here, I will deal with it”). Some children then only feel safe if they are with their parents.

7. If you are an anxious parent it is important to not project/transfer your own feelings/fears to your child – (e.g. how scary/dangerous is that spider?)

8. Encourage your child to use realistic thinking. Ask your child “challenge” questions whenever your child expresses worries or fears by reminding them to examine the evidence… “What is it that you are worried about? Has that ever happened before? Are there any other ways of looking at it?”

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Cognitive Behavioural Therapy• Very effective for anxiety and depression

• Hierarchy of tasks

• Graded desensitization

• Habituation and reinforcement

• “think positive” “act positive” “feel positive”

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Medication

• Symptomatic relief

• Never the whole answer

• Shallow evidence for efficacy; side effects

• SSRI

• Start low and go slow

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