anxiety
disorders in
children
Some troubling statistics
– At least 20% of children under age 18 have significant
mental health problems
– 75% of those don’t get help
ANXIETY IN CHILDREN
Jesse
– Is 8 years old. He has a great family, lives in the country, and likes to
play outside.
– Jesse has a learning disability and has a hard time in school
– Around age 7 ½ he started to worry a lot:
– Will there be enough time to play?
– Will there be enough time to do my homework?
– I won’t be able to do this homework.
– I don’t want mom to go out at night.
– He also started to complain of headaches and stomachaches quite a
lot.
– Parents say he is so anxious he doesn’t enjoy much.
Taylor
– Taylor is 7. She does well at school and has friends there.
– At home she has started to be afraid to eat – she fears the
food will make her sick
– She especially refuses to eat anything her older brother has
touched because “he’s gross”
– She is afraid to go to sleep because she might get sick
– Bedtime takes a very long time
– She has frequent meltdowns when things “don’t go right”
– She seems very tired and unhappy much of the time
– She is not gaining weight as she should
Cecelia
– Cecelia is 9. She has developed a fear of germs
– She won’t use the washroom at school or at the mall
– She doesn’t want her parents to have visitors or to let
friends drive in their car (because they bring in germs).
– She has to wash her hands for a long time and frequently
– She insists that her family wash their hands whenever
anyone comes in from outside and has a meltdown if they
don’t
– After visitors leave she sprays disinfectant on the furniture
Anxiety Disorders
– Anxiety disorders are the most common mental health
disorders
– Many anxiety disorders start in childhood and if untreated,
they may persist into adulthood
– Children may have more than one kind of anxiety disorder
– Up to 6% of children and youth have an anxiety disorder severe
enough to need treatment
Why do children get anxiety
disorders?
– Often there is a family (genetic) tendency to anxiety
– Children who live with too much stress can become anxious
– Stress can be in family, school or neighborhood
– Anxious parents can model anxious behaviour for children
Kinds of Childhood Anxiety
Disorders
– Separation anxiety
– Social phobia
– Generalized anxiety disorder
– Selective mutism
– Obsessive Compulsive Disorder
– Panic Disorder
– Phobias
– Post Traumatic Stress Disorder
Separation Anxiety Disorder
Separation Anxiety Disorder
– Child is afraid of leaving their parent(s)
– They may worry that something bad will happen to the parent or to
someone they love or to themselves
– May refuse to go to school
– May have stomachaches, headaches, or throw up if they fear
separation
– May refuse to go to playdates at other people’s houses
– Diagnosed if it causes problems at school or socially and has been
going on at least 4 weeks
Generalized Anxiety
Disorder
Generalized Anxiety
Disorder
– Children with this kind of anxiety may:
– Have lots of worries and fears
– Have problems sleeping because of worries
– Have trouble concentrating
– Get tired easily or have tension headaches
– Be tense or restless
– Be perfectionist
– Have an anxious desire for approval
Obsessive-Compulsive
Disorder
Obsessive-Compulsive
Disorder
– OCD often begins in early childhood or adolescence.
Children with this kind of anxiety may:
– Have frequent uncontrollable thoughts (obsessions)
– Usually they don’t like these thoughts, or they may think
they don’t make sense
– Perform certain behaviours or rituals to try and prevent
something bad from happening (or to get rid of thoughts)
– Examples are: handwashing a lot if there is a fear of germs;
checking that doors are locked; special touching rituals
Panic Disorder
Panic Disorder
– Happens less often with younger children
– People with this kind of anxiety have panic attacks
– Feel very scared
– Heart pounding, hard to breathe
– May feel shaky, dizzy, or sick
– May feel like they are going crazy or something really awful is
going to happen
– Sometimes they avoid school or want to stay in the house
– Frequent panic attacks = panic disorder
Selective Mutism
Selective Mutism
– Children may not talk to anyone who is not close to them,
such as immediate family
– They may look down, withdraw, turn red if required to talk
– Often they whisper if they do speak in a situation where
they are anxious
– Up to 2% of school age children may have these symptoms
– Some kids outgrow it; some go on to have social phobia
Social Anxiety/Social
Phobias
Social Anxiety/Social Phobia
– Happens more in teens than in young children
– Fear and worry about social situations
– Going to school
– Speaking in class
– Social events including recess and lunch
– Shy, self-conscious
– Easily embarrassed
– These kids tend to be sensitive to criticism and find it hard to
be assertive
Post Traumatic Stress
Disorder
Post Traumatic Stress
Disorder
– Symptoms start after a physical or emotional trauma or very
frightening event
– Can be marked by several of
– Behavioural changes
– Repetitive play
– Zoning out, numbing of feelings
– Jumpiness and watchfulness of surroundings
– Nightmares and sleep problems
– “Flashbacks”
Not very common in young children
Anxiety Disorders – What to
Watch For
Anxiety disorders - What to
watch for:
– Avoidance of school (refuses to go)
– Frequent stomachaches or headaches in the morning
before school
– Avoidance of activities
– Easily upset – distress out of proportion
– You spend a lot of time comforting your child and/or urging
her/him to participate in regular activities
– You feel that your family functioning is being disrupted by
your child's fears and worries, or meltdowns
What you can do:
– Be patient, calm and reassuring
– Be positive about their ability to manage the situation (with
support)
– Help your child succeed by doing “small steps”
– Reward and praise your child’s efforts as well as successes
– Be a model for your child – manage your own anxieties
– Help your child “avoid avoidance” with planned gradual
exposure to things they fear
– Teach your child positive self-talk
What you can do:
– Teach your child basic relaxation strategies such as belly breathing
and muscle relaxation
– Teach your child to visualize or imagine a pleasant, relaxing “happy
place”
– Keep stress low at home. Avoid parental conflict when the children
are present. Be calm and positive as much as possible.
– Deal with external situations that require adult intervention, such as
bullying
– Healthy living: enough sleep, regular routines, balanced diet, exercise
– Take time to have fun and relax with your child
Don’t:
– Criticize or yell at your child
– Tease or make fun of your child for anxiety
– Ignore the problem or wait for the child to get over it
– Tell the child to “toughen up”
– Pressure your child to do more than s/he can do
– Have unrealistic expectations
– Make it easy for your child to avoid anything that scares
them
Treatment of anxiety
– If your child is having significant problems with school, missing a lot of
school, or having other problems functioning, you should talk to your
doctor
– Anxiety disorders can be treated!
– The most common treatment is cognitive behaviour therapy (CBT) in
groups or individually
– In CBT children learn relaxation and stress management plus
– Gradual exposure to things that make them anxious, to decrease the fear
– Coping strategies to reduce anxiety
CBT is first choice, but medication may be needed in severe
situations
DEPRESSION IN
CHILDREN
Tyler
– Tyler is a 9 year old boy who lives with his mom and sees his
dad every second weekend
– His parents have been in a bitter custody battle
– He has trouble getting to sleep and is always tired in the
morning
– He still plays with his friends, but doesn’t seem to enjoy
himself as much as he used to; he wants to quit hockey
– He is angry and cranky with mom much of the time and he has
meltdowns over small things
– Sometimes he falls asleep in school; he can’t concentrate and
his marks have gone down
Emily
– Emily is 8 and lives with mom, dad and 2 brothers
– Recently she has started to complain of stomachaches often in
the morning
– She sometimes says “I’m stupid” or “I’m ugly”
– She cries at night and sometimes says “I wish I wasn’t here”
– She plays with her dolls by herself and doesn’t want to go
outside after school
– When frustrated she will sometimes hit herself on the head
– She says other kids are mean to her
Depression
Depression
– Depression is common: in Canada and US about 1 in 5 children will go
through a depression before finishing high school
– 4 – 8 of 100 children have a major depression at any point in time
– Symptoms include:
– Feeling sad, irritable or angry
– Not enjoying life, school or activities as much
– Trouble coping with home, school or work
– Feeling hopeless or worthless
– Problems with sleep, appetite, energy and concentration
What causes depression?
– Family history (genetics)
– Stress, including:
– Conflict between parents, or with parents or siblings
– Depression or too much stress in parents
– Separation or divorce of parents
– Conflicts with friends or classmates,
– Social stress
– School stress – not doing well, or too much pressure
– Bullying
– Loss of someone important
What to do
What should you do if you think
your child is depressed?
– Take your child to your family doctor or pediatrician
– The doctor can check for medical problems that could be
causing the changes in behaviour
– She/he may suggest mental health services (psychologist,
counselor, social worker, psychiatrist)
– IF YOU ARE WORRIED YOUR CHILD MAY HURT
HIMSELF/HERSELF, TAKE IMMEDIATE ACTION
– Call your doctor, the crisis line or the emergency department
Can depression be treated?
– YES
– Young children are most often treated with their family.
– Working with parents to help them help their child
– Family therapy if family problems are part of the problem
– Therapy: by a counselor, psychologist or psychiatrist
– Cognitive Behavioural Therapy is proved to be very effective
– The child learns ways to manage stress, do things that help her feel better,
and think more positively
– Medication
– Only used when other treatments don’t work, or when the depression is so
severe that other treatments aren’t possible
– Antidepressants are safe and effective when used correctly and monitored
by a doctor
Remember the basics!!
– Get enough sleep
– Eat healthy meals and snacks
– Take vitamin D supplements and consider omega 3 fatty
acids
– Get exercise – an hour a day if possible.
– Get enough sunlight (in winter, vitamin D supplements)
– Plan enjoyable activities and one on one time with your
child
– Parents need to take care of themselves too!
What can Parents Do?
What else can parents do?
– Listen actively to your child. Let them know you notice something is
wrong.
– Don’t overly pressure the child to talk, but make sure that you do talk
– Help the child problem-solve ways to deal with stresses
– Step in as the parent when stresses are beyond the child’s ability to
handle
– Speak to the school if there is school stress or if the depression is
affecting how your child does at school
– Maintain an atmosphere of calm and consistency at home
– Protect time for fun activities together
DON’T
Don’t
– Blame or criticize your child for symptoms of depression
– Tell your child to “just get over it” or “just snap out of it”
– Get into power struggles. Help your child have a sense of
control by giving choices whenever possible.
– Remove all expectations and let the child miss a lot of
school, not get up in the morning, play video games for
hours
– Make home stressful by fighting, yelling, criticizing, etc.
– Dismiss or belittle the child’s problems
Putting it all together:
Red Flags To Watch For:
Red Flags to Watch For
– Feeling sad or depressed for more than 2 weeks
– Increase in irritability and anger
– Drastic changes in behaviour or personality
– Expressions of wanting to die or plans to harm him/herself
– Severe mood swings affecting ability to function
– Intense worries or fears that interfere with daily activities
– Sudden overwhelming fear for no reason, often with difficulty
breathing and racing or pounding heart
– Decline in school performance
– Wanting to avoid school
What to do if you are
worried
– Talk (and listen) to your child
– Keep a calm and positive attitude
– Problem-solve with your child
– Look for resources on-line or in books
– Teach your child positive self-talk and self-encouragement
– Teach your child deep breathing and relaxation skills
– Identify what is stressing your child and address it
– Intervene on child’s behalf when appropriate
– Call your doctor. Consider calling the school counselor.
– Be aware of resources in your area
And what not to do:
– Ignore the problem
– Expect your child to “just snap out of it”
– Blame your child for the problem. These are medical
problems and cause changes in the brain.
– Keep it a secret. Anxiety and depression are very common
problems. Everyone gets hurt when they stay in the
shadows.
– Let your own anxiety or depression weigh down your child
If your child is being treated
by a professional
– Take a matter-of-fact approach, as you would if they had a
broken leg
– Ask what resources you should read or look at
– Ask what you can do to help
– Communicate with the professional
– Remember you and your child are the most important
members of the treatment team!
Prevention – There’s lots you
can do
– Make the home environment as calm and consistent as possible
– Establish a regular routine: mealtimes, playtime, homework time etc.
– Eat meals together as a family. Avoid negative talk at meals.
– Enough sleep
– Balanced meals and not too much junk food
– Have frequent one-on-one time with your child
– Make fun and enjoyable activities frequent and regular
– Limit video game, computer and TV time
– 7-9 year olds are too young for cell phones and Facebook
Relationships Matter
Relationship Matters
Because Relationships
Protect
– GO PLACES with your child:
– Give many more positive comments than negative ones.
– One on one time: have fun, laugh, do something you both enjoy, play
cards – make it a positive zone.
– Positive active responses whenever possible
– Listen more than you speak, validate the primary emotion
– Assert yourself calmly
– Connection before correction
– Emotional banking: everything you do counts
– Stick to your values but consider all points of view
Resources
– www.ementalhealth.ca
– Provides information about anxiety and recommendations for books and
videos, and details about where to look for help
– www.anxietybc.com
– Good information about self-help which parents can adapt for kids
– www.caringforkids.cps.ca/behaviourparenting/Fears.htm
– From the Canadian Pediatric Society
– http://www.cmho.org
– http://www.knowledge.offordcentre.com/
– Information on a range of mental health problems
Question Time