Helping Children Tame Anxiety Mary Bolger, Ph.D.

Anxiety is An important signal “Caution” “Be Alert” A source of motivation to take on challenges Neurobehavioral Physical make-up of our brain Maintained through reinforcement

Typical Early Childhood Worries Separation Anxiety New and unfamiliar situations Real and imagined dangers (dog bites, spiders, monsters, the dark, basements)

Typical Worries of School Aged Children Real world dangers (fire drills, burglars, illness) Social acceptance Academic and athletic performance Risk and safety

Typical Adolescent Worries Social acceptance Concerns about the larger world Moral issues Future success

When Anxiety is No Longer Protective Your child worries immensely over insignificant situations Your child’s automatic response is worry and avoidance Worry response is not temporary Worry functions not as a signal but a way of life

What Unhealthy Anxiety Looks Like in Children Behavioral reaction is excessive and disproportionate to the situation Age inappropriate clinginess, tantrums, irritability, or crying jags Withdrawal from family, friends, peers Excessive time spent consoling child about distress of ordinary situations, or excessive coaxing to do normal activities like homework, hygiene, meals, play dates Avoidance or giving up are primary response to challenges Not happy, not moving forward Coaxing, reassurances, logical plans don’t help Anxiety becomes a problem when it causes problems. It affects the way your child is leading their life. Is your child using mainly avoidance and hesitation Anxiety may happen periodically as your child grows, like when going through a developmental change or a new experience –new school, birth of a sibling. Can generally learn how to manage the situation. On the other hand, if the level of anxiety is so strong that it interferes with your child’s ability to function in a social or classroom situation at an age-appropriate level for an extended period of time, then it is time to get help.

What Unhealthy Anxiety Looks Like in Children Headaches, stomachaches, nausea, vomiting Sleeplessness, difficulty falling asleep, frequent nightmares, unable to sleep alone Refusal to go to school, outside the home, places in the home or unable to be without parent for appropriate time period Poor concentration Unrealistic, catastrophic, pessimistic thinking patterns Seeks excessive reassurance, “what if” questions

Reasons Not to Fear Anxiety Interventions for anxiety work! The brain’s capacity for “survival of the busiest” Handling worry is a skill that can be learned Best time to intervene is early because left alone the interference from anxiety becomes more disabling Overcoming anxiety builds competence! Advances in neurosciences are documenting the great capacity of the brain to change or rewire connections given the right kind of practice. The brain Circuitry operates on the principle of “Survival of the Busiest.” Whichever brain circuits we engage the most enlist the greatest numbers of neurons or brain cells. This concept has application to functions after stroke, working on OCD and managing Anxiety. The more we engage in worry, the more, the faster, and the more easily the brain will be mapped to make those anxious connection.

Cognitive-Behavioral Therapy Active, skilled focused intervention that is the treatment of choice Magic Circle Thoughts Feelings Behaviors

Components of Cognitive-Behavioral Treatment Magic Circle What you think the inner voice inside your head How you feel our thoughts result in many different feelings What you DO when feelings become very strong they start to have an affect on what you do and these actions REINFORCE thoughts and feelings

CBT for Children Education About Worry Worry begins in the Worry Center of the Brain Worry Center is sending mistake messages Get in Charge! Take Control of the Worry Center!

CBT for Children Externalization Anxiety can be thought of as a entity separate from the child, “The Worry Bully” Point out the child’s competencies Name and characterize the worry

CBT for Children Cognitive Restructuring Use self-talk (inner voice) to talk back to the worry bully The worry bully is sending a false alarm. I don’t need to listen. The bad feeling will go away soon.

CBT for Children Step by Step Exposure Competing demands, the ART of DISTRACTION Charting Progress

Desensitization Gradual exposure helps defeat worries -builds a sense of competence -creates new patterns of learning in brain Avoidance reinforces worry behaviors -give up, stop doing things -avoid situations that might be difficult -reluctant to try new things

Interventions for Anxiety Healthy Goal: promote mastery Unhealthy Goal: temporary relief Face the fear step by step Answer anxious questions only once or twice Learn to tolerate the discomfort Make home a safe haven Parent uses techniques to manage own anxiety Avoid Repeat answers over and over Reassure, coax, accommodate to minimize distress Push, scold, let child know the behaviors aren’t normal and are annoying

10 Best Parenting Practices for Fighting Anxiety Empower your child to fight back! Fight the worry not your child! Make a plan with your child Enlist the support of important people in your child’s life (teachers, school psychologist, nurse) Target erroneous thoughts, select a new skill to practice, and monitor change Practice containment of anxiety Role Play Always go forward, no matter how small the step Recognize each small step as a victory over the Worry Bully Be a role model for problem solving worries Remember to make home a safe haven

How to Collaborate with Your Child’s School Be proactive so your child is not misunderstood Find your support contact at school Schedule a time to talk Set regular check-ins Know Thyself Encourage therapist and teacher connection

Connecting Your Child’s Pillars of Support Email regular updates that include parent, school, and therapist Include outside therapists at school meetings Look for the positive contribution of each pillar Look for therapists who will work with the school and are flexible about how classroom plans are developed Feedback between therapist, school and home helps guide intervention to support change for child Remember the child is part of the team!

Classroom Environment Potential targets that can be manipulated to help anxious children: Classroom Seating Following Directions Classroom Management Testing Conditions Unstructured Times Returns from long absences Fire and Safety Drills Curriculum Content

Teacher Awareness About Anxiety More than 10 percent of the kids in class are anxious and have difficulty processing risk accurately I am here for you and will do everything I can to help you Emphasize handling emotions versus winning or being right Firm but understanding limits on behavior Create a classroom atmosphere that looks for the positive