Anxiety Disorder in Youth

Necessary Competencies  Friendship skills ( higher predictor success in life than poverty )  Strong interpersonal skills  Adaptive/flexibility problem solving  Need stress management skills  Friendship skills ( higher predictor success in life than poverty )  Strong interpersonal skills  Adaptive/flexibility problem solving  Need stress management skills

Prevalency Rates  % adolescents have mental health issues that are clinically sufficient, but only 1:6 contact mental health professionals Of those seeking help for Mental health :  13% Anxiety disorder  10% Disruptive Behaviour disorder  10% mood disorders ( Depression )  2% substance use disorder  % adolescents have mental health issues that are clinically sufficient, but only 1:6 contact mental health professionals Of those seeking help for Mental health :  13% Anxiety disorder  10% Disruptive Behaviour disorder  10% mood disorders ( Depression )  2% substance use disorder

Some Complications of Untreated Anxiety ( Dodds, et al, 1997)  Diminished academic achievement  Impaired relationships  Subsequent depression, alcohol abuse,  Greatest predictor of suicide  Diminished academic achievement  Impaired relationships  Subsequent depression, alcohol abuse,  Greatest predictor of suicide

Onset  Mean age of onset years old  Often elevated IQ, teacher pleasers  Teachers are best referral resource  Families often reluctant to seek mental health support  Mean age of onset years old  Often elevated IQ, teacher pleasers  Teachers are best referral resource  Families often reluctant to seek mental health support

ANXIETY…  Normal human emotion for survival; smart for evolution; helped be alert from predators, prepared ; pay attention to possible dangers  Individual differences continuum ____________________________ low normal excess  Normal human emotion for survival; smart for evolution; helped be alert from predators, prepared ; pay attention to possible dangers  Individual differences continuum ____________________________ low normal excess

Causes of Anxiety  Inborn, inherited tendency  Shy or cautious temperament  Unpredictable lifestyle  Stressful experiences  Learning from anxious parents  Habit patterns of avoidance  Inborn, inherited tendency  Shy or cautious temperament  Unpredictable lifestyle  Stressful experiences  Learning from anxious parents  Habit patterns of avoidance

Anxiety is Developmental  Infant/Toddler: separation  Preschool: animals, dark, separation  School age: performance, adaptations, family change  Pre-adolescence: health, performance, social  Adolescence: social, existential, future  Infant/Toddler: separation  Preschool: animals, dark, separation  School age: performance, adaptations, family change  Pre-adolescence: health, performance, social  Adolescence: social, existential, future

Anxiety is Physical  Classic “Fight or flight “ response -sweating (slippery to get away) -pupils dilate ( to take in more light and gain more sensory input in order to react quickly to danger) - arousal ( increased heart rate, shallow breathing, shaking, dizzy) -aches (tension, headaches, muscles, fatigue) -sleep (insomnia)  Classic “Fight or flight “ response -sweating (slippery to get away) -pupils dilate ( to take in more light and gain more sensory input in order to react quickly to danger) - arousal ( increased heart rate, shallow breathing, shaking, dizzy) -aches (tension, headaches, muscles, fatigue) -sleep (insomnia)

- the brain releases stress hormones, like epinephrine, and steroid hormones, like cortisol to give the body its much needed fuel to ward off the threat. -Muscles become tense, heartbeats start accelerating, and blood sugar shoots up. stomach ache, “scared peoples” - the brain releases stress hormones, like epinephrine, and steroid hormones, like cortisol to give the body its much needed fuel to ward off the threat. -Muscles become tense, heartbeats start accelerating, and blood sugar shoots up. stomach ache, “scared peoples”

Common Associated Features  Depressed, irritable moods, cries easily  Fidgety, nervous habits ( nail biting)  Sleep problems ( huge sleep rituals)  Headaches and stomach aches  Difficulty coping, easily overwhelmed  Perserverance- difficulty shifting tasks  Low frustration threshold  Perfectionist don’t want to disappoint  Depressed, irritable moods, cries easily  Fidgety, nervous habits ( nail biting)  Sleep problems ( huge sleep rituals)  Headaches and stomach aches  Difficulty coping, easily overwhelmed  Perserverance- difficulty shifting tasks  Low frustration threshold  Perfectionist don’t want to disappoint

Frequently Overlooked Features  Angry outbursts  Oppositional behaviours- refusals, resistance  Temper tantrums  Aggression  Attention seeking behaviours  Hyperactivity, difficulty sitting still  Attention and concentration skills  underachieving  Angry outbursts  Oppositional behaviours- refusals, resistance  Temper tantrums  Aggression  Attention seeking behaviours  Hyperactivity, difficulty sitting still  Attention and concentration skills  underachieving

Normal vs. Anxiety Disorder  Anxiety is a problem if it: - occurs too much of the time, or -is interfering with daily life  Remember: Internalized, so often doesn’t draw attention, often physical complaints  Anxiety is a problem if it: - occurs too much of the time, or -is interfering with daily life  Remember: Internalized, so often doesn’t draw attention, often physical complaints

Common Types of Anxiety Disorders 1)Separation Anxiety - age 5/6, then at 10, at 13 (usually girls) 2) Obsessive Compulsive Disorder 1- 4 %, age 8-10 onset, engage behaviours to stop negative thought patterns; usually high intelligence (movie: “As Good As It Gets” ) 1)Separation Anxiety - age 5/6, then at 10, at 13 (usually girls) 2) Obsessive Compulsive Disorder 1- 4 %, age 8-10 onset, engage behaviours to stop negative thought patterns; usually high intelligence (movie: “As Good As It Gets” )

3. Specific Phobias Most people have at least one: -dogs, heights, spiders, public speaking closed spaces, -Most common for kids is: Dogs -Most common for adult women: Spiders -Most common for adult males: Heights Most people have at least one: -dogs, heights, spiders, public speaking closed spaces, -Most common for kids is: Dogs -Most common for adult women: Spiders -Most common for adult males: Heights

4) Generalized Anxiety Disorder : -amongst most difficult to treat, not one trigger, can have carry over to others 5) Social Anxiety Disorder: -everyone looking at me, judging me -typical adolescence - drop out of social situations 6) Panic disorder: -all at once, out of blue, - simulated heart attack (like over- excercise) -can’t tell difference, end up in ER; 4) Generalized Anxiety Disorder : -amongst most difficult to treat, not one trigger, can have carry over to others 5) Social Anxiety Disorder: -everyone looking at me, judging me -typical adolescence - drop out of social situations 6) Panic disorder: -all at once, out of blue, - simulated heart attack (like over- excercise) -can’t tell difference, end up in ER;

7. Post-Traumatic Stress Disorder violent home, car accident, fire. 7. Post-Traumatic Stress Disorder violent home, car accident, fire.

Other common co-occurring  Depression  More than one anxiety  ADHD  LD  Tourettes/ticks  Depression  More than one anxiety  ADHD  LD  Tourettes/ticks

Evidence Based treatments  Medications- anti-depressants (Prozac, Paxil) -benxodiozepines (Valium, Ativan) - Cognitive Behaviour Therapy (CBT)  Medications- anti-depressants (Prozac, Paxil) -benxodiozepines (Valium, Ativan) - Cognitive Behaviour Therapy (CBT)

 1. Thoughts 4. Behaviour 2. Feelings  1. Thoughts 4. Behaviour 2. Feelings 3. Physical Symptoms

Cognitive Behaviour Therapy  Shift thinking cognition  Calming tools, lower distress  5 main steps  Shift thinking cognition  Calming tools, lower distress  5 main steps

1. Teach about Anxiety  Teach anxiety is normal, can be helpful, not dangerous  Talk about “talent for worrying”  Teach anxiety is normal, can be helpful, not dangerous  Talk about “talent for worrying”

2. Recognize Anxiety  Teach about worrying thoughts  How affects body- draw  Explain fight or flight ( physical aspects)  “false alarm” set “too sensitive,” like a fire alarm, name it - worry bug”  Teach about worrying thoughts  How affects body- draw  Explain fight or flight ( physical aspects)  “false alarm” set “too sensitive,” like a fire alarm, name it - worry bug”

3. Scale It  1-5; what number are you feeling ?

4. Relaxing Tools  Calm Breathing ( flower/ candle )  Progressive Muscle Relaxation  Visual Imagery  Counting  Bubbles  Calm Breathing ( flower/ candle )  Progressive Muscle Relaxation  Visual Imagery  Counting  Bubbles

5. Stop Thought pattern  Red light to Catastrophic Thought  Green Light  Come up with helpful brave thoughts,  Write them down, draw them, over and over  One step at a time, worry box, step ladder  “What’s your evidence?”  “What’s the worst that can happen ?”  Red light to Catastrophic Thought  Green Light  Come up with helpful brave thoughts,  Write them down, draw them, over and over  One step at a time, worry box, step ladder  “What’s your evidence?”  “What’s the worst that can happen ?”