1. Identifying and Managing Anxiety in Children Anthony Puliafico, PhD CUCARD Westchester

2. 2 What is Anxiety? Feelings of nervousness and fear in anticipation of a potential negative event Anxiety is universal Anxiety is often adaptive Often hereditary, can be brought on by life events

3. 3 Developmental Considerations Common Fears - 5-6 Years Separation from caregivers Imaginary Creatures Burglars Sleeping alone Natural disasters Animals Dying or death of others

4. 4 Developmental Considerations Common Fears – 7-8 Years Staying alone Personal harm or harm to others Media exposure to extraordinary events Failure and criticism Frightening dreams or movies Animals

5. 5 Developmental Considerations Common Fears – 9-12 Years Failure and criticism Rejection Kidnapping Dying or death of others Personal harm or harm to others Illness

6. 6 Developmental Considerations Common Fears – 13-18 Years Social Alienation Failure Embarrassment or humiliation Injury or serious illness Natural and human-made disasters (e.g., economic concerns; terrorism) Academic concerns; college

7. 7 Managing Your Child’s Daily Stress It is normal for children and teens to experience stress related to school, friendships or the future Offer to support child in managing stress, but discourage procrastination or escape Maintain realistic expectations for your child

8. 8 Managing Your Child’s Daily Stress Incorporate relaxing activities into your family’s regular schedule Family Game Night Reading before bed Mindfulness exercise? Model how to manage stress in your own life

9. 9 When Does Anxiety Become a Disorder? When it leads to avoidance of important situations or life events When it causes impairment in areas of functioning Academic Social Family/home When it causes significant distress

10. 10 Separation Anxiety Disorder Excessive distress upon separation May involve fear that something bad is going to happen when child and parent/caregiver are separated Onset generally in early to mid-childhood

11. 11 Social Anxiety Disorder Excessive fear of negative evaluation/embarrassment in social situations Fear leads to either avoidance of feared situation or extreme distress while in situation Often develops in late childhood, early adolescence

12. 12 Generalized Anxiety Disorder Excessive/uncontrollable worry about everyday life matters (school, performance situations, safety, etc.) Physical symptoms (i.e. headaches, stomachaches, sleeplessness) accompany worry Youth with GAD often seem like “little adults”

13. 13 Obsessive Compulsive Disorder Intrusive thoughts (obsessions) that are followed by repetitive behaviors (compulsions) intended to prevent harm and relieve anxiety Thoughts may seem bizarre or illogical (fear of taking on another person’s essence) May develop in childhood or adolescence

14. 14 Other Anxiety Disorders Specific Phobia Panic Disorder Post Traumatic Stress Disorder

15. 15 What do we see at home and school? Extreme shyness Hesitant to participate in social situations Extreme discomfort when the center of attention “Blends into the wallpaper” in social settings Calling/texting parents frequently

16. 16 What do we see at home and school? School avoidance Trouble paying attention Extra time spent on homework, or avoiding it, due to perfectionistic concerns Always expecting the worst Asks questions continually Excessive worry about failure

17. 17 Physical Symptoms of Anxiety Trouble catching breath Stomachaches/ headaches Complains of nausea Frequent trips to the bathroom Tightness or pain in the chest Sweating Dizziness or light headedness Heart racing or beating faster than normal Feeling faint Shaking or feeling jittery

18. 18 Managing Your Child’s Anxiety at Home Recognize that your child’s distress is genuine Make yourself available to listen Be sensitive and validate your child’s concerns Share your own experiences with anxiety and provide a “coping model”

19. 19 Managing Your Child’s Anxiety at Home Encourage your child to face anxiety-provoking situations Maintain expectations that your child keep her responsibilities (e.g. completing homework, attending sports games, etc) Discourage avoidance due to anxiety Seek professional help if anxiety persists or is causing significant distress or impairment

20. 20 Treatment Options for Child Anxiety Cognitive-Behavioral Therapy Treatment focused on modifying behaviors and thoughts to reduce anxiety Central component is gradual exposure to anxiety-provoking situations Therapist acts as a coach that teaches and guides child in using anxiety management skills

21. 21 Treatment Options for Child Anxiety SSRI Medication Prescribed by psychiatrist Common SSRI medications include Zoloft, Prozac, Luvox, and Paxil Children typically take medication for at least 6 months

22. 22 Contact Us Columbia University Clinic for Anxiety and Related Disorders (CUCARD) – Westchester 155 White Plains Road, Suite 200 Tarrytown, NY 10591 (914) 631-4618 www.columbiapsychiatry.org/clinicalservices/cucard-westchester