1. Dr. Kristie Moore October 30, 2014 Super Series Shafer Elementary

2.  A mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune  Moderate amounts of anxiety are adaptive; we act more effectively and cope with potentially dangerous situations  Excessive, uncontrollable anxiety can be debilitating  Anxiety involves 3 interrelated anxiety response systems:  Physical system: The brain sends messages to the sympathetic nervous system, which produces the fight/flight response and activates important chemicals  Cognitive system: Activation often leads to subjective feelings of apprehension, nervousness, difficulty concentrating, and panic  Behavioral system: Aggression and a desire to escape the threatening situation Avoidance perpetuates anxiety

3.  Increased heart rate  Fatigue  Nausea  Upset stomach  Dizziness  Blurred vision  Dry mouth  Vomiting  Sweating  Numbness  Muscle tension  Heart palpitations  Increased respirations

4.  Thoughts of being scared or hurt  Thoughts or images of monsters or wild animals  Self-critical thoughts  Thoughts of incompetence or inadequacy  Forgetfulness or blacking out  Thoughts of appearing foolish  Thoughts of bodily injury  Images of harm to loved ones  Thoughts of going crazy  Thoughts of contaminations  Difficulty concentrating

5.  Avoidance  Crying or screaming  Nail biting  Trembling voice  Stuttering  Trembling lip  Swallowing  Immobility  Twitching  Thumb sucking  Avoidance of eye contact  Physical proximity  Clenched jaw  Fidgeting

6.  Anxiety:  Future-oriented mood state, which may occur in absence of realistic danger; characterized by feelings of apprehension and lack of control over upcoming events  Fear:  Present-oriented emotional reaction to current danger, characterized by strong escape tendencies and surge in sympathetic nervous system  Panic:  Group of physical symptoms of fight/flight response that unexpectedly occur in the absence of obvious danger or threat

7.  Moderate fear and anxiety are adaptive, and emotions and rituals that increase feelings of control are common  Normal fears  Fears that are normal at one age can be debilitating a few years later  Whether a specific fear is normal also depends on its effect on the child and how long it lasts  The number and types of fears change over time, with a general age-related decline in numbers

8.  Normal anxieties  Anxieties are common during childhood and adolescence  The most common are separation anxiety, test anxiety, excessive concern about competence, excessive need for reassurance, and anxiety about harm to a parent  Girls display more anxiety than boys, but symptoms are similar  Some specific anxieties decrease with age, but nervous and anxious symptoms often do not and may remain stable over time

9.  Normal worries  Children of all ages worry  Worry serves a function in normal development and moderate worry can help children prepare for the future  Children with anxiety disorders do not necessarily worry more, but they worry more intensely than other children  Normal rituals and repetitive behavior  Ritualistic and repetitive activity is common; it helps children gain control and mastery of their environment  Many common childhood routines involve repetitive behaviors and doing things “just right”

10.  Disturbance in how information is perceived and processed  Intelligence and academic achievement: despite normal intelligence, deficits are seen in memory, attention, and speech or language  High levels of anxiety can interfere with academic performance; those with generalized social anxiety may drop out of school prematurely  Threat-related attentional biases: selective attention to potentially threatening/dangerous information  Anxious vigilance or hypervigilance permits the child to avoid potentially threatening events  Cognitive errors and biases  Perceptions of threats activate danger-confirming thoughts  See themselves as having less control over anxiety-related events than other children

11.  Somatic complaints, such as stomachaches or headaches, are more common in children with GAD, PD and SAD than in those with a specific phobia  More frequent in adolescents than in younger children and in children who display school refusal  90% have sleep-related problems, including nocturnal panic (abrupt waking in a state of extreme anxiety similar to daytime panic attack), insomnia, and nightmares  High rates of anxiety in adolescence are related to reduced accidents and accidental deaths in early adulthood, and higher rates of non- accidental death later in life

12.  Anxious children display low social performance and high social anxiety  See themselves as shy and socially withdrawn, and report low self-esteem, loneliness, and difficulty initiating and maintaining friendships  Deficits in understanding emotion and in differentiating between thoughts and feelings

13.  Attention and seek help if a child exhibits any of the following characteristics:  Exhibits some type of worry every single day  Seems worried often about events beyond their control  Tries to avoid particular situations or events  Preoccupied with pleasing everyone  Changes in behavior including clinginess or moodiness  Development of nervous habits such as nail biting or tics  Suddenly starts getting into trouble at school  Obsessed with schoolwork having to be perfect  Fears going to school  Worries excessively about his or her own safety or the safety of loved ones  Complains often about headaches, stomachaches, fatigue, or muscles aching  Sleep problems including insomnia or daytime sleepiness  Wants to be near parents at all times  Can’t concentrate on simple tasks  Gets scared easily  Rarely seems calm or relaxed  Fidgets often, can’t sit still  Frequently in a bad mood

14.  Biological Factors  Genetics  Neurotransmitters – serotonin & dopamine  Environmental Factors  In response to loss, change in the family, abuse, transitions,  Lack of downtime  Academic pressure  Social disruptions  Family/Individual Factors  Modeling anxiety from others in the family

15.  General Anxiety Disorder – General anxiety disorder (GAD) is the diagnosis when a child experiences anxiety, but the cause cannot be determined. General anxiety disorder can last a few months or several years.  Phobias – Children sometimes suffer from a specific phobia. These children greatly fear a particular object, animal or certain situation. When a child encounters his or her phobia, they often exhibit symptoms such as shaking, difficulty breathing, heart palpitations, and an upset stomach.  Panic Attacks – Panic attacks are also called as agoraphobia. Children suffering from panic attacks have repeated episodes of shaking, dizziness, chest pains, and intense feelings of fear. They often avoid certain situations for fear of having a panic attack.  Social Anxiety – Children with social anxiety only have symptoms when in social settings. They fear unwanted attention from anyone, including friends.  Obsessive Compulsive Disorder – Children with obsessive compulsive disorder (OCD) are consumed by a specific obsession. They perform repetitive rituals as a coping mechanism.  Post Traumatic Stress Disorder – When a child experiences a traumatic event, he or she may suffer from post traumatic stress disorder (PTSD). The child cannot stop thinking about the stressful event. Certain people or situations that remind the child of the traumatic event will make the child feel very anxious.

16.  Many self-help books that you can purchase online and review with your children  There are also many helpful online home treatments that can help young children cope with their anxiety disorders.  More severe cases may involve therapy which typically includes:  Cognitive Behavior Therapy (CBT) is a type of talk therapy that is administered by a trained mental health professional. He or she will talk to your child about his or her anxiety and teach them strategies for reducing the anxiety. The therapist will teach your child coping skills and strategies to help them relax in anxious situations.  Acceptance and Commitment Therapy (ACT) teaches a child to live in the present and not worry about things that happened in the past or might happen in the future.  Dialectical Behavioral Therapy (DBT) teaches children to maintain control of him or herself. It teaches the child what to do when experiencing negative feelings or anxiety.  Medications: There are different prescription medications that can help with symptoms of anxiety disorder. Most doctors won’t prescribe medicine unless the child is also receiving some type of therapy. It’s important to understand that medications don’t cure anxiety. They just relieve the symptoms as long as the patient is taking the medicine. Coping strategies to deal with anxiety and stress are more valuable than medications.

17.  Be aware of your child’s different moods and feelings. Know what upsets your child. Expect the child to be anxious in certain situations.  When your child becomes anxious, talk to him or her in a calming voice. Offer distractions. When you feel that your child is becoming anxious, try to get them involved in an activity they enjoy.  Realize that it is very difficult for the child to control his or her anxiety. Praise the child when he or she handles anxiety appropriately.  Don’t punish the child for anxious behavior.  Try to maintain a consistent routine. Let the child know if something out of the ordinary will occur in his or her day. Stick to a regular bedtime and mealtimes.  Limit your child’s exposure to violent or scary books, video games, and movies.  Listen to your child. It can be comforting to a child to know that they can talk to you about their feelings without judgment.  Encourage your child to be active. Exercise releases mood-boosting endorphins.  Encourage healthy habits. Make sure your child is getting his or her daily allowance of vitamins and nutrients. Make sure your child is getting enough sleep. Unhealthy eating and sleep deprivation can cause stress.  Make sure your child has quiet downtime to decompress.

18.  Do help your child break down large tasks into smaller tasks.  Do role play social situations with your child and model appropriate behavior.  Do praise your child for handling stressful situations appropriately.  Do give your child chores so he or she can feel like an important contribution to the family.  Do let your child know that feeling anxious sometimes is ok.  Do encourage your child to talk about his or her feelings.  Do take time for yourself. Having a child with anxiety disorder can be stressful, and parents need time away for their own well being.  Do keep your own personal fears to yourself. You don’t want to give your child something new to worry about.  Do have a sense of humor around your child. Show your child how to laugh at life.  Do be consistent with your spouse about how to handle your child’s anxiety. Children with anxiety disorders need consistency. It makes them feel safe.

19.  Don’t keep your child from normal activities.  Don’t do everything for your child. He or she must learn to be independent.  Don’t overly reassure your child that everything will be ok.  Don’t confuse other types of inappropriate behavior with your child’s anxiety. Children need to know that there are consequences for inappropriate behavior that they can control.