1. Helping Children Tame Anxiety
Mary Bolger, Ph.D.

2. 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

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

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

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

6. 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

7. 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.

8. 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

9. 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.

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

11. 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

12. 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!

13. 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

14. 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.

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

16. 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

17. 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

18. 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

19. 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

20. Connecting Your Child’s Pillars of Support
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!

21. 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

22. 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