1. Recent advances in Anxiety Disorders and Coping Skills
Erin D. Berman, Ph.D.
National Institute of Mental Health

2. How do we help children with anxiety?
Understand the anxiety FIRST! First step to any intervention.
Ever be misunderstood?
Nervous, scared, worried
Panic, Fight vs. Flight
Vs. problem solving!
How to deal with panic

3. Evolutionary picture of Anxiety
Anxiety is Adaptive
Amygdala
hub between the parts of the brain that process incoming sensory signals and the parts that interpret these signals
The reason I will spend some time on what is anxiety and the different types of disorders is because understanding the anxiety is important for the parent involved: Understanding the nature of anxiety and how it is experienced by the child will help parents sympathize with a child's struggles.

5. When does anxiety become a “disorder”?
Avoidance
Interference
Distress
Transient vs. Persistent
Lifetime prevalence of 25% (Kessler, 2005) and children 3-27% prevalence.
It wasn't so long ago that what disturbed people's tranquility were things like lions and bears and floods.

6. Anxiety Disorders Separation Anxiety Disorder
Generalized Anxiety Disorder
Social Phobia
Specific Phobia
Panic Disorder
Posttraumatic Stress Disorder

7. Anxious Youth In Schools
Problems may be less apparent than youth with behavioral disorders
Children may appear perfectionist; “good kids”; but can perform poorly in school (Mychailyszyn et al., 2010).
Somatic complaints often frequent
Especially in minority youth (Canino, 2004; Gee, 2004; Pina & Silverman, 2004)
Anxiety can also present as oppositional behavior, such as through avoidance of tasks or school refusal

8. Separation Anxiety Disorder
Developmentally inappropriate and excessive anxiety about separation from caregiver
More common in younger children
More common in girls
Persistent for 3 months
Fears of harm to either:
Themselves or family
Themes of monsters, illness,
natural disasters, driving safety.

9. Generalized Anxiety Disorder (GAD)
Worrier
Excessive worrying: not linked to any ONE event/situation.
The child is distressed over any number of things—from the health of family members to tests at school, performance and future events.
Self critical
Perfectionism

10. Recognize the Sound of Worry
Let the thought come in and go out like any other thought- don't try to stop it, don't push the pause button, don't try and force it out, play out the movie
Relabel- It's not me - it's worry, I am not weird/in danger/insert your own- XXX is a false alarm
No thought, no matter how horrible, changes what is going on in front of me
Just because I have the thought, doesn't mean it is true

11. Social Anxiety Disorder
More common in adolescents
Excessive Fear of social evaluation and/or embarrassment

12. Physical Symptoms of Anxiety
Stomachaches/ headaches
Nausea
Frequent trips to the bathroom
Tightness or pain in the chest
Sweating
Dizziness or light headedness
Heart racing
Feeling faint
Response (you can’t stop it)
Listen
Be a calming influence (panic spreads)
Remind that this ends

13. Instructional Intervention: Challenge Negative Thoughts
“NO ONE likes me”, “I messed up during class, now it is over”
Empathize FIRST vs. don’t just fix it right away
Empower your child to come up with ideas
Define “HELPUL” vs. “UNHELPFUL” thinking

14. Managing Anxiety in the School Setting (BALANCE!)
Don’t
Accommodate the anxiety too much
Let the child avoid too much
Single the child out/ridicule
Excessive reassurance
Being too directive (“taking over”)
Over control the child
Criticize the child Do
Be sensitive
Educate
Give positive feedback
Be calm
Be consistent
Slowly face their fears
Seek additional resources

15. Basic Stress Reduction Tools
Exercise (essential for treating depression)
Talking to friends
(essential coping skills for depression)
Playing (GET OUT of the House!!)
Reading
Listening to music
Drawing
Meditation
Cooking/baking
Deep breathing
Progressive Muscle Relaxation (yoga)

16. Problem Solving Skills

17. Face your fears: Baby STEPS
Small steps
Model first, if you can
Or find a “model” (other kids, cartoon characters) to watch
Gently encourage trying new things or new behaviors.

18. Emotion Thermometer 10___________ 9 ___________ 8 ___________
7 ___________
6 ___________
5 ___________
4 ___________
3 ___________
2 ___________
1 ___________

19. Face your Fears

20. Treating Anxiety Beyond the Home
Medication
SSRI’s
help regulate neurotransmitters
Generally well-tolerated
Therapy
Examining thinking and feelings
Education
Involving parents and schools
Homework
Facing fears
Therapist as a coach

21. NIMH Current Studies
Thorough evaluation & Participation provided free of charge. Travel reimbursement available.
Children Ages 8-17
Participation Includes:
Medical evaluations
Psychotherapy or treatment medication
(Outpatient visits over 8 weeks)
Participants must:
Be medically healthy
Not be taking any psychiatric medications

22. NIMH Contact Information OR

23. Resources www.adaa.org http://patientinfo.nimh.nih.gov
(therapists)
Helping Your Anxious Child: A Step-By-Step Guide for Parents Written by Sue Spence , Vanessa Cobham, Ann Wignall, Ronald M. Rapee