1. Childhood Anxiety Dr John Callary Child & Adolescent Psychiatrist
Father of 4

2. Case vignettes

3. Books: The Panic Book & The Secret Problem

4. Books: Living with Fear & The Hidden Gifts of The Introverted Child

5. Childhood Anxiety Phenomena – healthy vs unhealthy
Developmental and systemic considerations
Sensitization & Desensitization
Childhood Anxiety Disorders - prev 8-10%
Management

6. Anxiety Perceived threat > Perceived capacity to cope
Fight or Flight response

7. Normal age-related fears
Everyone has worries and fears. They are part of living.
Children of all ages have fears and their typical fears differ at different ages:
Infants and toddlers -
loud noises, separation, strangers
Preschoolers -
animals, especially dogs, the dark, ghosts and monsters
School age -
snakes and spiders, fear of failure and rejection, the news and TV shows,
blood, injury, and sickness, being home alone, robbers, death, parent’s well-being
Most children will grow out of these fears.

8. So why are some children more anxious
So why are some children more anxious? Why does their anxiety persist/worsen?
Genetic factors - Anxiety seems to run in families
Parents remark their child is like they were at that age...
Anxious children are often temperamentally intense and sensitive children.
Modelling - Anxious parents can unknowingly model anxious behaviours
communicates to children that there is something to be scared about.
Parental reaction to the child’s anxiety - to reassure
Sometimes reassuring children can accidentally reinforce anxious behaviours
Children may gain a lot of attention or may escape from a feared event by continuing to be anxious.

9. So when is anxiety a problem?
Degree of distress
Disruption to participating in everyday activities and routines

10. Anxiety-Response

11. Imagined Anxiety

12. Avoidance - Sensitization

13. Face the Fear – Graded Desensitization

14. Dynamic and Diagnostic Formulation
Why this child in this this point in time?
Bio
Psycho
Social
Cultural
Predisposing
Precipitating
Perpetuating
Protective

15. Systemic Aspects
Family
School – peers, teachers, studies
Community

16. Family of 6 = 15 relationships!

17. What does an Anxiety Disorder look like?
Unrealistic /excessive worries
Physiological
Constitutional
Avoidance (Social)
Behavioural

18. Anxiety Disorders - DSM
Separation Anxiety
Over-anxiety Disorder of Childhood
Social Phobia
Selective Mutism
Obsessive Compulsive Disorder
Panic Disorder +/- Agoraphobia

19. Comorbidity Attachment Disorder Learning difficulties Depression ADHD
Intellectual Disability
Asperger’s Syndrome

20. Management Psycho-education Intervention vs No intervention
Address co-morbidities & systemic
Parental anxiety
CBT, Relaxation therapy, Hypnotherapy, Social skills, Other therapies or activities
Medication

21. What can parents/carers do to help?
1. Find out what the problem is. Listening to how they feel in a sympathetic but calm way.
2. Teach them calming techniques, such as slowing their breathing, and relaxation techniques.
3. Encourage your child to generate suggestions on how they can cope with the anxiety; what your child can do to make themselves feel better. It is an important step for them to try to reduce their anxiety.
4. Summarise the options your child has in the situation. They can continue to feel upset and anxious and behave in an anxious manner or they can choose to do something that reduces their anxiety and lets them feel better. (e.g. relaxation techniques, realistic thinking)
....

22. What can parents/carers do to help?
5. Go through the options with your child and ask, “What would happen if you did this?”
Don’t allow them to use avoidance as a solution.
6. Resist the temptation to use excessive reassurance (e.g “its fine I am here, I will deal with it”). Some children then only feel safe if they are with their parents.
7. If you are an anxious parent it is important to not project/transfer your own feelings/fears to your child – (e.g. how scary/dangerous is that spider?)
8. Encourage your child to use realistic thinking. Ask your child “challenge” questions whenever your child expresses worries or fears by reminding them to examine the evidence… “What is it that you are worried about? Has that ever happened before? Are there any other ways of looking at it?”

23. Cognitive Behavioural Therapy
Very effective for anxiety and depression
Hierarchy of tasks
Graded desensitization
Habituation and reinforcement
“think positive” “act positive” “feel positive”

24. Medication Symptomatic relief Never the whole answer
Shallow evidence for efficacy; side effects
SSRI
Start low and go slow