Anxiety Disorders BY CAROLE BOUCHER AND HEATHER PORTER

Agenda Activate prior knowledge What is anxiety? Causes of anxiety Prevalence and facts Types of anxiety disorders Characteristics Treatments Tips for teachers Books for children Videos References

APK – True or False Oppositional Defiance Disorder is a type of anxiety disorder. One of the possible causes of anxiety is the child’s personality / temperament. 7% of Canadians are affected by anxiety disorders in any given year. There is a high level of comorbidity among the different types of anxiety disorders. Men are twice as likely as women to develop anxiety disorders.

Anxiety Disorders Internalizing DSM disorders. Impairments in people’s ability to perform at multiple levels (think, behave, and perceive). The anxiety becomes a disorder if, at any age, apprehension, fears, and worries become so frequent and intense that they disrupt day-to-day functioning. It must manifest itself for 6 months or longer. What distinguishes specific anxiety disorders from one another is where the focus of anxiety is directed. The different types of anxiety disorders in DSM-5 share many common characteristics. There is a high level of comorbidity among them.

Causes of Anxiety Personality / temperament Genetic predisposition Environmental factors Problems in the functioning of the brain circuits that regulate fear and other emotions

Prevalence of Anxiety Disorders and Facts Most prevalent yet treatable psychiatric condition among children and adults. According to ADAC, 12% of Canadians are affected in any given year. Only about one third of those suffering receive treatment. Women are twice as likely as men to develop anxiety disorders. It’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse. 75% of the youth in our community don’t know where to go for help. 75% of mental health problems arise before the age of 25.

Types of Anxiety Disorders Generalized Anxiety Disorder (GAD) Separation Anxiety Disorder Social Anxiety Disorder Specific Phobias Panic Disorder Agoraphobia Selective Mutism

Generalized Anxiety Disorder Characterized by excessive and uncontrollable worries about any number of events and activities. Excessive worry about future events. The intensity of worry evident in GAD is a differentiating factor rather than the number of worries a child has.

Separation Anxiety Disorder Characterized by excessive fears about separation from home or from people the individual is attached to. The fear is focused on losing or becoming separated from a major attachment figure through some catastrophic process such as an accident, or the child becoming lost.

Social Anxiety Disorder The fear of one or more social or performance situation. The individual typically has fears of being evaluated, rejected or embarrassed.

Specific Phobias This involves fear of a specific object or situation, and there is concern that some dreadful event will happen if the object is confronted or event is encountered. These fears can lead to excessive anxiety and panic attacks.

Panic Disorder Involves recurring and unexpected panic attacks, described as abrupt surges of intense fear or discomfort. These attacks are characterized by one or more of the 13 physical or emotional experiences listed in the DSM-5. Some examples are sweating, trembling, chest pains, fear of dying or feeling detached.

Agoraphobia This condition is often associated with panic disorder. The major characteristic of agoraphobia is significant and intense anxiety of fear about developing panic-like symptoms and being unable to escape or obtain help such as using public transportation, being in open spaces, or being in enclosed places.

Selective Mutism This disorder is less common in schools although it can have a major impact on a child’s ability to function socially and academically. Involves a child who will not initiate speech or reciprocally respond when spoken to by others. Unique part of this disorder is that children will readily speak and engage in conversation with certain family members but may not speak to close friends or members of the extended family. May communicate with others nonverbally and may readily engage in social encounters or situations where there is no expectation of speaking. Diagnosis is typically made in conjunction with another type of anxiety disorder such as social anxiety disorder.

Scenarios Read the scenario with your partners and determine which type of anxiety disorder your student suffers from. Once all teams have identified the type of disorder, a member of each teach will briefly describe to the class the student they had as well as the disorder he/she suffered from. Generalized Anxiety Disorder (GAD) Separation Anxiety Disorder Social Anxiety Disorder Specific Phobias Panic Disorder Agoraphobia Selective Mutism

Symptoms of Anxiety

Characteristics of Conditions in the Anxiety Disorder Domain General Characteristics Ø Apprehension Ø Fears and worries Ø Ø Distortions in Cognitive and Perceptual Processing Ø Experiences events as fear provoking or threatening; attentional bias toward threat Physical symptoms Ø Exaggeration in perceptions and thinking Increased levels of negative emotion and corresponding lower capacities for generating positive emotions Ø Low perceptions of personal competency and control Ø Increased levels of negative emotion and corresponding lower capacities for generating positive emotions Self-Regulation Difficulties Ø Heightened state of mental and physical arousal Ø Reduced behavioral control Ø Concentration and memory problems 5 signs and symptoms of anxiety Disruptions in Daily Living Ø Increased withdrawal and avoidance behaviors

Treatments Therapy Medication Complementary and Alternative Treatment

Therapy Cognitive Behavioral Therapy Exposure Therapy Acceptance and Commitment Therapy Dialectical Behavioral Therapy Interpersonal Therapy

Medication Selective Serotonin Reuptake Inhibitors Serotonin-Norepinephrine Reuptake Inhibitors Benzodiazepines Tricyclic Antidepressants

Complementary & Alternative Treatment Stress and Relaxation Techniques Meditation Yoga Acupuncture Mindfulness Etc.

The Worry Box Strategy Riley has been under a lot of stress lately. Although she had a wonderful year last year, she’s finding it difficult to transition to her grade 1 classroom. It’s a little bigger, has a few more kids, and doesn’t have her favourite teacher. As a result, she’s waking at night and experiencing some other symptoms of anxiety as well (headaches and stomach aches). While she leaves the house happy and confident, she always says, “Mommy, my heart is beating too fast” as soon as we approach the school. It’s breaking my heart. This strategy works well for children ages 3 -12, but has even been used with high school students. Some students prepare a more grown up approach such as “The Worry Journal”. http: //practicalkatie. com/2011/10/11/the-worry-box/

Tips for Teachers of Students suffering from Anxiety Disorders Check with the counsellor or resource teacher. Take the child’s concerns seriously. Communicate with parents. Adjust work expectations. Subject failures. Interaction in the classroom. Fight versus flight syndrome. Establish a cue and place for « time out » . Remind the child to use coping techniques. Be consistent.

Tips for Teachers (cont. ) Allow time at the beginning of the day or class for the child to transition. Use small group activities throughout the day. Reward effort. Create group activities that role-play appropriate behaviors. Decrease situations that induce stress. Find books that address children with anxiety. Teach positive self-talk to the entire class. Post the daily routine in the classroom and let the students know in advance of any changes in the schedule. Help students break assignments down into smaller segments. Play soothing music during down time. Encourage school attendance.

Tips for teachers (cont. ) Be mindful that reassurance alone may not be enough to resolve the anxiety. Check in with the student regularly. Create a “things to do” checklist and a study schedule. Provide brief, clear, and explicit directions. Create a “coping” book. Do not force the student to speak in front of the class. Pair the student up with “friendly” classmates. Help the student identify symptom onset. Invite your school psychologist to your classroom to talk about anxiety. Safe person. Cool down pass. Incorporate exercise into the school day.

Books for Children on Anxiety

Video Child anxiety Managing stress Ten tips for stress management Signs and symptoms of anxiety in children

References http: //www. adaa. org/about-adaa/press-room/facts-statistics http: //www. anxietybc. com/what-cbt-1 http: //www. anxietycanada. ca/english/index. php http: //www. anxietycentre. com/anxiety-symptoms. shtml? gclid=COOq 9 IWw 5 ss. CFQqsa. Qodrq 0 BCg https: //bbrfoundation. org/ http: //www. heretohelp. bc. ca/sites/default/files/images/adtoolkit. pdf http: //www. worrywisekids. org/node/40 Dunn, C. , Greenwood, A. , & Jones, V. (2016). Effective supports for students with emotional and behavioral disorders: A continuum of services. Boston, MA : Pearson. Highlights of changes from DSM-IV-TR to DSM-5. (2013). American Psychiatric Association. Available from www. dsm 5. org.