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Anxiety Disorder in YouthAnxiety Disorder in Youth
Necessary CompetenciesNecessary Competencies
Friendship skills ( higher predictor success in life than poverty )
Strong interpersonal skills Adaptive/flexibility problem
solving Need stress management skills
Friendship skills ( higher predictor success in life than poverty )
Strong interpersonal skills Adaptive/flexibility problem
solving Need stress management skills
Prevalency RatesPrevalency Rates
13- 20 % adolescents have mental health issues that are clinically sufficient, but only 1:6 contact mental health professionals
Of those seeking help for Mental health : 13% Anxiety disorder 10% Disruptive Behaviour disorder 10% mood disorders ( Depression ) 2% substance use disorder
13- 20 % adolescents have mental health issues that are clinically sufficient, but only 1:6 contact mental health professionals
Of those seeking help for Mental health : 13% Anxiety disorder 10% Disruptive Behaviour disorder 10% mood disorders ( Depression ) 2% substance use disorder
Some Complications of Untreated Anxiety
( Dodds, et al, 1997)
Some Complications of Untreated Anxiety
( Dodds, et al, 1997)
Diminished academic achievement Impaired relationships Subsequent depression, alcohol
abuse, Greatest predictor of suicide
Diminished academic achievement Impaired relationships Subsequent depression, alcohol
abuse, Greatest predictor of suicide
OnsetOnset
Mean age of onset 10-12 years old Often elevated IQ, teacher
pleasers Teachers are best referral resource Families often reluctant to seek
mental health support
Mean age of onset 10-12 years old Often elevated IQ, teacher
pleasers Teachers are best referral resource Families often reluctant to seek
mental health support
ANXIETY…ANXIETY… Normal human emotion for survival;
smart for evolution; helped be alert from predators, prepared ; pay attention to possible dangers
Individual differences continuum ____________________________ low normal excess
Normal human emotion for survival; smart for evolution; helped be alert from predators, prepared ; pay attention to possible dangers
Individual differences continuum ____________________________ low normal excess
Causes of AnxietyCauses of Anxiety
Inborn, inherited tendency Shy or cautious temperament Unpredictable lifestyle Stressful experiences Learning from anxious parents Habit patterns of avoidance
Inborn, inherited tendency Shy or cautious temperament Unpredictable lifestyle Stressful experiences Learning from anxious parents Habit patterns of avoidance
Anxiety is Developmental Anxiety is Developmental
Infant/Toddler: separation Preschool: animals, dark, separation School age: performance,
adaptations, family change Pre-adolescence: health, performance,
social Adolescence: social, existential, future
Infant/Toddler: separation Preschool: animals, dark, separation School age: performance,
adaptations, family change Pre-adolescence: health, performance,
social Adolescence: social, existential, future
Anxiety is Physical Anxiety is Physical
Classic “Fight or flight “ response -sweating (slippery to get away) -pupils dilate ( to take in more light and gain more sensory input in order to react quickly to danger) - arousal ( increased heart rate, shallow breathing, shaking, dizzy) -aches (tension, headaches, muscles, fatigue) -sleep (insomnia)
Classic “Fight or flight “ response -sweating (slippery to get away) -pupils dilate ( to take in more light and gain more sensory input in order to react quickly to danger) - arousal ( increased heart rate, shallow breathing, shaking, dizzy) -aches (tension, headaches, muscles, fatigue) -sleep (insomnia)
- the brain releases stress hormones, like epinephrine, and steroid hormones, like cortisol to give the body its much needed fuel to ward off the threat.
-Muscles become tense, heartbeats start accelerating, and blood sugar shoots up.
stomach ache, “scared peoples”
- the brain releases stress hormones, like epinephrine, and steroid hormones, like cortisol to give the body its much needed fuel to ward off the threat.
-Muscles become tense, heartbeats start accelerating, and blood sugar shoots up.
stomach ache, “scared peoples”
Common Associated Features
Common Associated Features
Depressed, irritable moods, cries easily
Fidgety, nervous habits ( nail biting) Sleep problems ( huge sleep rituals) Headaches and stomach aches Difficulty coping, easily overwhelmed Perserverance- difficulty shifting tasks Low frustration threshold Perfectionist don’t want to disappoint
Depressed, irritable moods, cries easily
Fidgety, nervous habits ( nail biting) Sleep problems ( huge sleep rituals) Headaches and stomach aches Difficulty coping, easily overwhelmed Perserverance- difficulty shifting tasks Low frustration threshold Perfectionist don’t want to disappoint
Frequently Overlooked Features
Frequently Overlooked Features
Angry outbursts Oppositional behaviours- refusals,
resistance Temper tantrums Aggression Attention seeking behaviours Hyperactivity, difficulty sitting still Attention and concentration skills underachieving
Angry outbursts Oppositional behaviours- refusals,
resistance Temper tantrums Aggression Attention seeking behaviours Hyperactivity, difficulty sitting still Attention and concentration skills underachieving
Normal vs. Anxiety Disorder
Normal vs. Anxiety Disorder
Anxiety is a problem if it:
- occurs too much of the time, or -is interfering with daily life
Remember: Internalized, so often doesn’t draw attention, often physical complaints
Anxiety is a problem if it:
- occurs too much of the time, or -is interfering with daily life
Remember: Internalized, so often doesn’t draw attention, often physical complaints
Common Types of Anxiety Disorders
Common Types of Anxiety Disorders
1) Separation Anxiety - age 5/6, then at 10, at 13 (usually girls)
2) Obsessive Compulsive Disorder 1- 4 % , age 8-10 onset, engage behaviours to stop negative thought patterns; usually
high intelligence (movie: “As Good As It Gets” )
1) Separation Anxiety - age 5/6, then at 10, at 13 (usually girls)
2) Obsessive Compulsive Disorder 1- 4 % , age 8-10 onset, engage behaviours to stop negative thought patterns; usually
high intelligence (movie: “As Good As It Gets” )
3. Specific Phobias3. Specific Phobias
Most people have at least one: -dogs, heights, spiders, public
speaking closed spaces, -Most common for kids is: Dogs -Most common for adult women:
Spiders -Most common for adult males: Heights
Most people have at least one: -dogs, heights, spiders, public
speaking closed spaces, -Most common for kids is: Dogs -Most common for adult women:
Spiders -Most common for adult males: Heights
4) Generalized Anxiety Disorder : -amongst most difficult to treat, not one trigger,
can have carry over to others
5) Social Anxiety Disorder: -everyone looking at me, judging me -typical adolescence - drop out of social situations 6) Panic disorder: -all at once, out of blue, - simulated heart attack (like over- excercise) -can’t tell difference, end up in ER;
4) Generalized Anxiety Disorder : -amongst most difficult to treat, not one trigger,
can have carry over to others
5) Social Anxiety Disorder: -everyone looking at me, judging me -typical adolescence - drop out of social situations 6) Panic disorder: -all at once, out of blue, - simulated heart attack (like over- excercise) -can’t tell difference, end up in ER;
7. Post-Traumatic Stress Disorder
violent home, car accident, fire.
7. Post-Traumatic Stress Disorder
violent home, car accident, fire.
Other common co-occurring
Other common co-occurring
Depression More than one anxiety ADHD LD Tourettes/ticks
Depression More than one anxiety ADHD LD Tourettes/ticks
Evidence Based treatments
Evidence Based treatments
Medications- anti-depressants (Prozac, Paxil) -benxodiozepines (Valium, Ativan) - Cognitive Behaviour Therapy (CBT)
Medications- anti-depressants (Prozac, Paxil) -benxodiozepines (Valium, Ativan) - Cognitive Behaviour Therapy (CBT)
1. Thoughts
4. Behaviour 2. Feelings
1. Thoughts
4. Behaviour 2. Feelings
3. Physical Symptoms
Cognitive Behaviour Therapy
Cognitive Behaviour Therapy
Shift thinking cognition Calming tools, lower distress 5 main steps
Shift thinking cognition Calming tools, lower distress 5 main steps
1. Teach about Anxiety1. Teach about Anxiety
Teach anxiety is normal, can be helpful, not dangerous
Talk about “talent for worrying”
Teach anxiety is normal, can be helpful, not dangerous
Talk about “talent for worrying”
2. Recognize Anxiety2. Recognize Anxiety
Teach about worrying thoughts How affects body- draw Explain fight or flight ( physical
aspects) “false alarm” set “too sensitive,” like
a fire alarm, name it - worry bug”
Teach about worrying thoughts How affects body- draw Explain fight or flight ( physical
aspects) “false alarm” set “too sensitive,” like
a fire alarm, name it - worry bug”
3. Scale It3. Scale It
1-5; what number are you feeling ? 1-5; what number are you feeling ?
4. Relaxing Tools4. Relaxing Tools
Calm Breathing ( flower/ candle ) Progressive Muscle Relaxation Visual Imagery Counting Bubbles
Calm Breathing ( flower/ candle ) Progressive Muscle Relaxation Visual Imagery Counting Bubbles
5. Stop Thought pattern5. Stop Thought pattern
Red light to Catastrophic Thought Green Light Come up with helpful brave thoughts, Write them down, draw them, over and
over One step at a time, worry box, step ladder “What’s your evidence?” “What’s the worst that can happen ?”
Red light to Catastrophic Thought Green Light Come up with helpful brave thoughts, Write them down, draw them, over and
over One step at a time, worry box, step ladder “What’s your evidence?” “What’s the worst that can happen ?”