Anxiety in schoolchildren

HOW TO DEAL WITH THE ANXIETY STUDENTS IN THE

CLASS ROOM

Our doctor psychiatrist in Dubai is famous doctor in Dubai. He is expert in mental health

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Objectives• Understanding of Anxiety disorders in children and youth and symptoms to look for

• Overview of treatment modalities for anxiety• Strategies to help youth with anxiety in the school environment

• Our doctor is a expert in the mental health. Our doctor psychiatrist in dubai is a experienced doctor in giving treatment for the mental disorder treatment.






6 Month Prevalence Rates of Mental or 6 Month Prevalence Rates of Mental or Addictive Disorders in Children 4-17Addictive Disorders in Children 4-17

Anxiety DisordersAnxiety Disorders 7 %7 % ADHDADHD 5 %5 % Conduct DisorderConduct Disorder 4 % 4 % Mood Disorders Mood Disorders 4 %4 % Substance Use DisordersSubstance Use Disorders 1 %1 % Any Disorder Any Disorder 14 %14 %

Waddell et al, Can J Psychiatry, 2002Waddell et al, Can J Psychiatry, 2002






When i have a really big project due a get so worried. I can't sleep at night. Even if i know i will finish it on time i get so freaked out. Is there something wrong with me. Non of my friends feal this way. Can you help me?For this type of questions please contact our doctor psychiatrist in Dubai.






What is Normal Anxiety?

Situation or Trigger:

First date Preparing for an exam Performing at a concert

Giving a speech Moving from

home Climbing a tall

ladder

Anxiety:Apprehension Nervousness Tension Edginess

Nausea Sweating

Trembling

Transient

Does not significantly interfere

Does not prevent a person from achieving their goals






When is it a problem?

Brain RegistersDANGER!

Initiation of Physiologic Cascade

Heart Rate

Tension

Alertness Perception

ANXIETY

Sensory Perception

Taste

Touch

Nose

Ears Eyes

Internal SignalsThoughts Physical

Emotions

No Danger

!?!

!!

When is Anxiety a Disorder?• Most children, adolescents and adults use anxiety to help them make good

decisions• Anxiety becomes a problem when it makes the decisions for you, interferes with

your life and/or causes distress. • Two forms: misinterpreting threat or extreme response

• When the children think a lot about their work for long time then it will appear like a dis order. If we leave the children like this it will become a sever headache that can’t control. So if you find such a problems in your child it is better to contact our Indian specialist doctor Psychiatrist in Dubai.






Epidemiology of Anxiety Disorders

• Approximately 1 in 10 children• Most prevalent mental health problem in kids • High comorbidity with ADHD, Depression, ODD,

substance misuse• Functional impairments: school failure and/or dropout,

peer/social difficulties, family dysfunction, restricted career opportunities






What Causes Anxiety?• Genetics/Biological Basis

• Anxiety runs in families• Common for at least one parent to be anxious • Research has shown that what is passed on from

parent to child is not a specific tendency to be shy or worry but a general personality type and/or cognitive style predisposing child to develop anxiety.






What causes anxiety?

• Parent Reaction • Reactions to child or teen’s anxious behaviour might also play a

role in increasing anxiety (e.g., being over-protective, excessive reassurance).

• Modeling • Children and adolescents copy their parents coping strategies

(e.g., avoiding fearful situations).

• Stressors/Traumatic Life Events • Bit by a dog, death of a loved one, being bullied, getting sick,

academic struggles






Anxiety in the Classroom• Irritability/ tiredness• Absenteeism• Frequent somatic complaints • Decline in grades• Withdrawal from peer group• Use of alcohol/drugs• Poor coping with everyday stress• Calling home frequently/reassurance seeking• Angry outbursts/ suicidal ideation






Anxiety Performance Curve (Yerkes-Dodson Law)

Hebb, D. O. (1955). Psychological Review, 62, 243-254

Anxiety Disorders in Children• Separation Anxiety Disorder: separation from caregivers, concern

bad things will happen to them • Selective Mutism: Failure to speak in specific social situation

despite speaking in others• Generalized Anxiety Disorder: uncontrollable excessive worry

about many areas of life functioning (e.g., school work, family, friends, health)

• Social Phobia: fearful of social or performance situations






Anxiety Disorders in Children

• Specific Phobia: fear of particular objects or situations• Panic Disorder: misinterpret bodily changes and have a fear of losing

control• Obsessive Compulsive Disorder: the presence of intrusive repetitive

thoughts (obsessions) or behaviours (compulsions), >1 hour/day• Post traumatic Stress Disorder Experience traumatic event,

reexperiencing, avoidance and numbness, increased arousal, >1 month






Treatment of Anxiety Disorders in Children

• 1st Line: Cognitive Behavioural Therapy-CBT

• 2nd Line: Medication plus CBT• Anxiety disorders including OCD:

SSRI medication has strongest evidence(e.g. sertraline/zoloft, fluoxetine/prozac,

fluvoxamine/luvox, citalopram/celexa)






Three Components of Anxiety

Feeling

ThinkingDoing






THOUGHTS






Thinking• Anxious children and teens have unrealistic or extreme thoughts that

centre around harm or threat.• “My mom is late, she’s been in a car accident.”• “I can’t do this presentation because my classmates will think I’m

dumb and laugh at me.”• “I will get sick in school and throw up, and everyone will know.” • “I will get in trouble if my work is not perfect.”• Whatever mental disorder problems you have you come to my

clinic. We are specialized giving treatment for that type of problems






Thinking Errors• Anxious children overestimate how likely it is that an unpleasant event will happen.

• They overestimate how bad the consequences will be if the event does happen.

• They underestimate their ability to cope with the anxiety and the unpleasant event






Anxiety and the Brain






Feeling• Anxious children and teens become “pumped up” or aroused. This is

the flight-fight response.• Immediate or short-term anxiety is named the flight-fight response.

It’s the body’s way of protecting you from danger.• The flight-fight response causes you to sweat, increase heart rate,

tense muscles, make you breath faster, feel hot or cold, dry mouth, and feel lightheaded or dizzy.

• School Situations: oral presentation, test, separating from parent, substitute teacher, answering question in class






Physiologic arousal FIGHT/FLIGHT/FRIGHT

Signal dangerEnhance alertnessPrepare body for action

Sympathetic Nervous System

Doing- Anxious Behaviours• Pace, fidget, cry, cling, shake• Avoid

•Refusing to go to school or class•Refusing to go somewhere alone•Complain of headache or stomach ache to get out of doing something

• Reassurance seeking.• “Am I going to die?”•“Are you sure ________ won’t happen?”

• Repetitive behaviours to prevent eventPowered bywww.saiwebtech.co.inWeb Design Hyderabad





BEHAVIOURS

Core Components of CBT• Education about Anxiety• Realistic Thinking/Cognitive Restructuring• Skills Training (e.g., relaxation, problem solving, social skills, assertiveness, stress management)

• Exposure **






Cognitive Strategies• Realistic Thinking or Detective ThinkingWhat is the evidence that anxious thought is true or false?• Problem Solving Identifying problem and generating solutions and potential

outcomes• Positive Self Talk






Realistic Thinking

Event Thought/Belief Emotion

Test I will fail worriedTest I don’t care irritableTest I can pass if I study hopeful






Behavioural Strategies

• Coping skills• Exposure to anxiety provoking situations and Response

Prevention• Encourage and reward all positive steps in fighting

anxiety• Modeling and parent education






COPING STRATEGIES• Muscle Relaxation• Deep Breathing• Refocusing – e.g. Five senses• Staying on Task • Worry Time• “Acting as if” (..you are not anxious/worried)






Cognitive Behavioural Therapy 101

• Identify what is an anxious behaviour, thought or physical feeling. Label it for them.

• “Do you think your stomach ache is really because you are anxious about the test”

• “Your heart is racing because of worry.”

• Once a behaviour is identified, help the child think of ways to cope on their own:

• Take a deep breath.• Coping self talk (e.g., “Its just my worry, I am not going to forget

everything. I can do this.”)






Anxiety Behaviour Management 101

• Acting as a team- parents and school• Remove attention from anxious behaviours

• Decrease reassurance seeking, increase positive coping• Identify when ignoring the behaviour

• “I have already answered that question, go to the next one” • Praise the positive behaviour, as soon as it

occurs.• “Nice job continuing on with your work”• **comments given to individual- not whole class






Avoidance Behaviour- Anxiety CurveAnxiety Exposure Curve

0

10

20

30

40

50

60

70

80

90

100

Time 0 Time 1 Time 2 Time 3 Time 4

Wor

ry S

cale

ExposureAvoidanceAnxiety






Prevent Avoidance• By avoiding feared situations, or seeking reassurance, children learn

they are not able to cope with the situation or their worry• Model being brave and problem solving• Encourage them to take little steps toward accomplishing the feared

task• Take the bus to school 2 days a week.• Oral presentation alone with teacher• Go to first class

• Safe place to go in school when anxious• Reward effort!






Consultation Example Consultation Example 1• 10 year old girl not attending school for past 4 weeks.

Stomachaches every morning and thinks she is going to be sick.

• Mom informs school she is not able to force her to go.






Cognitive Behavioural StrategiesCognitive Behavioural Strategiesa)a) Graded ExposuresGraded Exposures: : n+1 rule n+1 rule (what is step up from current situation?) (what is step up from current situation?)

b) b) DesensitizationDesensitization: visit school after school hours, : visit school after school hours, arrive early when school is quieterarrive early when school is quieter

c) c) Flooding:Flooding: force full time return (usually only force full time return (usually only works for absences of 2-3 weeks or less)works for absences of 2-3 weeks or less)

d) d) Remove incentivesRemove incentives for staying home for staying home




Consultation Example 2• 15 year old boy in Grade 10. Not completing assignments

or tests, nothing handed in.

• Home info: spending 4 hours per night on homework, not completing or not good enough and so won’t hand in.

• What to do?



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Date post:	11-Apr-2017
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Anxiety in schoolchildren

Health & Medicine