Stress & Anxiety in Children

Gina Rocco, Heather Davis and Nicole W. McGarry

McKinley School Counseling Presents

Special Guest - Nicole W. McGarry, LPC, PLLC Licensed Professional Counselor & Clinical Supervisor at McLean Psychotherapy Practices

Nicole has over 10 years of experience providing individual and group psychotherapy services for children, adolescents, adults, and families.

She specializes in:● early childhood development● attachment issues and adoption● adolescent development● behavioral challenges● mind/body integration work● women’s issues● trauma

Nicole also has extensive experience treating:● Anxiety● Depression● ADHD● Divorce● Sexual abuse● Parenting and relational issues

Stress vs. Anxiety

Some commons stressors for children:

● Problems with friends● Changing schools/moving● Problems at home● Going through body changes● Money problems● Seeing parents going through a

divorce● Worrying about schoolwork and

grades

Stress tends to come from real, external factors.

Unresolved high levels of stress can lead to emotional and behavioral

symptoms such as anxiety.

Anxiety tends to stem from irrational fears and worries.

Typical or Not? What is developmentally appropriate - -

Infants and toddlers – fear of separation from parent, strangers, loud noises, imposing objects

Ages 2-4 – fear of separation from parent, dogs and/or large animals, darkness, sleeping alone, monsters, loud and/or unfamiliar noises, burglars

Ages 5-6 – separation from parent, dogs, darkness, sleeping alone, monsters, bugs, strangers, getting lost, thunder, injury, illness, death

Ages 7-12 – dogs, school issues, performance anxiety, social anxiety, fires, heights, darkness, thunderstorms, burglars, kidnappers, injury, illness, death, natural disasters, nuclear war

Teens – school issues, performance anxiety, social anxiety, personal future, natural disasters, nuclear war

Some possible signs of unusually high levels of anxiety include:

● Persistent fears or resolute avoidance of specific situations or places (that similar-aged children have no problem with or have already grown out of)

● Resists separation from parent; often seeks reassurance or is clingy● Difficulty falling asleep and staying asleep● Frequent nightmares● Frequent stomach aches and/or headaches● Fidgety or restless; often chews fingernails, toys with hair or sucks thumb● Excessive shyness● Resistant to change – for example, reacts negatively to changes in schedule, or insists

on wearing specific clothing, or not eating/only eating certain foods● Is unusually fearful of germs or of becoming ill● Has difficulty making friends or participating in group activities

Continued - - -

● Often worries that a "bad guy" might break in or try to hurt someone● Tends to be bossy or seems determined to control other family members● Is easily overwhelmed by challenges; gives up easily● Exhibits negative and catastrophic thinking – imagines and expects the worst

possible outcome● Worries excessively about performance in tests or that completed assignments may

not be good enough● Or on the other hand, may be inexplicably underachieving in school or resistant to

doing schoolwork● One or both parents tend to be anxious● Performs repetitive actions such as hand washing, checking door locks or belongings

over and over, or has recurring disturbing thoughts

Common Anxiety Disorders

Separation Anxiety Disorder – extreme reluctance to leave home, parents or caregiver

Generalized Anxiety Disorder – excessive worrying about everyday issues

Specific Phobias – overwhelming irrational fear of specific things or situations; some very common phobias in children are phobias of dogs, water, storms and lightning, bugs, heights

Obsessive Compulsive Disorder – repetitive thoughts that are difficult to control or an uncontrollable need to repeat behaviors to relieve anxiety, such as frequent hand washing

What can the school do?Teachers:

Support the use of strategies in classroom, fidget tools, break cards, prompting to recognize physical symptoms/negative thinking, recommend breaks,

empathizing

School Counselors (psychologists/social workers):

Short-term solution focused work with students one-on-one, small group, teach strategies to whole class, consultation

County Resources & Outside Referrals:

APS Parent Resource Center, recommendations to Arlington Department of Human Services, and private practice providers

How can parents help?● Remember anxiety is not willful behavior, but reflects an inability to control it● Be patient, prepared to listen● Be consistent in how you handle problems and administer discipline● Share that mistakes are a normal part of growing up; praise and reinforce

effort, even if success is less than expected● Do not assume the problem will go away on its own; seek help if the

problem persists and continues to interfere with daily activities● Don’t underestimate the power of structure, routine and consistent (calm,

relaxed) family time

Parental Responses: A Tale of Two Fears

OLD WAY

● �Why are you worried? It’s fine.● �There’s nothing to worry about.

Nothing is going to hurt you.● �But I’m scared. I can’t do it.● �Ok, just wait for me, I’ll go up

with you.

NEW WAY

● ��You are really feeling scared right now.

● �What’s worry telling you about going upstairs by yourself?

● �What do you think is really true and why?

● �What part of this can you do? Can you go up to the top and then I’ll come up?

What Children Learn from Our Responses OLD WAY● �When I feel worried or scared, it

means there’s trouble.● �Things are dangerous or too

hard.● �Parents don’t believe I can do

things so I shouldn’t try.● �The only way to fix it is to avoid

or hope someone fixes it for me.

NEW WAY● ��Worry and fear are normal

reactions to new situations.● �They are temporary.● �Things seem harder than they

are because that’s how worry tells the story.

● �I need to think about what I really believe is true.

● �Worry goes away by proving it wrong through action.

Steps to Overcome Worry and Stress

�Step One: Empathize (doesn’t mean agreeing, means not disagreeing)�Step Two: Relabel: Pin the problem on the worry brain�Step Three: Re-thinking and Re-wiring the Brain�Step Four: Unplug: Calm down the System�Step Five: Mobilize! Face your fear ON PURPOSE, one step at a time

STEP 1: How Parents Can Communicate Empathy

● �It’s OK to feel this way.● �I understand it feels hard right now.● �I know it’s hard to think about this right now.● �I know this isn’t how you want to be feeling right now.

STEP 2: ReLabeling

● �Pin the Problem on the Problem○ �It’s not the test, the tryout, or playdate;○ �It’s what worry is saying about those things

● �Instead of Asking: “Why are you worried?”● �Ask: “What is Worry Telling You will Happen?

In this way kids aren’t defending why they are worried, you are partnering with them to look for reasons not to worry.

STEP 2: ReLabeling - Talking Back to Anxiety

● �Is Anxiety Call/Texting You?● �Use your bossy voice● �If someone were giving you bad advice would you

listen?● �Under-react to your Overprotective Brain● �Start to doubt the authority of anxiety

STEP 3: Rethinking and Rewiring

● �What are the fears, what are the facts?● �Don’t trust worry, test it.● �What part do you control, what part do you not?● �What’s the answer to the million dollar question?● �Part of you thinks this, what does another part of you

think?

STEP 4: Unplugging: Mindfulness/Meditation

● �Finger breaths● �Making the Candle Flame Flicker● �Leaves on a Stream● �Guided visualization–color of relaxation replaces color

of stress● �Regular practice builds muscle memory

STEP 5: MOBILIZE!

● �Preparing to Approach○ What part of this do you feel ready to try?○ �If worry weren’t bugging you–what would you want to be doing?○ �When this fear is out of the way, what will you be able to do?○ �What part of that could you try now?○ �What do you need to practice or learn to help?

● �Zone of Optimal Learning○ Taking Anxiety’s Temperature○ 8 or Above-Unplug/Change Body Chemistry○ �Daily practice of 4’s on the 10 pt. scale

References

● Presentation (2008): Anxiety Disorder; Dr. Melissa Deichmann.● Dr. Thomas J. Huberty (2004). Anxiety and Anxiety Disorders in Children: Information for Parents.

National Association of School Psychologists.● Stress in Childhood (February 2018). U.S. National Library of Medicine.

https://medlineplus.gov/ency/article/002059.htm ● �What to Do When You Worry Too Much (2005) : A Kid’s Guide to Overcoming Anxiety;

Huebner.● �What to Do When Your Brain Get’s Stuck: A Kid’s Guide to Overcoming OCD (2007); Huebner. ● �Freeing Your Child From Anxiety (Revised 2014) : Tamar Chansky, Ph.D● �Helping Your Anxious Child 2nd Edition (2008); Rapee, Wignall, Spence, Cobham, and Lyneham● �Sitting Still Like A Frog(2013): Eline Snel● �A Handful of Quiet: Happiness in Four Pebbles (2012): Thich Nhat Hanh● �Presentation (2017): Mind Matters: The Neuroscience of Child Anxiety; Dr. Cathrine McCarthy● �Presentation (2017): Helping Pressure Cooker Kids Who Worry Too Much; Dr. Tamar Chansky● �Presentation(2017): Between a Rock and a Calm Place; Jessica Minahan, M.Ed, BCBA

Symptoms of Anxiety

Cognitive:

● Difficulty concentrating ● Self-consciousness● Obsessions● Thoughts of

incompetence● Thoughts of going

crazy or dying● Thoughts of harm

befalling caregiver● Thought of appearing

foolish/dumb

Behavioral:

● Avoidance● Muscle tension● Fidgeting/restlessness

/twitching● Nail/finger/hair biting● Stuttering ● Compulsions● Crying● Maintaining close

proximity to caregivers

Physical:

● Increased heart rate● Sweating● Dry mouth● Nausea● Fatigue● Heart palpitations● Upset stomach