Strategies for helping children to understand and · PDF fileStrategies for helping children to understand and manage their ... • Children who met criteria for a diagnosis of

Strategies for helping children

to understand and manage their

anxiety.

Maria Ivanka Milić Clinical Psychologists

Psychstuff4kids

Westmead + Chatswood

Ph: 0411 36 11 26

1

“ANXIETY”

• What is anxiety?

• What does it looks like?

• Strategies:

psychoeducation/understanding

structural,

behavioural &

cognitive tools.

2

What is anxiety?

• Normal emotion which is adaptive and important to our lives.

• Triggered by “threat”.

• Everyone gets anxious.

• Real and perceived threat.

• Three aspects to anxiety : physiological, cognitive, & behavioural.

© Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids 3

ANXIETY: When is it helpful?

Very poor

PERFORMANCE

Very good

Average

ANXIETY LEVEL

Very calm aroused panic

4

ANXIETY: The Psychological model

Trigger

situation

thought

bodily sensation

© Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood 5

Words in my

mind.

If I…..then…

What if…..

F

e

e

l

i

n

g

s

Actions:

Avoidance of

feared trigger Bo

dy

cl

ue

s

What may trigger anxiety feelings?

• Everyday events.

• Temperament.

• “Normal” fears and anxieties at a particular

developmental stage.

• Expected and unexpected changes.

• Acute and/or ongoing stresses for child, family,

community.

• Individual life challenges (eg. learning, friendships).


Flight - fight response • The body reacts to real and perceived threats in the same way.

• The body prepares to run, freeze or fight the threat.

• Perceived threats are not the sorts of threats that you can easily run,

freeze or fight so there is no corrective response that would remove

the FFF symptoms.

• Over-breathing (and possibly hyperventilation) causes the carbon

dioxide levels to change and any of the following bodily changes:

– light headedness - difficulties concentrating

– dizziness - tingling sensations in hands

– weakness in the legs - pain in the chest

– increased heart beat - irregular heart beat

– tightness in the chest

– feeling you cannot breathe

CONCLUSION: the physical symptoms are real, not imagined

© Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids

Primary Anxiety


My primary anxiety(ies)

Primary + Secondary Anxiety


Anxiety about my anxiety

My primary

anxiety(ies)

Levels of anxiety.


Anxiety about how you will respond

to my anxious behaviour

Anxiety about my anxiety

My primary

anxiety(ies)

ANXIETY: What does it look like?

Different for different children:

• slower in starting & completing tasks

• avoidant (“stubborn” & “defiant”)

• irritable and snappy out the door

• confused quiet, reserved

• over plan/organise meltdowns/tears

• very compliant very very helpful

© Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and Chatswood

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Impact of anxiety:

• Executive functioning skills.

• Cognitive tiredness.

• Missed opportunities for learning • classwork,

• “I can do it!”

• can cope with the feeling and it does go away,

• anxiety bigger than it needs to be,

• new skills


Executive Functioning Cooper-Kahn & Laurie Dietzel (2008). Late Lost and Unprepared: A

Parent’s Guide to Helping Children with Executive Functioning.

List of executive functions:

1. Inhibition: “Stopping myself!”

2. Shift: “Can I move my thinking around?”

3. Emotional Control: “ Stop and think when feeling”.

4. Initiation: “getting started and thinking about how to start”

5. Working Memory: “how much can I hold in my thinking” “my

RAM”

6. Planning/Organisation: “of what I have to do now and in the

future”

7. Organisation of Materials: “where are my things”

8. Self-Monitoring: “how am I going?”

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When is anxiety “clinical”?

• Children who met criteria for a diagnosis of anxiety disorder

become anxious more easily, more often, and more intensely.

• The anxiety significantly interfers with functioning : school,

social, family.

• Disproportionate anxiety present for 6 months of more.

• These children are not different.

• Most common disorder occurring in children and adolescence.

• Under diagnosed and yery treatable.

• If Anxiety in children and adolescence is left untreated ->

increased risk of depression, adult mental health disorder.


Clinical Anxiety Diagnoses

DSM-V anxiety disorders in children and adolescents :

– Separation Anxiety Disorder

– Selective Mutism

– Specific Phobia

– Social Anxiety Disorder

– Panic Disorder

– Agoraphobia

– Generalised Anxiety Disorder

– Unspecified Anxiety Disorder

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Anxiety Management :

Practical Strategies

• Adult and situation considerations.

• Talking feelings.

• Educating children about anxiety.

• Helping children manage physical symptoms

• Detective thinking

• Fighting Fears by Facing Fears’ (exposure)


In the classroom: • Use strategies to compliment executive functioning/learning eg.

break down tasks into stages, regular breaks.

• Model coping talk out loud in class.

• Allow and coach flexibility in tasks.

• Make things predictable and familiar when eg.

– Changing activities

– Starting a new activities

– Doing an unfamiliar activity

– Giving a more complex task

• Make clear expectations of how you want the task completed

• When disciplining the class, be aware of who you are disciplining.

• Watch for tiredness and overload.

© Maria Ivanka Milic, Clinical Psychologists, Psychstuff4kids Westmead and

Chatswood

17

Can I detect and talk feelings?

The child:

© Maria Ivanka Milic, Clinical

Psychologists, Psychstuff4kids 18

How do I talk about and to anxiety?

• It is OK to feel anxious. Eliminating or avoiding anxiety is not the

solution. One builds resilience by learning “I can feel anxious and I

can manage this feeling. I am OK.””I can ask for help if I need to.”

• Be aware of one’s own emotional response (eg. your tone of voice,

body language, words).

• Your role is to support not to “take away” the child’s anxiety.

• Modelling a positive way of talking about your own feelings helps.

• Think about the now for a few minutes. Once acknowledged, think

about what they can do now to return to task. Plan for how the anxiety

can be managed in more detail later (Who? When? Where?).


Can I detect and talk feelings?

• Labeling emotions

• Younger children (e.g., under 6) – may need to

do this for them ‘looks like you might be feeling

anxious right now, I can tell because you are

tensing your face and looking scared’

• Older children (e.g., > 6 years) – ask ‘how are

you feeling right now?’ May still need to guess

and label emotion for them

© Psychstuff4kids Westmead and Chatswood 20

How BIG are my feelings of

anxiety?


Ways to decrease the physical symptoms

• Explain physical symptoms (“psychoeducation”) about the flight-

fight response.

• Help them to monitor their own body and learn which symptoms they

get.

• Strategies:

– Slow breathing exercise.

– Relaxation/mindfulness techniques.

– Distraction techniques.

– Exercise

• Repetition is critical.

• Progress is not smooth.

• Adults in the environment need to remain calm.

• Reward the child for their efforts.


Thinking

Like a detective, look for the evidence….


Anxiety makes us think:

-Something bad will

happen,

-Overestimate likelihood,

-Overestimate how “bad”

it will be,

-Underestimate our ability

to cope.

Like a detective ask questions:

Acknowledge the fear though then wonder with the child aloud:

- Has it ever happened? What happened? How often?

- Has it ever happened to their friend or classmate? What happened?

How often?

- If it has happened or less happened, what have they noticed actually

happened?

- Is Mr Worry playing tricks and telling you lies?

- Is it only a little problem or not a problem, and Mrs Naughty is making it

sound really really big and bad?

Chat out loud, your own unhelpful thoughts and helpful coping

thoughts in a situation you were scared.

Reflect on what you have learnt about anxiety

- “Mr Scared shrinks if I ignore his words and keep trying”.


Facing the fear - Graded Exposure

• Fears are faced gradually, working from lesser fears through to

greater fears.

• The child should stay in the feared situation “long enough” for their

anxiety/fear to drop so that they learn “nothing bad will happen”.

So, the longer they stay the better.

• Repetition is critical.

• Progress is not smooth.

• Monitor for subtle avoidance and distraction.

• Excessive reassurance must be avoided.

• Adults in the environment present as calm.

• Reward the child for their efforts.


As the support person it is important to:

• Encourage and support the child to practice facing their fears.

• When the child is facing their fears:

– Ask the child to rate their level of anxiety before the exposure.

– Monitor for subtle avoidance and distraction, and if you notice any, remind

them they need to focus back on the task.

– Avoid giving (excessive) reassurance. Ok to give them some helpful self-

talk if they are young

– If the child refuses to do the task, physically forcing them to do so is not

effective and could be detrimental.

– Reward the child for their efforts.


Some helpful resources: Rapee, Wignall, Spence, Cobham, Lyneham (2008) Helping Your Anxious Child:

A Step-by-Step Guide for Parents (2nd Edition)

Gottman (1997) Raising and Emotionally Intelligent Child: The Heart of

Parenting.

For the parent or teacher to read with the child:

• Morgan & Cartlidge (2004) Brave Mouse

• Zelinger & Zelinger (2011) Please Explain “Anxiety” to Me! Simple Biology and

Solutions for Children and Parents.

• Ironside (2011) The Huge Bag of Worries.

• Cook (2012) Wilma Jean the Worry Machine

• Al-Ghani (2013) The Panicosaurus: Managing Anxiety in Children Including Those

with Asperger’s Syndrome.

• Huebner (2006) What to Do When You Worry Too Much: A Kid’s Guide to

Overcoming Anxiety

©Maria Ivanka Milic, Clinical Psychologist, Psychstuff4kids Westmead 27

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Strategies for helping children to understand and · PDF fileStrategies for helping children to understand and manage their ... • Children who met criteria for a diagnosis of