Anxiety – you & your anxious child [Albano] New York: penguin [2013]

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Anxiety – you & your anxious child [Albano] New York: penguin [2013]

1:2 formula
– if you fear that your child cannot handle a situation alone, then that’s what you need to let him/her do
– once with your guidance
– then 2x alone

Thinking traps:
– All or nothing thinking
– “Its all my fault.”
– “Things will ever get better.”
– Discounting the positive
– “Those kids were only nice because they had to be.”
– Mindreading
– “My teacher must think I’m a dummy.”
– Fortune-telling
– “I just know I won’t have any fun if I go to camp.”
– Catastrophising
– “That’s never going to happen.”
– Should’s, can’ts, won’ts
– I can’t do this; I should be able to do this; I won’t ever be able to do this.
– Overgeneralisation
– “I’m a loser at everything I do.”

When do common fears begin?
– Infants/toddlers (birth to 2 years)
– Separating from parents, Sudden loud noises, strangers, Water (e.g. Taking a bath), Large objects
– Preschoolers (3 to 5 years)
– The dark, Small animals, imaginary figures (ghosts, monsters), Sleeping alone, Nighttime noises, costumed characters & masks, thunder & lightning
– School-age (6 to 12 years)
– Insects, snakes and other animals, injections, doctors & dentists, death and dying, natural disasters, people with observable illnesses or disabilities
– Adolescents (13 to 18 years)
– Fear of rejection, embarrassment, humiliation, fear of conflict with others, negative feedback, making mistakes, taking tests, fear of the unknown future

Anxiety – fear or disorder?
– Avoidance
– Interference
– Distress
– Impact at home

CBT: the basic principles
– Psychoeducation (What anxiety is; Triggers)
– Body awareness and management
– Cognitive restructuring (Replacing anxious thoughts with realistic thoughts)
– Exposure (Staircase/ stepladder) – To gain experience and mastery
[Key aims: Change the pattern of thinking, feeling, & behaving; help the child learn to tell the difference between real threats and ones that exist only in the mind]
[Teaches the child practical skills]

– Excessive anxiety stalls a child’s development by holding them back from doing the things children do at their age
– You’ve been limiting your expectations for what your child can do for herself
– Links to a VICIOUS CYCLE
– Reassurance works in the short term but it BACKFIRES In the long term
– It teaches the child that only you can make them feel better
– Like the proverb: give a man a fish & you feed him for a day; Teach a man to fish he eats for a lifetime
– Help the child see the world more realistically so he/she can calm herself
– Learn to help her feel the fear and go toward it anyway
– Parents play a crucial role in the success of therapy by reinforcing the child’s coping efforts no matter how small they seem to you, and also by not reinforcing any attempts to avoid the situation

GAD:
Where the child agonises and worries about everything (Health, friends, financial situation, earthquakes, clowns, car crashes, robbers, global warming)
– The worries are intense and debilitating
– Constant questions
– constant reassurance
– Great difficulty seeing the positive or even the neutral
– it’s as if they are programmed to see Life’s lemons
– The unknown is viewed as perilous and unbearable – worst-case scenario
– They are in a future-oriented mood state where he is always preparing for something bad to happen (Anxious apprehension)
– The non-stop questions are meant to cover all bases

Practice: The child’s inner – voice what she/he says to herself/himself in response to fears and worries – that which works & talks her/him out of anxiety and helps her/him to remain calm

As the questions become more sophisticated, parents of an anxious child (with GAD) tend to increase their involvement to comfort and reassure the child – as with SAD, this sets up a vicious cycle where parents provide more and more reassurance of the child however the child is less and less apt to believe them, And turns more and more to the parents for help

When parents become overly involved in allaying a Child’s concerns, it deprives the child of the opportunity to struggle with the situation and learn how to adapt or to move on by himself or herself – he/she will always need mum or dad to help & it forces the parents to do more and more for the child

Parents need to be vigilant to the countless excuses for escaping and avoiding situations that provoke anxiety
– A child with GAD Makes excuses, stalls, fusses, frets, and avoids situations all time

Parents job is to help the child move from:
– What’s the worst thing that can happen in this situation?
To
– What’s the most likely thing that can happen in this situation?

Socratic questioning of the child to help them problem-solve:
– What’s the worst that can happen?
– How likely is this to happen?
– What can I do to cope with this?
– What is my goal in this situation?

Other things to consider:
– exercise
– diet: (Cut out caffeine – Chocolate and soda; cut-Down on sugar; No skipping meals)
– Good sleep (Go to bed and wake up same time each day; Exercise earlier in the day; Nightly wind down ritual; Shut up all electronics 30 to 60 minutes before bed; Keep Childs room cool, dark & quiet; Banish electronics, including television, from Childs bedroom)

SOCIAL PHOBIA
Quiz
– Does your child seem afraid of looking silly or incompetent, or being embarrassed or is the child always concerned about looking just right?
– Does your child refuse to speak to anyone except to you? Does she refuse to speak outside of your house?
– Does your child ask to stay home from school or ask you to ask the teacher if she can be excused from an oral presentation?
– Is your child already a teenager but you still have to order for her in a restaurant?
– Does your child’s teacher tell you he never raises his hand or answers questions in class?
– Does your child have only one or two close friends and refuses to go places where there will be more than just a few children gathering?
– Within a few minutes of dropping your child off at a party or school event does she call you to be picked up?
– Does your child refused to eat at school but chows down at home?
– Does your daughter love playing the piano but refuses to participate in the piano recital?
– Does your son turned out invitations to most play dates, parties and sleepovers?

– Embarrassment can be so intense it actually induces a full-scale panic attack

– The Less and less children interact, the more anxious they feel about interacting which makes them avoid more and makes the anxiety worse – in other words we set up a vicious cycle of avoidance and heightened anxiety that spirals on and on
– In Psychology we speak about three types of social status in youth:
– The peer accepted
– The peer rejected
– The peer neglected (Invisible to others; un-noticed)

– social anxiety can be hard to spot because it looks/sounds like the child is being responsible (possibly beyond their years)

Social anxiety triggers
– Meeting new people
– Speaking in front of a group
– Starting a conversation
– being called on in class
– Feeling flushed/butterflies in the tummy
– being the centre of attention
– Going to a party
– Performing on stage or in sports
– Asking a teacher question
– Joining a group of children
– Situations with unfamiliar people
– Going on a date
– Making a phone call
– Eating or drinking In public

Social anxiety can also be more specific & limited to certain situations, although it is not as common in children as it is in adults

Challenge your child’s thinking
[Children with anxiety always go to the worst case scenario]
Q: Am I 100% sure that X will happen?
Q: Do I have evidence that X will happen?
Q: How many times has X happened before?
Q: Is X really so important that my whole future depends on its outcome?
Q: What is the likelihood that X will happen?
Q: Does X’s opinion reflect that of everyone else?
Q: Do I have a crystal ball?
Q: What is the worst that could happen?
Q: What can I do to cope with and handle the situation?

Be careful about providing labels for your child in their presence – they may become an identity that is inadvertently built for them.

Gauge to your child’s age – I.e. use judgment

Websites for Internet safety:
Www.cyberbullyinghelp.com/
Www.facebook.com/help/parents
Www.cyberbullying.us/resources.php
Www.atg.wa.gov/internetsafety/teens.aspx
Www.ncpc.org/topics/Internet-safety/social-networking-websites

Clinical interview – background information
– child’s prenatal development and early childhood development
– Were there any problems?
– Milestones met on time or delayed [babbling, talking, walking, toilet training]
– Any major illnesses, hospitalisations, accidents or surgery?
– Your family and home situation
– Who lives at home?
– Who cares for your children during the day?
– What are your child’s routines?
– What are your parenting strategies?
– Family history of the biological parents, siblings, grandparents, aunts and uncles, and especially the history of anxiety or other mental illnesses?
– Has your child had any prior counselling or treatment for behavioural or emotional issues? Any special education, speech therapy or occupational therapy?
About the present problem:
– What is your main concern?
– When did this problem FirstStart and how long has it gone on?
– What makes the problem worse or better?
– What have you tried to do to help manage the situation?
– Why are you seeking help for your child at this time?

Interviews:
– Anxiety disorders interview schedule (ADIS)
– Child anxiety impact scales – child and parent forms (CAIS-C/P)
– Multidimensional anxiety scale for children (MASC)
– Screen for Child anxiety related emotional disorders – parent form (SCARED-P)

How long therapy will take:
– The type of anxiety your child has
– The severity of the symptoms
– Whether the problem is anyone specific area or over several areas
– How long your child has been suffering
– How and in what ways your child’s life & functioning have been disrupted due to these issues
– How quickly your child progresses
– How much and the type of support your child receives from you and other family members
– Parents need to become an effective coach – So as to help your child take responsibility for taking themselves out of their anxiety.

Often parents need to work on their own issues

CBT Always needs to be practised at home

Signs of success is when the child begins becoming upset at home (sign things are being tackled) – Known in psychology as the “extinction burst” – worsening of the behaviour before it stops and goes extinct.

Remember: Help guide the child to the answer – don’t give them to her/ him

Medication – GP decision together with parents (often SSRI Antidepressants such as: Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro)

Medication/progress chart

Be mindful of shortchanging the siblings (By providing attention to the anxious child – Siblings learn that causing a ruckus or getting upset gains the parents’ attention)
– Time for them too
– praise – Don’t be stingy with the compliments
– Focus on the positive
– Always be honest (Acknowledge spending more time with the anxious child and acknowledge the frustration this must cause for the sibling)
– Use rewards and reinforcers
– Use the same problem-solving strategies with your non-anxious child as you do with the anxious child
– Set up the rules clearly – There will be no personal attacks, name-calling or teasing

Reward coping behaviour through small acts:
– Smiling at him/ her
– Tell him/her what you like about what he’s doing
– Give a pat on the shoulder or back
– engage him/ her in a conversation
– Later in the day, tell him/her that you noticed he was coping so well

[Consistent reinforcement; Intermittent reinforcement]

Form a Parenting partnership:
– Present a united front
– Assess your strengths and weaknesses
– Split up tasks based on strengths
– Figure out both of your fears in relation to your child

Don’t use your anxious child as a scapegoat – for e.g. Saying you cannot have a dog because so-and-so is anxious

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