www.pspbc.ca

Childhood & Adolescent Anxiety

Todd Kettner, Ph.D. R.Psych.

Kootenay Lake Hospital

April 18, 2013

Mastery and ConfidenceRecognizing children’s anxiety and helping them overcome their fears

We want our patients and our

own kids to:Learn wellBe socially competentBe successful in lifeOther wishes for our children and teens?

Unfortunately,

Anxiety gets in the way of…

Learning

Social Competence

Lifelong Success

Understanding Anxiety

Anxiety

Some Examples

Actions

Thoughts

Emotions

Managing our anxiety and depression AND improving our physical health outcomes

Prevalence of anxiety disorders in children and

adolescents

8% to 20%

Neuroanatomy of Anxiety

Main Types of Anxiety Disorders

Separation Anxiety Panic DisorderAgoraphobiaSpecific PhobiaSocial Phobia (Social Anxiety)Obsessive Compulsive DisorderPosttraumatic Stress DisorderGeneralized Anxiety Disorder

Recognizing worry and Anxiety in children and teens

Physical Symptoms

Cognitive Symptoms

Behavioural Symptoms

Emotional Contagion

Laughter

Emotional Contagion

Anxiety and Stress

peers

parents

educators

Behavioral and environmental interventions are first line for

anxiety

Strategies for Resilience

Maintaining Optimal Stress Levels

the Yerkes Dodson Law

Modeling

Parent, sibling, peer and health professional

modeling

Relaxation Exercises

Progressive Muscle Relaxation

Relaxed BreathingMindfulness

Graduated Mastery

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CN Tower Toronto533 meters

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““Look what I just Look what I just did!”did!”

MORE MORE IMPORTANTLY:IMPORTANTLY:

““look at who I am…”look at who I am…”BraveBrave

AdventuresomeAdventuresomeCapableCapable

IndependentIndependentStrongStrong

MORE MORE IMPORTANTLY:IMPORTANTLY:

““look at who I am…”look at who I am…”BraveBrave

AdventuresomeAdventuresomeCapableCapable

IndependentIndependentStrongStrong

Structure andPredictability

Gentle Logic

Mood and Activity Tracking

Optimism Online iPhone App

Optimism Online Emailed to Health Care Provider (M.D.,

Counselor, Psychologist)

Behavioral Strategies

Sleep hygieneExerciseHealthy EatingSocial activities: drama, sports, art, musicInformationResolve real issuesReferral for support

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6 Key Steps

1.Identification of children at risk2.Useful methods for screening and diagnosis3.Treatment template4.Suicide assessment5.Safety/contingency planning6.Referral flags

Delivery of Effective Treatment for Anxiety Disorders

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Ideal position of first contact health providers

Screen usual-risk youth at routine vaccination and start of school visits

I. Identification of Children & Youth At Risk

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Anxiety Disorder Identification Table

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Educate about risk Obtain family history “Clinical review” threshold Standing “mental health check-up” Confidentiality, understanding & informed consent

A Child is Identified At Risk

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Screen at-risk youth every 6 months

15 minute office/clinical visits every 6 months

Standing “Mental Health Check-up”

Anxiety symptoms worsen:- During school year-Before first weeks of school-Should not cause severe distress or dysfunction

Anxiety symptoms decrease:- In summer months- After first few weeks of school

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Appropriate/Adaptive Anxiety

› Short duration (< a few weeks)

› Resolves spontaneously, or

› Ameliorated by social supported or environmental modification

Anxiety Disorder

› Long duration (usually lasting many months)

› Significantly interferes with functioning

› Is often out of sync with magnitude of stressor

› Usually require health provider intervention

› Diagnosis made using DSM IV-TR criteria

Differentiating Distress from Disorder

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Psychotherapeutic Support for Teens (PST) Kutcher Adolescent Depression Scale (KADS)

› A screening tool for depression Teen or Child Functional Assessment (TeFA; CFA)

› Self-report tool (child depending)

› 3 minutes to complete

› Assists in evaluating four functional domains of teen mental health School Home Work Friends

Tool for Assessment of Suicide Risk (TASR-A)

Useful Methods for Screening & Diagnosis

Use of SCARED in Assessment

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Anxiety disorder is suspected:if score of 25 or higher

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Clinical Approach to Possible Child / Adolescent Anxiety Disorder

Visit 1: SCARED FunctionUse PST & MEP as indicated and as time allows

If SCARED is 25 or greater (parent and/or child) or shows decrease in function, review WRP/Stress management strategies and proceed to step 2 in 1-2 weeks.

If SCARED < 25 and/or shows no decrease in function, monitor again (SCARED) in a month. Advise to call if feeling worse or any safety concerns.

Visit 2: SCARED, Function. Use PST & MEP

If SCARED > 25, and shows decrease in function, utilize PST strategies, review WRP and proceed to

step 3 within a week.

If SCARED <25 and shows no decrease in function, monitor again in a month. Advise to call if feeling worse or any safety concerns.

Visit 3: SCARED, Function. Use PST & MEP

If SCARED remains > 25 or shows decrease in function, proceed to diagnosis (DSM-IVTR criteria) and treatment

If SCARED <25 and shows no decrease in function, monitor again (SCARED) in one month. Advise to call if feeing worse or any safety concerns.

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 Screen for depression

› Use the Kutcher Adolescent Depression Screen (KADS) Screen for suicide risk

› Use the Tool for Assessment of Suicide Risk (TASR) Mental Health Check-ups

› Second visit one week from visit Can include TeFA and/or PST (15 – 20 mins) If suicide or depression concerns use KADS & TASR-A

› Third visit two weeks later Repeat SCARED and other tools as indicated Make treatment plan as indicated

Teen Anxiety Disorder is Suspected

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If Panic Disorder:

› Complete Panic Attack Diary

› Complete DPG:TD Diary

If Social Anxiety Disorder

› Complete K-GSADS-A

Teen Anxiety Disorder is Suspected

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Don’t Get Overwhelmed

Onset of anxiety

disorder

is not an

emergency

Onset of anxiety

disorder

is not an

emergency

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Specific Factors

› Evidence based treatments: Structured psychotherapies (e.g. Cognitive Behavioral

Therapy - CBT) Medication

Non-specific Factors

› Activities Decrease stress, improve mood and general well-being

› Supportive psychological interventions PST in toolkit guide

III. Childhood Anxiety Treatment Template

Enroll the Help of Others

Who does the child want to help them?

Family Teacher

School Counselor Coach

Neighbor

Babysitter

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Psychotherapy

1. Anxious Teen by Holly2. Learning by woodleywonderworks3. Social Competence by Purhoor Photograpy4. Lifelong Success by Jorge Franganillo 5. Amygdala - unknown6. Spider by Dincordero7. Spider on eye blog.ericlamb.net8. Beach by Zanzibar9. Yerkes Dodson – secretgeek.net10.Scared Child by Espon Faugstad11.Distressed Teen in Car by PLCjr12.Peers by teapics13.Parents by phub.com.au14.Educators – apa.org15.Classroom by horizontal.ingegration16.Counselor in chair by Parker Knight17.Staircase by Gwenael Piaser

Photos credits (mostly from Flickr)

Resources

Anxiety BC Main Website - FANTASTIC!

Guides for relaxed breathing, muscle relaxation, shyness, test anxiety

Quick Screening Questionnaires

Tools for teaching students with mental health issues