Grace West-Masters, Children’s Wellbeing Practitioner

Katie McDonnell, Children’s Wellbeing Practitioner

Islington CAMHS

8 th June 2018

Building confidence and managing anxiety in your child

Aims of the session

Explain about anxiety in children

Explain about different factors that lead to the development of anxiety in children

Help you think a bit about things you can do as parents to manage anxiety and build confidence in children

What is anxiety?

Anxiety in your child

How does their anxiety show in their behaviour? What do they do?

What are their thoughts and worries?

How does it show itself physically in their bodies?

ANXIETY VIDEO

What is anxiety?

• Anxiety is a normal emotion, and in the right amounts it can be useful

• Anxiety has three characteristics:

◦ Physical sensations in the body Associated with adrenalin - preparing the body for action

E.g. sweating, heart beating faster, trembling

◦ Anxious thoughts Over-estimate “danger”; underestimate ability to cope “Worry” – similar worries exist in “clinical” and “non-clinical” populations (e.g.

school, health, personal harm, friendships)

◦ Anxious behaviour Behaviour aimed at helping the child anticipate and/or avoid future danger, e.g.

looking out for danger (hypervigilance), avoiding worrying situations

N.B. Anxiety occurs in children AND parents!!!

Fears and worries are normal and tend to link in with development (Moore & Carr, 2000)

Age Developmental stage Fears and worries

0-6 months Sensory Strong sensory stimuli (e.g. loud noises); loss of support

6-12 months

Sensori-motor: cause and effect; object-constancy

Strangers; separation from care givers

2-4 years Pre-operational thinking: imagination, but limited distinction between fantasy and reality

Imaginary creatures; potential burglars; the dark

5-7 years Concrete operational thinking: Concrete, logical thinking

Natural disasters; injury/illness/death; animals; media-based fears

8-11 years Self esteem based on academic and athletic abilities

Poor academic and athletic performance

12-18 years Formal operational thinking: meta-thinking and anticipation of future dangers. Self esteem based on peer relationships

Peer rejection; world issues

Books to help you talk to children about death and

dying:

Michael Rosen -The Sad Book

Oliver Jeffers - Heart in a Bottle

Judith Kerr - Goodbye Mog

Marge Heegaard - When someone very special dies

Susan Varley - Badger’s parting gifts

Doris Stickney - Water Bugs and Dragonflies

Also look at the Winston’s Wish website

How can we work out whether a child’s anxiety has become “a problem” ?

Things to consider:

When did the symptoms develop: are they a “normal” response to something that’s happening in their lives, e.g. starting school

How strong is their worry? Is it becoming hard for them/you to manage?

Is the anxiety stopping them from doing what they want to/should be doing?

In their social life (causing problems with friendships)

Academically (stopping them from doing as well as they should be)

In their mood (are they miserable/low as a result?)

Is their anxiety stopping you from doing what you want to/should be doing? e.g. going out/to work

Different types of anxiety problems in children

• Generalised anxiety – “a bit of a worrier”

• Anxiety in social situations

• Anxiety about being apart from parents/carers

• Phobias

• Panic attacks

• Obsessive thoughts and behaviours

• Post traumatic stress disorder

Models of the development of childhood anxiety

People have done a lot of research looking at different factors that influence the development of anxiety in children

Things that cause it to develop in the first place

Things that keep it going

How these factors link together

e.g. Rapee (2001); Hudson and Rapee (2004); Murray, Creswell and Cooper (2008)

Understanding anxiety in children and parents

We are designed by evolution to protect our children!!

If our children seem vulnerable to us, we will be on the look out for signs that they are in danger

We will step in to protect them at all costs

This has advantages and disadvantages ……

Things that tend to keep anxiety going:

There are a number of common maintenance cycles in anxiety:

things that children do to look after/protect

themselves

and things other people do to try and help/protect them

Things that might keep a child’s anxiety going:

Genes/ temperament

Learning by

example

Learning from other people’s

reactions

Coping experiences

Life events

ANXIETY

Things that might cause a child to develop anxiety:

• Anxious thinking: notice / remember things that fit in with their worries; overestimate danger; underestimate coping

• Misinterpret physical symptoms of anxiety: “something bad is happening”;

• Anxious behaviour: avoidance; “safety behaviours”; seek reassurance from others

Things children do: Things others do:

• Demonstrate anxious behaviour • React to the child in an anxious way • Become very involved and protective

– maybe too much? • Reassure them – maybe too much? • Don’t encourage them to try/do

things

Containment as children grow …

All children feel anxious at times – at different ages they struggle with different anxieties.

Sometimes these anxieties connect to life experiences; other times they come from worries inside them that they might not recognise or understand.

Sometimes there is an obvious connection between their worry and anxious behaviour; other times the connection isn’t as clear ….

Your job as parents is to recognise that they are struggling and try to understand what’s going on for them. This can make them feel less alone with their difficulties; and sometimes feel more able to do the things they are worried about.

Strategies to manage anxiety and increase confidence

What can parents do to manage anxiety and build confidence in their children?

Be aware of your own anxiety responses, and those of others around them

Try and get them on board with standing up to their anxiety: what is their anxiety stopping them from doing? What would they like to be able to do that they can’t do at the moment?

Physical symptoms of anxiety: teach them how and why these physical sensations happen; explain that they are “normal” (even if they’re not pleasant); and learn ways to manage them e.g. relaxation

Strategies to manage anxiety and build confidence

Working with anxious thoughts: “catch” them; take a step back from them and think “are these worries realistic? Might there be another way of looking at things?”

Learn ways of coping with worries that aren’t worth worrying about: “it’s one of those annoying worries again”, and distract themselves

Problem-solve situations that really might be difficult – how will they cope? Who else can help them out?

Challenging negative thoughts

THINK LIKE A JUDGE

Evidence for this thought Someone in the family has died

People die

Bad things happen in the world

Sometimes I’m not with them so I don’t

know if they’re ok

Rate truth of statement 0-100%

70%

Thought on trial “I worry something bad will happen to my

parents”

Evidence thought might not be

100% true My parents are still alive and well

They are healthy

They are still young

If I separate from them, they always come

back

They are able to look after themselves

They can call for help if they are in trouble

Closing summary: Although it is possible for bad things to happen

to people, and people do die. My parents are

young, fit and healthy, they always come back

to me after separating and are able to know if

they are unwell/in trouble and call for help.

Review truth of statement 0-100%

30%

Key principles for building independence

Be confident in your child – and let them know you are confident

Show your child how to be independent and do things for themselves

Encourage them to have an internal voice that says “have a go – I can do this”

Allow and encourage them to be independent rather than jumping in and doing things for them

Be tolerant of and respect their struggle, rather than criticising them

Slowly build up what your child can do Give your child choices, rather than choosing for them

Encourage them to do some new things by themselves

Usual age Skill

6+ Choosing own clothes, dressing self Tying shoes

7+ Taking a bath independently Brushing teeth or combing hair without help

8+ Putting dirty clothes in the washing basket

9+ Making breakfast or a packed lunch Packing bag for school

10+ Choosing own haircut/style

11+ Getting up in the morning without a reminder (using an alarm) Being responsible for own bedroom (e.g. tidiness, decorations)

12+ Arrange own transport e.g. bike, bus

If your child gets anxious…

Try and manage your own anxious behaviour

Model calm and coping behaviour

Don’t keep reassuring them. It’s better to help them earn how to manage their own worry

Don’t collude with them avoiding the thing they’re worried about. It’s better to support them in gradually facing their fear and learning to solve problems

Do promote “brave” behaviour, where your child stands up to anxiety and “has a go” at doing something: Pay attention to it

Give clear and specific praise for it

Model brave behaviour to your child

Allow and encourage independence

What strategies do you use already use to calm down your child when they’re anxious?

Try things out with your child

Count back from 20 in 2s

Imagine a big red STOP sign and stop your/their worries

Describe something you can see in detail

Spell the names of your family

Make a time of the day to think about your worries or a time to write in a worry book

Try mindfulness

Mindfulness

Present moment

Non-judgemental: aims to creative distance between thoughts and our cognitive reaction to them

Practical skill

Wide evidence base

increased sensory awareness

greater cognitive control

enhanced regulation of emotions

acceptance of transient thoughts and feelings

the capacity to regulate attention

Deep breathing exercise

Useful reading

Creswell, C. and Willetts, L (2010). Overcoming your child’s fears and worries: A guide for parents using cognitive behavioural techniques.

Sitting still like a frog: Mindfulness Exercises for Kids (and Their Parents)- Eline Snel

Apps: HeadSpace, Smiling Mind, Sleep Meditations for Kids, My First Yoga

Superhero's get anxious too

A N Y Q U E S T I O N S ?

Thank you for coming.