www.pspbc.ca

Childhood & Adolescent Anxiety

Fast Facts About Anxiety in Children

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Childhood = toddlerhood to puberty (2-12 yrs)

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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 TableSignificant Risk Affect

Moderate Risk Affect

Possible “group” Identifiers(not causal for anxiety

disorder; may identify factors related to adolescent onset

anxiety)

1. Family history of anxiety disorder

2. Severe and/or persistent environmental stressors in early

childhood

1. Children with shy, inhibited and/or cautious temperament (innate personality type)

2. Family history of a mental illness (mood disorder, substance abuse disorder)

3. Have experienced a traumatic event

1. School failure or learning difficulties

2. Socially or culturally isolated

3. Bullying (victim and/or perpetrator)

4. Gay, Lesbian, Bi-sexual, Transsexual

5. Substance abuse and mis-use (cigarettes & alcohol)

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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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D. Standing “Mental Health Check-up”

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Standing “Mental Health Check-up”School reports and patterns

Physical complaints

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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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SCARED score is 25 or higher

Discuss issues/problems in the youth’s life/environment. Teen Functional Activities Assessment (TeFA) Supportive, non-judgmental problem solving assistance

› Psychotherapeutic Support for Teens (PST) as a guide Strongly encourage and prescribe:

Exercise Regulated sleep Regulated eating Positive social activities

Teen Anxiety Disorder is Suspected

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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

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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