Meeting the Needs ofChildren and FamiliesAnxiety DisorderBy: Jocelyn (De Plata) Shah
http://www.flickr.com/photos/pinksherbet/3372060864There is a little girl in the center her nameis Faith. She become so anxious whenshe finds stressful situation and shestruggles with self regulation. She isseven years old and according to hermother she has been diagnosed withAnxiety Disorder but she did not specifywhat types of anxiety Faith has.
What is Anxiety Disorder?A generalized feeling of apprehension,fear, or tension that maybe associated withparticular object or situation or may befree-floating, not associated with anythingspecific (Wood et al. 2011).Anxiety disorder is a psychiatric conditionthat may require medical or psychologicaltreatment (CMHO).Children express their anxiety bywithdrawing from situations.
What can we learn about children with anxiety? http://www.youtube.com/watch?v=loR C9T8qUGk
Causes of Anxiety in Children Separation Anxiety Fear of Change and the Unknown Traumatic Events Family and Home-Related Stressors Environment-Related Stressors
Signs of Anxiety in Children fearful of puppets or large dolls. displays excessive attention seeking or jealousy with parent or main caregiver easily gets frustrated. experience recurrent headaches and/or stomach aches. short attention span. experiences insomnia. experiences nightmares. displays excessive anger. experiences bedwetting.
How Common are AnxietyDisorders?Anxiety disorders are the most commonmental health condition in children andadults. Roughly 6% of children and youthhave an anxiety disorder that is seriousenough to require treatment.How long do they last?Without treatment, some of the anxietydisorders that begin in childhood can last alifetime, although they may come andgo(ementalhealth).http://www.ementalhealth.ca/Toronto/Anxiety-Problems-in-Children-and-Youth-Information-for-Families/index.php?m=article&ID=8872
Types of Anxiety DisorderVideo link:http://www.glogster.com/babae/project-glog-by-babae-anxiet-disorder/g-6kruhe125pvmqf10cn0mua0
Generalized Anxiety Disorder Separation Anxiety (in Panicchildren and Disorder with youth). or without Agoraphobia Types of Anxiety DisorderObsessive-Compulsive Phobia Disorder Selective Mutism
Generalized Anxiety Disorder Generalized Anxiety Disorder (GAD) is an anxiety disorder. Children and teens with GAD worry excessively and uncontrollably about daily life events (Anxiety BC). Girls are more likely to have GAD than boys. In fact, 2 out of every 3 children with GAD are girls (Anxiety BC).
Strategies for GAD Teach calming techniques such as taking deep breaths, thinking of a quiet place, counting to ten, and do yoga. Plan plenty of time for play. Inform the child when there will be transitions. Provide a verbal and visual cue to describe upcoming activity. For example show pictures and say “Five more minutes, then lunch time”.Resource link:http://www.anxietybc.com/sites/default/files/hmgad.pdf
Panic DisorderUnpredictable attacks of Dizziness, unsteadiness,acute anxiety that are lightheadedness oraccompanied by high faintinglevels of physiological De-realization or de-arousal and that last from a personalizationfew seconds to a few hours(Carlson & Heth, 2010). Fear of losing control or going crazySigns and Symptoms: Fear of dying Palpitations, increased heart rate or pounding Feeling of choking heart Chest pain or discomfort Sweating Nausea or abdominal Trembling or shaking distress Sensations of shortness of breath or smothering
Phobia – an uncontrollable, irrational, and persistentfear of a specific object, situation, or activity. Social • Fear of social situation Phobia Specific • Fear of spiders, heights, blood Phobias etc.
Specific phobia Situational phobias: types claustrophobia (fear of close space) and acrophobia (fear of heights). Fear of natural environment ex. Storm and water. Blood/injection/injury phobia Animal phobias
Selective Mutism Anxiety that interferes with speaking in certain situations, commonly school (SickKids). Children with selective mutism have a specific worry about speaking, but only in the situations that make them feel anxious (CMHO).
Obsessive-Compulsive Disorder (OCD) is an anxiety disordercharacterized by persistent intrusive ideas, thoughts, impulses orimages (obsessions) which often result in performing compulsiverituals over and over again. Typical Compulsions obsessions include Contamination (there are washing germs all over you) organizing Doubt (Did I turn off the stove or the iron?) Checking Disturbing sexual and counting religious thought VIDEO:OCD http://www.youtube.com/watch? v=izT40QNFXuM
Separation Anxiety – when an infant or toddler is anxious aboutbeing away from her primary caregiver . According to Anxiety BC “Separation Anxiety Disorder has three peaks: between ages 5-6, 7-9, and 12-14”. http://www.anxietybc.com/parent/separation.ph p Physical symptoms: stomachaches, feeling sick to their stomach, or even throwing up out of fear Strategies: Making goodbye easier Timing is everything Practice Be calm and consistent Follow through on promises
How parents can help their child: Prepare the child for Transition to school e.g. Visit the school with your child in order to be familiarized with the new environment, teacher and other staff member. Encourage the child to make friends. Be consistent in the schedule or routine. Set a realistic expectation and explain to the child.
How early childhood educatorsmeet the needs of the child?Provide adaptive learning environment.Examples: Create a welcoming environment with ample space without barriers.
Creating a PositiveEnvironmentConsider the following to create awelcoming and positive environment: Physical SpaceConsider the size and function of eachplay area. Make sure that there is anample of space for the child to movefreely.
Change in the environment AccessibilityConsider the location and materials ofeach play area. Make sure that thechildren can reached them easily. VisibilityUse visuals to reinforce play areaexpectations. Adding/Reducing Sensory Stimulation
Using Visual Aides Label routines by using pictures with words. use a maximum of six or seven visuals in the sequence. label pictures with the exact words.
Label con’t labeltoys and toy shelves with pictures of the items on them.
Use a Mini-Schedule providepictures for the main steps required to complete the task.
Visual of First/Then Is a transition or skill-building activity. Show the first/then board to the child and name the activities while pointing to the pictures.
Calming Activities Breathing Exercise Blowing up balloons Blowing out Birthday Candles Physical Activities Sticking Hands Tense and Relax Stretching Yoga Sensory PlayListening Centre •Feeling Box Visual Centre
Con’t Follow the child’s lead and implement activities that involved interaction. Keep consistent routines. Give warnings for transitions. Provide adaptive devices such as calming music and activities. Collaborate and communicate with the family about the children’s need.
Strategies to use to help thechild: Personal Stories Role Play Problem Solving/Brain Storming Positive Self Talk Story Book: Social Story Fun Games
Plan an intervention for children withemotional and behavioral problem. Make sure activities are developmentally appropriate and based on the interest of the child. Get to know each child. Asks parents about children’s likes, dislikes, and special interests. Get parents involved they know what is best for their own child.
Anxiety Disorder NeedsTreatment Anti-anxiety medications: Selective serotonin reuptake inhibitors (SSRIs). Drugs that help regulate brain chemicals, and cognitive behavioral therapy (CBT).
Who can help the child with heranxiety? Early Childhood Educator Therapist Psychologist Public Nurses Psychiatrist Family Doctor Pediatrician Behavioural Consultant Behavioural Interventionist Social Worker
Resources for Faith’s Parents:Complete Home Toolkits http://www.anxietybc.com/parent/comp lete_home_tool_kit.phpIncludes:Helping Your Child Face Fears:Exposurehttp://www.anxietybc.com/sites/default/files/HelpChildFaceFears_2b.pdfHow to do Calm Breathinghttp://www.anxietybc.com/sites/default/files/calm_breathing.pdf
Meeting the Needs of theFamilyHelping Your Anxious Child Make Friendshttp://www.anxietybc.com/sites/default/files/HelpingYourChildMakeFriends.pdfHelping Your Child Cope with Back toSchool Anxietyhttp://www.anxietybc.com/sites/default/files/CopingwithBacktoSchool.pdfDeveloping and Using Cognitive CopingCardshttp://www.anxietybc.com/sites/default/files/coping_cards.pdf
1. Centre for addiction and Mental Health public hospital, Funded by Toronto Central Local Health Integration Network (TC LHIN). accessible for people who have problems with mental Illness or addiction. Serves children, youth, senior and supports family. Provides multi-lingual resources. Follow this link:http://www.camh.ca/en/hospital/health_information/Pages/information_in_other_languages.aspx
Referral process:1. The referral could be completed by a Family Physician or Psychiatrist.2. Faxed to our intake fax line: 416-260- 4208.3. The referral will be reviewed by our Intake Coordinators.4. Then it will be directed to the appropriate clinic to book an appointment for an assessment. http://www.camh.ca/en/hospital/about_c amh/who_we_are/Pages/who_we_are. aspx
Contact CMHOCanadian Mental Health Association,Ontario180 Dundas Street West, Suite 2301Toronto, ON M5G 1Z8416-977-55801-800-875-6213 (toll-free in Ontario)Fax 416-977-2813E-mail firstname.lastname@example.org
SickKidsThe Anxiety Disorders Clinic assesses andprovides individual or group treatment forchildren ages four to 17. Diagnoses describedin the DSM-IV includes: Specific phobia Social phobia Generalized anxiety disorder Panic disorder Separation anxiety disorder Obsessive compulsive disorder Selective mutism Acute post-traumatic stress disorder
Referral Who can refer:Pediatricians and family physicians. Parents can call to inquire about the process but a physicians referral is required. How to send your referral:1. Send your completed referral via ARMs, our on-line Ambulatory Referral Management system or2. Fax a completed referral form (available in PDF format) to us at 416- 813-7361.
Treatment Recommendations: Information and advice for parents to handle the problems without ongoing professional support. Referral to a mental health professional near where the family lives. Ongoing treatment at Sick Kids.Note: Waiting time for assessmentappointments is approximately 6months.
211http://www.211ontario.ca/#context:m=QUICK&r=0&z=contextUrl:about Is a non-profit, community-based or government organizations that provide a direct service to the public (211). Compose of 56,000 agencies and services. Service is open 24/7 Available to all residents of ON with 150 languages.
Kids Mental HealthChildrens Mental Health Ontario(CMHO) represents and supports theproviders of child and youth mentalhealth treatment services throughoutOntario. Consist of 80 community-based children’s mental health center. Link for the list of community center:http://www.kidsmentalhealth.ca/about_us/memberslist.php
Anxiety Disorders Association ofCanadaIs a registered Canadian non-profitorganization whose aim is to promotethe prevention, treatment andmanagement of anxiety disorders andto improve the lives of people whosuffer from them (ADAC).http://www.anxietydisordersontario.ca/
Mental Health Helpline is an organization funded by the government.Services: provide information about counseling services listen, offer support and provide strategies to help you meet your goals provide educational informationhttp://www.mentalhealthhelpline.ca/
Canadian Mental HealthAssociation Ontario is a non-profit, charitable organization. CMHA is to be the primary source of information about mental health, mental illness, and policy in Ontario. Population: Aboriginal, children & youth, immigrants and refugees, women, and seniors.http://www.ontario.cmha.ca/about_mental_health.asp?cID=23091 closely with its 33 local branches in communities across the province.http://www.ontario.cmha.ca/branches.asp
Toronto Distress Centrehttp://www.torontodistresscentre.com/about.shtml24/7 Distress and Crisis Line Provide supports to those experiencing emotional distress or in need of crisis intervention and suicide prevention.General InformationDistress CentresBox 243, Adelaide P.O.Toronto, Ontario M5C 2J4Telephone: 416-598-0166Email: Info@TorontoDistressCentre.com
Supporting the Families:Centre for Addiction and Mental HealthAnxiety Disorders Clinic100 Stokes Street, 4th Floor, Bell Gateway Building (Queen St. Location)Toronto, Ontario, Canada, M5T 3L2Director: Ash Bender, MD, FRCP(C)Tel: 416-979-6819Fax: 416-979-6853Fees: OHIP-coveredHospital for Sick ChildrenAnxiety Disorders Clinic555 University AvenueToronto, Ontario, Canada, M5G 1X8Director: Katharina Manassis, MD, FRCP(C)Tel: 416-813-7464Fax: 416-813-5326Fees: OHIP-covered
Humber River Regional Hospital Sunnybrook Youth Anxiety ClinicAdult Mental Health Program Department of Psychiatry, Sunnybrook Health Sciences CentreToronto, Ontario, Canada 2075 Bayview AvenueContact: Heather Wheeler, PhD,CPsych Toronto, Ontario, Canada, M4N 3M5Tel: 416-658-2003 Director: Sharon Reiter, MD, FRCP(C)Fax: 416-658-2009 Tel: 416-480-4098Fees: OHIP-covered Fees: OHIP-coveredSocial Phobia Support Group ofToronto http://www.martinantony.com/anxiety- referralsToronto, Ontario, CanadaContact 1: Earla L. Dunbar, GroupfacilitatorContact 2: Paul M. Rennie, GroupfacilitatorTel: 416-746-4819Email 1: email@example.comEmail 2: firstname.lastname@example.orgWeb: http://www.socialphobia.ca/
Free Resource Book http://www.martinantony.com/downloa dsOvercoming Animal & Insect Phobias: How to Conquer Fear ofDogs, Snakes, Rodents, Bees, Spiders & MoreBy: Martin M. Antony, PhD, and Randi E. McCabe, PhDOvercoming Medical Phobias: How to Conquer Fear of Blood,Needles, Doctors, and DentistsBy: Martin M. Antony, PhD, and Mark A Watling, MD
References:Canadian Mental Health AssociationOntariohttp://www.ontario.cmha.ca/about_mental_health.asp?cID=23091
References:http://www.flickr.com/photos/pinksherbet/3372060864 http://www.anxietydisordersontario.ca/ http://connectability.ca/2010/09/23/using-visuals/ Photograph by Jocelyn De Plata Photograph by: Jocelyn De Plata
Anxiety Disorders Association of Canada.http://www.anxietydisordersontario.ca/http://www.anxietybc.com/sites/default/files/hmgad.pdfhttp://www.martinantony.com/anxiety-referralsCanadian Mental Health Ontario. Retrieved fromhttp://www.anxietyuk.org.uk/about-anxiety/young-people-and-anxiety/generalised-anxiety-disorder-gadhttp://www.youtube.com/watch?v=loRC9T8qUGkCanadian Mental Health Association of Ontario.http://www.ontario.cmha.ca/about_mental_health.asp?cID=23091http://www.ontario.cmha.ca/about_mental_health.asp?cID=23091ttp://www.ontario.cmha.ca/branches.asp
Carlson & Heath 2010. Psychology the science of behaviour. Pearson Canada Inc. Toronto,OntarioCentre for addiction and Mental Healthhttp://www.camh.ca/en/hospital/about_camh/who_we_are/Pages/who_we_are.aspxhttp://www.camh.ca/en/hospital/health_information/Pages/information_in_other_languages.aspxDeveloping and Using Cognitive Coping Cardshttp://www.anxietybc.com/sites/default/files/coping_cards.pdfHelping Your Anxious Child Make Friendshttp://www.anxietybc.com/sites/default/files/HelpingYourChildMakeFriends.pdfGlogster http://www.glogster.com/babae/project-glog-by-babae-anxiet-disorder/g-6kruhe125pvmqf10cn0mua0Helping Your Child Cope with Back to School Anxietyhttp://www.anxietybc.com/sites/default/files/CopingwithBacktoSchool.pdfHelping Your Child Face Fears: Exposurehttp://www.anxietybc.com/sites/default/files/HelpChildFaceFears_2b.pdf Hogdon, L. (1995). Visual Strategies for Improving Communication. Quirk RobertsPublishing.
http://connectability.ca/2010/09/23/calming-strategies-to-use-with-children/http://connectability.ca/2011/10/11/anxiety-for-young-children-2/http://www.anxietybc.com/parent/complete_home_tool_kit.phpHow common are anxiety disorder.http://www.ementalhealth.ca/Toronto/Anxiety-Problems-in-Children-and-Youth-Information-for-Families/index.php?m=article&ID=8872How Early Childhood Educators can help.http://connectability.ca/2011/10/11/anxiety-for-young-children-2/
How to do Calm Breathinghttp://www.anxietybc.com/sites/default/files/calm_breathing.pdfKids Mental Health . http://www.kidsmentalhealth.ca/about_us/memberslist.phphttp://www.kidsmentalhealth.ca/parents/anxiety.php#Selective MutismMental Health Helpline. http://www.mentalhealthhelpline.ca/Home/AboutObssessive Compulsive Disorder. Retrieved from http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/anxiety-anxieux-eng.phpPanic Disorder. Retrieved from http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_4-eng.phpPhobia. http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/anxiety-anxieux-eng.phphttp://www.sickkids.ca/Psychiatry/What-we-do/Clinical-care/Anxiety-disorders-program/index.html
Separation Anxiety. Retrieved from http://connectability.ca/2011/10/11/anxiety-for-young-children-2/Separation Anxiety. Retrieved fromhttp://kidshealth.org/parent/emotions/feelings/sep_anxiety.htmlhttp://www.anxietybc.com/parent/separation.phpLisa classnotesSign of Anxiety in children. Retrieved fromhttp://connectability.ca/2010/10/28/what-is-child-anxiety/Supporting the Families. http://www.martinantony.com/anxiety-referralsTypes of Anxiety Disorders. http://www.anxietycanada.ca/english/index.phpToronto Distress Centre. http://www.torontodistresscentre.com/about.shtmlUsing Visual Aides. Hogdon, L. (1995). Visual Strategies for ImprovingCommunication. Quirk Roberts Publishing.http://connectability.ca/2010/09/23/using-visuals/Wood et al. 2011. Generalized Anxiety Disorder. Pearson Education, In. Toronto,Ontario211 http://www.211ontario.ca/#context:m=QUICK&r=0&z=contextUrl:aboutYou tube-Videoshttp://www.youtube.com/watch?v=i-jHGYWAFTQhttp://www.youtube.com/watch?v=OBbgw3mSwiUhttp://www.youtube.com/watch?v=4RSdV9R8wXQ