Anxiety Disorders in Kids...An Overview for Parents and Teachers


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This presentation is an overview of how anxiety symptoms manifest in children and teens, and an overview of the two primary treatment modalities (Cognitive-Behavioral therapy and medication). This talk was presented with Dr. Sherri McClurg at Lake Ridge Academy in North Ridgeville, OH, October 6, 2011.

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Anxiety Disorders in Kids...An Overview for Parents and Teachers

  1. 1. Anxiety Disorders in KidsAn Overview for Parents and TeachersSherri McClurg, Psy.D.Managing Director, Family Center by the FallsStephen Grcevich, MDPresident and Founder, Family Center by the FallsPresented at Lake Ridge AcademyOctober 6, 2011
  2. 2. Some fears are normal and age-appropriatein children: Infants: Fear of loud noises, fear of being startled Toddlers/Young Children: Fear of imaginary creatures, fear of the dark, animals, strangers School-age children: Worry about injury, natural events (storms), death Older children, teens: Fears related to school performance, social competence, health issuesJ Am Acad Child Adolesc Psychiatry 2007;46(2) 267-83.
  3. 3. How are kids with anxiety disordersdifferent from their peers? They misperceive the level of threat, danger in their environment They think too much…eventually to the point that academic performance, family functioning, friendships, extracurricular activities are compromised…rumination, perseveration, indecisiveness, perfectionism Decision to treat is grounded in the degree to which anxiety interferes with daily functioning
  4. 4. Epidemiology of Anxiety Disorders: 8% of teens ages 13-18 have anxiety disorders, most with onset around age 6 (only 18% have received treatment) Girls>Boys (especially phobias, panic disorder, agoraphobia, separation anxiety) Severity=persistence Kids often develop new anxiety disorders over time Greater risk of depression, substance abuse Genetics, parent-child interactions, parental modeling, temperament are risk factors Coping skills may be considered as protective factors Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283
  5. 5. Warning signs of significant anxiety inchildren and teens: “What if” questions Avoidance Excessive need for reassurance Excessive physical complaints Sleep disturbances (especially increased sleep latency) Difficulties with concentration, attention Perfectionism Excessive absence from school Easily distressed Lying
  6. 6. Specific Anxiety Disorders in Children, Adolescents: Note: Kids may experience different manifestations of anxiety as they progress through developmental stages  Separation Anxiety Disorder  Specific Phobia  Generalized Anxiety Disorder  Social Anxiety Disorder  Panic Disorder  Obsessive-Compulsive Disorder  Selective MutismJ Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283
  7. 7. Conditions associated with or mistakenfor anxiety disorders in children, teens: ADHD (treatment may exacerbate anxiety) Asperger’s Disorder Learning Disabilities Depression Psychotic Disorders Medication-induced anxiety
  8. 8. Treatment of anxiety disorders inchildren, adolescents: Cognitive-behavioral therapy (with modifications for specific anxiety disorders) SSRIs, other medications Parent-child, family interventions Classroom-based accommodations, interventions Evidence-based interventions in redJ Am Acad Child Adolesc Psychiatry, 2007; 46(2):267-283
  9. 9. Medications Used in Kids With Anxiety Disorders  SSRIs (Sertraline, Fluvoxamine, Fluoxetine)  Clomipramine  Venlafaxine  Tricyclic antidepressants (imipramine)  Buspirone  BenzodiazepinesJ Am Acad Child Adolesc Psychiatry 2007; 46(2) 267-283
  10. 10. CAMS (Child-Adolescent AnxietyMultimodal Study): NIMH-funded, RCT comparing placebo, sertraline, CBT and combination treatment (CBT+sertraline) for treatment of separation anxiety disorder, social anxiety disorder, generalized anxiety disorder Children, ages 7-17, N=488 CBT: 14 sessions, using “Coping Cat” curriculum Sertraline: started at 25 mg/day, increased by fixed- flexible titration (mean dose:133 mg/day)Walkup JT et al, N Engl J Med, 2008;359:2753-2766
  11. 11. CAMS (Child-Adolescent AnxietyMultimodal Study): Response rates: COMB: 80.7%, CBT: 59.7%, SER: 54.9%, PBO: 23.7% COMB>CBT=SER>PBO Effect Sizes: COMB: 0.86, SER: 0.45, CBT: 0.31 No adverse effects>PBO in medication groups Beneficial effects of COMB vs. SER evident after week 8Walkup JT et al, N Engl J Med, 2008;359:2753-2766
  12. 12. CAMS (Child-Adolescent AnxietyMultimodal Study): Response rates: COMB: %Responders 80.7%, CBT: 59.7%, SER: 100 54.9%, PBO: 23.7% 80 COMB>CBT=SER>PBO 60 Effect Sizes: COMB: 0.86, 40 SER: 0.45, CBT: 0.31 20 %Responders 0 No adverse effects>PBO in medication groups Beneficial effects of COMB vs. SER evident after week 8Walkup JT et al, N Engl J Med, 2008;359:2753-2766
  13. 13. Cognitive Behavioral Therapy (CBT) What is CBT?The goal is to alter cognitive processes by increasing self awareness, facilitate better self- understanding, and improving self control by developing more appropriate cognitive and behavioral skills.
  14. 14. Cognitive Behavioral Therapy (CBT) ThoughtsThree Components: Cognitive Emotional/Physiological Behavioral Behavior Feelings
  15. 15. Cognitive Behavioral Therapy (CBT) Unhealthy Process Healthy Process Thoughts Distorted thinking: Overly More positive, acknowledge negative, self-critical, success, balanced, and selective and biased recognized strengths Feelings Unpleasant, anxious, Pleasant, relaxed, happy, depressed, angry calm Behavior Avoid, give-up, Confront, try, appropriate inappropriate
  16. 16. Cognitive Behavioral Therapy (CBT) Common Pattern of Anxiety Child enters difficult situation Child becomes anxious and fearfulAnxious behavior escalates and child gets stuckChild avoids the situation or asks others to help Child continues to think the situation is dangerous and feels helpless
  17. 17. Cognitive Behavioral Therapy (CBT) Build Confidence Reduce Anxiety Build stronger relationships Learn to communicate Take on more responsible roles Develop new skills Increase independence and self- Gradually face fears help skills
  18. 18. Cognitive Behavioral Therapy (CBT) What not to do Do not try to convince them it will be okay. Do not minimize their experience. Do not tell them to fight the anxiety. Do not physically force them into the situation. Do not verbally bully them into the situation.
  19. 19. Cognitive Behavioral Therapy (CBT) What to do Accept their feelings Demonstrate understanding Build competence Have expectations but alter the process Parent cooperatively vs. balancing Respond vs. react
  20. 20. Cognitive Behavioral Therapy (CBT) Calming Strategy  Catch your breath  Accept negative feelings  Label emotions  Model coping skills
  21. 21. Conclusions: Anxiety is one of the two most common mental health disorders among children and teens in the U.S. The vast majority of kids with significant anxiety develop symptoms during their grade school years (or earlier) and receive no treatment for their condition. Kids with anxiety may be overrepresented among the student body at independent schools Cognitive-Behavioral therapy (CBT) and medication are effective treatments for kids with anxiety…best response when CBT, medication used together
  22. 22. Questions?
  23. 23. Stay in Touch!Family Center by the Falls: http://www.fcbtf.comPhone: (440) 543-3400E-mail:, @drgrcevich
  24. 24. Additional Resources:American Academy of Child and Adolescent Psychiatry: Institute of Mental Health adolescents/index.shtmlAnxiety Disorders Association of America
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