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Parenting an
Anxious Child
What parents should know


Fellow Lecture Series
March 9th 2011




Pallav Pareek M.D.
Freeing Your Child From Anxiety by
Tamar E Chansky Ph.D
Helping Your Anxious Child (A step by
step guide for parents) Rapee et.al
Your Anxious Child : John S Dacey
Handbook of Clinical Family Therapy
    Anxiety is an expected, normal and
     transient response to stress; it may be a
     necessary cue for adaptation, and
     coping
    What makes it pathological?
a)     Autonomy: No/minimal recognizable
       trigger
b)     Intensity: exceeds pt’s capacity to bear
c)     Duration: persistent rather than
       transient
d)     Behavior: avoidance or withdrawal
 NO !!!!
 Anxiety (abnormal) results
  from unknown internal
  stimulus or excessive
  response to the external
  stimulus
 While Fear is sense of
  dread and foreboding that
  occurs in response to an
  external threatening
  event.
Simple Phobia, Social Phobia, Agoraphobia


Panic Disorder, Generalized Anxiety Disorder


Separation Anxiety Disorder


Post Traumatic Stress Disorder, OCD
 Harder to calm
  themselves
 Usually above average
  creativity, they can’t use
  this creativity in coping
 Even with a good plan:
  get discouraged/quit
  easily
 Fail to recognize their
  success
   Reassurance is a natural parental response to
    a child’s distress
   No reassurance » alone & insecure
   Children with anxiety: ask for reassurance far
    more often » VICIOUS cycle
   If the heavens are falling: no amount of kisses
    and hugs are too much, but for an excessive
    unjustified fear » child learns a wrong
    message
   Often it feels: “They could do it only if they
    tried a little harder” & it’s not easy NOT to
    become angry or frustrated on your anxious
    child
   Anger            More fright & anxiety
 COPE method
 Calming the nervous
  system
 Originating an
  imaginative plan
 Persisting in the face
  of obstacles
 Evaluating and
  adjusting the plan
 Stressful Situation          Fight/Flight
 Hard wired human response
 We should not elicit the FF response for every
  trivial situation
 Ways to calm the nervous sytem
a) Abdominal Breath Control
b) Sensory awareness :know your orange
c) Personal Punching Pillow: Vent
d) Know your heart Rate
e) Paradoxical Paradigm (witch hairy, scary witch)
f) Scale the fears
g) Link it to an ouch (rubber-band around wrist)
   Vertical vs. lateral thinking
   Writing stories (completion)
   Functional freedom (uses of
    brick)
   Mindless activities (don’t use
    in OCD)
   You be me
   Empty Chair
   Successive approximation
 Identify the problems
 It’s not scary after all.
 Glorify well intentioned
  mistakes
 Model moderate risk taking
 Negative vs Positive
  thoughts (write them down)
 We got your back…
 Plans are fluid
 Let them have feedback on
  their own (photos/videos)
 Charting success
 Pretest vs post test
   Pass on your own fears. Letting them face
    challenges is better than overprotection
   Leave perfectionism for your own self
   ALWAYS REMEMBER
    Reflective listening is the key !!!!
   Based on the Cool Kids Program, developed
    by Ronald Rapee Ph.D. and group at
    Macquarie University Sydney AUS.
   Based on Cognitive therapy principles
   Event “Iam waiting to be picked up from
    school, mom is late”
   Thought : She could be dead
   Evidence: its been only 10 minutes, (?) traffic,
    she was late twice before (never died), other
    kids are still there (not all parents could be
    dead)
   Reorganized Realistic thought: She is running
    late, and will arrive soon
   Rewarding Brave, non anxious behavior (no
    matter how small a bravery: start from there)
   Ignoring behaviors you don’t want
   Modeling brave, non-anxious behavior
   Be Consistent (more so for an anxious child)
   Keep your emotions in check
   Distinguish between anxious and naughty:
    even if anxious some behaviors are not
    pardonable
   Removal of privileges
   Natural consequences are sometimes the
    best teachers
 The MASTERPLAN
1) Empathize what your child is feeling
2) Re-label the problems (anxieties) as the
   worry brain
3) Rewire, act with smarts not with fears
4) Get body on board: deactivate alarms
5) Refocus: on what we need to do
6) Reinforce your child’s efforts at fighting
   Anxiety Disorders Association of America
    http://www.adaa.org/
   Worry Wise Kids :
    http://www.worrywisekids.org/parents/paren
    ting_child.html
   The Child Anxiety Network
    http://www.childanxiety.net/
   Cool Kids Program Sydney Australia:
    http://www.kidsmatter.edu.au/primary/progr
    ams-guide/cool-kids-school-version/
   St. Louis Behavioral medicine
    Institute : 1129 Macklind Ave.
    Phone: 314-534-0200
    http://www.slbmi.com/
   Dr. Jennifer L Abel (Psychologist
    specializing in Anxiety disorders)
    314 -721-7201
    http://www.anxietystlouispsycholog
    ist.com/
   Family Resource center 3rd floor in
    St. Louis Children’s Hospital : 314-
    454-2350
    http://www.stlouischildrens.org/con
    tent/familyresourcecenter.htm
   Center for Cognitive Behavioral
    Therapy, St. Louis, Inc 314-576-
    4900 http://site.cbt-stl.com/
When I was
young, I
admired clever
people. Now
that I am old, I
admire kind
people.
~Abraham
Joshua Heschel

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Parenting an anxious child

  • 1. Parenting an Anxious Child What parents should know Fellow Lecture Series March 9th 2011 Pallav Pareek M.D.
  • 2. Freeing Your Child From Anxiety by Tamar E Chansky Ph.D Helping Your Anxious Child (A step by step guide for parents) Rapee et.al Your Anxious Child : John S Dacey Handbook of Clinical Family Therapy
  • 3. Anxiety is an expected, normal and transient response to stress; it may be a necessary cue for adaptation, and coping  What makes it pathological? a) Autonomy: No/minimal recognizable trigger b) Intensity: exceeds pt’s capacity to bear c) Duration: persistent rather than transient d) Behavior: avoidance or withdrawal
  • 4.  NO !!!!  Anxiety (abnormal) results from unknown internal stimulus or excessive response to the external stimulus  While Fear is sense of dread and foreboding that occurs in response to an external threatening event.
  • 5. Simple Phobia, Social Phobia, Agoraphobia Panic Disorder, Generalized Anxiety Disorder Separation Anxiety Disorder Post Traumatic Stress Disorder, OCD
  • 6.  Harder to calm themselves  Usually above average creativity, they can’t use this creativity in coping  Even with a good plan: get discouraged/quit easily  Fail to recognize their success
  • 7.
  • 8. Reassurance is a natural parental response to a child’s distress  No reassurance » alone & insecure  Children with anxiety: ask for reassurance far more often » VICIOUS cycle  If the heavens are falling: no amount of kisses and hugs are too much, but for an excessive unjustified fear » child learns a wrong message
  • 9. Often it feels: “They could do it only if they tried a little harder” & it’s not easy NOT to become angry or frustrated on your anxious child  Anger More fright & anxiety
  • 10.  COPE method  Calming the nervous system  Originating an imaginative plan  Persisting in the face of obstacles  Evaluating and adjusting the plan
  • 11.  Stressful Situation Fight/Flight  Hard wired human response  We should not elicit the FF response for every trivial situation  Ways to calm the nervous sytem a) Abdominal Breath Control b) Sensory awareness :know your orange c) Personal Punching Pillow: Vent d) Know your heart Rate e) Paradoxical Paradigm (witch hairy, scary witch) f) Scale the fears g) Link it to an ouch (rubber-band around wrist)
  • 12. Vertical vs. lateral thinking  Writing stories (completion)  Functional freedom (uses of brick)  Mindless activities (don’t use in OCD)  You be me  Empty Chair  Successive approximation
  • 13.  Identify the problems  It’s not scary after all.  Glorify well intentioned mistakes  Model moderate risk taking  Negative vs Positive thoughts (write them down)  We got your back…
  • 14.  Plans are fluid  Let them have feedback on their own (photos/videos)  Charting success  Pretest vs post test
  • 15. Pass on your own fears. Letting them face challenges is better than overprotection  Leave perfectionism for your own self  ALWAYS REMEMBER Reflective listening is the key !!!!
  • 16. Based on the Cool Kids Program, developed by Ronald Rapee Ph.D. and group at Macquarie University Sydney AUS.
  • 17. Based on Cognitive therapy principles  Event “Iam waiting to be picked up from school, mom is late”  Thought : She could be dead  Evidence: its been only 10 minutes, (?) traffic, she was late twice before (never died), other kids are still there (not all parents could be dead)  Reorganized Realistic thought: She is running late, and will arrive soon
  • 18. Rewarding Brave, non anxious behavior (no matter how small a bravery: start from there)  Ignoring behaviors you don’t want  Modeling brave, non-anxious behavior
  • 19. Be Consistent (more so for an anxious child)  Keep your emotions in check  Distinguish between anxious and naughty: even if anxious some behaviors are not pardonable  Removal of privileges  Natural consequences are sometimes the best teachers
  • 20.
  • 21.  The MASTERPLAN 1) Empathize what your child is feeling 2) Re-label the problems (anxieties) as the worry brain 3) Rewire, act with smarts not with fears 4) Get body on board: deactivate alarms 5) Refocus: on what we need to do 6) Reinforce your child’s efforts at fighting
  • 22. Anxiety Disorders Association of America http://www.adaa.org/  Worry Wise Kids : http://www.worrywisekids.org/parents/paren ting_child.html  The Child Anxiety Network http://www.childanxiety.net/  Cool Kids Program Sydney Australia: http://www.kidsmatter.edu.au/primary/progr ams-guide/cool-kids-school-version/
  • 23. St. Louis Behavioral medicine Institute : 1129 Macklind Ave. Phone: 314-534-0200 http://www.slbmi.com/  Dr. Jennifer L Abel (Psychologist specializing in Anxiety disorders) 314 -721-7201 http://www.anxietystlouispsycholog ist.com/  Family Resource center 3rd floor in St. Louis Children’s Hospital : 314- 454-2350 http://www.stlouischildrens.org/con tent/familyresourcecenter.htm  Center for Cognitive Behavioral Therapy, St. Louis, Inc 314-576- 4900 http://site.cbt-stl.com/
  • 24.
  • 25. When I was young, I admired clever people. Now that I am old, I admire kind people. ~Abraham Joshua Heschel