1. Understand Stress and A i t
U d t d St d Anxiety
In Children, Teens and Adults
Presented by:
James Korman, PsyD, ACT
Michael Likier, PhD
Jamie Schwartz, LCSW

2. Caused or Exacerbated by Stress
Adults
• Heart disease
H t di  Chronic i
Ch i pain
 Diabetes  Migraines
 Asthma  Ulcers
 PMS  Heartburn
 Obesity  High blood pressure
 Infertility  Skin problems
 Autoimmune diseases  Irritable bowel syndrome

3. Emotional Reactions
Adults
 Feeling
F li angry, irritable or easily frustrated
i i bl il f d
 Feeling overwhelmed
 Feeling nervous or anxious
 Feeling that you can’t overcome difficulties in your life
 Having trouble functioning in y
g g your j or personal life
job p
 Feeling afraid or worried
 Feeling Helpless or Hopeless
 Desire to hide or runaway

4. Cognitive Reactions
Adults
• Difficulty Making Decisions
• Confusion
• Difficulty Naming Familiar Items
• Poor Concentration
• Blaming Others
• Memory Problems
• Replaying Events Over & Over
• Thinking the Future is bad

5. Behavioral Reactions
Adults
• Difficulty functioning at work or home
• Withdrawal
• Isolation
• Suspiciousness
S i i
• Working more and being less productive
• Excessive Humor or Silence
• Increased Smoking, Alcohol or Food
• Change in Activity Level
g y
• Angry Outbursts
• Crying Spells
• Sleep

6. Reactions to Stress
Small Children (under 5)
 Throwing temper tantrums
 Yelling and pouting
 Experiencing nightmares
 wetting the bed
 Clinging on to parents
 Thumb sucking or sudden fear of the dark
 Crying more than they usually do
 Rocking from side to side and biting people

7. Reactions to Stress
5 – 9yrs of age
• Feel lightheaded • Aggressiveness and a
tendency to back answer
• Changes in appetite are
recorded • Having p
g panic attacks
• Stuttering • Not interested in the normal
day to day activities
• Complaining of stomach
problems and headaches • Crying
• Experience restlessness • Become accident prone
• Moody and withdrawn

8. Reactions to Stress
10 – 12yrs of age
• Biting nails, clenching fists, • Exhibit destructive behavior
hair twirling like bullying others
• Develop new fears and • They seem worried at all
worries
i times
ti
• Skipping school often • Having panic attacks
• Loss of concentration • They might seem lazy and
not interested in things
g
• School work starts to
deteriorate

9. Reactions to Stress
Teens
• The majority of their reactions are on an emotional level:
 Worried and anxious
 Depressed
 Negative thoughts and feelings
 Lose vitality and self-confidence
 Argumentative
 Fights against anything and anyone
 Skip school
 Drugs and alcohol

10. Objectives
j
• What is stress?
• How does it Manifest in Children teens
Children,
and young adults
• What is Anxiety?
• What can be done about stress and
anxiety

11. What is Stress?
 Stress is a normal component of the body’s response
body s
to demands that are placed on it.
 When demands are in balance with your coping
abilities and resources you do not feel stressed.
 When demands are greater than your coping abilities
you feel stressed.

12. Sources of Stress
The Good The Ugly
Family verbal/physical
Promotion to next
violence
grade
The Bad Sexual Abuse
Graduation
Overscheduled Death of family
Getting in to the
g
Tough classes member
musical
Moving Divorce
Meeting new friends
Sibling Ri l
Sibli Rivalry Bullied
Having a new
girl/boyfriend Peer Pressure
Bad Teacher

14. The Stress Response is
the Body’s 911 System

15. Fight or Flight Reaction
• Productive if you were in a situation where you need
to protect yourself

16. It is a Matter of Perception
 Stress and its associated physical reactions is your
body preparing itself for a threatening situation
 Wh we perceive Th t we prepare ourselves f
When i Threat l for
action
 Very rarely a ac ed by Bears so threat is now:
e y a e y attacked ea s ea s o
 Social
 Emotional
 Financial
 Work related

17. Stress is Good in Small Doses
 Gives you a burst of energy when you need it
I
Increases your motivation to complete tasks
ti ti t l t t k
 Protects you from harm
 Prevents you from walking down a dark alley way at
night

18. Stress Can be Bad
"© copyright Mental Health America
© America"

19. Anxiety?
• A Fight or Flight Reaction
• Worry or Concern
 Often concern about the physical reaction
or its meaning (Perception)
 Fear
F
 Panic
• Avoidance

20. Understand Stress and A i t
U d t d St d Anxiety
In Children
Presented by:
Jamie Schwartz, LCSW

21. What is Stress vs Anxiety
y
All children experience anxiety when faced with an
unfamiliar or stressful situation such as:
• Illness
• Death
• Parental Separation
• Divorce
Di
• School Issues
• Social Issues

22. Developmentally Appropriate Stress and
Anxiety
• Infancy 0-2 years
 Separation Anxiety
S ti A i t
 Stranger Anxiety
• Early Childhood 3-6 years
Ghosts and monsters
Darkness
Doctors and Hospitals
Sleeping Al
Sl i Alone

23. Developmentally Appropriate Stress and
Anxiety
• Middle Childhood
-School Performance
-Social competence
• Adolescence
-New Experiences
-School Performance
-Social Competence

24. Types of Childhood Anxiety Disorders
• Generalized Anxiety Disorder (GAD)- Affects 3 to 4
percent of children. E
t f hild Excessive worry and anxiety th t
i d i t that
lasts at least 6 months.
• Social Phobia-Subtype of specific Phobia. Child is
extremely shy or uncomfortable around people or
situations where performance is the focus.

25. Types of Childhood Anxiety Disorders
• Separation Anxiety Disorder (SAD)-
Having difficulty separating from caregivers or home.
Those with SAD have this problem for at least 4 weeks.
• Obsessive Compulsive Disorder-
Display recurrent obsessions or compulsions that are
severe enough to be time consuming and interfere with
their daily living.

26. What are the signs of anxiety in children?
• Distress out of proportion to the situation
 Crying, sadness, anger, frustration, hopelessness,
embarrassment especially in stressful situations
p y
• Repetitive reassurance questions
• Physical complaints (headache, stomachache, too sick
to go to school)
• Anticipatory anxiety
• Difficulty with sleep

27. Signs of Anxiety
• Perfectionism
• Overly responsible, unnecessary apologizing
• Excessive avoidance
• Disruptions of child or family functioning
• Excessive time spent consoling child about distress with
ordinary situations

28. Parental Intervention
• Understand the Illness
• Listen to your child’s feelings
• Redirectingg
• Be careful how you describe
• Set up Worry Time
p y
• Relaxation Techniques

29. Professional Intervention
• Cognitive Behavioral Therapy
g py
• Medication

30. Understand Stress and A i t
U d t d St d Anxiety
Teens and Adults
Presented by:
Michael Likier, PhD

31. Adolescence
• Begins at p
g puberty, ends with
y
assumption of adult roles.
• Physical, Cognitive, Social/Emotional
Development.
• Stress and anxiety can be problematic
on each of these domains.

32. Physical Challenges
y g
• Puberty onset age 10-12 girls,13 boys.
y g g y
• Early onset boys > girls.
• Idealized body image
image.
• Emerging sexuality.
• Awkward development.
• Curiosity of alcohol and other drugs.
y g

33. Physical Challenges
Healthy Stress/Concern Unhealthy Stress/Anxiety
• Thoughts, expressions of • Chronic self-critical
concern about bodyy thoughts regarding
g g g
type/shape/size, physical physical appearance.
features. • Interference with
• Desire taking steps to
Desire, social/academic life
life.
improve physique, eating • Extreme, abrupt changes
habits. in eating/exercise habits.
g
• Sudden weight loss/gain.
• Diet pills, steroids.

34. Sex and Drugs
g

35. Sex and Drugs
Healthy Stress/Concern Unhealthy Stress/Anxiety
• Curiosity • Interfering with social or
• Exploratory thoughts and academic performance
p
behaviors • Risky sexual behavior
• Struggles around • Any use of cigarettes,
cigarette, alcohol and
i tt l h l d alcohol, other d
l h l th drugs? ?
other drug use • Use that interferes with,
• Struggles around sexual causes negative changes
behaviors in functioning
• Questioning one’s sexual • Fear of sexual orientation
orientation • Bullying

36. Cognitive Development
g
• Imaginary audience: “everyone’s
g y y
watching me”
• Personal Fable: “nobody feels like I do”
nobody do
• Idealism
• A
Argumentativeness
t ti
• Over/underachievement

37. Cognitive Development
Healthy Stress/Concern Unhealthy Stress/Anxiety
• “I can’t go outside with • Withdrawal from activities
this pimple”
p p & peers. ( y
p (Cyberspace)
p )
• “Nobody understands • Depressive symptoms
me” • Obsessive worrying
• “Y ’ such a h
“You’re h hypocrite”
it ” • Incessant arguing
• “I want to do my best at • “I must excel at
all things”
things everything and it’s awful if
it s
• “Why do I have to do my I don’t”
best at all things” • “I don’t care whether or
not I do well”

39. Socioemotional Development
• More complex self understanding
p g
• Peer influence
• Self-esteem
Self esteem challenges
• Gaining skills for independence:
academic, career
d i
• Cultural Identities

40. Social/Emotional Development
p
Healthy Stress/Concern Unhealthy Stress/Anxiety
• Questioning: values, • Chronic arguing
career, religion • Pattern of risky, self-
y,
• Seeking peer over defeating behaviors
parental approval • Hopelessness around
• Concern over ability to adulthood
choose a career • Self downing
• Moodiness • Abrupt negative
• Changing friends, changes re: peers,
styles,
styles interests activities

41. Young Adulthood
The role of the parent is to
launch the child into
adulthood…

42. Challenges Entering College/World of Work

43. Challenges Entering College/World of Work
g g g
Healthy Stress/Concern Unhealthy Stress/Anxiety
• Expressions of doubt • Failing classes
• Adjustment struggles • Losing jobs
e.g., d
dorm, campus, • Increase in alcohol
workplace and/or other drug use
• Feeling overwhelmed • Obsessive thoughts
• Financial concerns • Social withdrawal

44. Tips for Parents
• Encourage independence/stay
connected
• Encourage p
g participation in
p
extracurricular activities
• “I” v “You” statements
I v. You
• Active listening
• E
Encourage freedom to disagree
f d t di
• Natural consequences

45. Cognitive Distortions
g
• ways that our mind convinces us of
something that isn’t really true.
• usually used to reinforce negative thinking or
emotions.
• EVERYBODY uses these at times.
• They become problematic when they lead to
depression, anxiety, etc.
• Parents and teens can learn to identify and
change them.
h h

46. Cognitive Distortions
Distortion Reasonable Thought
• All or N thi
Nothing • Sh d of G
Shades f Gray
“If you don’t get straight A’s “Strive to do the best you
your future will be bleak can,
can grades are not the
• Mind Reading sole determinant of your
“Jenny ignored me, she
y g future”
must be mad at me” • Get the Facts
• Overestimating Risk “I wonder why Jenny didn’t
“I’ll never b able t pass
be bl to say hi?
hi?”
that class” • Real Odds
“The only time I’ve failed a
y
class is when I didn’t do
the work”

47. A Word on Medication
• Cognitive Therapy (CT) is the recommended
treatment for anxiety.
• Medication may be helpful with CT.
• SSRI may be used for children and
adolescents.
• Benzodiazapines are not recommended for
children.
• Consult with a psychiatrist if child is not
responding to CT
di CT.