This document summarizes a presentation given by Dr. Todd Kettner to the Kootenay Lake School District's DPAC meeting about recognizing and helping children overcome anxiety. It discusses how anxiety can get in the way of learning, social competence, and lifelong success. It provides information on the prevalence of anxiety disorders, symptoms of anxiety in children, classroom strategies to help students, and community supports. Key points covered include the role of emotional contagion, using relaxation exercises, structure and predictability in the classroom, and accessing supports from parents, schools, and community organizations.

1. Mastery and
Confidence
Kootenay Lake School District #8
Recognizing our children’s
Nelson, British Columbia
DPAC Meeting – School Board Office anxiety and helping them
February 28, 2013
Todd Kettner, Ph.D. , Registered Psychologist overcome their fears

2. We want our
children to:
Learn well
Be socially competent
Be successful in life
Other wishes for our children?
Copyright 2013 Todd Kettner, Ph.D. 250-505-7019

3. Anxiety gets in the way of…

4. Learning

5. The Prevalence of Anxiety Among Middle and
Secondary School Students in Canada L.Tramonte & D.
Willms. Canadian Journal of Public Health
2010;101(Suppl. 3):S19-S22.
Females had a higher prevalence of anxiety than males in
both middle and secondary schools in a nationally
representative sample. The prevalence of anxiety did not
vary substantially among schools for either middle or
secondary schools. Less than one half of Canadian
students can be considered “in flow.” That is, > 50% of
students feel confident in their skills and challenged in their
classes. Students who lacked confidence in their skills
were nearly twice as likely to experience anxiety.

6. Social Competence

7. Merkingas, Burstein, Swanson, et. al.
Journal of the American Academy of
Child & Adolescent Psychiatry. 2-1
Oct:49 (10):980-989.
5.5% of 13 to 18 year olds will have
Social Anxiety (a subtype of
anxiety) during their teens.

8. Lifelong Success

9. The risk for early-adulthood anxiety and depressive
disorders in adolescents with anxiety and depressive
disorders. Pine DS, Cohen P, Gurley D, Brook J, Ma Y.
Archives of General Psychiatry. 1998 Jan;55(1):56-64.
“An epidemiologically selected sample of 776 young people
living in upstate New York received DSM-based psychiatric
assessments in 1983, 1985, and 1992 using structured
interviews… In simple logistic models, adolescent anxiety
or depressive disorders predicted an approximate 2 to 3
fold increased risk for adulthood anxiety or depressive
disorders.”

10. DuPont, R. L., DuPont, C. M. & Rice, D. P. (2002). Economic costs of
anxiety disorders. In D. J. Stein & E. Hollander (Eds.). Textbook of
Anxiety Disorders. American Psychiatric Publishing:
Washington, D.C.
The Anxiety Disorders Association of Canada/Association Canadienne
des Troubles Anxieux presented to the Committee on Social
Affairs, Science and Technology in June 2003. They extrapolated
the annual cost of anxiety disorders in Canada to be $65 Billion (direct
and indirect). http://www.anxietycanada.ca/english/pdf/kirby.pdf
This submission also stated that anxiety disorders are the most
common mental health problem among Canadians with a 12% one-
year prevalence and >25% lifetime prevalence.

11. UNDERSTANDING ANXIETY
Approximately 40% of most psychological characteristics
(anxious/easygoing, optimistic/pessimistic) are genetically
related. This makes sense when we think of the heritability of
height, set-point for body weight, propensity towards heart
disease, risk of cancer and chance of alcohol misuse.
Once we consider the genetic factors, this leaves a huge
amount of variance left for modeling, socialization, and
learning.

12. Neuroanatomy of Anxiety

13. Prevalence of anxiety disorders
in children and adolescents
10% to 20%
Anxiety and Anxiety Disorders in Children and Adolescents: Developmental Issues and Implications for DSM-V.
Besdoo, Knappe, and Pine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018839/ Psychiatry in Clinical Practice North
America. 2009 September: 32(3); 483-524. Prevalence was found to be 15 to 20%. Note: Other studies have shown somewhat
lower prevalence rates.

14. Thoughts
Actions
Emotions
Managing our anxiety and depression AND improving our physical health outcomes

15. Anxiety
Some Examples

19. Main Types of Anxiety Disorders
Panic Disorder
Agoraphobia
Specific Phobia
Social Phobia (Social Anxiety)
Obsessive Compulsive Disorder
Posttraumatic Stress Disorder
Generalized Anxiety Disorder
Copyright 2013 Todd Kettner, Ph.D. 250-505-7019

20. RECOGNIZING WORRY
AND ANXIETY IN
CHILDREN AND TEENS

21. Physical Symptoms

22. Physical Symptoms
Crying Muscle tension Headaches
Stomach aches Nail biting Picking at skin
Fidgetiness Increased heart rate Sweating
Shallow breathing Dizziness Fatigue
Disrupted sleep Feeling of choking Feeling nauseas
Tightness in chest Trembling Numbness
Tingling sensations
Extreme anxiety can lead to hair loss, trichotillomania, rashes

23. Cognitive Symptoms

24. Cognitive Symptoms
Difficulty concentrating
Fear of illness – “I must be having a heart attack”
Fear of losing it – “I’m going crazy”
Fear of abandonment – “My girlfriend might leave me”
Fear of failure – “I’m going to flunk the exam”
Fear of rejection – “Nobody will like me at Trafalgar”
Fear of fear – “I know I’ll have a panic attack if I go the Bombers basketball
game”
Fear of criticism – “My teacher won’t like the story I wrote.” “My parents will
think the money they spent on my new hockey equipment was a complete
waste”
Fear of success – “I don’t want to try out for choir because my friends think I
have a good voice and if I made it, then I’d have to be on stage”
Fear of death
Fear of loss
Fear of catastrophe if something isn’t in the right order or sequence

25. Behavioural Symptoms

26. Behavioural Symptoms
Avoidance
School refusal
Skipping class
Dropping out of sports
Alcohol, pot, other drugs to avoid anxiety or other challenging emotions
“Losing homework”
Not wanting friends over
Refusal of overnights at friends, relatives, school trips, summer camps
Tantrums
Yelling
Sometimes even physical aggression – “had to drag him kicking and
screaming”
Copyright 2013 Todd Kettner, Ph.D. 250-505-7019

27. Emotional Contagion
Laughter
Emotional Contagion (Studies in Emotion and Social Interaction).
Hatfield, Cacioppo & Rapson. 1993. Popularized in Malcolm Gladwell’s
2002 Bestseller “The Tipping Point.”
Examples:
EMTs and ER nurses who calm their patients by talking calmly.
Parents and teachers who talk quieter in order to “infect” their loud and
boisterous children with their subdued volume.

28. Emotional Contagion
Anxiety and Stress

29. peers

30. parents

31. educators

32. Classroom Strategies
Helping our students gain mastery

33. Yerkes Dodson Law
Copyright 2013 Todd Kettner, Ph.D. 250-505-7019

34. Classroom Strategies
Teacher and peer
modeling

35. Classroom Strategies
Relaxation Exercises

36. Graduated Mastery
Classroom Strategies

37. Classroom Strategies
Structure and
Predictability

38. Classroom Strategies
Gentle Logic

39. Classroom Strategies
Tests

40. Help
Outside
the
Classroom

41. Parental Supports
Sleep hygiene
Exercise
Information
Resolve real issues
Referral for support
Copyright 2013 Todd Kettner, Ph.D. 250-505-7019

42. School Supports
Learning Support Teacher
School Counselor
Psychologist

43. Community Supports
Nelson Community Services
Child and Youth Mental Health
Private counselors
Family physician
Referral from family physician to
pediatrician

44. Photos credits (mostly from Flickr)
1. Anxious Teen by Holly
2. Learning by woodleywonderworks
3. Social Competence by Purhoor Photograpy
4. Lifelong Success by Jorge Franganillo
5. Amygdala - unknown
6. Spider by Dincordero
7. Spider on eye blog.ericlamb.net
8. Beach by Zanzibar
9. Yerkes Dodson – secretgeek.net
10. Scared Child by Espon Faugstad
11. Distressed Teen in Car by PLCjr
12. Peers by teapics
13. Parents by phub.com.au
14. Educators – apa.org
15. Classroom by horizontal.ingegration
16. Counselor in chair by Parker Knight
17. Staircase by Gwenael Piaser

45. Anxiety BC’s Excellent Website
Resources. Results. Relief.
Information for
Children, Teens, Parents, and Adults
http://www.anxietybc.com/

46. Resources for Teachers:
Fostering Resilience in Students
with Mental Health Issues
http://keltymentalhealth.ca/education

47. Handouts for:
Relaxed Breathing
Building Social Confidence
Overcoming Fears
Progressive Muscle Relaxation
http://youth.anxietybc.com/resources

48. Empirically Validated Quick
Screening Measures for:
Depression
Anxiety
Stress
Alcohol Use
Social Anxiety
Drug Use
http://www.mindcheck.ca/mood-stress

49. QUIZ
1. What three main things did we discuss that anxiety gets in the
way of for our students? (must name all 3 for 2 points)
2. True or false. A recent student published in the Canadian Journal
of Public Health showed anxiety is more prevalent among female
than male students. (1 point)
3. One studied showed adolescent anxiety or depressive disorders
predicted a ____ risk of adult anxiety or depressive disorders.
a) 50% b) 100% c) >200% (1 point)
4. Explain emotional contagion and the role it plays in the
maintenance of anxiety in students. (3 points)
5. Which two of the classroom strategies discussed do you feel is
most important or relevant to your students? Why? (2 points)
Copyright 2013 Todd Kettner, Ph.D. 250-505-7019