ANXIETY IN CHILDHOOD

• Alison Marrelli LCSW

• Pinnacle Canyon Academy

• FALL 2019
 THINGS TO KEEP IN MIND:

• Kids don’t know how to say they are feeling anxious so they use other
symptoms to describe it.
• Kids get more anxiety from home than from school through anxious
parents, pressure to perform, stressful homes. But school has its own
pressures to perform and kids will feel more anxiety in difficult subjects.
• A lot of “escape behaviors” manifest from anxiety to perform a task, they
would rather be in trouble than fail to perform in front of their peers.
• Peers can cause anxiety when students have low self-esteem, those who
have higher self-esteem don’t mind failing in front of their peers and can
benefit from learning from mistakes but others with low self-esteem and
anxiety will resist even making an attempt.
Teachers can create anxiety by hyping up
testing and so it is best to use different
phrasing such as “checking for
understanding” and the teach back method
where possible.
SIGNS AND SYMPTOMS
WHAT TO LOOK OUT FOR?
•1in 4 children (possibly higher in our school) have anxiety. Early
intervention is best. High rate of comorbidity, other learning
disorders, is something to watch out for.

• Signs:
not wanting try, ebb and flow of anxiety at noticeable
consistent times. Consider why are some more likely?

• Typesof anxiety: separation, social, generalized, phobias, panic

attacks, selective mutism, Note: no longer is ptsd nor OCD included
in the new definition of anxiety.

• What is Eternalizing vs internalizing anxiety

• What
are behaviors that look like anxiety?
Examples
• Whatare some that don’t but you’re
aware of from experience personal or
professional: may include Refusal to
work, to make choices, to speak up,
codependency, paralysis, etc
FACES OF ANXIETY

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ASSESS

• What is really the problem? Treat the fire not the smoke.
Underlying fears, thoughts, triggers.
• What does anxiety look like? Internal v external.
• Learning to manage not rid kids of their feelings. Name,
Acknowledge and Validate. Adele Faber book.
• Lizard brain vs prefrontal cortex; fight flight freeze
• First step: identify. I am FEELING xyz. Emotion identification using precise
language and that they are not the problem/feeling. “my worry monster” Teach
them not to fear their feelings. (puppies on a path or colors: red vs green ways of
thinking)
• Use stories to teach them about their feelings and self control. Inuit people. The
kissing hand. Red string of love for separation anxiety. Use stories and
imagination.
• Teach relaxation. Square breathing. Belly breathing to engage diaphragm. ART
coping strategies. Body scan. Tense and relax story to teach progressive muscle
relaxation. Practice practice practice. Model model model.
• Question thought errors and absolutes Red thoughts and use Motivational
Interviewing to help them get to green thoughts. Don’t rescue them with your
own examples.
• The half-life on the Autonomic nervous system
https://www.practicewise.com/Portals/0/Demo/match/anxiety/flowchart.html
THOUGHT ERRORS: THE
DIFFERENCE BETWEEN FEAR AND
DANGER

• Transfer attention from threat to what can go right

• From red thinking to green
• Engage them but do not rescue: Whats happened before in this
situation? What’s the best thing that could happen? How can you
handle what might go less than perfectly?
• This is all patterns, all modeled behaviors that once worked in one
way or another. “The ways you learned to survive may not be the
way you want to continue to live. Heal and shift as you learn.”
• Everyone finds a way to function. Find the Mal-adaptive way
they are meeting needs and help flip it into a prosocial.
• Attention seeking: examples? What need is it meeting:
examples?
• Help kids determine why they have the need.
• Help classroom meet need in prosocial way. Refer to therapy so
counseling Dept can help family meet need in a prosocial way.
• Mal adaptive coping is easier. It’s harder to do prosocial methods
so resource the kid to be strong enough and to see that the benefit
outweighs it.
• Discipline NOT motivation.
• The hedonic calculus: if it feels good do it, if it feels bad don’t. We need
to associate this with motivation and then will understand that
motivation is fleeting and cannot be our foundation.

• What we need to teach kids is disciplined habits. It takes just a few

weeks to make a behavior a habit. We can undo Mal adaptive
functioning and install prosocial skills with supervision and motivational
interviewing.

• Motivational interviewing for students should have a visual component

to help kids absorb the information. Create an image with steps up to
where they are trying to get to from where they are now with steps in
between.
So what do we do?
ART, family therapy, assertiveness training, anger management, emotion wheel,
Adele faber book,
Teach families to let them fail, let them cope with mistakes as lessons learned.
“snowplow parenting” how does it differ from helicopter parenting?
Therefore, assertive children are more likely to be able to:
• identify their own feelings;
• speak up for themselves and others;
• avoid and respond to bullying;
• disagree respectfully;
• negotiate with others;
• say “no” without feeling guilty;
• build up stronger relationships;
• build confidence and self-esteem; and,
• feel in control.
Teaching Assertiveness
Teaching assertiveness early in life is very valuable as, generally speaking, assertive children grow up to be
assertive teens and adults. Here are some ideas for how you can teach your children to be assertive
Assertiveness training starts with you! Model assertive behavior when interacting with family members,
acquaintances, and others. At times, you will need to explicitly teach your child how to be assertive. If your
child is feeling left out at recess, teach him how to manage this situation. For example, you can coach him on
how to join in activities or games that he enjoys playing. You can also role-play different scenarios so your child
has an opportunity to practice being assertive.  Other traits to teach include: confident posture (body upright,
shoulders relaxed, relaxed facial expression, and good eye-contact), and listening without interrupting. 
Site https://www.melbournechildpsychology.com.au/blog/how-to-teach-children-to-be-assertive/

Researchers found that 9 percent of children whose families participated in a year-long therapy intervention
developed an anxiety disorderduring the study period, whereas 21 percent of children in a control group, who
received a pamphlet about anxiety disorders, developed an anxiety disorder during the study. In a third group, in
which families received neither written instruction nor therapy, 31 percent of kids developed anxiety.
The study included 136 families that had at least one parent with an anxiety disorder, and at least one child
between ages 6 and 13. Anxiety disorders include panic disorder, social phobias and 
generalized anxiety disorder, according to the National Institutes of Health. 
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2015.14091178
Empathy training:
he word "empathy" has become a "catch-all" term for three distinct processes:
1. Emotional sharing (also called "emotional contagion"), which occurs when we experience feelings of
distress as a result of observing distress in another individual
2. Empathic concern, which is the motivation to care for individuals who are vulnerable or distressed, and
3. Perspective-taking, the "ability to consciously put oneself in the mind of another individual and imagine
what that person is thinking or feeling." 
When we speak in everyday terms of someone being "very empathic," or showing "low empathy," we're
probably guilty of mixing up several distinct concepts.
Certainly, some individuals score high in all three areas, and others (a very small portion of the population)
may test poorly across the board. But it's common for people to experience these phenomena in varying
degrees -- and to change over time.
For instance, many young children show high levels of emotional sharing; demonstrate strong, but more
limited, evidence of empathic concern; and struggle with certain types of perspective-taking.
As they get older, their perspective-taking skills improve, especially when we provide them with opportunities
to practice.
They learn social norms about when and how show to empathic concern. They also learn about their own
emotional responses.
These experiences might lead to enhanced empathy for others, or the reverse. Children may learn to show
more responsiveness and caring, or less. It depends on the content of their lessons.
https://www.parentingscience.com/teaching-empathy-tips.html
Additional resources:
https://www.pbisworld.com/behavior-descriptions/anxiety/

https://pdo.ascd.org/LMSCourses/PD13OC003M/media/Special_Ed_CCSS_M3
_Reading1.pdf
https://www.youtube.com/watch?v=G0T_2NNoC68
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2015.14091178
https://www.youtube.com/watch?v=ZcDLzppD4Jc
https://www.youtube.com/watch?v=E9W3jZIgF_Y