Parenting an anxious child
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Parenting an Anxious ChildWhat parents should know
Fellow Lecture SeriesMarch 9th 2011
Pallav Pareek M.D.
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References
Freeing Your Child From Anxiety by Tamar E Chansky Ph.DHelping Your Anxious Child (A step by step guide for parents) Rapee et.alYour Anxious Child : John S DaceyHandbook of Clinical Family Therapy
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What is anxiety? Is it abnormal? 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 triggerb) Intensity: exceeds pt’s capacity to
bear c) Duration: persistent rather than
transientd) Behavior: avoidance or withdrawal
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Is Anxiety = Fear
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.
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Anxiety Disorders (family of)
Simple Phobia, Social Phobia, Agoraphobia
Panic Disorder, Generalized Anxiety Disorder
Separation Anxiety Disorder
Post Traumatic Stress Disorder, OCD
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Characteristics of an anxious child
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
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Parenting: what NOT to do?????
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Too much Reassurance
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
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Becoming Impatient
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
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Parenting : Approach #1
COPE method Calming the
nervous system Originating an
imaginative plan Persisting in the
face of obstacles Evaluating and
adjusting the plan
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Calming the nervous System Stressful Situation Fight/Flight Hard wired human response We should not elicit the FF response for every
trivial situation Ways to calm the nervous sytema) Abdominal Breath Controlb) Sensory awareness :know your orangec) Personal Punching Pillow: Ventd) Know your heart Ratee) Paradoxical Paradigm (witch hairy, scary witch)f) Scale the fearsg) Link it to an ouch (rubber-band around wrist)
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Inoculate Imaginative thinking 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
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Persistence
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…
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Evaluating the PLAN
Plans are fluid Let them have feedback
on their own (photos/videos)
Charting success Pretest vs post test
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Don’t !!!
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 !!!!
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Parenting: Approach #2
Based on the Cool Kids Program, developed by Ronald Rapee Ph.D. and group at Macquarie University Sydney AUS.
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The Detective approach
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
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Helpful ways to handle anxiety
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
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Important principles
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
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Use Stepladders
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Freeing your child from anxiety
The MASTERPLAN1) Empathize what your child is feeling2) Re-label the problems (anxieties) as
the worry brain3) Rewire, act with smarts not with
fears4) Get body on board: deactivate
alarms5) Refocus: on what we need to do6) Reinforce your child’s efforts at
fighting
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Online Resources
Anxiety Disorders Association of America http://www.adaa.org/
Worry Wise Kids : http://www.worrywisekids.org/parents/parenting_child.html
The Child Anxiety Network http://www.childanxiety.net/
Cool Kids Program Sydney Australia: http://www.kidsmatter.edu.au/primary/programs-guide/cool-kids-school-version/
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Resources: Local to the Lou 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.anxietystlouispsychologist.com/
Family Resource center 3rd floor in St. Louis Children’s Hospital : 314-454-2350 http://www.stlouischildrens.org/content/familyresourcecenter.htm
Center for Cognitive Behavioral Therapy, St. Louis, Inc 314-576-4900 http://site.cbt-stl.com/
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QUESTIONS?
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धन्यवा�द
When I was young, I admired clever people. Now that I am old, I admire kind people. ~Abraham Joshua Heschel