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SUPPORTING STUDENTS WITH ANXIETY DISORDERS Myque Harris, MS, LCPC Tennessee State University Loyola University, 2005 Licensed Clinical Psychotherapist, 2007 Psychiatry Clinic, Private practice, School based mental health

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VIDEO: IN THEIR OWN WORDS... http://www.youtube.com/watch?v=4VbxjsO9IYI&feature=colike http://www.youtube.com/watch?v=4VbxjsO9IYI&feature=colike http://youtu.be/Rcy2jF1EXjk http://youtu.be/Rcy2jF1EXjk Cleansing Breath Today we will talk about Anxiety and ADHD with a primary focus on anxiety. Discuss inattention/impulsivity and acknowledge possible root in anxiety or ADHD

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ANXIETY Anxiety is the most common, chronic, costly emotional disorder in the U.S. (NIHM) for both Children and Adults 25% of Adults Children age 8 (25.7%); Age 17 (21.4%) Women vs. Men More likely to affect females (Social Anxiety is equal) Comorbid with Depression and ADHD GAD and depression more common Why? BOTH Nature (40%) AND Nurture (60%) play a part 3 main ingredients MYQUE HARRIS, MS, LCPC 3

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3 INGREDIENTS IN ANXIETY Biological Sensitivity Research in infants shows biological sensitivity from birth; Over sensitive to stimuli (sounds, odor, touch) Temperament can be ID as early as 4 months to show which babies will be more likely to have anxiety Stress Overload Correlation between Stress and Anxiety School months verses summer months Personality Traits People with Anxiety have similar traits Further lookNext slide... MYQUE HARRIS, MS, LCPC 4

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ANXIETY DISORDERS DSM-IV General Anxiety Disorder Separation Anxiety Obsessive Compulsive Disorder Obsession: intrusive thoughts or images, associated with negative feelings Compulsion: Ritualized behavior, checking, counting, hoarding Panic Disorder Overanxious Disorder Social Anxiety Disorder Phobias Post Traumatic Stress Disorder (PTSD) Anxiety due to medical issues (allergies, Crohns) Obsessive Personality Disorder (Personality Disorder vs. an Anxiety disorder) MYQUE HARRIS, MS, LCPC 5

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WHAT IS ADHD? MYQUE HARRIS, MS, LCPC 6 The inability to maintain focus and manage internal (thoughts) and external (noise) distractions; organize, sequence and make things happen, inhibit impulses and issues in some memory function. Types of ADHD Predominately Inattentive (ADD) Predominately Hyperactive- Impulsive Combined type ADHD NOS 6 symptoms, 6 months, 2 or more settings Before the age of 7 years

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AttentionProcessingComprehensionMemory There is a breakdown in the area of attention This breakdown prevents complete and accurate processing of information, comprehension, and recall Barrie Morganstein, Ph.D. & Trey Ishee, Psy.D.

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DIFFERENTIAL DIAGNOSES Anxiety Stress and worry can also cause poor attention and distractibility prevents information from accurately and completely entering the brain. Anxiety and low self-esteem can also cause children to hesitate in responding which can look like comprehension difficulties or verbal apraxia.

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ANXIETY AttentionProcessingComprehensionMemory Anxiety can also cause breakdowns in the areas of attention and processing, but can also cause breakdowns further along the process and disrupt communication in a variety of ways

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BRAIN PARTS AND FUNCTIONS MYQUE HARRIS, MS, LCPC 10

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BRAIN STRUCTURES MYQUE HARRIS, MS, LCPC 11

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YOUR BRAIN ON ANXIETY Model of the brain Functions MYQUE HARRIS, MS, LCPC 12 Brainstem: Connects to the spinal chord Heart rate, breathing, sleeping, eating Cortex: Multi-layered, complex Pre frontal lobes: Logic, fore thought, planning, mindful choices Fully develops in our 20s Limbic Region: Emotion, behavior, motivation, long term memory, olfaction Amygdala: Part of the limbic system Processes strong emotional, such as fear, anger, anxiety Acts as a smoke alarm Alarm System Next slide for visual

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EMOTIONAL HIJACKING! MYQUE HARRIS, MS, LCPC 13

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NEURAL STATIC AND IMPRINTING Neural Static Brainstem and limbic system hijack the brain and body (fight, flight or freeze) and temporarily create static in the brain that inhibits the brain from functioning We are not (literally) thinking clearly and using all of our resources Imprint neural firing patterns Similar situations, Alarm systems warns us, but makes errors Values speed over accuracy Hebbss axiom: Neurons that fire together wire together MYQUE HARRIS, MS, LCPC 14

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EXPLICIT AND IMPLICIT MEMORY Explicit (Aware) and Implicit (Unaware) Memory These memories affect and influence future experiences WOMENS BUG STORY Fearful memories are attached to an/a: 1. Informational component (Nobody likes me!; Im not smart enough to do math!) 2. Energy/Emotional component (Helplessness, sadness, confusion) 3. Negative conclusion or message about self (Ill never have friends; I will fail math and there is nothing I can do about it.) MYQUE HARRIS, MS, LCPC 15

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THE ALARM SYSTEM Jobs: at risk alerted Imprints experiences in which we have felt at risk so we can be alerted to similar experiences in the future. *Note: Usually in childhood these experiences are perceived as very intense because of the vulnerability, naivety and lack of experience of children. MYQUE HARRIS, MS, LCPC 16

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PERSONALITY TRAITS COMMON TO ANXIOUS STUDENTS MYQUE HARRIS, MS, LCPC 17 Looks like a model student? Responsible Prefers structure Likes to please Avoids conflict Perfectionism Worry Difficulty relaxing Low assertiveness Positive Cooperative Motivated Student Thoughtful/Reflective Negative Higher Stress/Anxiety levels Personalizes makes things about them Easily exploited

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TYPICAL WORRIES, AGES 7-15 MYQUE HARRIS, MS, LCPC 18 School performance Appearance Social Acceptance Peer relationships Death of a parent Global/Societal Issues Violence, hunger, poverty, economy Refer to Developmental handout

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HOME Major transitions (i.e. moving) Divorce of parents Parents Illness Unstable Parent (Mood, lack of presence, etc.) Inconsistent home structure Families create anxiety in children MYQUE HARRIS, MS, LCPC 19

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SCHOOL RELATED ANXIETIES Text Anxiety a specific phobia (Handout) Symptoms Excessive or unusual fear, tension, apprehension, somatic arousal. Can occur before, during or after exam Concentration, problem solving and creative thinking are affected. Associated with some major concern about performance Fear of Anxiety symptoms MYQUE HARRIS, MS, LCPC 20

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FEAR OF ANXIETY SYMPTOMS MYQUE HARRIS, MS, LCPC 21 Students can have anxiety about have anxiety Fear of embarrassment Fear of losing control I dont know whats wrong! Teary; embarrassed Cycle created

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Somatization MYQUE HARRIS, MS, LCPC 22 Gastrointestinal (GI) Issues Headaches Aches and Pains Wrist and knee braces Internalizing Anxiety These issues can be real or imagined. Many anxious students develop real health issues because of how they internalize their anxiety.

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Supporting children and families dealing with anxiety MYQUE HARRIS, MS, LCPC 23 WE CAN HELP!!! Children can Learn new patterns Develop new coping skills Understand new concepts Change patterns in thinking

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THERAPY: STUDENTS AND FAMILIES MYQUE HARRIS, MS, LCPC 24

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COUNSELING TECHNIQUES Counseling Other MYQUE HARRIS, MS, LCPC 25 Cognitive Behavior Therapy (CBT) Rational Emotive Behavior Therapy (REBT) Talk Therapy Play Therapy Art Therapy In-Vivo (exposure) Therapy Mindfulness Medication Food restrictions Reducing caffeine Supplements Relaxation and Breathing Techniques Sleep hygiene Nutrition

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HOW PARENTS/TEACHERS CAN HELP Recognize signs of a possibly anxious child/student Equip that child/student with skills they can use at home or in the classroom or in social situations (Stop-Think- Reflect-Choose) Make accommodations when needed (Tell child/students what will happen on a trip, the morning of the outing) Communicate with teachers/parents about observations Help students understand how to recognize a different perspective Integrate specific techniques into your home or classroom routine (Breathing, reflecting, relaxation) MYQUE HARRIS, MS, LCPC 26

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HOW PARENTS/TEACHERS CAN HELP FEAR THERMOMETER Parents/Teachers can MYQUE HARRIS, MS, LCPC 27 Listen to the students perspective or send them to an adult who has the time to listen MO rate their feeling, ask why 5? Catch it early: Use techniques to calm kids before they cross over Feeling vocabulary Help kids understand where they feel their feelings in their bodies Talk therapy can be free!!!! Use it at home or in school!!! 9 I cant take it! 7 Im very uneasy 1- Im A Ok! 5 Im a little uneasy

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TECHNIQUES 3s Signals, Source, Solutions/Skills Stop-Breath-Reflect-Choose Worry Box Worry Time Breathing In and out through nose (Para sympathetic nervous system) Managing Test Anxiety (or specific subject, Math) Relaxation Techniques (Progressive muscle relaxation) Redirect thinking Mini CBT FAFL Face, Accept, Float, Let time pass MYQUE HARRIS, MS, LCPC 28

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RELAXATION TECHNIQUES Music Breathing Nostril breathing Belly breathing Stillness Practice being still, increase time Meditation, Chanting Physical practice Yoga MYQUE HARRIS, MS, LCPC 29

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PROGRAMS Life Skills Program for Anxiety in Kids Reduce stress (adjust schedules, Time management Skills Adjusting parenting and home structure Sleep Hygiene Feelings support work Having reasonable goals (At School and Home) Relaxation Techniques MYQUE HARRIS, MS, LCPC 30

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YAY! PROGRESS More Relaxed Less worry Increased positive outlook Higher self esteem Risk tolerance is higher Better social skills MYQUE HARRIS, MS, LCPC 31

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QUESTIONS MYQUE HARRIS, MS, LCPC 32

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REFERENCES Foxman, P. The Worried Child: Recognizing Anxiety in Children and Helping Them Heal, 2007 Fralich, Terry, Cultivating Lasting Happiness: A 7-Step Guide to Mindfulness, 2007 Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition National Inst. Of Mental Health MYQUE HARRIS, MS, LCPC 33