1. Meeting the Needs of
Children and Families
Anxiety Disorder
By: Jocelyn (De Plata) Shah

2. http://www.flickr.com/photos/pinksherbet/3372060864
There is a little girl in the center her name
is Faith. She become so anxious when
she finds stressful situation and she
struggles with self regulation. She is
seven years old and according to her
mother she has been diagnosed with
Anxiety Disorder but she did not specify
what types of anxiety Faith has.

3. What is Anxiety Disorder?
A generalized feeling of apprehension,
fear, or tension that maybe associated with
particular object or situation or may be
free-floating, not associated with anything
specific (Wood et al. 2011).
Anxiety disorder is a psychiatric condition
that may require medical or psychological
treatment (CMHO).
Children express their anxiety by
withdrawing from situations.

4. What can we learn about children with anxiety?
 http://www.youtube.com/watch?v=loR
C9T8qUGk

5. Causes of Anxiety in Children
 Separation Anxiety
 Fear of Change and the Unknown
 Traumatic Events
 Family and Home-Related Stressors
 Environment-Related Stressors

6. Signs of Anxiety in Children
 fearful of puppets or large dolls.
 displays excessive attention seeking or
jealousy with parent or main caregiver
 easily gets frustrated.
 experience recurrent headaches and/or
stomach aches.
 short attention span.
 experiences insomnia.
 experiences nightmares.
 displays excessive anger.
 experiences bedwetting.

7. How Common are Anxiety
Disorders?
Anxiety disorders are the most common
mental health condition in children and
adults. Roughly 6% of children and youth
have an anxiety disorder that is serious
enough to require treatment.
How long do they last?
Without treatment, some of the anxiety
disorders that begin in childhood can last a
lifetime, although they may come and
go(ementalhealth).
http://www.ementalhealth.ca/Toronto/Anxiety-Problems-in-Children-and-Youth-
Information-for-Families/index.php?m=article&ID=8872

8. Types of Anxiety Disorder
Video link:
http://www.glogster.com/babae/project-
glog-by-babae-anxiet-disorder/g-
6kruhe125pvmqf10cn0mua0

9. Generalized
Anxiety
Disorder
Separation
Anxiety (in Panic
children and Disorder with
youth). or without
Agoraphobia
Types of Anxiety
Disorder
Obsessive-
Compulsive Phobia
Disorder
Selective
Mutism

10. Generalized Anxiety Disorder
 Generalized Anxiety Disorder (GAD) is
an anxiety disorder. Children and
teens with GAD worry excessively and
uncontrollably about daily life events
(Anxiety BC).
 Girls are more likely to have GAD than
boys. In fact, 2 out of every 3 children
with GAD are girls (Anxiety BC).

11. Strategies for GAD
 Teach calming techniques such as taking
deep breaths, thinking of a quiet place,
counting to ten, and do yoga.
 Plan plenty of time for play. Inform the
child when there will be transitions.
 Provide a verbal and visual cue to
describe upcoming activity. For example
show pictures and say “Five more
minutes, then lunch time”.
Resource link:
http://www.anxietybc.com/sites/default/files/
hmgad.pdf

12. Panic Disorder
Unpredictable attacks of  Dizziness, unsteadiness,
acute anxiety that are lightheadedness or
accompanied by high fainting
levels of physiological  De-realization or de-
arousal and that last from a personalization
few seconds to a few hours
(Carlson & Heth, 2010).  Fear of losing control or
going crazy
Signs and Symptoms:
 Fear of dying
 Palpitations, increased
heart rate or pounding  Feeling of choking
heart  Chest pain or discomfort
 Sweating  Nausea or abdominal
 Trembling or shaking
distress
 Sensations of shortness
of breath or smothering

13. Phobia – an uncontrollable, irrational, and persistent
fear of a specific object, situation, or activity.
Social • Fear of social
situation
Phobia
Specific • Fear of spiders,
heights, blood
Phobias etc.

14. Specific phobia
 Situational phobias: types
claustrophobia (fear of close space)
and acrophobia (fear of heights).
 Fear of natural environment ex. Storm
and water.
 Blood/injection/injury phobia
 Animal phobias

15. Selective Mutism
 Anxiety that interferes with speaking in
certain situations, commonly school
(SickKids).
 Children with selective mutism have a
specific worry about speaking, but
only in the situations that make them
feel anxious (CMHO).

16. Obsessive-Compulsive Disorder (OCD) is an anxiety disorder
characterized by persistent intrusive ideas, thoughts, impulses or
images (obsessions) which often result in performing compulsive
rituals over and over again.
Typical Compulsions
obsessions include
Contamination (there are washing
germs all over you) organizing
Doubt (Did I turn off the
stove or the iron?)
Checking
Disturbing sexual and counting
religious thought
VIDEO:OCD http://www.youtube.com/watch?
v=izT40QNFXuM

17. Separation Anxiety – when an infant or toddler is anxious about
being away from her primary caregiver .
According to Anxiety BC “Separation Anxiety
Disorder has three peaks: between ages 5-6,
7-9, and 12-14”.
http://www.anxietybc.com/parent/separation.ph
p
Physical symptoms:
stomachaches, feeling sick to their stomach, or
even throwing up out of fear
Strategies: Making goodbye easier
Timing is everything
Practice
Be calm and consistent
Follow through on promises

18. How parents can help their child:
 Prepare the child for Transition to
school e.g. Visit the school with your
child in order to be familiarized with
the new environment, teacher and
other staff member.
 Encourage the child to make friends.
 Be consistent in the schedule or
routine.
 Set a realistic expectation and explain
to the child.

19. How early childhood educators
meet the needs of the child?
Provide adaptive learning environment.
Examples:
 Create a welcoming environment with
ample space without barriers.

20. Creating a Positive
Environment
Consider the following to create a
welcoming and positive environment:
 Physical Space
Consider the size and function of each
play area. Make sure that there is an
ample of space for the child to move
freely.

21. Change in the environment
 Accessibility
Consider the location and materials of
each play area. Make sure that the
children can reached them easily.
 Visibility
Use visuals to reinforce play area
expectations.
 Adding/Reducing Sensory Stimulation

22. Using Visual Aides
 Label routines by using pictures with words.
 use a maximum of six or seven visuals in
the sequence.
 label pictures with the exact words.

23. Label con’t
 labeltoys and toy shelves with
pictures of the items on them.

24. Use a Mini-Schedule
 providepictures for the main
steps required to complete the
task.

25. Visual of First/Then
 Is a transition or skill-building activity.
 Show the first/then board to the child
and name the activities while pointing
to the pictures.

26. Calming Activities
Breathing Exercise
Blowing up balloons Blowing out Birthday Candles
Physical Activities
Sticking Hands Tense and Relax
Stretching Yoga
Sensory Play
Listening Centre •Feeling Box Visual Centre

27. Con’t
 Follow the child’s lead and implement
activities that involved interaction.
 Keep consistent routines.
 Give warnings for transitions.
 Provide adaptive devices such as
calming music and activities.
 Collaborate and communicate with the
family about the children’s need.

28. Strategies to use to help the
child:
 Personal Stories
 Role Play
 Problem Solving/Brain Storming
 Positive Self Talk
 Story Book: Social Story
 Fun Games

29. Plan an intervention for children with
emotional and behavioral problem.
 Make sure activities are
developmentally appropriate and
based on the interest of the child.
 Get to know each child.
 Asks parents about children’s likes,
dislikes, and special interests.
 Get parents involved they know what
is best for their own child.

30. Anxiety Disorder Needs
Treatment
 Anti-anxiety medications: Selective
serotonin reuptake inhibitors (SSRIs).
Drugs that help regulate brain
chemicals, and cognitive behavioral
therapy (CBT).

31. Who can help the child with her
anxiety?
 Early Childhood Educator
 Therapist
 Psychologist
 Public Nurses
 Psychiatrist
 Family Doctor
 Pediatrician
 Behavioural Consultant
 Behavioural Interventionist
 Social Worker

32. Resources for Faith’s Parents:
Complete Home Toolkits
 http://www.anxietybc.com/parent/comp
lete_home_tool_kit.php
Includes:
Helping Your Child Face Fears:
Exposure
http://www.anxietybc.com/sites/default/fi
les/HelpChildFaceFears_2b.pdf
How to do Calm Breathing
http://www.anxietybc.com/sites/default/fi
les/calm_breathing.pdf

33. Meeting the Needs of the
Family
Helping Your Anxious Child Make Friends
http://www.anxietybc.com/sites/default/files
/HelpingYourChildMakeFriends.pdf
Helping Your Child Cope with Back to
School Anxiety
http://www.anxietybc.com/sites/default/files
/CopingwithBacktoSchool.pdf
Developing and Using Cognitive Coping
Cards
http://www.anxietybc.com/sites/default/files
/coping_cards.pdf

34. 1. Centre for addiction and Mental Health
 public hospital,
 Funded by Toronto Central Local Health
Integration Network (TC LHIN).
 accessible for people who have problems
with mental Illness or addiction.
 Serves children, youth, senior and supports
family.
 Provides multi-lingual resources. Follow this
link:
http://www.camh.ca/en/hospital/health_informat
ion/Pages/information_in_other_languages.asp
x

35. Referral process:
1. The referral could be completed by a
Family Physician or Psychiatrist.
2. Faxed to our intake fax line: 416-260-
4208.
3. The referral will be reviewed by our
Intake Coordinators.
4. Then it will be directed to the
appropriate clinic to book an
appointment for an assessment.
http://www.camh.ca/en/hospital/about_c
amh/who_we_are/Pages/who_we_are.
aspx

36. Contact CMHO
Canadian Mental Health Association,
Ontario
180 Dundas Street West, Suite 2301
Toronto, ON M5G 1Z8
416-977-5580
1-800-875-6213 (toll-free in Ontario)
Fax 416-977-2813
E-mail info@ontario.cmha.ca

37. SickKids
The Anxiety Disorders Clinic assesses and
provides individual or group treatment for
children ages four to 17. Diagnoses described
in the DSM-IV includes:
 Specific phobia
 Social phobia
 Generalized anxiety disorder
 Panic disorder
 Separation anxiety disorder
 Obsessive compulsive disorder
 Selective mutism
 Acute post-traumatic stress disorder

38. Referral
 Who can refer:
Pediatricians and family physicians.
 Parents can call to inquire about the
process but a physician's referral is
required.
 How to send your referral:
1. Send your completed referral via
ARMs, our on-line Ambulatory Referral
Management system or
2. Fax a completed referral form
(available in PDF format) to us at 416-
813-7361.

39. Treatment Recommendations:
 Information and advice for parents to
handle the problems without ongoing
professional support.
 Referral to a mental health
professional near where the family
lives.
 Ongoing treatment at Sick Kids.
Note: Waiting time for assessment
appointments is approximately 6
months.

40. 211
http://www.211ontario.ca/#context:m=QUICK&r=0&z=contextUrl:about
 Is a non-profit, community-based or
government organizations that provide
a direct service to the public (211).
 Compose of 56,000 agencies and
services.
 Service is open 24/7
 Available to all residents of ON with
150 languages.

41. Kids Mental Health
Children's Mental Health Ontario
(CMHO) represents and supports the
providers of child and youth mental
health treatment services throughout
Ontario.
 Consist of 80 community-based
children’s mental health center.
 Link for the list of community center:
http://www.kidsmentalhealth.ca/about_u
s/memberslist.php

42. Anxiety Disorders Association of
Canada
Is a registered Canadian non-profit
organization whose aim is to promote
the prevention, treatment and
management of anxiety disorders and
to improve the lives of people who
suffer from them (ADAC).
http://www.anxietydisordersontario.ca/

43. Mental Health Helpline
 is an organization funded by the
government.
Services:
 provide information about counseling
services
 listen, offer support and provide
strategies to help you meet your goals
 provide educational information
http://www.mentalhealthhelpline.ca/

44. Canadian Mental Health
Association Ontario
 is a non-profit, charitable organization.
 CMHA is to be the primary source of
information about mental health, mental
illness, and policy in Ontario.
 Population: Aboriginal, children & youth,
immigrants and refugees, women, and
seniors.
http://www.ontario.cmha.ca/about_mental_health.asp
?cID=23091
 closely with its 33 local branches in
communities across the province.
http://www.ontario.cmha.ca/branches.asp

45. Toronto Distress Centre
http://www.torontodistresscentre.com/about.shtml
24/7 Distress and Crisis Line
 Provide supports to those experiencing emotional
distress or in need of crisis intervention and suicide
prevention.
General Information
Distress Centres
Box 243, Adelaide P.O.
Toronto, Ontario M5C 2J4
Telephone: 416-598-0166
Email: Info@TorontoDistressCentre.com

46. Supporting the Families:
Centre for Addiction and Mental Health
Anxiety Disorders Clinic
100 Stokes Street, 4th Floor, Bell Gateway Building (Queen St. Location)
Toronto, Ontario, Canada, M5T 3L2
Director: Ash Bender, MD, FRCP(C)
Tel: 416-979-6819
Fax: 416-979-6853
Fees: OHIP-covered
Hospital for Sick Children
Anxiety Disorders Clinic
555 University Avenue
Toronto, Ontario, Canada, M5G 1X8
Director: Katharina Manassis, MD, FRCP(C)
Tel: 416-813-7464
Fax: 416-813-5326
Fees: OHIP-covered

47. Humber River Regional Hospital Sunnybrook Youth Anxiety Clinic
Adult Mental Health Program Department of Psychiatry,
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
2075 Bayview Avenue
Contact: Heather Wheeler, PhD,
CPsych Toronto, Ontario, Canada, M4N 3M5
Tel: 416-658-2003 Director: Sharon Reiter, MD,
FRCP(C)
Fax: 416-658-2009
Tel: 416-480-4098
Fees: OHIP-covered
Fees: OHIP-covered
Social Phobia Support Group of
Toronto http://www.martinantony.com/anxiety-
referrals
Toronto, Ontario, Canada
Contact 1: Earla L. Dunbar, Group
facilitator
Contact 2: Paul M. Rennie, Group
facilitator
Tel: 416-746-4819
Email 1: dunbarlamont@aol.com
Email 2: pmrennie@yahoo.com
Web: http://www.socialphobia.ca/

48. Free Resource Book
 http://www.martinantony.com/downloa
ds
Overcoming Animal & Insect Phobias: How to Conquer Fear of
Dogs, Snakes, Rodents, Bees, Spiders & More
By: Martin M. Antony, PhD, and Randi E. McCabe, PhD
Overcoming Medical Phobias: How to Conquer Fear of Blood,
Needles, Doctors, and Dentists
By: Martin M. Antony, PhD, and Mark A Watling, MD

49. References:
Canadian Mental Health Association
Ontario
http://www.ontario.cmha.ca/about_ment
al_health.asp?cID=23091

50. References:
http://www.flickr.com/photos/pinksherbet/
3372060864
http://www.anxietydisordersontario.ca/
http://connectability.ca/2010/09/23/using-
visuals/
Photograph by Jocelyn De Plata
Photograph by: Jocelyn De Plata

51. Anxiety Disorders Association of Canada.
http://www.anxietydisordersontario.ca/
http://www.anxietybc.com/sites/default/files/hmgad.pdf
http://www.martinantony.com/anxiety-referrals
Canadian Mental Health Ontario. Retrieved from
http://www.anxietyuk.org.uk/about-anxiety/young-people-and-
anxiety/generalised-anxiety-disorder-gad
http://www.youtube.com/watch?v=loRC9T8qUGk
Canadian Mental Health Association of Ontario.
http://www.ontario.cmha.ca/about_mental_health.asp?cID=23091
http://www.ontario.cmha.ca/about_mental_health.asp?cID=23091ttp://w
ww.ontario.cmha.ca/branches.asp

52. Carlson & Heath 2010. Psychology the science of behaviour. Pearson Canada Inc. Toronto,
Ontario
Centre for addiction and Mental Health
http://www.camh.ca/en/hospital/about_camh/who_we_are/Pages/who_we_are.aspx
http://www.camh.ca/en/hospital/health_information/Pages/information_in_other_languages.a
spx
Developing and Using Cognitive Coping Cards
http://www.anxietybc.com/sites/default/files/coping_cards.pdf
Helping Your Anxious Child Make Friends
http://www.anxietybc.com/sites/default/files/HelpingYourChildMakeFriends.pdf
Glogster http://www.glogster.com/babae/project-glog-by-babae-anxiet-disorder/g-
6kruhe125pvmqf10cn0mua0
Helping Your Child Cope with Back to School Anxiety
http://www.anxietybc.com/sites/default/files/CopingwithBacktoSchool.pdf
Helping Your Child Face Fears: Exposure
http://www.anxietybc.com/sites/default/files/HelpChildFaceFears_2b.pdf
Hogdon, L. (1995). Visual Strategies for Improving Communication. Quirk Roberts
Publishing.

53. http://connectability.ca/2010/09/23/calming-strategies-to-
use-with-children/
http://connectability.ca/2011/10/11/anxiety-for-young-
children-2/
http://www.anxietybc.com/parent/complete_home_tool_kit.
php
How common are anxiety disorder.
http://www.ementalhealth.ca/Toronto/Anxiety-Problems-in-
Children-and-Youth-Information-for-
Families/index.php?m=article&ID=8872
How Early Childhood Educators can help.
http://connectability.ca/2011/10/11/anxiety-for-young-
children-2/

54. How to do Calm Breathing
http://www.anxietybc.com/sites/default/files/calm_breathing.pdf
Kids Mental Health . http://www.kidsmentalhealth.ca/about_us/memberslist.php
http://www.kidsmentalhealth.ca/parents/anxiety.php#Selective Mutism
Mental Health Helpline. http://www.mentalhealthhelpline.ca/Home/About
Obssessive Compulsive Disorder. Retrieved from http://www.hc-sc.gc.ca/hl-vs/iyh-
vsv/diseases-maladies/anxiety-anxieux-eng.php
Panic Disorder. Retrieved from http://www.phac-aspc.gc.ca/publicat/miic-
mmac/chap_4-eng.php
Phobia. http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/anxiety-anxieux-
eng.php
http://www.sickkids.ca/Psychiatry/What-we-do/Clinical-care/Anxiety-disorders-
program/index.html

55. Separation Anxiety. Retrieved from http://connectability.ca/2011/10/11/anxiety-for-young-
children-2/
Separation Anxiety. Retrieved from
http://kidshealth.org/parent/emotions/feelings/sep_anxiety.html
http://www.anxietybc.com/parent/separation.php
Lisa classnotes
Sign of Anxiety in children. Retrieved from
http://connectability.ca/2010/10/28/what-is-child-anxiety/
Supporting the Families. http://www.martinantony.com/anxiety-referrals
Types of Anxiety Disorders. http://www.anxietycanada.ca/english/index.php
Toronto Distress Centre. http://www.torontodistresscentre.com/about.shtml
Using Visual Aides. Hogdon, L. (1995). Visual Strategies for Improving
Communication. Quirk Roberts Publishing.
http://connectability.ca/2010/09/23/using-visuals/
Wood et al. 2011. Generalized Anxiety Disorder. Pearson Education, In. Toronto,
Ontario
211 http://www.211ontario.ca/#context:m=QUICK&r=0&z=contextUrl:about
You tube-Videos
http://www.youtube.com/watch?v=i-jHGYWAFTQ
http://www.youtube.com/watch?v=OBbgw3mSwiU
http://www.youtube.com/watch?v=4RSdV9R8wXQ