Promoting Mental Wellness Through Self-Regulation Dr. Connie Coniglio Provincial Executive Director...

Promoting Mental Wellness Through

Self-Regulation

Dr. Connie Coniglio

Provincial Executive Director

Children and Women’s Mental Health and Substance Use ProgramAugust 19, 2014

Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders

Overview

• Prevalence of mental disorders• Anxiety among school aged children and youth• Causes, signs and symptoms of anxiety• How we all can help• General and targeted resources for educators


Prevalence Data

• Average overall community prevalence rate for mental disorders among children and youth in BC is 12.6% (Waddell et al., 2014)

• Approximately 84,000 BC children and youth will experience mental disorders causing significant distress and impairment to functioning at home, at school, with peers and/or in the community (Waddell et al., 2014)

• A multifaceted approach is required including universal programs for all children, targeted programs for children at risk and clinical programs for children with severe disorders


Prevalence of Mental Disorders in BC Waddell et al., 2014

Disorder Prevalence Approx # in BC

Any Anxiety Disorder 3.8% 25,300

ADHD 2.5% 16,600

Any Substance Use 2.4% 8,400

Conduct Disorder 2.1% 14,000

Major Depressive Disorder 1.6% 10,600

Any Autism Spectrum Disorder 0.6% 4,000

Bipolar Disorder 0.6% 2,100

Any Eating Disorder 0.2% 700

Schizophrenia 0.1% 300

Any 12.6% 83,700


Context

• Most mental disorders emerge during childhood or adolescence; 75% of all lifetime cases of mental disorders begin by age 24

• Mental health challenges are the most common health issues for teens and young adults in their early 20s

• Less than half of youth in BC with a mental disorder have accessed the help that they need

• Stigma is a serious barrier to help seeking for children, youth and their families


Reasons for not accessing mental health services (among youth who need them) McCreary

Society 2013

• Didn’t want parent to know 62%• Thought/hoped the problem would go away 60%• Afraid of what they would be told 41%• Didn’t know where to go 40%• Afraid someone I know might see me 34%• Too busy to go 29%• Didn’t think I could afford it 16%• Had prior negative experience 12%• No transportation 11%• Parent/guardian would not take me 9%• On a waiting list 4%• I could not go when it was open 3%• Service is unavailable in my community 2%


People who youth found helpful (among youth who sought help in the past year) McCreary

Society 2013

• Friend 73%• Family 69%• Teacher 41%• School Counsellor 27%• Doctor 25%• Sports Coach 23%• Other School Staff 16%• Nurse 10%• Youth Worker 8%• Social Worker 4%


Anxiety• Anxiety is the most commonly occurring mental disorder in children, youth and adults

• The 12 month prevalence for any anxiety disorder is over 12%; one in four Canadians will have at least one anxiety disorder in their lifetime

• All anxiety is characterized by intense fear, anxious arousal, irrational thinking and avoidance

• There are seven types of anxiety disorders in children and youth

Separation anxiety Social anxiety (school phobia) Generalized anxiety Panic Post traumatic stress disorder Obsessive compulsive disorder (OCD) Specific phobia


Anxiety

• 3 to 4% of individuals experience severe and chronic levels of anxiety

• Anxiety often co-occurs with other mental disorders, in particular depression

• Untreated anxiety in youth is a strong risk factor for depression and substance use in early adulthood

• Co morbidity = more disability and use of services later in life• Chronicity is linked to a 10 fold increase in the risk of suicide


Anxiety

• Anxiety is a hidden illness; sufferers are embarrassed, secretive and avoidant

• The rate of detection among GPs is well below 50%

• There is a service gap between need and resources despite the fact that anxiety is the most treatable of mental disorders


Anxiety Defined

• Anxiety is our body’s reaction to perceived danger or important events; it is instinctive and protective; it keeps us safe

• It is an internal alarm system, alerting us to danger and helping our body to prepare for it

• Everyone experiences anxiety from time to time; it can be adaptive

• When we are anxious it impacts our thoughts, body and behaviour

• It triggers the fight-flight-freeze response – our automatic response to help cope with danger


Causes of Anxiety in Children and Youth

• Anxiety disorders have multiple, complex origins including

GeneticsTemperamentEnvironment


Causes of Anxiety in Children and Youth

• Risk and protective factors can help improve understanding• Risk includes characteristics of the individual and their

environment; this includes poverty, poor housing, trauma• Protective factors help build resilience in the child; this can

include individual, familial and community factors• Key protective factors are support from a consistent adult,

good learning and social skills and a positive world view• Children and youth do best in communities where

neighbourhoods and schools function well and where they feel a sense of belonging or inclusion – sometimes referred to as “connectedness”


Anxiety and Self-Regulation

• As children develop, the regulatory skills become more sophisticated

• Self-regulation skills develop gradually; it is important that adults have developmentally appropriate expectations for children’s behaviour

• The growing edge of competency – those skills a child is ready to learn

• Understanding the balance between accepting/supporting and challenging

• For most children, self-regulation skills develop naturally; they have had opportunities to experience and practice with adults and capable peers


Anxiety and Self-Regulation

• For anxious children and youth, there are challenges with self-regulation

• It is critical to identify these children and to understand the anxiety that may drive impulsive behaviour, hypersensitivity to transitions, or overreaction to minor challenges or stressors

• Structure, predictability and enrichment provided by school can be helpful – the attuned, responsive teacher can make a huge difference

• It is also important to know when more intensive interventions are needed


Recognizing Anxiety

• Symptoms of anxiety in children and youth generally fall into four categories

ThoughtsBehavioursFeelings Physical symptoms


Recognizing Anxiety

• It’s normal for children to be anxious in situations like the first day of school, exams or presentations

• Anxiety becomes a problem when a child or youth is anxious in situations in which someone of the same age is not usually afraid

• Anxiety is also a problem if it does not get better with time

and significantly affects the life of the child and their family


Recognizing AnxietyThoughts Behaviour Physical Symptoms

Worrying about something bad happening

What if mom doesn’t pick me up from school?What if I throw up?Will everyone laugh at me?

Needles, death, health worries, future

Fighting, avoiding situations, people or objects

Looking for comfort or reassurance, clinging

Throwing temper tantrums

Crying

Trouble sleeping

Panic

Racing or pounding heart

Tummy ache

Sweating

Headache

Dizziness, light headed


When is it a Problem?• Anxiety becomes a problem when the child experiences fear or worry

even when there is no real danger or much less harm than they think; these fears may not make any sense to others or even to themselves

It is important to consider: the amount of anxiety the child is feeling the intensity level of anxiety how long it’s been going on how much the anxiety is getting in the way of how they function how distressing it is for the child and for their family when the anxiety happens too often and gets in the way of doing

things at home, at school, or with friends, it’s important to seek help


Helping Children and Youth with Anxiety

• Anxiety is the most treatable mental disorder – children, youth and their families can learn how to manage anxiety effectively, and these two key areas of treatment can help

1. Cognitive-Behavioural Therapy (CBT) focuses on how to:– relax– identify anxious thoughts and behaviours– challenge those thoughts and behaviours– replace them with more helpful thinking and behaviours

2. Medications can be useful in treating an anxiety disorder. They are mostly used with CBT– Parents can help by learning about anxiety and CBT. They can coach their child

in ways to relax, be brave and use positive self-talk to get through anxiety


Cognitive Behaviour Therapy

• First line, evidence-based treatment for children, youth and adults with anxiety

• Includes a variety of strategies to help a child or youth reduce anxiety, challenge anxious thoughts, and combat long standing avoidance behaviours

• Includes affective education, behavioural relaxation, cognitive restructuring, imagined and in-vivo exposure, modeling and rewards and behavioural parent training


Helping All Children with Anxiety

• Regular routines (morning, school, homework, bedtime)• Clear expectations, limits, and consequences that are realistic for the child’s age• Paying attention to the child’s feelings and helping the child identify them• Staying calm when the child is anxious (self-regulation)• Giving praise and reward even for small accomplishments• Planning for times that may be difficult (getting to school, returning to school after

breaks)• Showing the ways you identify your own feelings and solve problems• Modeling and encouraging healthy living habits, including:

regular physical activity a healthy and balanced diet getting a good night’s sleep stress management and relaxation healthy relationships community involvement social support


Classroom Strategies

• Create “safe space” for a child to go when feeling anxious or stressed; create guidelines for use of the space (time limits, etc.)

• Be aware of physical symptoms and provide calming activities• Teach relaxation and positive self talk• Talk about what can help• Allow for transitions (e.g. sitting quietly for a few minutes at the

beginning of the day; preparation to get started)• Create group activities to role play appropriate behaviours (e.g.

handling anger, stress, anxiety about tests)• Reward effort with anxious children and youth• Small group activities


Classroom Strategies

• Decrease situations that induce stress• Discuss alternate ways to handle situations (problem solving)• Establish daily routines with notification of changes• Play soothing music during down times• Incorporate exercise into the day• Break work into small manageable segments• Incorporate examples, stories, books about anxiety and

coping into the curriculum• For children who avoid school, negotiate shorter times at

school


Provincial Mental Health Resources

• Kelty Mental Health Resource Centre • Anxiety BC website (main site & site for youth)• mindshift anxiety app for teens• Anxiety Quick Reference Sheets for Children, Teens and

Parents• mindcheck.ca website• stop wondering, start knowing mental health school video

resource


Educator Strategies• Universal Resources

– FRIENDS for Life Program providing CBT skills for children in Grades 4/5 (MCFD)– SEL curriculum– Improved mental health literacy among educators and parents of children and

youth

• Targeted Resources– Early identification and intervention in school and community environments with a

focus on teaching CBT skills and referring appropriate children to more intensive supports

– Self help resources and tools like the mindshift app and mindcheck.ca for youth

• Clinical Resources– Referrals to MCFD Child and Youth Mental Health Teams in communities; tertiary

referrals for children with more severe mental disorders requiring specialized assessment and intervention


Educator Strategies

• Provide universal prevention programs for all children• Consider prevention as an upstream whole systems approach to

connectedness and engagement of children, youth and families• Provide mental health literacy for all adults who interact with

children and youth • Ensure mechanisms for early identification and intervention are

in place and coordinate services and programs with system partners in your community

• Provide evidence-based interventions (CBT as first line)• Establish meaningful partnerships with parents/families to

expand capacity and support children and youth


Targeted Educator Resources

• Orientation to Child and Youth Mental Health Services: A Guide for Teachers

• BCTF: Teaching to Diversity Parent Support• Teen Mental Health (teenmentalhealth.org)• BC FRIENDS for Life School Program• Mind Masters; MindUp• Kelty Mental Health Resource Centre• Mental Health Summer Institute


Thank You!!

Promoting Mental Wellness Through Self-Regulation Dr. Connie Coniglio Provincial Executive Director...

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