1. Improving Understanding and
Supports for Children and Youth with
Anxiety and Mental Disorders
Dr. Connie Coniglio
Provincial Executive Director
Children and Women’s Mental Health and Substance Use Program
February 18, 2014

2. 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

3. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Prevalence Data
• Average overall community prevalence rate for mental
disorders among children and youth in BC is 15% (Mheccu, 2002)
• Approximately 140,000 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(Mheccu, 2002)
• 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

4. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Prevalence of Mental Disorders in BC
Mheccu, 2002
Disorder Prevalence Approx # in BC
Any anxiety disorder 6.5% 60,900
Conduct disorder 3.3% 30,900
ADHD 3.3% 30,900
Any depressive disorder 2.1% 19,700
Substance use 0.8% 7,500
Pervasive DD 0.3% 2,800
OCD 0.2% 1,900
Schizophrenia 0.1% 900
Tourettes 0.1% 900
Any eating disorder 0.1% 900
Bipolar <0.1% <900
Any 15% 140,500

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

6. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Reasons for not accessing mental
health services (among youth who
need them) McCreary Society 2009
• Thought/hoped the problem would go away 56%
• Didn’t want people to know 43%
• Didn’t know where to go 30%
• Afraid someone I know might see me 23%
• Afraid of what a Dr would say or do 21%
• Didn’t think I could afford it 11%
• No transportation 8%
• Parent/guardian would not take me 7%
• I am not treated with respect there 3%
• I could not go when it was open 3%

7. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
People who youth found helpful
(among youth who sought help in the
past year) McCreary Society 2009
• Friend 94%
• Doctor or Nurse 78%
• Teacher 77%
• School Counsellor 67%
• Religious Leader 57%
• Youth Worker 54%
• Other School Staff 52%
• Social Worker 38%

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

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

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

11. Improving Understanding and Supports for Children and Youth with Anxiety and 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

12. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Causes of Anxiety in
Children and Youth
• Anxiety disorders have multiple, complex origins including
Genetics
Temperament
Environment

13. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
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 the
individual feels a sense of belonging or inclusion –
sometimes referred to as connectedness

14. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Recognizing Anxiety
• Symptoms of anxiety in children and youth generally fall into
four categories
Thoughts
Behaviours
Feelings
Physical symptoms

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

16. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Recognizing Anxiety
Thoughts 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

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

18. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Helping Children and
Youth with Anxiety
• Anxiety is the most treatable mental disorder - children and youth 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

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

20. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
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
• 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

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

22. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Educator Strategies
• Universal Resources
– FRIENDS for Life Program providing CBT skills for children in Grades 4/5 (MCFD)
– 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

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

24. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
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
• Kelty Mental Health Resource Centre
• Mental Health Summer Institute

25. Improving Understanding and Supports for Children and Youth with Anxiety and Mental Disorders
Thank You!!