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Child Safety TrainingChild Safety Training

Topics of Discussion• Childhood Anxiety Disorders• Child Safety & Supervision• Lying (What Should You Do)

Childhood Anxiety Disorders

• Generalized Anxiety Disorder • Panic Disorder • Separation Anxiety Disorder • Specific Phobias• Selective Mutism • Social Phobia • Obsessive Compulsive Disorder

Generalized Anxiety Disorder

• Generalized Anxiety Disorder: Generalized Anxiety Disorder (GAD) is characterized by excessive worrying about a variety of events, including those in the past, present, and future.

Generalized Anxiety Disorder

• Generalized Anxiety Disorder: Primary Symptoms:

Excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities.

Generalized Anxiety Disorder

• Primary Symptoms: The anxiety and worry are associated with at least three of the following six symptoms:

• restlessness or feeling keyed up or on edge,

• being easily fatigued, difficulty concentrating, irritability,

• muscle tension, and sleep disturbance.

Generalized Anxiety Disorder

• Generalized Anxiety Disorder: Treatment: The studies that have been done on the treatment of Generalized Anxiety Disorder in children have shown that education about the nature of anxiety, education about ways to identify, evaluate, and change anxious thoughts, and training in relaxation strategies have all been used with some success.

Generalized Anxiety Disorder

•Treatment: Children with Generalized Anxiety Disorder are also taught to learn to recognize the physiological symptoms of anxiety, and are taught to use positive “self-talk” rather than negative self-talk. Parents are included to provide reinforcement and rewards for children’s success, and to learn to implement and practice the skills with their children

Panic Disorder• Panic Disorder:

The key characteristic of panic disorder is recurring panic attacks and persistent concern or worry that an attack will lead to several more panic attacks, or physical or psychological harm.

Panic Disorder• Panic Disorder:

Children and teenagers who experience panic disorder can often begin to avoid going places, and engaging in activities, out of a fear that a panic attack might occur.

• A panic attack is defined as an episode of intense fear and unease, comprised of both physical symptoms and a number of fearful thoughts.

Panic Disorder• Panic Disorder:

Primary Symptoms: Physical symptoms of a panic attack include increased heart rate and chest pain, choking sensations, difficulty breathing, sweating and trembling, gastrointestinal distress, body temperature changes, hot or cold flushes, dizziness, and numbness or tingling in the limbs.

Panic Disorder• Panic Disorder:

Primary Symptoms: Cognitive symptoms (thoughts), include fear of dying or losing control of one’s mind or self, feeling as if one is in a dream and events seem unreal. Symptoms of panic attacks often accelerate quickly (within 10 minutes) and peak after several minutes before diminishing either rapidly or gradually. Very often, panic attacks are unexpected in nature and feel as if they are coming on “out of the blue”.

Panic Disorder• Panic Disorder:

Primary Symptoms: For example, one may be in a very calming place (e.g., at home eating breakfast) and still may have a panic attack. Other times, people may have panic attacks in shopping malls, or restaurants, and the panic attack causes the person to flee the situation. Very often, children and adolescents begin to avoid the situations in which they have experienced a panic attack in the past

Panic Disorder• Treatment:

Cognitive behavioral treatment strategies have been found to be effective in the treatment of adults with panic disorder. Currently, several research studies are underway which have provided initial support for the efficacy of using cognitive behavioral treatment strategies with children and adolescents.

Panic Disorder• Treatment:

Research has shown that children and adolescents with panic disorder seem to benefit from treatments that have several components.

• Children can be taught ways to identify and change dysfunctional thought patterns that serve to perpetuate fear.

Separation Anxiety• Separation Anxiety Disorder:

Separation anxiety disorder refers typically to younger children who are extremely unwilling to separate from major attachment figures (e.g., parents grandparents, older siblings) or from home (DSM-IV 1994).

Separation Anxiety• Separation Anxiety

Disorder: Primary Symptoms: Excessive worry about potential harm toward oneself (e.g., getting sick at school) or one’s primary caregivers (e.g., being in a car accident). The child may also avoid activities that may result in separation from parents.

Separation Anxiety• Separation Anxiety

Disorder: Primary Symptoms: Nightmares and somatic complaints are common, inducing trembling, headaches, stomachaches, nausea, vomiting, stomach pain and sweating

Separation Anxiety• Separation Anxiety Disorder:

Treatment: Cognitive-behavioral treatment for separation anxiety disorder is focused on teaching children several major skills.

• Children are taught to recognize anxious feelings regarding separation and to identify their physical reactions to anxiety. They are taught to identify their thoughts in anxiety provoking separation situations, and are taught to develop a plan to cope adaptively with the situation.

• Children are also taught to evaluate the success of the coping strategies they employed, and are taught to praise themselves for positive coping. In

Phobias• Specific Phobias:

Children may experience specific phobias, which are intense, irrational fears of certain things or situations, (e.g., dogs, bees, injections, the dark, escalators, tunnels, flying, etc.). Children may not realize that fear of such objects are unreasonable.

• Typically, children or adolescents will become extremely distressed when confronted with the feared object or situations.

Phobias• Specific Phobias:

Primary Symptoms: Children’s avoidance or distress re: the feared object results in significant disruption in the child’s routine, school functioning, or family functioning, or social relationships.

• In children, the anxiety felt may be expressed by crying, tantrums, freezing, or clinging. In addition, children may experience rapid heart rate, dizziness, sweaty palms, etc. when confronted with the feared object or situation.

Phobias• Specific Phobias:

Primary Symptoms: Treatment: Cognitive behavioral treatment packages have also been successfully employed in the treatment of specific phobias, such as fears of dogs, spiders, the dark, needles, etc. Techniques commonly used include relaxation training, use of imagery techniques, token reinforcements implemented by parents (e.g., praise, sticker charts), and children’s and parent’s careful monitoring of the child’s positive behaviors. In addition, children are taught to change their anxious thoughts and replace them with positive, coping thoughts.

Mutism• Selective Mutism:

Although this is not classified as a child anxiety disorder, selective mutism is often seen around the time that children enter school for the first time, and can be accompanied by anxiety. The essential feature of selective mutism is the persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations. I

Mutism• Selective Mutism:

In order to be diagnosed with selective mutism, the person’s speech refusal must interfere with educational or occupational achievement or with social communication, and must be going on for at least one month.

Mutism• Selective Mutism:

Selective mutism is not diagnosed if the individual’s failure to speak is due solely to lack of knowledge of the language.

Mutism• Selective Mutism:

Primary Symptoms: Primary symptoms of selective mutism include persistent failure to speak in specific social situations where there is an expectation for speech.

• The child should be able to speak in other situations. This disorder is usually first seen in childhood, and is treatable with cognitive-behavioral techniques

Mutism• Selective Mutism:

Treatment: One of the most important first steps in the treatment of selective mutism is conducting a thorough evaluation, including getting a good social history of the child, and a history of the onset, duration, precipitants, and consequences of the child’s non-speech behavior.

• Also, it is important for the clinician to get a good understanding of the child’s speech behavior in different settings.

Social Phobia• Social phobia is an intense

fear of becoming humiliated or embarrassed in social situations. It often begins around early adolescence, or even younger.

• Children who suffer from social phobia might appear to be excessively shy and may fear that they will do or say something in front of others that will promote embarrassment.

Social Phobia• Primary Symptoms:

Persistent fear of one or more situations in which a child is exposed to unfamiliar people or scrutiny by others. The child begins to avoid and fear school related events, and significant interference in most social activities is indicated. A key complaint issued by many youngsters is a fear of appearing foolish or doing something that would invite ridicule from others.

Social Phobia• Treatment:

Treatment components include teaching appropriate social skills to children who lack knowledge of social situations and appropriate social behaviors.

• Children and adolescents are also taught to identify and change anxious thoughts that serve to increase feelings of anxiety in social situations. By thinking more positive, rational thoughts, children are typically able to enter social situations more easily. Cognitive therapy techniques help children to reduce distortions in their thinking.

Obsessive Compulsive Disorder• Obsessive Compulsive Disorder:

The essential features of Obsessive Compulsive Disorder (OCD) are recurrent obsessions (intrusive thoughts) and compulsions (repeated behaviors) that are time consuming and cause marked distress or significant impairment in daily functioning.

• Obsessions are persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress.

Obsessive Compulsive Disorder

• Obsessive Compulsive Disorder: Most common obsessions are repeated thoughts about contamination, doubting oneself, needing to have things in a particular order, or aggressive impulses. Usually, the child with obsessions tries to neutralize these disturbing thoughts with some other thought or action (a compulsion).

• Compulsions are repetitive behaviors or mental acts (e.g., hand washing, ordering, checking, praying, counting, repeating words silently), the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure.

Obsessive Compulsive Disorder• Obsessive Compulsive Disorder:

Primary Symptoms: Typically, the obsessions and compulsions cause marked distress, are time consuming, and may significantly interfere with the child’s functioning at home, school, or in social activities. Also, because obsessive intrusions can be distracting, kids may show poor performance on tasks that would require concentration, such as schoolwork. In addition, many kids may avoid objects or situations that provoke obsessions and compulsions.

Obsessive Compulsive Disorder• Obsessive Compulsive Disorder:

Treatment strategies commonly used to treat OCD in children include “exposure and response prevention”, in which children are taught to face the fear that triggers the obsessive thoughts or anxiety. By facing the feared situation, anxiety is triggered, and through repeated exposure over repeated trials, the anxiety decreases or “habituates”.

• The principle of “response prevention” means that children are taught to stop the performance of the ritual that decreases their anxiety (e.g., washing hands to feel less anxious, checking the door, etc.)

Obsessive Compulsive Disorder• Obsessive Compulsive Disorder:

Early in treatment, this may involve partial prevention (i.e., washing the hands 10 times rather than 20 times), or altering ritualistic behaviors. Particularly during this phase, allies such as parents need to be included to assist children in carrying out this treatment effectively. As treatment progresses, complete response prevention is introduced.

Child Safety• Child safety is one of the most

vital issues to consider during child rearing.

• Since children don’t come with childcare how-to manuals, this guide is a compilation of first-hand experience, lessons learned,

• and information gathered while raising our own children to help answer those child safety questions all parents have.

What are the most important things parents should tell

children about safety?• Always check first with a parent,

guardian, or trusted adult before going anywhere, accepting anything, or getting into a car with anyone.

• Do not go out alone. Always take a friend with when going places or playing outside.

• Say no if someone tries to touch you, or treats you in a way that makes you feel sad, scared, or confused. Get out of the situation as quickly as possible.

• Tell a parent, guardian, or trusted adult if you feel sad, scared, or confused.

• There will always be someone to help you, and you have the right to be safe.

What should a parent know when talking to a

child about safety?• Don’t forget your older

children. Children aged 11 to17 are equally at risk to victimization. At the same time you are giving your older children more freedom, make sure they understand important safety rules as well.

• Speak to your children in a manner that is calm and reassuring. Children do not need to be frightened to get the point across. In fact, fear can thwart the safety message, because fear can be paralyzing to a child.

• Speak openly. Children will be less likely to come to you about issues enshrouded in secrecy. If they feel that you are comfortable discussing the subject at hand, they may be more forthcoming.

What should a parent know when talking to a

child about safety?• Do not teach “stranger

danger.” Children do not have the same understanding of “strangers” as adults; the concept is difficult for them to grasp. And, based on what we know about those who harm children, people known to children and/or their families actually present greater danger to children than do “strangers.”

• Practice what you preach. You may think your children understand your message, but until they can incorporate it into their daily lives, it may not be clearly understood. Find opportunities to practice “what if” scenarios.

• Teach your children that safety is more important than manners.

Is "stranger danger"—that dangers to kids come from strangers—really a myth?

• Yes. In the majority of cases, the perpetrator is someone the parents or child knows, and that person may be in a position of trust or responsibility to the child and family.

• We have learned that children do not have the same understanding of who a stranger is as an adult might, therefore, it is a difficult concept for the child to grasp. It is much more beneficial to children to help them build the confidence and self-esteem they need to stay as safe as possible in any potentially dangerous situation they encounter rather than teaching them to be "on the look out" for a particular type of person.

Lying (What Should You Do?)

• Lying is the single most common child behavior problem reported by foster parents. In this program parents learn to understand and deal with this frustrating problem by looking at four types of lying behavior: lying to save face, lying to gain attention, pathological lying, and lying to get others in trouble.

Lying (What Should You Do?)

• Lying is the single most common problem among foster children -- something that comes as a rude awakening for many foster parents. But these children come from a world where lying is common and, for many, becomes a means of survival.

Lying (four types of chronic lying )

• Lying to Save Face: Harold and Madeline are up against a barrage of lies from Kyle, their nine-year-old foster child. Dr. Delaney helps these parents get past Kyle's constant denials and excuses into a deeper understanding of how he steals objects to fill a deep void created in his very early life. Harold and Madeline also learn some simple but effective strategies - such as not arguing with Kyle about a lie - that could turn the tide for this family.

Lying (four types of chronic lying )

• Lying to Gain Attention: Bonnie and Charles are concerned about their 10 year-old adopted daughter, Tillie. She tells the most fantastic lies. To Dr. Delaney, Tillie is a child with a terribly deflated ego who exaggerates to get the attention she desperately needs.

Lying (four types of chronic lying )

• Pathological Lying: Armand has been with his foster parents, Jose and Juanita, for only three months, but this teen tells a continuous string of lies. In their interview with Dr. Delaney, it becomes clearer that one reason Armand lies so automatically is that he used lying to try to set himself free from his birth father's abuse and tight control. One suggestion from Dr. Delaney is for them to avoid using questions that may sound like an interrogation to Armand.

Lying (four types of chronic lying )

• Lying to Get Others in Trouble: Allie is a single foster mom to Sarah, a seven-year old who seems to always instigate trouble between other kids by tattling, gossiping and bad-mouthing. Dr. Delaney soon discovers that Sarah probably learned that being the troublemaker in her birth family was a way of punishing her mom and, at the same time, keeping her one step head of her siblings. One thing Allie can do, according to Dr. Delaney, is to give Sarah more positive one-on-one time.

Group Project• Discussion of 3 topics