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- Queen Elizabeth Health Complex
2100 Marlowe
Suite 626
Montreal, Qc, H4A 3L6
514-482-3327
Children/Adolescents/Families
We provide a warm environment for children and adolescents. We recognize that when children feel comfortable, listened to, and understood they are more likely to be responsive to learning therapeutic strategies. Our ultimate goal is a happy child. We work on:
- Strengthening attachments between the child and caregivers
- Coaching the child to adopt new ways that will increase overall confidence to decrease anxious and/or depressed feelings on her/his own
- Foster an optimistic mind-set.
What is Anxiety?
Children get scared. This is normal. However, children can’t always identify their feelings or figure out why they feel scared. To make the situation worse their anxious behaviours are, at times, misunderstood by parents, family, and teachers. It is not unusual for anxious children to be labelled as lazy, angry, defiant/oppositional, immature, or as having attention (ADD) or hearing deficit problems. A child who is anxious needs to be able to identify her feelings, understand the causes, and know simple and concrete steps to overcome her anxiety. These steps help him to feel better and to make any stressful situation more manageable.
The word Anxiety describes the thoughts, feelings, and behaviors that occur when the child anticipates danger. The situation is not happening right now. The child’s anxiety is about a “might-be” situation. Your child’s anxiety can range in both severity and in the time it lasts. That is, anxiety can range from a mild tinge of uneasiness to a full-blown panic-stricken state. Anxiety can last for a few moments to being a whole day affair or it can “disappear” for a few days and then re-emerge (e.g., your child’s anxiety may begin to decline when the school bell rings Friday afternoon and then re-appears Monday morning). Finally, your child’s anxiety can be specific (towards either objects, people, or situations) or generalized (about everything).
Thoughts:
Thoughts that emphasize danger in “might-be” situations are Worries. Older children and adolescents can often express their worries with “what-ifs” that always seem to have really really bad outcomes.
Younger children may worry about scary monsters that suddenly emerge in the dark. With a flick of the light switch, these scary monsters suddenly turn back into moving curtains, clothes thrown on a chair, and toys sticking out from under the bed. Outcome: Separation from parents.
School-aged children may worry about being mocked during an oral presentation, a teacher telling them “bad job”, looking different from other kids, and making mistakes. Outcome: Looking stupid and being rejected.
Adolescents may also worry about their appearance, future, and worry about whether a girlfriend or boyfriend will call.
Outcome: Peer rejection, failure, romantic rejection.
The brain doesn’t differentiate between reality (an actual outcome happening right now) or an outcome that is imagined. This means your child’s brain reacts to the worry as if it will most definitely happen. For the young child who fears scary monsters it is then understandable why she is terrified to turn off the bedroom light.
Bad things also do happen. The child may then worry that this bad thing could happen again in the future. If the danger is real (and not just perceived) it will need to be addressed first. For example, children who experience bullying will develop worries about teasing and physical bodily harm. In order to stop the bullying children need interventions from adults.
Feelings:
Anxious thoughts are not only quite distressing but they produce equally distressing feelings and physical sensations that are very unpleasant and uncomfortable. The child can feel unpleasantness in any part of his body: headache, belly ache (butterflies), pounding heart, sore legs, and shallow, fast breathing. The child may have nose-bleeds, feel like fainting or throwing up. The child may have trouble sleeping.
Behaviours:
Anxiety is evident in the child’s behaviours. Anxiety triggers the “fight-flight” response which prepares the body to either fight the danger or to immediately flee to a safe place.
Fight: Children may lash out or have a temper tantrum. Alternatively, you may get defensive, surly responses from your child clearly expressed in her verbal tone (“attitude”), eye-rolling, and stiff body posture. Once upon a time, only adolescents were thought capable of flinging such angry contempt at their parents and other adults. Today, even children as young as 5-year-olds are learning this nasty habit. Is this phrase familiar? “You are not the boss of me!”. In some cases, aggressive behaviours can become a habitual response to anxiety. This is a serious behaviour problem that will also need to be addressed.
Flee: Children may cry or try to withdraw further under their bed covers as a way to avoid facing the dangerous place. In school, they may retreat into their own imagination and appear to be “dans la lune”. Sometimes, children engage in rituals to cope with and allow them distance from their unpleasant feelings. Excessive hand-washing and counting rituals are two examples. Adolescents may flee to drugs, alcohol, sex, engage in self-injurious behaviours such as cutting or develop serious eating problems.
In summary, anxiety-caused thoughts, feelings, and behaviours can have a devastating impact upon the child’s life (and his family‘s life). If left unchecked, the child’s life may become very restricted wherein he feels comfortable with only a handful of familiar and perceived “safe” people and activities.
Anxiety and Depression
The restrictions anxiety places on a child’s life can make him very unhappy. Imagine he is the only child in his class who refuses to go on a field trip to the Insectarium because he is scared of bugs. Upon their return, his class-mates will surely be laughing and talking about their experiences which may make him feel outside of the group. He may blame himself (or others) for having such anxieties. Consistent self-blame can alert you to a depressive pattern of thinking, feelings, and behaviours.
Thinking: Thoughts revolve around themes of worthlessness and inadequacy: “I am stupid“, “What‘s the point? It‘s hopeless“ “It‘s their fault I feel this way”. There may be suicidal thoughts.
Feelings: Sadness, irritability, guilt, anger are typical.
Behaviours: Isolation and withdrawal from family, friends, and activities once enjoyed.
Sometimes, children who are anxious receive a comorbid diagnosis such as depression.
Below are examples of triggers for anxiety or depression that we typically see at our Center:
Monsters and Violence:
Children with vivid imaginations are certainly blessed with a wonderful gift! However, at times, they can scare “their own pants off”. Typically, scary thoughts and images result from exposure to books and television that depict monsters and violence. Sometimes, it can be very helpful to stop reading books about monsters prior to bed-time and to ban all television programmes or movies that emphasize violence.
Transitions:
A change has occurred that is profound for the child (e.g., the birth of a new sibling, parents’ separation). The child may also be overwhelmed by parental tension and conflict in the home.
Parental Authority:
In the home, limit-setting, boundaries, and discipline (not referring to physical punishment) are inconsistent. For some children, who are more sensitive to inconsistent environments, they will exhibit anxious thoughts, feelings, and behaviours. Also, power plays between a parent and child may mask the anxiety of both parties.
Peers:
Children who struggle with peers may lack basic social skills in how to make and maintain friendships. Children who are isolated from their peers feel anxious and are more likely to have poor self-esteem.
Identity/Self-Image:
Adolescents who describe themselves as “tough”, “bad”, or “different” are then caught between trying to numb their anxious feelings and in seeking out understanding and affection from their parents. The latter is a real need and desire on their part. You may feel you are walking on egg-shells with such an adolescent and it seems no matter what you do and how much you try their response is always: “You don’t listen to me and you don’t understand me”. Understandably, you may also feel quite frustrated and anxious.
Genetic Disposition: Temperament
High Energy:
In a quiet movie theatre, your child is wriggling in his seat, looking around at other people, asking tons of questions about the movie even “when will it be over?” (he may be enjoying it!).
Slow-to-Adapt
In a group of laughing children watching strangers perform a marionette show, your child is hanging back at the edge of the group looking uncertainly at the performing actors.
Perceptive
A 10-minute walk predictably turns into 30 minutes as your child observes, stops, and explores everything that he sees.
Sensitive (to sound or to taste, temperature, texture, emotions)
A fire-truck suddenly and loudly appears and your dozing toddler is startled awake screaming, she stays upset for a long time, and has difficulty calming herself or being calmed.
Negative Mood
Your adolescent is hanging out with a group of friends and enjoying herself. A friend she has not spoken to in months walks by and her mood suddenly switches and her enjoyable day is now defined as “the worst day ever in my life“.
Genetics plays a role in how children act and respond to people and situations. This is called Temperament. Your child’s mood, ability to calm herself, and activity level are all influenced by her biology, neurology, and physiology. We are more than our Biology (Nature). Nurture matters as well. This means that your actions, over time, can influence and even modify the way your child acts and responds to people and situations
Treatment:
Cognitive-behavioural therapy is the research-validated therapeutic approach for anxiety and depression. We have extensive experience and expertise using this approach.
Parents:
Over the years, we have seen that these parental behaviours generally do not work in decreasing anxiety or in helping the child to understand his temperament style:
- Reassurance
- Getting Angry at the Child
- Allowing the child to consistently Avoid the anxiety-provoking situation
- Simply telling the child to toughen up is not enough
Productive Strategies:
- Empathize and Validate your child’s feelings
- Help your child to understand Anxiety
- Help your child to understand her temperament (for example, she gets “stuck” in a negative pattern of thinking or acting)
- Highlight the positive side of her temperamental traits and her other strengths
- Give your child concrete strategies to calm himself down (e.g., balloon belly breathing)
- Give her lots of time to practice new skills in relating positively to people and situations - give her praise when she succeeds at a new skill
- Have consistent bed-time and eating routines