Don’t worry, be happy plan for kids
“IN A SUITE of offices behind a coffee shop in Brisbane’s multi-cultural West End, a small woman with dark hair asks a group of preschoolers about their week.
“‘What was your happy thing for the week? she asks a boy.
As the child replies, she reminds him to look her in the eye end smile.
“Did you practise what we talked about, helping someone and smiling,” she asks.
“Did you help your mum and dad? Did you give your mum a hug when she was tired?”
It’s sounds like the most casual of chats between child and adult. But this adult is psychology professor Paula Barrett and through this conversation she is carrying out her life’s mission.
She is helping to build social, emotional and coping skills in children, skills that add up to that 21st-century buzz word resilience.
In an increasingly pressured world. Barrett and others like her believe children in general — and some children in particular — need more skills to cope with life’s demands.
Barrett, head of the Pathways Health and Research Centre at West End, does not believe children have changed —but the world has.
“Life is very different now from what it was 10, 20, 30 years ago,” she says. “It’s more active. There’s more stimulation, lack of sleep, bad diet and developmentally inappropriate expectations for children. Everything goes so fast, lights flashing, loud noises, computers, phones. It’s just very intense stimulation all the time. And children have to grew up very fast. There’s not enough time to be children, to play and relax.”
Barrett believes all children can benefit from honing emotional, social and coping skills early on. But for one in five children the need for these skills is more acute. This is the sensitive child with increased vulnerability to anxiety and depression.
“This is not your average child,” Barrett says. “They are usually very artistic, or musical, or very sporty. They are in general high achievers.”
Combine this sensitive temperament with a traumatic life event and 1 child can be in trouble. A third of mastic children will develop anxiety while at primary school. And If the problem is not dealt with at this stage, it can lead to depression in late adolescence and early adulthood.
“We know one in five kids is going to be prone (to anxiety) but by mid-primary school a percentage of these will show signs — social anxiety, separation anxiety, generalised anxiety, stomach aches, headaches all the tine and they’re stressed.” Barrett says.
“If these kids don’t get help, almost surely in Years 11 and 12 or is beginning of university they are going to he depressed because we know that anxiety in primary school age is the greatest risk factor for depression in late adolescence. So it would be in everyone’s beet interests to not just say ‘what are we going to do about these depressed kids but to prevent it from happening in the first place.”
Barrett does not focus on Australia’s alarming suicide statistics.
An estimated 2500 people will commit suicide this year and the number who attempt it will be up to 20 times greater. Suicide is now the leading cause of death in people aged under 30.
The goal of the Portuguese-born mother-of-two is to maximise every child’s chances of happiness through prevention or treatment of anxiety and depression.
Enter the non-profit Pathways Health and Research Centre where Barrett and her staff, all with a clinical masters degree or PhD in psychology, are working at building resilience in children.
After more than 20 years as an academic first at Griffith University and now The University of Queensland, Barrett is “walking the bridge” between academia and the community to disseminate the results of her extensive research.
RESEARCH SHOWS THAT four main factors protect against anxiety and depression.
Barrett lists these as: “Positive family interactions and unconditional family support, focusing on what is positive in the child: constructive friendships. positive thinking, being a glass half-full person; and stable, unconditional attachment.
“This is the message that no matter what your kids do, you will always love them and there will always be a place for them in your home and you will always be there for them even if you detest their behaviour.”
Also important are extended family support networks and family friendships through neighbourhood, church or sporting communities.
Pathways’ programs are aimed at helping children and their families to maximise these factors. Barrett several years ago developed the Friends program for primary and high school children. It has since been extensively clinically trailed internationally and two years ago was endorsed by the World Health Organisation as “best practice”.
The Friends program is used in primary and high schools in Canada, the US, Norway, New Zealand, Holland, Mexico, most Australian states and in some Queensland private schools.
Now Barrett has gone a step further, developing Fun Friends, a program for 4-6-year-olds, which was successfully trialled in 28 Queensland preschools last year.
Fun Friends is not yet in use in schools — it is run privately at Pathways — but Barrett’s goal is to have the program in every Queensland Prep or preschool class.
“If we work with a preschool, we teach the teachers to run the program with the parents so it’s a social and emotional skills acquisition program,” she says.
“Some of the skills are non-verbal: looking people in the eye, smiling, asking people how they are, being helpful to other people, understanding feelings in yourself and other people, taking turns, sharing, thinking happy thoughts and helpful thoughts about themselves and others, breaking challenges into small easy steps, making step plans, thinking about role models and how to be a good friend to yourself and others.”
Barrett scorns the “Aspirin fix”, the idea that emotional problems can be solved with an hour of talking. “People should feel very happy about learning social, emotional and coping skills rather than when they have a massive life problem they have to go and get treatment,” Barrett says. “Let’s prevent big problems from happening by learning skills in advance.”
Stressful times tend to be the major transition points in life, beginning school, moving from primary to high school, making career choices, starting university or work, having your first child. Anxiety can manifest as the preschooler who won’t join in games, the otherwise confident Year 7 student who suddenly develops health phobias, the bright high school student who tortures herself over assignments for fear they won’t be “perfect”.
Child and adolescent psychiatrist Dr Tony Cook agrees that childhood anxiety is a major issue in today’s society. He estimates one in 10 have an anxiety disorder but sees these children as sitting at the top of a pyramid with “a lot of kids at the bottom with sense general anxiety”.
“There has been a range of changes in society over the past 30-40 years which have had the effect of disadvantaging kids — marital break-up father’s absence. increasing use of drugs, two parents working and less extended family to help. I think kids have lost out in this world. Responses vary, but one of the responses can be more anxiety.”
Cook says recognised strategies to overcoming anxious thinking include the Friends program and books such as Helping Your Anxious Child by Ron Rapee of Macquarie University’s Anxiety Research Unit.
“Significant anxiety can have a very marked effect. It can cause kids to miss cramps and have fewer friends, decreased academic performance and reduced career options,” Cook says.
Cook advises parents to try to counter unrealistic thinking in their children and to stop avoidance. “If your child has a school phobia, every day they stay away the fear grows by 10 percent but if they go, it diminishes by 10 per cent.”
As awareness grow, of the need to build emotional resilience in children, a variety of methods are being developed.
The University of Queensland is trialling an internet treatment program for anxious children who might otherwise not receive help.
Psychologist Dr Caroline Donovan says long waiting lists for government treatment programs, coupled with the stigma and expense of seeing a private psychologist, mean many children and teenagers miss out.
“The internet is an obvious way to reach them because most families have computers and kids are computer literate,” Donovan says.
“Anxious kids are the good kids in the class so it’s not picked up by teachers. They hand their assignments in on time. They are not the behaviour-disorder kids on they are often overlooked. People say they will grow out of it. Maybe they will but maybe they won’t.” Some teenagers seek relief through substance abuse.
At Churchill, Raceview and Leichhardt state schools in the Ipswich area west of Brisbane. primary students are developing their emotional intelligence through games run by teachers from an innovative DVD, Play is the Way.
Created by Perth-based drama teacher Wilson McCaskill, the games are based on the theory of emotional intelligence, as outlined by American psychologist Daniel Goleman. “The outcome of the game can’t be achieved unless you are behaving in an appropriate way.” McCaskill says “You have to he able to control yourself, handle the team you are in and your own emotional state and stay motivated.”
On Brisbane’s northside, a cluster of 10 state and Catholic primary schools in the Geebung area has trialled a resilience project developed by Griffith University at the request of the Queensland Government.
Professor Don Stewart, who will report to Queensland Health this month, says an evaluation has found “major advantage in having a project that builds resilience and social and emotional wellbeing”
“Schools have begun to realise they have a role to plan in making children and their families feel connected to society,” Stewart say. “This will pay off over the generations.”
Stewart would like to see the program used in all Queensland primary schools.
“Building resilience at primary school leads to benefits in high school,” he says. “If they learn they’re OK, the squabbling and fighting in the peer group in secondary school doesn’t seem to be insurmountable. We are teaching skills as well as mental attitudes being able to bounce back, being able to tolerate difference, and improving your communication so people know when you are feeling down and upset.”
St Peters Lutheran College, Brisbane Girls Grammar School and St Joseph’s College Gregory Terrace are among the Brisbane private schools using Barrett’s Friends program.
WHEN Flynn Hammonds, 5, took part in a resilience program at hi preschool last year, he learnt about “milkshake breathing”.
His mother, Kerry Hammonds, said the children were taught the breathing technique as part or the Fun Friends program trialled at the C&K Rosalie Kindergarten-Preschool in Brisbane’s inner west.
“You breathe in through your nose and count to three and then breathe out through your mouth.” Hammonds said. “You do it when you are frustrated or upset.
“When Flynn’s older sister Paris way upset recently he went up to her and said: ‘Paris, use your milkshake breathing’.”
Hammonds, a mother of three, said the preschoolers also learnt about changing their thoughts from “red thoughts” when they were frustrated or angry to calmer “green thoughts”.
And the steps to make friends were spelt out and practised.
“They learnt what to do: put a smile on your face. say ‘hello my name is Flynn, would you like to play with me’?
“There was also information about being empathetic and caring towards other people.”
The whole family, including Paris, 9, and Jack, 7, was involved through worksheets sent home with exercises to do. “It was really quite amazing,” Hammonds said. “It would be fantastic if the Government introduced it into all schools.”
Rosemary Tucker enrolled her son, Blake, 14, in the primary school-age Friends program at 11 after his school called her to say he was having social difficulties.
“The other kids wanted to include him but he wouldn’t join in. And if more than 10 people came in our home he wouldn’t come out of his room,” she said.
Tucker, of Rochedale on Brishane’s southside, said her son now had the confidence to successfully attend a large secondary boys school.
Signs of anxiety in primary school
Dr Paula Barrett says: “Anxious children may be exhibiting signs of perfectionism. They tend to think: ‘Everything has to be perfect and if I’m not sure I can be absolutely perfect I’m not even going to try’.
“They also tend to worry a lot about everything, whether people like them, whether everything is going perfectly at school. So anything new or that hasn’t gone perfectly, like a school excursion that is changed, or a new teacher, or they’ve got a B+ instead of an A+, while another person would just move on, they worry sick about it.
“They go to bed at night and they lie there for an hour or two worrying before they can go to steep and they tend to get a lot of psychosomatic symptoms. They go the GP with a lot of stomach aches and skin disorders. They find it hard to face anything new like a new teacher or a sports carnival, school excursion or school camp.”
Signs of depression in late adolescence
They Include insomnia, early morning waking, negative thinking, lack of hope and thinking that no one can help them, that no one understands.”
Anxiety disorders in children
“Anxiety disorders are among the most prevalent mental problems in childhood and adolescence affecting ny as 10% – 21% of all children and youth. This estimate indicates that 1 in 5 children and youth or 4 to 6 students within a classroom of 30 children are at risk ‘for experiencing an anxiety disorder. Further, the World Health Organization has stated that obesity, early onset diabetes, anxiety and depression disorders will be more prevalent in Western countries than any other health problem in the next 30 years. Once present, childhood anxiety disorders tend to be chronic and recurrent and remit without treatment. In addition, many children experience clinical levels of anxiety will experience more than one disorder with recent estimates suggesting that 65% to 95% of anxious children and youth will experience comorbid anxiety disorders. Childhood anxiety also has a strong association with depression and childhood anxiety disorders may actually precede the development of depression with studies indicating that 22% to 44% of anxious children and youth also experience depression. Given the significant relationship between anxiety and depression and the precedence of anxiety disorders, effectively treating anxiety in childhood and adolescence may help reduce the likelihood of a depressed mood in later life (Kendall, Safford, Flannery-Schroeder, & Webb, 2004).
Unfortunately, most children and youth who suffer from anxiety will not actually receive clinical intervention (Olfson, Gameroff, Marcus, & Waslick, 2003) and for those who do many will terminate before program completion, some will relapse, and others will fail to respond to treatment (Barrett and 011endick, 2004). Additionally. anxiety disorders in childhood are frequently overlooked as the symptoms are often unrecognizable. Anxious children tend to be shy, cooperative, compliant, and may be present as the ‘perfect” child within the school setting and when away from home. Increased attention is usually given to children with disruptive behaviours as they more clearly interfere with daily life functioning, home life and school life (Albano, Chorpita, & Barlow, 2003). Anxiety can become a chronic condition for many anxious children and can subsequently affect several areas of their life including academic performance, social interaction, self-confidence, and the ability to enjoy everyday life experiences (Barrett, 1999). Disruptions in their academic performance tend to occur as anxious children may find it difficult to start and complete tasks due to the fear that their work will not be good enough. These children tend to be highly perfectionist and often experience a heightened dependence upon others which can be seen through their constant reassurance seeking and needed approval from others (i.e, peers, parents, and teachers). Such a child may continually ask the teacher, “Is my work okay, did I do a good enough job?” or their friends, “Am I still your best friend today?” Anxious children tend to be overly sensitive to criticism, have low self-esteem (Barrett, 1999) and usually become preoccupied with their worries and the uncomfortable physiological arousal that accompanies them (hyperventilation, nausea, sweating, loose bladder, etc.). School refusal is commonly seen in anxious children as they display difficulty in attending and staying in school often resulting in a complete avoidance. Such effects of childhood anxiety often lead to strained relationships between the child and their peers, parents, and teachers and, if left untreated, can often lead into depression in adolescence.
The FRIENDS program has an extensive evidence-base and is the only anxiety program that is supported by the World Health Organisation as an effective program for the prevention and treatment of anxiety and depression in children and youth (World Health Organization, 2004). The program has been disseminated around the world and is currently used in Mexico, Hong Kong, New Zealand, the Netherlands, Germany, Portugal, Finland, Norway, UK, USA and Canada.
The FRIENDS program is a positively focused program which aims to increase social and developmental skills through the use of cognitive-behavioural techniques. The program allows for easy implementation at all levels of prevention, early intervention and treatment. It can be offered as a selective, indicated and universal program within the community or school setting. The FRIENDS program can be delivered with ease by health professionals, teachers and school counsellors following an accredited training workshop. Teacher training workshops can be organised through Pathways Health and Research Centre in Brisbane, Australia (www.pathwayshrc.com.au).
The FRIENDS program includes two developmentally tailored workbooks for use with children (aged 7-11 years) (Barrett, 2004) or youth (aged 12-17 years) (Barrett, 2005), a leader’s manual with the content and process of each session, and can be run in both group and individual settings. The FRIENDS program consists of 10 weekly sessions and two booster sessions which can be held 1 month and three months following the . completion of treatment (or at a convenient time within your classroom). Each session is designed to run for approximately 1 to 1,5 hours. The general size for an effective group is between 6 to 10 children, which allows for adequate time for all children in the group to share ideas. In the classroom setting, it is useful to have children work together on activities in small groups (of 4 or 5 children) with an adult helper (e.g. teacher, teacher’s aid, parent, older student) and then return to the large group for a general discussion. The use of co-facilitators/ helpers within the classroom is very helpful in managing the group process and in assisting children who may have any reading or writing difficulties.
The program utilizes the acronym “FRIENDS” to help children remember the strategies they learn to manage their anxiety. The FRIENDS acronym (Barrett 2005) stands for:
Remember to Relax. Have quiet time.
I can do it! I can try my best!
Explore solutions and coping step plans.
Now reward yourself! You’ve done your best!
Don’t forget to practice.
Stay calm for life!
The word FRIENDS highlights the main objectives and themes of the program. Children are encouraged to: 1) think of their body as their friend as it tells them when they are feeling worried by giving them clues (physiological and somatic response); 2) to be their own friend and to look after their body through emotional regulation exercises; 3) to talk to their friends when they are in difficult situations and to help others when they are in difficult situations, and; 4) to reward themselves when they’ve tried their best.
The FRIENDS program incorporates several important cognitive-behavioural components that are based on skill acquisition, including; 1) psycho-education regarding feelings; 2) understanding the physical expression of anxiety and how to use relaxation skills: 3) cognitive restructuring and positive self-talk; 4) problem-solving skills and graded exposure for achieving goals and facing fears; 5) the importance of self-rewards and trying hard. achieving goals, and: 6) relapse prevention and learning how to maintain skills for life. The booster sessions facilitate the generalisation of skills and help children to apply the FRIENDS skills to everyday situations and future challenges.
The FRIENDS program also includes a family skills component which involves parents during each stage of the program. A collaborative “team” approach is emphasized within the FRIENDS program where the facilitator, parent(s), siblings and the children work together with a shared goal of increasing confidence and coping skills, The family component of FRIENDS is aimed at empowering everyone in the family to recognise their skills and strengths and to use these skills to help one another become more confident and brave. Parents are educated about the development of anxiety in childhood and the distinction between normal developmental fears and anxiety disorders. Parents are taught about the identification of the risk and protective factors of anxiety; they learn strategies to recognise and manage their anxious children: and they learn how to recognise and modify negatively reinforcing parenting practices. Parents learn about the FRIENDS skills during the two structured parent sessions which are outlined in the current editions of the leaders manuals (Barrett, 2005). It is recommended that program leaders conduct 2 comprehensive parent sessions which comprise the entire content of the program. Within the school setting it may be difficult to attract some parents to the parent sessions so it is recommended that the sessions be held during convenient times for the parents (e.g. during lunch, immediately after school, in the evening). In the treatment setting (e.g. private health clinic) parents are actively involved in every session as they usually join each session (group or individual) for the last 30 minutes to discuss the skills that were taught. Parents are encouraged to work with and practice the FRIENDS skills through the “family homework” activities that are assigned at the end of each session. Parents are encouraged to take an active role in the program as research has indicated that the inclusion of parents in program implementation has a positive impact on the treatment of anxious children.
Due to the large evidence-base and extensive results indicating that the FRIENDS program for children and youth is effective, the next logical step in research was to develop the FRIENDS program for an even younger age. The Fun FRIENDS program (Barrett, 2007), is a downward extension of the pre-existing FRIENDS program targeted for children aged 4 to 6 years. Research reviews strongly suggests that the preschool years are essential for building social-emotional skills (Heckman, 2000). Children who are socially and emotionally well adjusted do better at school, have increased confidence. have good relationships, take on and persist at challenging tasks and communicate well (National Research Council and Institutes of Medicine, 2000).
The Fun FRIENDS program was initially trialled at Pathways Health and Research Centre and was then piloted within several local preschools within Brisbane, Australia. During this trial within the preschools. feedback was obtained from teachers, parents, and children. in order to improve the original program. The revised version of Fun FRIENDS (2007) is currently being run at Pathways Health and Research Centre — Brisbane and has a large emphasis on experiential play and exercises.
The Fun FRIENDS program focuses on developmentally sensitive cognitive-behavioural techniques to teach children social-emotional learning to increase resilience and decrease emotional distress. The developmentally tailored CBT skills include: teaching children cognitive problem-solving skills for dealing with interpersonal challenges; recognising and dealing with body clues (i.e. physiological arousal) through breathing control and progressive muscle relaxation; cognitive restructuring (recognising and changing unhelpful red thoughts to helpful green thoughts); attention training (looking for the positive, happy aspects of a given situation); graded exposure to fears (creating coping step plans), and family and peer support.
The Fun FRIENDS program targets three major areas of social-emotional learning curriculum; 1) Self Regulation: the ability to adjust to new situations, awareness of own feelings and the ability to manage emotions; 2) Responsibility for self and others: demonstrates self-direction and independence, respects and cares for the classroom or group environment, follows routine and rules; and 3) Pro-social behaviour: plays well with others, recognises others feelings and responds appropriately, shares, respects the rights of others and uses thinking skills to resolve challenges and conflicts. The program incorporates all the above skills and each session corresponds with one of the three curriculum areas mentioned for social-emotional development. The program is 10 sessions, although, each session is broken down into 15 minute learning activities (4 to 5 learning activities for each session), so that the program objectives are reinforced daily through experiential, play -based activities such as the use of play, dramatic role-play story telling, music, movement and art.
In sum, the FRIENDS program has a strong evidence-base and has been shown to be both an effective treatment and preventative intervention, for children and youth with anxiety and depression. Research to date indicates that one in five adults and children suffer anxiety or depression (more prevalent than drug use, attention deficit disorder, or any other mental health problem) but only 5% of cases receive intervention. Suicide is the NUMBER 1 cause of death in Australia in the 15-34 years age group, and Queensland together with the Northern Territory have the highest incidence of suicide in Australia, (Australian Bureau of Statistics , 2005). We all have an ethical obligation to intervene and promote preventative and effective treatment strategies for our children and youth.”
Family based treatment for childhood OCD
“When people think of obsessive-compulsive disorder (OCD), they tend to think of the box office hit “As Good As it Gets” with Jack Nicholson, or the more recent US television sitcom “Monk”. These popular culture depictions of OCD do tend to correctly portray the “bizarre”, “senseless” and sometimes even “laughable” nature of the disorder.
What they do not accurately represent is the often extremely intense emotional distress, functional impairment and debilitation that typify this condition for many children, teenagers and adults. Whilst television viewers might describe “Monk” as eccentric, or as having a quirky character, real sufferers of OCD tend to be very normal, sensible people, who are, however, frequently completely crippled by fear ayid anxiety, due to this neurobehavioural disorder.
OCD is a severe form of anxiety affecting approximately 3-4% of children and adults. It is characterized by the experience of obsessions (uncontrollable, intrusive, “scary” thoughts) and compulsions (repetitive behaviours of a ritual nature). Sufferers may develop compulsions in an effort to “neutralize” the thoughts and therefore prevent something terrible from happening.
Both children and adults suffering from OCD are totally aware that these thoughts and behaviours are not “normal”, are “weird” — hence the secretive nature of the disorder. Most children try to hide their rituals because they are fully aware that these are “strange”. Often parents, teachers and friends only find out about the problem when it becomes very severe and impossible to keep secret! As a consequence, most children and adults seeking treatment are usually experiencing debilitating levels of OCD by the time they seek help.
We don’t know exactly why some children develop OCD and others don’t. We know for certain that parents do not cause OCD in children. Research suggests there is a biological component to OCD. Children from families with a history of the condition or other anxiety problems are more likely to have OCD. But since many people hide their OCD and never receive treatment, it may be difficult to trace a family member with OCD. Some children may have a genetic predisposition but may never end up having OCD, and similarly children can develop OCD without having a genetic predisposition.
The development of OCD is based on the complex interaction between biological vulnerability and life circumstances. Stress plays an important role. There may be increased stress in a child’s life or their family environment. This can have a negative effect and contribute to the development of OCD. OCD also often becomes more severe during times of stress, or when a child is tired, run down or unwell.
OCD is most often described as a neurobehavioural condition. We know from neurological research that brain chemistry (i.e., serotonin levels), and specific areas in the brain associated with processing information, are implicated in the development and/or maintenance of this disorder.
Research from the University of California (Los Angeles) using PET scan imaging has shown that sufferers with OCD have increased chemical activity in certain regions of the brain compared with controls who do not have OCD. Interestingly, this brain chemistry and reactivity appears to return to normal following cognitive-behavioural treatment – highlighting the fact that we know our brains are malleable! We can change our brain chemistry, by simply changing our thinking patterns and behaviours!
It is important to realize that children do not choose to have OCD, just like other kids do not choose to have asthma, diabetes or allergies. Children with OCD typically cannot control their symptoms prior to treatment; therefore, they do not engage in rituals to frustrate family members or manipulate situations.
The annoying thing for family members is that children may not perform rituals whilst at school or with their friends; hence it is difficult for families to understand why the must do their rituals at home. Due to the secretive nature of the problem, children are able to suppress symptoms for a short while; however, once in the safety and comfort of their own home they are-almost impossible to stop.
Being more aware of OCD signs early in the onset of the problem makes treatment so much easier. There is no need to feel embarrassed about the nature of the symptoms – help is possible. Many other families have gone through the same difficulties and they did overcome them. Families do not need to feel like they are “slaves” of the OCD forever. There are solutions! There are effective treatments for this mental health disorder!
Because of its pervasive, chronic nature, most adults suffering OCD tend to report having experienced the disorder since childhood. Now we know we can effectively treat this severe problem during childhood. That means we can change, in very positive ways, the life trajectory of people vulnerable to experiencing OCD early in life – during their childhood. This is done by providing children and their families (both their parents and their siblings) with a “bag of tools” they can use to “fight OCD”.
Our research team at Griffith University conducted the first controlled trial of Cognitive Behavioural Treatment (CBT) for childhood OCD (in conjunction with Professor John March from Duke University, USA – a world renowned authority in the treatment of OCD). More than 80 children were carefully assessed and treated both in individual and group format. Both forms of treatment involved parents and siblings. All our programs at Pathways Health and Research Centre aim to empower the whole family with skills and strategies to help them overcome the problems they may be experiencing.
Results showed extremely high success rates – with more than 80% of the sample diagnosis free at both post treatment and 18 months follow up (Barrett, Healy-Farrell, & March, 2004; Barrett, Farrell, Dadds & Boulter, in press). This research demonstrated that group treatment and individual treatment were equally effective. In fact, families who participated in group treatment reported many benefits. These included the unique opportunity of normalization of their experiences, group support and empathy, learning from others’ successes and continuity of support networks formed after treatment had finished. Our team is now conducting an evaluation of the treatment at five years following completion of the program, to report on the durability of gains made.
The FOCUS PROGRAM (Freedom from Obsessions and Compulsions Using Cognitive-BehaviouralStrategies) (Barrett & Farrell, 2005) is offered at Pathways Health and Research Centre for children, teenagers and adults in individual or group format. From early 2006, we will also be disseminating training resources to allow qualified professionals nationally and internationally to learn to deliver this program to their own clients.
The FOCUS PROGRAM is delivered over 12 two hour sessions and it contains the following components:
– psycho-education about the nature, causes and course of OCD;
– empowering techniques to help externalise the OCD;
– body clues and specific relaxation/ mindfulness techniques;
– forming an expert team — child/ parents/ siblings/therapist against OCD;
– parenting/Sibling strategies to “fight” accommodation to OCD rituals (helping with checking etc). Learning to reinforce small positive steps towards success;
– mapping the OCD across time and settings;
– identification of specific cognitive “traps” of OCD and treatment strategies;
– exposure and response prevention;
– preparing for lapses, set-backs and ongoing life stressors and
– staying “the boss” of OCD — strategies to stay free from OCD.
We are strong believers that anyone (child or adult) can learn skills to overcome this “invasive”, “grasping” disorder — OCD. Childhood is an optimal time for intervention as many times we can “catch it” early enough without the need to resort to medication as an added treatment component. Often, in late adolescence and adulthood, the severity, pervasiveness and duration of OCD warrants the use of appropriate medication in conjunction with learning the FOCUS PROGRAM. Moreover, it is common in late adolescence/adulthood for sufferers to experience both OCD and depression as co-morbid diagnoses. In these case, treatment may be more challenging and longer in duration, since the disorder has often resulted in a long and unnecessary period of suffering for all involved.
Concluding remarks — please don’t wait! If you know any child, youth, or adults experiencing this difficult disorder, please let them know they can find effective help. Many have done so and the benefits extend beyond family life. Schooling and friendships are also affected by OCD making the young sufferers socially isolated and incapable of performing academically to the level of their ability.
YOU! — the reader of this article — can change that today — for one child and one family! Even just one!”
FRIENDS of the family
“HOW many times have you dragged your child kicking and screaming to school because he or she doesn’t want to go?
How many times have you kicked yourself for lacking the parenting skills to defuse a situation involving an over-anxious child or teenager?
And how many times have you and your child ended up extremely distressed?
Dr Paula Barrett, a clinical psychologist, senior lecturer at Griffith University. and internationally recognised expert in child and adolescent anxiety and depressive disorders does not claim to have an overnight cure.
But her program, FRIENDS. a treatment and intervention protocol for anxiety and depression — which can trigger mental health disorders — gives parents and schools the wherewithal to help children develop coping skills. The processes through which Barrett works have been described by her peers as not only effective but “magical”.
Says Barrett: “It can be used as a prevention and resilience-building program in primary and high schools run in small groups. We can also run it as a clinical intervention in children with moderate to high levels of anxiety and we teach the children a variety of skills to cope better.”
These involve identification of emotions, relaxation, cognitive, behavioural and maintenance skills, including positive thinking, problem-solving, choosing appropriate role models, facing fears, controlling anger and increasing self-esteem. Parents are taught to implement the skills in the family environment and encouraged to join support networks where there is no extended family. Barrett says it is a gradual process and busy parents should take children to a professional.
“It’s not a big ask. If they don’t, perhaps they’re going to spend many hundreds of hours when the child is an adolescent trying to fix a much bigger problem.”
FRIENDS has been running for about eight years. What does it stand for? Says Barrett: “F for feelings: R relaxation, I for I can do it: E. explore solutions: N, nice work for trying your best: D. don’t forget to practise; S. stay calm.”
She also says a healthy diet and plenty of sleep are essential for children and adolescents to avoid anxiety disorders.
Up to one in five children are at risk of severe anxiety and up to 25 per cent of young people will have a serious disorder at some stage in their lives, according to researchers.
The most recent Australian study published in the US Journal of Genetic Psychology, in 2001, has found the prevalence of anxiety in adolescents to be about 15 per cent.
High school kids may be under str,’ss from peer pressure, exams, bullying and hormonal and social interaction problems.
Barrett’s program has a worldwide following, with clinical trials under way in Australia. the US and Europe. She will be a keynote speaker at the third international conference on Child and Adolescent Mental Health to be held in Brisbane from June 11 to 15.
While more than 100 Australian schools have introduced the program, Barrett is pushing for nationwide inclusion in the curriculum, requiring teachers to attend training workshops and parents to buy a $15 workbook. Her treatment also has been used in hospitals and health services, with about 8000 children completing the program since 1998. Up to 80 per cent of children no longer show signs of anxiety on completion of the program.
Major child anxiety disorders include separation anxiety: fear of separating from parents, home or other familiar surroundings; general anxiety; excessive worry and tear, usually accompanied by headaches. stomach aches. vomiting and sleep disturbance; post-traumatic stress; severe anxiety following a traumatic event; social phobia; fear of being humiliated or embarrassed in front of other people; panic attack: intense fear or terror, often accompanied by physical symptoms such as palpitations, chest pain and choking or smothering sensations; and agoraphobia; anxiety about, or avoidance of, places or situations from which it may be difficult or embarrassing to escape.
Barrett expanded and adapted her program from research carried out in the 1980s by US psychologist Phillip Kendall, who treated children individually under his program for anxiety. Barrett added a group format and a family intervention component for young children and received funding from the Common-wealth Government’s National Mental Health Strategy.
In 1998, she produced an updated FRIENDS program for seven to 11-year-olds and 12 to 16-year-olds. Constant fine-tuning is necessary to make it relevant to today’s youth.
Just under one in 10 adults has an anxiety disorder, according to the National Survey of Mental Health and Well-being and 20 per cent of 12 to 16-year-olds have a mental health problem.
It doesn’t help that many of those people are stigmatised, says Professor Graham Martin, a child and adolescent psychiatrist at the University of Queensland.
“They don’t reach out to professionals. They try to rationalise difficulties, then they try to pretend it’s not happening,” he says.
Martin says over-caring parents exacerbate worries. He believes anxiety is a hidden problem.
“We have an image of ourselves as Australians as very strong people. For young people the group is terribly important and if they’re all 18 stone rugby players and you’re a seven stone weakling, you’re in dead trouble. I think it’s more difficult for young men than young women. We don’t educate young men to recognise what’s going on inside them and express themselves. We do not understand their mental health and we are not skilled at engaging them.”
Down the track it could trigger dangerous or aggressive behaviour. Health services perhaps did not take the disorder seriously enough, with psychosis and depression prioritised.
Martin says there are a range of pro-grams such as Barrett’s but a lack of funding ensures services are generally not available.
Experts say although we now live longer because of scientific and medical breakthroughs, psychological illnesses are becoming more common.
Children and youth are now more likely to develop a mental illness than they were 20 years ago.
So with anxiety the most common for, of mental disorder in children and adults in the country, experts are seeking solutions that not only address the disorder but also the economic burden on the health system.
Anxiety can have a devastating effect on a child’s ability to cope with stress, socialising, adapting to change and school adjustment. If untreated, childhood anxiety may develop into chronic adult anxiety disorders or clinical depression. which may trigger suicide.
Clinical psychologist Professor Matt Sanders and founder of the Triple P Positive Parenting Program will be on the scientific committee at the conference in June. His program is instrumental in helping parents, children and adolescents with strategies to manage behavioural and emotional problems. He says children’s capacity to manage anxiety is influenced by parenting techniques.
‘The way in which parents respond to children’s distress and worries and the ways of avoiding things they’re frightened of can inadvertently feed and accidentally promote anxiety,” he says.
When parents learnt skills that coached children to conquer fear by confronting it, parents could be extremely helpful.
Sanders says an anxious child’s appraisal of threat can be disproportionate to that which the child is actually experiencing. “Anxiety that’s excessive is often irrational.” Parents could be influential in several ways. “First, the children share their genes so if a parent is anxious there’s an increased likelihood their offspring will experience some difficulties with anxiety,” he says. However, it is unknown if it boils down purely to genetics.
So how can parents quell children’s fears and anxiety?
“Parents can influence their children’s degree of anxiety through modelling,” Sanders says.
If parents were fearful, their child could sense their body language, no they should learn to manage their own distress. Praising children about confronting fear could be powerful. Parents could create opportunities for modelling to provide coping mechanisms for an anxious child
“For some kids that involves learning to control their breathing and calming themselves down. Another would be positive thinking so the child learns to say affirming things like ‘I can do this, there’s nothing to be afraid of’.”
Professor Graham Martin says there are several methods for treating anxiety, one of which involved “imploding” the anxiety.
“You can take the feared circumstance, put the child in that circumstance until their anxiety abates. Acute anxiety lasts no more than about 45 minutes. Physiologically it’s impossible for it to last longer.”
Sanders’ approach appears similar but with a more subtle edge. He says parents need to stop being over-protective towards distressed kids to allow them to deal with a problem. Anger, irritability and depression were signs children were not coping.
“The points of transition where children have to make adjustments can pose a challenge,” he says.
Parents should not accidentally reward a child for avoiding distressing situations. “For example. parents shouldn’t let them stay at home and watch TV instead of going to school.”
The issue needed to be discussed with the child, with a plan put in place. Sanders says incentives can be given. “Then the youngster needs to learn that even though it’s uncomfortable to be feeling panicky, there’s nothing surer than this: that it will pass.
PROFESSOR Barry Nurcombe, a child and adolescent psychiatry expert from the University of Queensland, agrees with Sanders’ proposition that anxiet- could be passed from one generation to the next.
“These are kids who are noted from the age of two or three to hold back at social gatherings. These kids stand on the margins,” Nurcombe says.
If not treated, Nurcombe says children can in adolescence or adulthood. develop serious anxiety disorders, agoraphobia, depression or end up committing suicide.
He says although more boys than girls commit suicide, primarily because boys choose lethal means such as guns and hanging, girls attempt suicide more often. Girls are more likely to try to overdose on pills as a cry for help. But both genders are increasingly using hanging as a means to commit suicide.
Experts agree Queensland consistently has the highest rate of suicide in the country. The Australian Bureau of Statistics, in 2000, reported 81 youth suicides in the 15 to 24 age bracket compared with 338 youth suicides nationally, with boys about five tunes more likely to commit suicide than girls. However, the director of the Australian Institute for Suicide Research and Prevention at Griffith University, Professor Diego De Leo, says youth and national rates are declining in line with the rest of the developed world.
Drug abuse also is linked to anxiety. Nurcombe says anxious and depressed kids take drugs to self-medicate and dampen anxiety.
“Some of these kids are predisposed to drug-taking. If there’s been a background of serious sexual abuse. that in-creases the risk dramatically.”
Nurcombe, who will present a symposium into research on the treatment of sexually abused children at the conference. believes society underestimates youth problems “But it’s getting better. A lot of it has something to do with media publicity. The apparent drop in suicide may indicate we’re doing something right.” ”
Youth anxiety at crisis point
“BULLYING and the “fast pace of life” caused one in five children to suffer from an anxiety disorder, experts warn.
Kids Help Line received almost 190,000 calls last year. Experts told The Sunday Mail the rise in anxiety levels has resulted in children suffering insomnia, loss of appetite, excessive worry and illness.
And they warned that, if left untreated, children were at risk of depression and suicide.
Psychologist Dr Paula Barrett from the Pathways clinic at Griffith University said factors, including bullying, family problems and dramatic life events, led to many children suffering from anxiety.
Dr Barrett said the increase in anxiety disorders had led to the development of the Friends program in Queensland schools, which teaches children how to deal with increased levels of stress.
And she warned that anxiety in primary school was the biggest risk factor for depression and youth suicide in adolescents.
“Children are having to grow up faster than ever before,” she said.
“Some kids take on too many extra-curricular activities … and some put too much pressure on themselves.”
Mum Vicki Done, 46, took her daughters Maddison, 11, and Abbie, 9, to the program after the break-up of her marriage.
“I noticed Maddison was becoming withdrawn and very quiet,” Vicki said.
Grade 7 student Maddison, from Upper Kedron in Brisbane, said: “I blamed myself a lot for what happened. By speaking to Paula, I learned how to cope. It helped me become more calm and relaxed.””
Is your child obsessed?
“It’s a heartbreaking fact for parents to face up to, but one in every 200 children in Australia will suffer from obsessive compulsive disorder.
When Carol’s daughter Ann began sting in the bathroom for one and half hours every day, her mother grew concerned. Carol could hear the window opening and shutting and there were strange noises coming from the bathroom. She soon learn that 13-year-old Ann was cleaning and scrubbing everything in the house, including the shower, window, toilet, taps, floor and toilet. Not just once, but over and over again.
Her teenage daughter’s behaviour was becoming more bizarre every day.
‘She was obsessed with rituals and sticking to a routine,’ Carol says.’Everything in her room had to be a certain way. Nothing could be moved.
‘Ann couldn’t walk through a doorway without doing something with her hands and her feet. She might have to rub her hands a certain number of times or touch the fridge with each hand. Or walk through the doorway with one foot meticulously in front of the other.’
Ann was suffering from obsessive compulsive disorder (OCD), an anxiety disorder that can strike children as young as six. Some children will develop fears about contamination, spending hours washing, scrubbing their hands until the skin is raw.
According to Dr Paula Barrett, director of a program aimed at dealing with childhood anxiety at Griffith University, Queensland, one in every 200 children will experience severe compulsions and obsessions in the lifetime.
‘There’s a very strong genetic link to obsessive compulsive disorder,’ she says. ‘Severe anxiety or depression in a family is likely to be one of the factors affecting it, as are major stresses and hormonal changes.
‘In my work with these children, I’m beginning to see a lineage of suffering from anxiety and depression’.
Children and teenagers who suffer from OCD are likely to be extremely secretive and feel ashamed of their thoughts. Dr Barrett says that one of the symptoms is a need for excessive reassurance about cleanliness, order and affection.
‘They need to do lots of ritual all the time to feel secure. These youngsters worry about things like illness and contamination. And rituals can constantly change in response to the situation.’
In Ann’s case er mother was unable to persuade her daughter about what was going on.
‘If we tried to talk about it, something new would come out. At one stage we thought Ann was getting better until we discovered she was doing the rituals in her mind. ‘Her school work was affected,’ Carol recalls. ‘Her teachers told me that if Ann typed something on her computer and made a mistake, she would have to start all over again, right from the beginning. She was unable to delete anything.’
The family became very distressed about it, but Ann bluntly refused to go to a doctor with her mother.
Finally, after a family trip to see her grandparents interstate Ann did realise and was wilting to acknowledge that something was wrong. On her return, Carol booked them both into the program at Griffith University.
‘Within 14 weeks therapy (CBT) she was a different child — a happy, normal girl who enjoyed life.’
Ann’s major difficulties stemmed from a close friendship at school, one which was causing her serious anxiety as she was totally unable to deal with a bullying friend.
Lara Healy, a psychologist from Griffith University who works in the program, says the typical onset of OCD is around 10-12 years old.
‘In younger years it seems to affect more boys than girls,’ she says. ‘Once they get into adolescence, more girls seem to be affected.
‘The triggers seem to be stressful life events. It may be the loss of a pet, or that the child has been very sick, even hospitalised — or perhaps if the home has been burgled.
‘If OCD is left untreated, it tends to become a chronic condition that waxes and wanes,’ she points out.
With treatment, youngsters are able to identify what’s going on and get it under control. Lara explains: ‘We use a technique known as cognitive behavioural therapy (CBT) which focuses on the child’s thoughts, feelings and behaviours. We teach them to respond to threatening situations in a more rational way.
‘We teach them how they can control their feelings and thoughts, as well as how to approach situations without their rituals or engaging in avoidance. Our results indicate 80 per cent of our young patients have a significant reduction in their symptoms.'”
New hope for OCD sufferers
“OBSESSIVE Compulsive Disorder (OCD) has become better known in a recent times with movies such as As Good as It Gets and-the television show Monk.
As clearly demonstrated by these fictional portrayals, OCD severely impacts and disrupts the everyday functioning of adults living with the condition.
A lesser known truth about OCD is that many children are also suffering from it.
OCD involves obsessional worrying about everyday situations and compulsive behaviours undertaken to avoid some dreaded event.
The anxiety which accompanies these symptoms is debilitating and makes OCD the most severe of the anxiety disorders.
OCD can appear in many forms and typically leads to marked interference in daily living. Common examples are fears about being hurt, about terrible events happening to family and friends, rituals involving repeated checking of locks, incessant hand washing or having to spend one hour in the shower.
Pathways Health and Research Centre is an innovative community-based research clinic providing specialist psychological service to enhance the emotional well-being and resilience of children.
The Directors of Pathways, Associate Professor Paula Barrett (…), have developed the world’s first family-based cognitive-behavioural treatment program to help children and adolescents who suffer from the condition (Freedom from Obsessions and Compulsions Using Cognitive Behavioural Skills: FOCUS).
The treatment has been empirically validated at Griffith University and has been acknowledged world wide as a ground-breaking program for youngsters who suffer from OCD.
Dr Barrett, who has also written the internationally acclaimed FRIENDS program, is excited by the launch of FOCUS as it will help children and families overcome OCD and improve their everyday life.(…)”
Planet girl in crisis
“The suicide of two teenage girls highlights every parent’s nightmare, writes Elizabeth Allen
WHEN two Victorian high school students were found hanged this week, a shiver went clown the collective spines of parent, of Australian teenagers.
What could have caused two 16 year old girl, to kill themselves in as pact, after posting suicide messages on the internet?
The shock of the parents of Stephanie Gestler and Jodie Gater was palpable.
“Stephanie, why didn’t you tell me you were so upset?” wrote Jolt, a police officer, on her daughter’s webpage. “Why didn’t you just come home? There is nothing that couldn’t have been sorted out.”
The deaths have caused many parents to cast lingering looks at their own teenage daughters, those hormone-charged, often unpredictable girls who like to spend so much time in their rooms and on the internet.
Could they too be at risk without their parents knowing?
The views of expert, in the wake of the tragedy are alarming.
Suicide among teenage girls is relatively rare: 24 girls aged 15 to 19 killed themselves in Australia in 2005, the latest figures available from the Australian Bureau Of Statistics.
But psychology professor Paula Barrett, of Brisbane’s Pathways Health and Research Centre, expects the rate of youth suicide to rise sharply.
“There are going to be many more youth suicides in the next 20 years.” she says, citing the speed of modern life, a tat k of extended family-support networks and increased academic pressures as among the stresses which may cause teenagers to kill themselves.
Psychologist Michael Carr-Gregg puts it this way. “Planet Girl is in crisis.”
And Dr Barbara Spears, an expert in girls’ peer relationships, strike an even more chilling note.
“It’s easy o not see the journey from trivial to tragedy”.
Carr-Gregg, the author of several books on adolescence, says messages posted by best friends Gestler and Gater on their MySpace webpage clearly indicated they were depressed.
“Depression is the common cold of psychiatry”.
Alarmingly, an estimated 60 percent of sufferers do not receive treatment.
Carr-Gregg believes parents need to be much more involved in their teenagers lives if they are to safeguard their psychological wellbeing.
“As a society we appear to he losing it when it comes to parenting our girls, he says in Princess Bitchface, his latest book on adolescent girls.
“More and more young women appear to he in charge of their own lives, more worried about pleasing their age peers than listening to or respecting their parents.
“Right across Australia. battle-weary parents are raising the white flag and beating a hasty retreat from the fray.”
According to Carr-Gregg. exactly the reverse needs to happen.
“While it is counterproductive for parents to be in the faces of their daughters every hour of every day, it is vital that you are supportive, make them feel safe, valued and trusted and, above all, that you know where they are, who they are with and what they are doing.” he says.
In the aftermath of the Victorian tragedy, Carr-Gregg strongly recommends parents monitor and limit their children’s Internet usage.
“If the parents of these girls had been monitoring their MySpace. alarm bells would have rung,” he says. “Parents need to take a hell of a lot more interest in what their kids do online, not just what they download but also what the upload.”
He advises concerned parents to use software such as Keylogger to record what their children write on the Internet. This is then emailed to parents the next day. Other filters such as Cybersitter can monitor the time spent on a particular site.
Medical experts say they may sound like invasive measures, but today’s teenagers are living in a very different world from their parents’ time.
“In the old days, they could only socialise with kids who they went to school with or played sport with,” Carr-Gregg says.
“Today they have access to hundreds of thousands of disconnected or disaffiliated kids.”
The result can be a virus of negative thoughts. Carr-Gregg advises families to draw up a family Internet contract A government site. netalert.net.au, can help parents with this by spelling out what is appropriate online behaviour.
He also advises limits on internet time, citing cases of patients who spend 15 hours a day playing one internet game.
“They are obese morbidly depressed and lasing their lives in cyberspace.” he says. He wants parents to take the lead in encouraging their children to lead balanced lives. “They need a healthy diet sport, dance, art… but what’s happening is that a lot of them are coming home and disappearing behind this firewall called MySpace and MSN.
“It’s a digital divide. But kids won’t build a bridge hack. Parents base to he proactive.”
Child and adolescent psychiatrist Tony Cook also believes teenagers should be encouraged to interact with “real people”.
He says it is “most likely there was a depression element present” in the suicide of the Victorian teenagers.
Coot says depression can present in different ways at different ages: “In young people, they have a lot more irritability and quickness to anger. When you are older you know the sun will come up tomorrow and that problems have solutions. But young people can think there’s no tomorrow.”
Cook advises parents to talk to their child and “maintain a relationship”. “That’s difficult with some 16-year-olds but it’s a lifelong commitment,” he says.
Teenagers should also be aware help is available, “If there’s a strained relationship with a parent approach a teacher, a church person, a netball coach. Seek professional help.”
Dr Barbara Spears, a senior lecturer in education at the University of South Australia. believes one of the big issues in understanding girls is how to separate the drama queens from the real girls at risk.
“It’s easy to not see the journey from trivial to tragedy,” she said. “With relationship issues, we as adults say, ‘It will pass’. We offer platitudes. The journey they are on can seem trivial to us but it’s not. The journey to tragedy is quite fast.”
Spears says parents who operate in an authoritative — not authoritarian — way have better relationships with their children. “They set boundaries but the kids have freedom within those boundaries,” she says. “They can make choices within those constraints.”
In contrast, authoritarian parents give no freedom and laissez-faire parents do not give enough care.
However, psychologist and academic Dr Barrett does not agree with Spears that the path to suicide can be quick. “Usually when kids get to this point there’s been a history of difficulty, whether it’s three months or many months.” she says.
“You don’t go from totally happy to committing suicide.”
With one in five young people either very anxious or depressed, Barrett wants to see society building social and emotional skills in children from a young age.
Barrett’s Friends program, which promotes resilience in primary and high-school students, has been adopted by the World Health Organisation as best-practice.
The program, run by the Pathways centre at Brisbane’s West End, is used in schools in Canada, New Zealand. Greece, Finland, Norway, Britain and some Queensland private schools, but not in Queensland state schools.
Barrett says if all young children were taught social and emotional skills, they would be alert if someone was in trouble.
“If someone was having a particularly bad time, everyone around them would be alert to the warning signs.” she says.
“It would be like a community safety net to catch the child.”
Barrett advises parents to be vigilant for signs of distress.
“Sometimes parents think their teenagers are just revolting and if they ignore them it will go away,” she says.
“But parents should have it checked out. Give them a chance to talk to someone professionally.”
“After the initial barrier of 15 minutes of sulking, they will talk.
“Once you crack that harrier, then you realise this person is so desperate for someone to help them.”
Good days, bad days warning
SOCIAL campaigner and World Vision head the Reverend Tim Costello has warned of the dangers of the impact of a “toxic culture” on young girls.
Commenting after the suicide deaths of two 16-year-olds in Melbourne earlier this week. Costello told an audience of girls and parents at St Aidan’s Anglican girls school that society places too much emphasis on how girls look.
“There is no doubt there are toxic forces at work in our culture which impact on girls,” he said.
“There’s pressure about how they look, about what brands they wear and the assumption is if they get those things they’ll be happy. That ‘s not true.”
Costello said it was important parents and girls realised they would have had days.
“But we all need to realise that black feelings are not final.
“They are always a transition phase.
“The trouble is, when you put those black feelings into MySpace it has a finality about it that can be lethal.
“That’s the difference these days. The precipice seems closer, and the risks greater.”
Watching for the signs of trouble
PSYCHOLOGIST Paula Barrett says signs of depression in teenagers can include excessive worry and sleep disturbance.
“They either go to bed early and can’t sleep because they are worried or they have early rooming insomnia.” she warns.
“They wake up feeling really bad about themselves and feel hopelessness and helplessness.”
Social plantation can also be a sign.
“They start withdrawing and not relating to anyone. spending a lot of time in their room and/or with one special friend, They can form pacts.
“Usually they can’t concentrate at school and lose interest in everything that used to make them happy. They are irritable all the time; everything gets on their nerves. They frequently get physically sick and have headaches arid stomach aches and a lot of psychosomatic symptoms.
“Some kids even talk about suicide. They are really negative about themselves or the world.”
Barrett says parents should be alert for behaviour that is aberrant for their child, as everyone has different levels of emotional reactivity.
Emo culture. to which the Victorian schoolgirls belonged, has made it cool to he sad and negative, Barrett says, and has coincided with an increase in self-harm among teenagers.
Barrett, the mother of a 17-year-old boy, advises parents to stay in touch with their children by participating in their activities and inviting their friends over.
“Under supervision, allow parties or dinner parties in your house,” she says. “Encourage your kids to have human relationships, not just with computers. Kids who have social difficulties tend to escape into their virtual reality space and the more they do that, the worse their social skills become.”
Parents should also try to “just listen” to their daughters. “If they don’t want to talk to you, try to get them to go and talk to someone else, even if it’s Kids Helpline or a teacher.
“Or if parents find their kids have written a letter or something on the internet, saying ‘I don’t want to be here any more’ I would straight away take them to professional help. They may be bluffing but what if they’re not.””
OCD – Mind Wellness
“Nine-year-old Marie is a typical girl: she loves music, netball and hanging out with her friends. But unlike most nine-year-olds, Marie needs to make 20 trips to’ her bedroom before she leaves for school, to check that her pillows are perfectly straight on her bed. If she doesn’t do this each morning, she suffers debilitating as she truly believes that straightening the pillows prevents her family having a car accident.
Obsessive-compulsive disorder (OCD) is a condition involving unwanted thoughts, images or impulses (obsessions) which cause the individual such distress that they are driven to perform certain behaviours (compulsions) to reduce the anxiety. It’s a common disorder affecting three in 100 people. Many people with OCD don’t seek treatment, usually because they’re either embarrassed about their thoughts or they don’t think they’re such a big deal, so this number may actually be higher.
OCD usually emerges in mid to late childhood or early adulthood and often the symptoms change over the course of the sufferer’s lifetime.
The common thread with sufferers of OCD is they place unusual importance on usual thoughts. In Marie’s case, she firmly believes that having the pillows straight is actually keeping everyone safe.
AVOIDING THE CRACKS
Most people tend to associate OCD with compulsive handwashing or avoiding cracks in the footpath, partly because of how OCD is portrayed in films like As Good As It Gets, Matchstick Men and The Aviator. However, in my work as a clinical psychologist specialising in OCD, I’ve seen numerous variations.
Sometimes the symptoms cluster around an aggressive theme. For example, Denis, 34, was fearful of driving his car because he was scared of hitting a pedestrian. Every bump in the road caused him such anxiety that he had to park his car and get out to see whether he had hit someone. The fear eventually became so bad that he stopped driving.
“Contamination” cases are another common type of OCD. Michael, 17, is an extreme case. He was concerned with being poisoned so he began wearing gloves and was unable to use any appliances because he feared he would poison himself. The fear became so bad that he was hospitalised because he was unable to eat or drink. Less severe cases involve an individual not taking public transport or eating in restaurants for fear of being contaminated by germs.
SOMETHING’S NOT RIGHT
Another type of OCD involves having to do something until it “feels right”. For example, university student Michelle was preoccupied with preventing her left foot touching the floor when she was seated. If her foot did touch the floor, her anxiety would be severe and she’d have to stretch out her arms to relieve the tension. She couldn’t explain why it was important that her left foot didn’t touch the floor, except to say it “didn’t feel right”.
Another client, Dorothy, explained her thinking: “My life is set into boundaries. I have to leave my home with my left foot, leave school with my left foot…and everything has to be in even numbers. If I’m about to go through a door, I check my watch; if it’s 12.47 I have to wait until 12.48. If I’m at the supermarket and the cost of the purchase is $17.30, I will have to buy something extra to increase the cost to $18.”
NEW WAYS OF THINKING
Cognitive behavioural therapy (CBT) has had great success treating mild cases of OCD, with more severe cases often requiring a combination of CBT and medication. CBT works to provide the individual with various skills to help them realise the intrusive thoughts characterising the disorder are not abnormal and the things they fear will not happen.
There are many clinics in Australia providing CBT programs. The “Freedom from Obsessions and Compulsions Using Strategies (FOCUS)” program at Pathways Health and Research Centre in Brisbane, for example, involves 15 weekly sessions with a clinical psychologist. The individual learns how to challenge their negative thinking and to start “bossing” the OCD.
The individual, their family and the therapist work as a team to fight the OCD and to take back those aspects of the individual’s life that are being controlled by the disorder.
The focus of the program differs from others in its emphasis on empowering the individual to externalise the OCD (to “boss it back”) and on the involvement of parents, partners, peers and family in the individual’s treatment.
A study conducted in 2004 by the director of the program, Professor Paula Barrett, found that 88 per cent of 77 children who participated in the program were diagnosis free (did not have OCD symptoms) at the end of treatment and at three-and six-month follow-ups.
The FOCUS program is conducted by clinicians who are passionate about helping individuals with OCD. Its success in treating children with OCD can be attributed to its strong emphasis on family.
It’s also an effective treatment for adult sufferers, particularly as it empowers them to conceptualise the OCD as a pest, a “former boss”, and something separate from and outside of themselves. They can therefore say, “It’s the OCD trying to make me think something bad will happen if…” rather than attributing the problem to a character flaw.”