There is a significant body of research showing that children and teens with symptoms or diagnoses of anxiety disorders have been shown to “think in different ways” compared with children who do not have these challenges.

For instance, studies have found children with anxiety are more likely to remember negative or threatening information in their environment, interpret ambiguous situations as potentially dangerous, and be able to identify a greater number of threats in any given situation. Other studies have found that the degree or amount of “negative thinking” a young person regularly does/has (catastrophizing, black and white thinking, mind reading) is correlated with the severity of anxiety they experience. Finally, studies have also found that children with anxiety disorders spend significantly more time “worrying” (thinking repeatedly about fearful thoughts repeatedly) than children without anxiety disorders. A note for interest – although these effects have been found in children of all ages, they are more pronounced in older children/teens than in younger kids.

Given these differences in the way anxious children think compared to non-anxious children, it is not surprising that there is a long history of psychologists trying to help anxious young people to either think differently, or to think differently about their thinking.

There are at least three models of psychological treatment which outline strategies for how children/teens with anxiety might manage, respond to or view thoughts and beliefs - cognitive behaviour therapy, metacognitive therapy and acceptance commitment therapy. Each of these models of treatment have slightly different views about the way worried thoughts or beliefs contribute to anxiety. I have briefly summarized these below. Please note that each of these therapy models include other important components in their treatment protocols – in this summary however I have just focused on how these different treatment models view thoughts and beliefs.

Tina is in year 1, lives with her Mum and her older brother, and is very anxious about going to school. This issue has been a challenge for Tina and her Mum for some time – from kindergarten onwards.

However since starting year 1, Tina has become even more anxious. Every school morning, while Mum tries to convince her that she will be okay at school, she cries, yells, says she is sick, throws things, says “I hate you so much” and hits her Mum. Sometimes she vomits. Tina gets a stomach ache and headache most afternoons when she thinks about school the next day.

Tina is now only going to school once a week and has missed over 50 days of school this year.

As well as being anxious about going to school, Tina also feels uncomfortable staying with her grandparents when Mum goes out on the weekend, and does not want her Mum to leave when she goes to other children’s houses to play.

As I’m sure you have guessed, Tina (not a real person) is a child with separation anxiety, the most common anxiety disorder diagnosed in childhood – and school anxiety.

I’ve recently been undergoing physiotherapy rehabilitation after having tendon surgery. At my first visit, the physio had me download an “app” which lists my daily exercises, uses an alarm notification to remind me to complete them and has a “tick off” function for each exercise after I complete them daily. I’m an old hand at rehab and so am generally committed to doing it consistently, but having a visual record of exercise completion over a week in this app has provided extra incentive make sure I don’t miss any days.

This app is of course, encouraging self-monitoring behaviour. In case you need a refresher, self-monitoring within education and psychology fields is defined as the paying of attention to a specific aspect of our life – usually a behaviour or a mood - and regularly recording whether or when that behaviour or mood happened (Korotitsch, 1999).

As you are no doubt aware, self monitoring has been used for decades by psychologists and teachers to help people change something about their life or emotions. For example, we might ask people to record – on a daily basis - their mood on a scale of 1-10, how often they used a helpful or unhelpful coping strategy, what they ate, how often they got angry, how often they practiced a meditation task, their thoughts in a difficult situation, their worry behaviours, how often they drank alcohol – and many more types of behaviours. One study found that 83% of behaviourally orientated psychologists used self monitoring at least half the time with their clients.

Dealing with Coronavirus is tough for everyone – kids, young people and adults - and us as professionals too. For children with “big feelings” and challenging life events, it can be even harder.

Here are some ideas about how we can answer children or young people’s questions or respond to their worries. A few general principles in how to do this are as follows:

1. Try to ask a question or two before we respond to a child/teen’s concerns – we may be able to get more information about exactly what they are worried about and therefore answer more helpfully.

2. Express care and sympathy rather than “dismissing, shutting down or minimising”. As professionals working with children’s well-being - we are usually pretty good at this :)

3. Answer with a matter of fact, calm and confident voice and facial expression. Children are watching and learning from the adults around them - including us, their trusted teachers, psychologists, counsellors and support workers.

4. It’s okay to put some limits on the time we spend talking about this issue. We can keep our sessions, lessons and work with young people more or less as normal if this seems appropriate. For some children/teens we will need to spend more time on it, but it’s also okay to end the conversation. For example, we might say something like: “That’s a problem for adults to solve and there are lots of clever adults working on that right now. You don’t need to spend much time thinking about that. Let’s go back to doing X/discussing Y for a while”. We might also say something like: “We’ve spent enough time talking about this for now, it’s good for our brains and bodies to have a break from thinking about worrying things and problems, let’s do /talk about X/Y instead”.

In the last few weeks I’ve presented at a number of school “acquaintance” and “orientation” nights to parents of primary and secondary students – and one of the topics I cover in these seminars is sleep: how much children and teens need and how we support them to get enough.

It’s only a small part of the talk (I discuss a range of factors which are associated with success and wellbeing for young people) but I thought I’d do some reading to make sure I was across any significant developments in the science of sleep for young people.

Once I started reading, I went down the “reading research rabbit hole”. I spent a few hours (and missed some of my own sleep time) reading some interesting new studies and reports – as well as some old ones I’d missed.

I thought some of them might be worth sharing with you in this article. Here they are, in no particular order:

Like almost all Australians, I spent the Christmas/New Year period watching fire apps, bushfire news and feeling devastated for the families who have been impacted.  I know that many of our Calm Kid Central members/families/professionals who receive these articles - particularly those who live in the Gippsland regions, KI, Adelaide Hills - as well as others - have been significantly impacted by fires, with some of you experiencing massive stress, trauma and fear.  I'm so sorry for what some of you have experienced.  All of us at Developing Minds have been feeling distressed and worried for people around Australia, including our Calm Kid Central members from bushfire affected communities.  

I also know that many other families who have not been directly impacted by fires, also have children who are experiencing stress and anxiety as they watch the news, are affected by smoke or hear conversations by their friends and family.  Children with existing emotional health challenges are sometimes particularly impacted by this anxiety, as it adds "one more thing" to their existing worries.   As professionals, you like us are probably having many conversations each day with these children who are experiencing anxiety and stress about this topic.

There have been many excellent guides published by various organisations about how to talk with children about fires, what to say and how to help them.  Rather than recreate these here, I've included links to a few of the best I've seen at the end of this article so you can print out and give to families as you see fit.

One of the most powerful ways to help children act more calmly, more often – and to reduce their angry behavior – is to coach them to develop frustration management skills.   

These skills include the following: 

• Using (appropriate) language to express their feelings and desires

• Asking for help or support

• Using strategies to lower physiological arousal,

• Switching their attention away from difficult situations,

• Noticing “angry” (blaming, non-empathic, catastrophic) thinking

• Using calm sentences to remind themselves that frustrating situations and behaviours from others are not terrible, not always intentional, often understandable and can be managed.

• Identifying potentially frustrating situations ahead of time (and planning for them);

To help children learn these skills we need to first have a sufficiently warm and trusted relationship with them, provide age appropriate rationale and explanation, model the skills, rehearse with them and ensure they have enough motivation for practicing and using the skills.  

However, all of this coaching work can only be done when children are calm.

In other words, children do not learn these skills “in the heat of the moment” when they are angry or frustrated.  Instead, they learn these skills before and after frustrating situations, when they have the time and state of mind required to talk and practice efficiently.

There is no doubt that biological factors play a large part in contributing to children and young people’s anxiety.  We now have research which strongly suggests a genetic component (e.g. identical twins are more likely to have similar rates of anxiety than non-identical twins) to anxiety, research which has identified physiological differences (for example heart rate reactivity, a number of brain structures/processes) between more and less anxious children and research which has found differences in infant behavior which predict which children grow up to be more or less anxious. 

As I explain to families I work with, all these fields of study put together indicate that at least some tendencies towards anxiety in humans is “hard wired” into some young people much more strongly than in the average young person.

However there are other research studies which show that there are aspects of a young person’s environment which also influences their levels of anxiety.  For instance, various studies have found factors such as early traumatic life experiences, friend and peer relationships, school life, sleep quality, nutritional intake, exercise and technology use – also contribute to how much anxiety children and young people experience.  

In other words, when families ask about the causes of anxiety in young people, we can confidently state that it is a combination of nature and nurture.

When was the last time a child/young person acted kindly towards you in your role as a professional?  I vividly remember an experience I had a few years ago when I had to cancel an appointment with an 11-year-old girl (I was ill that day).  The next session she bought me a detailed “get well” drawing which she had obviously spent some time on.  It was a lovely gesture which made my day - and I stuck it up on my office wall where it stayed for quite some time.  It also told me volumes about this child’s strengths in empathy and emotional connection.

Several studies have found that young people who frequently act kindly towards other people are more likely than others to do well in many life areas.  For example a longitudinal study published in 2015 by Jones and colleagues found that children who showed a high level kindness and other prosocial skills when they were 5 years old had better mental health, lower levels of substance use, better relationships with others and better performance in the workplace when assessed nearly 20 years later (and this relationship held true regardless of level of school achievement at aged five). 

Many years ago I was mid session with a bright and engaging 5 year old when he looked me in the eyes and tearfully said the following:

"I'm so ugly.  That’s why no-one wants to play with me". 

As an early career psychologist working with children at that stage, it was a confronting moment.  Like many adults, I'd believed (or perhaps just hoped) that children of this age did not have excessively critical thoughts about themselves the way many adults do.

Sadly, as my working life progressed, I’ve come to realise this is not true.  

Many children and teens are absolutely capable of - and frequently do - view themselves in harsh and negative ways.  Although it some young people do this less than others, and some not until they are older - eventually almost all young people berate, criticise or feel negatively about themselves at least on some occasions during their childhood and adolescence.

When we are angry, we have a strong instinct to express our outrage and needs in strong and emphatic ways.   We use our words to defend ourselves, attack or defeat someone – or something.  

As adults, we are (sometimes) able to disguise or dampen these themes, but in younger people (without the benefit of fully developed adult frontal lobes) these ideas are often expressed loudly and clearly.

• James and his brother were playing a ball game which ended in them both yelling “You’re a cheater”, “this is stupid” and “Shut up!”

• Jordi was furious at Sara for telling others something told to her in confidence and texted her:“You’re a liar” and “Don’t ever talk to us again”

• Tom* was asked to get ready for school three times until Dad took the ipad away from him which prompted him to yell: “Give it back to me” and “You’re horrible”

• Ruby wasn’t bought something she desperately wanted at the shops, and she stomped, cried and shouted “This is so unfair” and “You are so mean” to her Mum.

Unfortunately, while it is entirely normal for young people to speak in angry and aggressive ways at times - not only does it often make them feel worse, it makes people around them less likely to want to be with them, negotiate with or support them.   Which in turn can lead to worse mood, poorer social relationships and more anger.

I was watching an episode of The Good Wife the other night (I know, as usual about a decade behind the times) and there was a discussion about the way some people say “sorry” when they accidentally bump into someone in the stress and others say “hey, watch out!”.

It reminded me of a topic I’ve been doing a lot of thinking and reading about lately – the relationship between cognitive appraisal and attributional style in children and their subsequent behaviour.  In other words the way children think about arguments, problems or difficult situations with their peers and the way this influences how they act either angrily or calmly to these problems. 

For those who need a quick recap, this area of research started back in 1980 when a few pioneering psychologists (eg William Nasby, Ken Dodge and Nicki Crick in particular) started a series of experiments in which they showed children pictures of or told them stories about hypothetical problems with peers – for example someone getting knocked over in a game – and then asked them to say whether they thought another child had done this deliberately and intentionally or whether it had been an accident.

Have you talked to an angry/worried/upset child or teen today?

If you are a child mental health or education professional probably the answer to this is (using the words of my 11 year old): "duh!"

A significant part of our work with young people (the exact amount depends on our role of course) requires us to hear young people tell us about something distressing. 

They might be frustrated about something which has happened, worried about something coming up, annoyed by something they think is unfair, sad about something which has happened, jealous of someone else, embarrassed by an event - and so on.

I find it interesting to notice my reactions when young people tell us about their distress.   Despite many, many years of working in this role I still notice my instinct to want to just "fix it fast" when I hear children's distress.  This is not surprising perhaps - there are so many pressures - time constraints, professional roles, parental expectations - for me to make this child/teen feel better as quickly as possible.