Anxiety in children
What is it, what causes it and how do psychologists work with anxious children?
Kirrilie Smout, Developing Minds: www.calmkidcentral.com and www.developingminds.net.au
What is Anxiety?
Anxiety is a group of physical sensations, types of thinking, feelings and actions which occur when we are feeling unsure, vulnerable or unsafe.
Feelings and types of thinking: Worry, fear, nervousness, racing thoughts, feeling “stuck”, wandering or distracted thinking.
Physical sensations: Stomach and headaches, tiredness, sweating, fast breathing/heart rate, sleeping problems, physically restless, feeling sick.
Behaviours and actions: Avoidance, defiance (not following instructions), acting irritably – yelling, aggression, withdrawing from people, talking about worries a lot, asking for reassurance.
Children with anxiety symptoms might show more irritability or physical symptoms compared to adults with anxiety symptoms.
Anxiety can be mild to moderate. It can also be severe. If a child has anxiety which significantly interferes with their daily functioning, is well-beyond what occurs normally for other children their age, and has been present for some time they may be diagnosed with an anxiety disorder. Some categories of anxiety disorders are below.
Anxious about certain specific situations - Specific Phobia
Anxious about being apart from caregivers or caregivers being hurt - Separation anxiety and school avoidance
Anxious about what other people think - Social Anxiety
Anxious about speaking in front of others - Selective mutism
Many worries about many topics - Generalized anxiety disorder
How common is anxiety?
Anxiety is one of the most common psychological disorders diagnosed in childhood. Mild anxiety is extremely common – for example 70% of children report having at least one personal worry by the time they are of school age. 9-20% (1 in 6) will have experienced an anxiety disorder during their childhood or adolescence.
What causes anxiety in children?
1. Being human!
· To some degree, being anxious is part of being a human being.
· The older children get, the more “capable” they are of feeling worried about situations and events.
· It’s important to not “pathologise” the normal experience of worry or fear in children.
2. Biology/physiological factors
Research suggests:
· There is a genetic component to anxiety.
· There are brain and body differences between anxious and less anxious children.
· Ways of interacting with the world can be seen in infancy (“temperament”) and these seem to be related to later anxiety.
3. Environmental factors
Many aspects of a child’s environment can contribute, in some cases, to them experiencing anxiety.
• This might include grief and loss, traumatic events, difficult backgrounds or early life experiences, challenging peer issues, bullying, illness, disability, learning problems, sleep problems, difficulties with getting sufficiently adequate nutrition, sleep and exercise, medical/health issues, medication and environmental challenges.
• Certain parenting/caregiver styles can also impact anxiety in some children, specifically lower levels of “autonomy granting/independence building” behaviours (including inappropriate ‘accomodations’ for anxious children), high levels of “harsh/punitive” caregiving/parenting or repeated ‘modelling’ of anxiety). It is important for parents to remember that these behaviours may not be a contributing factor for all children with anxiety – and even if they are – it is only one factor among many which contributes to anxiety!
4.Thinking styles and actions
Children with anxiety have a tendency to think and act differently compared to children who experience less anxiety. For example, children with anxiety have a:
• Tendency to interpret ambiguous situations as scary, to avoid difficult or challenging situations, to have high standards for themselves/others, to have a creative thinking styles and ability to look ahead to the future.
All of these contributing factors (normal anxiety experiences, biological/genetic factors, environmental causes and thinking styles interact with each other in the causing of anxiety
What do psychologists do to support children with anxiety
Evidence based approaches for helping children with anxiety
Arguably, the best evidence for helping children with anxiety comes from Cognitive Behavioural Therapy (CBT).
Psychologists in community settings will usually use therapy components which come from CBT (or CBT-like approaches) but will tailor them to the specific needs of each individual child and family.
What are some common components of CBT
1. Helping children (and caregivers) to understand anxiety and worry (psychoeducation)
Psychologists will usually spend time (using developmentally appropriate language - eg “danger checker” or “flipped lids”) to help children know and understand a few key principles about anxiety, for example:
- Helping children understand that it is normal (and not dangerous) to experience worry and anxiety
- Understanding that it is not anyone’s fault when they feel worried and anxious
- Helping children to label, understand and notice their worry and anxiety triggers
- Helping children understand that we can all get better at managing worry and anxiety
2. Helping Children Reduce Physiological Arousal
Psychologists will aim to help children to understand their physiological arousal (fight or flight) symptoms - why these symptoms happen and what they are.
They will also help children to have strategies to lower their fight or flight response (practicing first, and then in the moment)
3. Helping children to notice worried thoughts, test them out and ‘add in’ alternative thoughts and beliefs
Anxious children often have ‘anxious’ thinking styles (catastrophizing, black and white thinking, future predicting, all or nothing thinking.
Therapeutic programs often aim to assist children to notice, label, “step back from” or test out these thoughts.
They then will want to help children “add in” calm, positive and more helpful thoughts and beliefs – and to reassure themselves
4. Helping Children Reduce Rumination
Psychologists will often be supporting children to learn the power of "busy" brains and to be able to redirect their attention away from worries and ruminating (going over and over their concerns).
They will often explain this in language children understand, set up exercises and activities to help them practice this
This is designed to help children to reduce rumination and long periods of worry.
5. Helping children to increase brave behaviours
One of the most important strategies to help children with anxiety is about helping them (and their parents/caregivers) to understand the cycle of anxiety naturally leading to avoidance, and then avoidance leading to increased anxiety
Psychologists will often be wanting to help children reduce anxious behaviours (even while they still feel anxious) and instead to – bit by bit - act in more confident ways . This might involve:
How to explain the reasons for brave behaviour and increase children’s motivation to act in brave ways
Setting up “brave behaviour” (exposure) activities which consistent of the smallest possible steps a child can manage (sometimes these might need to start much smaller than some families expect)
Setting up the gradual increasing and frequency of these behaviours (sometimes these need to occur much more frequently than children/families might expect)
How to cope with panic/high anxiety symptoms during brave behaviour steps
5. Supplementary Strategies
Other strategies which are helpful for some children:
• Building strengths and self esteem
• Building social connection and friendships
• Using more routine and predictability
• Helping children better express their needs
• Improving sleep and nutrition Is therapy for anxious children effective?
Is therapy effective?
Evidence suggests about 60-70% of children will experience significant improvement
This research is based on:
Therapy which is 10 to 12 sessions long (usually fortnightly)
Includes the completion of activities and homework in between sessions
Caregivers and children who are able to complete all the activities and homework in between sessions
If families find it difficult to attend this number of sessions or complete activities in between sessions, it can take longer or be less successful.
Therapy is not successful for everyone unfortunately.
Working with parents and caregivers
Depending on the age of the young person – working with parents and caregivers can assist children to learn and implement these CBT components themselves – is an essential part of therapy.
The younger the child – the more important this is.
Once children are around 14 – they start to have the right to make decisions themselves about their parent/caregiver’s involvement.
However even then – is often important to have parents involved. For children/young people who are not able to – or willing to come to therapy – sometimes there are options for parent only intervention – with no children in the room, this can be just as effective as individual CBT
However working with caregivers can be tricky as we we do have to consider wishes of the child and also funding for more than 2 parent only sessions is not possibly under Medicare
How can families seek help? Psychology and therapy services
1:1 therapy
Families can access therapy via psychologists in private practice, government based mental health programs or school based psychologists
GPs are a great place to start to get referrals or names of programs or psychologists.
The Find a Psychologist service run by the Aus Psych Society
Family, friend and school referrals
When starting work with a therapy - ask about their approach, appointment availability and their experience working with children and families
For information about our therapy services – please click here - https://developingminds.net.au/information-about-therapy
Online programs
Brave online Helping 4 to 11 year old children to manage worry and anxiety online is an evidence based program which can be helpful.
Our online program is Calm Kid Central – please click here to learn about this - https://www.calmkidcentral.com/
