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.

Tricky question 7181# :  You’ve just talked to a parent who has a child who has just been diagnosed with a physical, mental health, emotional or learning disability and he/she says to you:  what should I say about this to my child? 

Or perhaps you work with small groups or classes of children in which some have a mental health/learning/health diagnosis (known about and observed by others in the group) – and one of them asks you:  “Why is Jodie like that?”

10% of young people are diagnosed with a physical disability and up to 20% with a mental health diagnosis during their childhood and adolescence.  Many more young people don’t have a formal diagnosis per se but have tough struggles in a particular area (learning, social, mental health, physical health). 

It’s not surprising therefore that as professionals one of the issues we need to grapple with is the issue of talking about challenges and diagnoses to children and young people.

In Australia, around 10% of children have a physical, cognitive or mental disability or disorder.  This means as professionals who work with children it is very likely we will have worked with hundreds of children/adolescents with:

• a speech or language disorder or disability

• autism spectrum disorder

• a significant learning disorder or dyslexia,

• a hearing or visual impairment

• attention deficit/hyperactivity Disorder

• a chronic health condition leading to physical disabilities

• and many others

Supporting these children and teens – in clinics, at school, extra-curricular or in home settings- as they overcome, cope (or struggle) with the various hurdles associated with their disabilities is incredibly meaningful and challenging work.  It makes us think harder, work harder and be more creative, compassionate and persistent than when we are working with children without these disabilities.  Despite its challenges - I love this work.

9 year old David comes home from school and told his Mum that his friend said him he was a loser in front of a group of friends. 

15 year old (in tears) Talia has her Dad pick her up from a party because a girl in another class told someone she likes her friend’s boyfriend. 

6 year old Joseph tells grandma that he hates school because the other kids try not to not play with him.

If you’ve worked with young people for any length of time, you will know of course that kids and teens have negative experiences with other children and young people very frequently.  From the age of 4 (when physical aggression starts to decrease) feeling hurt, frustrated, distressed and disappointed when interacting with friends and classmates becomes increasingly common. 

For example, one study found that children report having a conflict with one of their good friends approximately once per fortnight.  Another study found that approximately 60% of children and teens report having a “mutual enemy” (someone they dislike and who dislikes them) which presumably is associated with at least some negative interactions.  Other studies find that - depending on how you ask the question - 1 in 4 children/young people say they have experienced “bullying” during their primary or secondary years

A few months ago I was working with a 10 year old girl I’ll call Jennifer (as always, names and details changed). I was initially working with Jennifer on helping her reduce her anxiety about being around her peers.   However something else which was quite noticeable about Jennifer’s challenges was this:  she struggled to show almost any positive emotion.  Jennifer rarely smiled in sessions, and despite me doing a great deal of play, games and rapport building with her, found it almost impossible to talk positively or enthusiastically about any of her interests.   

When I asked Jennifer’s Mum about how she acted at home,  she told me that Jennifer frequently looked unhappy or anxious at school and around other children too – and had been like this for some time.   

I’m sure you’ve noticed in your work with children that some of them smile less frequently, and/or show less enjoyment, interest, excitement or happiness in their words or faces than other kids.  They have a “blank”, sad or worried expression on their face a lot of the time, often stay quiet when something positive happens to them, or talk much less enthusiastically or positively about their interests compared to other children. 

When I’m working with some young people, it almost feels like I can actually hear their internal threat detection alarm systems blaring saying : Run! Fight! Freeze! They don’t feel safe, relaxed or comfortable at any point in the day. It’s no wonder many of these children “self medicate” (gaming, agitated behaviour, anger attacks etc).

Do you work with children like this? There’s an inherent palpable tension about them and you can just sense that from an evolutionary perspective their body is gearing up to fight a battle.

As I’m sure you do, I’ve spent lots of time explaining the “fight/flight/freeze” response to children and parents (see the bottom of this page for a free article you can download and give to parents). I think it is really important for children/teens and their parents to know that when they are highly distressed, frustrated or angry, in the short term - their brain is not going to be able to think, communicate, remember complex information or explain ideas is reduced.    This can help parents/caregivers avoid trying to teach important lessons or have important conversations when young people are highly distressed. It can also help children/teens to know they need to take a break when this is happening for them.

It’s also important for parents/caregivers to know that if their child/teen has a high level of tension in the long term, is also going to lead to ongoing physical, emotional and cognitive problems (eg anxiety, headaches and stomache aches, muscle soreness, attention and learning problems, sleep problems). This can help increase compassion and understanding, and help motivate them to think about what they can do to tackle this problem.

But awareness is only the first step - we also want to help children/teens reduce their physiological tension. Traditionally psychologists, well-being co-ordinators, counsellors and teachers have used relaxation programs to help young people do this.

But do these programs work?

Challenging behaviour in childhood and adolescent is ubiqitious.  All children and teens will argue back, be deceitful, fail to follow instructions and act angrily, rudely and unfairly towards peers.   Community surveys show almost all toddlers show aggressive behaviour and even in the middle years, over 60% of parents report concerns about their child acting aggressively at least once over the preceding 12 months.  One research study found that non-compliant behaviour was more frequently expressed a concern at a pediatricians office than physical health concerns.  

However, while a small percent (between 1-9% have more persistently and troubling challenging behaviour and meet the criteria for an oppositional defiant or conduct disorder), challenging behaviour generally reduces in frequency and severity gradually over time. 

There are many ways parents can help children and teens through this process.

One of the important questions I ask the children and teens I work with is this: “would you please tell me about your friends”.    

This question sometimes surprises families. Having made an appointment to see a psychologist they are expecting questions about feelings, emotions and life challenges, and not necessarily those about who they hang out with.  But it’s essential for me to know about young people’s friendships because research shows peer relationships are vital to children and teen’s positive mental health.

For example, studies show that children and teens with good friendships record higher levels of happiness than children and teens without these friendships.  Other studies show that young people with positive peer relationships are less likely to act in disruptive and challenging ways.  Other studies suggest that young people with positive peer relationships are more likely than others to achieve better educational outcomes.  There have also been numerous studies suggesting young people who experience genuine bullying (i.e. not just “unkind” behavior) are more likely to experience mental health issues as adults.