Anxiety is a major buzzword of our times. Recent media reports state that it is a rising problem in our society. It appears a wave of fear is gripping people today, threatening to paralyse us from facing uncertainty and challenges in our lives.
Sounds dramatic, doesn’t it? Catastrophic almost. Anxiety it seems, is a very powerful and harmful thing in many people’s lives, so it’s important to examine what it is, and explore whether the current hype around it is warranted.
What is anxiety?
According to the Australian Psychological Society, anxiety is a “natural and usually short-lived reaction to a stressful situation, associated with feelings of worry, nervousness or apprehension. It typically occurs in new, unfamiliar or challenging situations, where the person might not feel up to the task, or where the outcome is uncertain”.
Anxiety is part of being human. It has kept us safe in dangerous situations since prehistoric times. If a lion was chasing you, it prompted you to run away or freeze. Your body would become primed for flight or fight. Breathing would become shallow and rapid, hands would sweat, thoughts would tunnel in focusing on the source of fear. In such stressful situations, anxiety was and is useful.
This leads us to the question – what features make this adaptive survival mechanism a type of disorder? According to the Australian Psychological Society, it becomes a disorder when anxious thoughts, feelings or physical symptoms are severe, upsetting, frequent and interrupt daily life.
When considered in relation to children, it is important to note that there are developmental factors which come into play as well. Children experience many different types of anxiety including phobias, initially to things like the dark and monsters, and when older, to more concrete things like spiders. The two most common anxieties of childhood are separation anxiety and generalised anxiety. Separation fears appear in infants as young as 11 months of age. At this age, anxiety is an expected response to certain situations.
But anxiety becomes problematic if it continues beyond a child’s early years or is extreme in its expression.
According to Beyond Blue, an independent, non-profit organisation and a major contributor to information about mental health difficulties and a resource for support, current figures for anxiety rates in children stand at around 6.9%, with sparse longitudinal research available to assess changes in prevalence. However, recent research has found that between 2008 and 2013, rates of diagnosis by paediatricians have doubled. There are many factors which may be causing this, including increased awareness and less stigma about receiving medical treatment, and current trends in parenting.
What are the causes of anxiety?
The causes of anxiety are well established.
First, there is a genetic factor involved. Psychologist Amy Przeworski, PhD says, “Individuals inherit a predisposition to being an anxious person, [and] about 30 to 40 percent of the variability is related to genetic factors”. And some people have what is called in psychology circles as a ‘low threshold of arousal’, meaning it does not take much to make them anxious.
Certain parenting behaviours can also bring on anxiety. The classic example is a parent trying to protect their child from experiencing anxiety by removing them from a stressful situation. The removal is in fact reinforcing the anxiety and does not teach the child to manage their feelings.
Trauma experienced by the child can also lead to a change of behaviour. An added layer in anxious presentations is a comorbidity the child may be experiencing.
Comorbidity means another factor or factors which may be influencing an anxious presentation.
These factors include learning difficulties, Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorder. It is important to remember comorbidities are the rule rather than the exception. They make diagnosing and treating anxiety a complex task.
How does anxiety present itself in children?
Some common thoughts of anxious children include the belief that things must be perfect. They must have control of situations; if they don’t, all is lost. Anxious people also need approval and have a tendency to catastrophise situations. Some common situations where it rears its head are in the playground, where a child may want the rules to go their way in games because they believe if they fail, bad things will happen. Or when asked to give a talk in class, the child begins to battle a feeling of impending doom that it will not go perfectly and they will be ridiculed and humiliated, so the prospect of giving the talk is suddenly too much for them.
The child may also refuse to participate in activities such as going to school camp and experience friendship difficulties. Adults around the child notice they are not living up to their potential. When these things are happening for an extended period of time and not improving, it is time to seek help.
How is anxiety treated?
The most common and evidence-based treatment for anxiety is cognitive behaviour therapy, which teaches children to ‘ride the wave’ of their fear by stepped exposure, and the ability to evidence check ‘thought mistakes’. Children also benefit from practising brave behaviours to build up resilience.
Things to remember about anxiety are that it is common and it is treatable. When considering whether or not to get help for your child who presents in this way, it is important to think ‘what’s the worst thing that could happen?’
Strategies which may assist an anxious child
Teach them to breathe
Remember to make it slow, sucking air in through the nose, out through the mouth. There are many ways you can teach your child to breath. You can ask them to imagine blowing out candles with their fingers, or a favourite of mine, tracing a finger along the ridge of the opposite hand’s fingers, slowly breathing in on the upside of the finger, and breathing out when tracing down the opposite side.
Use rating scales
Zero to 5 is good for children. Get your child to check in with you where they are on the scale, five being very anxious, zero being calm and happy. Your child can go through things they can do to make themselves feel better when worried, such as think about something or someone they like, do some drawing or have a short time out. It’s also useful to grade problems by asking your child: “Is this a big problem or a little problem?”
Give them the right words
Teach children emotion words so they feel better equipped to describe their feelings rather than the basic five of happy, sad, angry, worry or surprise. Create a word bank with your child and put it up somewhere at home or in the classroom for your child to refer to. If reading is an issue, put different facial expressions on the wall to point to.
Use positive reinforcement
Reward non-anxious behaviours and ignore anxious behaviours. Natural consequences are important as well. For example, if a child is too anxious to buy a treat at the school canteen, they miss out.
Remember the child is not deliberately being difficult. Give them graded exposure to things that worry them. This can happen via a stepped approach with rewards at intervals. Give ample warning of any change in routine and set realistic expectations for the child.
Remember, there will be good days and bad days. Just keep trying.