Anxiety is a normal emotional response to many situations and can be an appropriate and helpful part of life. It becomes concerning when it has a negative impact on how well a person functions or their quality of life. Anxiety occurs in approximately 20% of children and teenagers.
Symptoms of anxiety include:
- withdrawal & avoidance
- anger & outbursts
- trouble falling asleep or frequent waking through the night
- always needing reassurance
- trouble concentrating
- changes in appetite
- physical symptoms such as headaches, nausea,
- tummy pain, dizziness & muscle cramps
There are also many others forms of anxiety. These have additional signs, including separation anxiety, social anxiety, selective mutism, specific phobia, panic disorder, selective mutism and obsessive compulsive disorder. Other signs that anxiety has reached a concerning level are restlessness, fatigue, difficulty concentrating, irritability, sleep difficulties and muscle tension.
Very few kids can say they are anxious and many will either withdraw, become irritable or complain of feelings in their body such as headaches or tummy pain.
Cognitive behavioural therapy (CBT)
CBT is one of the main approaches we use to treat mental illness. While it isnโt always the best or only option, it is evidence-based and useful for you to understand so that you can explore what works for your child.
The first step in CBT is called โpsychoeducationโ. That might sound a little daunting, but it simply means giving the child and their carers a better understanding of what is happening to them from a scientific point of view.
The second aspect is symptom control. While this is different for everyone, the general principles are helpful to understand. As weโve discussed, anxiety is a triggering of nerves and hormones in our bodies that activates the fight or flight response. What we need to find out when a child has anxiety is what feelings they get when that system gets triggered and what helps to switch it off. Strategies such as deep breathing or muscle contractions and relaxations are really helpful ways to take control of the sensations that tell us we are anxious. With support, kids can become aware of these feelings from a very early age and learn to respond.
The third component of CBT is cognitive restructuring, which is developing new ways of thinking about the things that trigger anxiety in our kids.
The fourth aspect is exposure, where we gently guide children back into situations and environments that previously caused anxiety.
The fifth and final aspect is relapse prevention. One of the biggest risk factors of mental illness is a previous episode, which is why all children and adults who have experienced challenges with their mental health should be supported to proactively work to avoid future episodes, rather than simply breathing a sign of relief that it has resolved.
Strategies for parents
Helping everyone in the family to learn about anxiety is a really great way to build mastery of our feelings, especially the difficult ones. Understanding what can trigger worry and fear and what happens in our body when these feelings happen helps to know when itโs present, but also shows kids itโs okay.
When children do become anxious, we must make sure we never dismiss it. Leaving a child to face their fears on their own will worsen those feelings, and risks that they wonโt tell you about them in the future. We should all be constantly learning what works best to help calm us in these tough moments. All children need guidance with this, and it is different for every child. Common approaches tap into calming down the alarm system in our body. Moving to less stimulating spaces helps to settle the alarm in many children, and activities like deep breathing help us to focus on our bodies and the present moment. This can be done from a young age.
Key lessons
Feeling anxious is a common and helpful part of life, and all children will experience it to a certain degree. Like all emotions, experiencing anxiety during childhood is an opportunity for kids to be supported in learning how to deal with it.
Anxiety becomes concerning when it happens frequently and leads to difficulties functioning at home or school. Common triggers can be separating from a caregiver, social interactions and environments where judgement may occur (e.g., the classroom).
When children are showing excessive anxiety, it is important to support them to understand these feelings and how to manage them. It is different for each child, but management often involves a child learning and practising ways to settle their nervous system, such as deep breathing, tensing and relaxing muscles or listening to music.
This is an excerpt from the book Ten Things I Wish You Knew About Your Childโs Mental Health by leading developmental paediatrician Dr Billy Garvey published by Penguin Random House