Anxiety might just be the fastest growing childhood mental health issue in Australia.
Several universities researching child behaviour estimate that between 8-22% of children now experience anxiety more intensely and more often than their peers. To date, GPs are the most used service provider when it comes to mental health of children.
Feeling anxious, stressed, angry or scared are normal parts of growing up and learning about the world. It can be challenging to figure out the exact moment in time where a child shifts from being simply anxious, to developing an anxiety disorder. For example, pre-school aged children may be anxious about changes in their routine, separating from parents and spending time with unfamiliar people, all normal responses as are fearing the dark or of monsters. It is important to recognise the ranges of ‘normal feelings’ so that as health professionals we don’t over-label conditions.
Why does it seem like anxiety is increasing in children?
This is likely to be multi-factorial.
Anxiety is increasing in adults. Children learn their own coping mechanisms through watching how their parents deal with stress.
The Covid-19 pandemic has increased anxiety through the media and constant reminders of the threats related to the virus through lockdowns and changes at school.
Children are given less opportunity to take risks. Children are being praised more often to the point they feel they have failed if they don’t get a reward.
Children’s diets are deteriorating. There is more fast food and sweet food availability and less awareness of good food choices.
The impact of devices and computer games. The pressure to be ‘perfect’ on social media. The longer periods of time spent playing with technology.
What is an anxiety disorder?
The DSM classifies anxiety for children in the same way it does for adults. The exception of this is PTSD and ADHD where children have their own criteria.
Social anxiety disorder, Obsessive Compulsive Disorder and Phobias remain the most common childhood anxiety disorders. Anxiety disorders are also commonly seen in conjunction with neurodevelopmental conditions such as Autism Spectrum Disorder and ADHD. For this reason, it is important to take time when considering the diagnosis and follow families up over a few consultations. Enquire about that child’s overall development. When in doubt involve a developmental paediatrician.
What are the symptoms?
Children present quite differently to adults when it comes to mental health. The breadth of symptoms can be wide and often warrants consideration of medical and psychological causes. Behavioural changes can occur such as frequent meltdowns, anger and defiance and difficulty with separation from loved ones. Also think about anxiety whenever a child presents with prolonged or atypical physical symptoms such as abdominal pain, headaches, dizziness, poor concentration or insomnia.
Clarify with parents the degree each of these symptoms is occurring through asking is the emotion pervasive, severe, and persistent? A child mental health condition can be distinguished from a vulnerability by its intensity, duration, and by the extent of its impact on the whole ecology of the child.
Medical causes are still important to exclude, and most children will warrant a physical examination (BMI, ears, throat, chest, abdomen) and basic panel of blood tests.
How do we ask about anxiety in a child?
Practice a ‘child centred approach’. Start with positive questions to build rapport. Find out what really makes them buzz. It might be a book, game, tv show or special friend. Spend some time discussing this before delving into more challenging questions around emotions.
Questions related to anxiety require child friendly language that is easy to understand. Instead of the word anxiety, use words like, being scared, having a tummy ache or butterflies, or labelling the anxiety as something else like ‘the worry monster.’
Normalising can be immensely powerful. For example, ‘I’ve talked to other children before who get a bit scared at night when Mum and Dad put them to bed, does this happen to you?’
I will often leave parents with a screening tool to take home and bring back in the follow up. Two tools you could consider are the strengths and difficulties questionnaire and the spence anxiety score.
What practical tips can we provide parents when their children are anxious?
Sleep – discussed sleep hygiene and no screens after dinner. Melatonin can be useful for the difficult sleepers.
Diet – Avoid packaged foods. A diet lower in added sugars and colours. Water as the main drink.
Physical symptoms – Tummy aches, headaches, anxious feelings – daily mindfulness to slow down using the smiling mind app or bedtime explorer’s podcast. Teach children how to take 5 big deep breaths when they are stressed. Encourage them to label their emotion using an emotion chart (available at office works), drawing and colouring.
Home – Encourage parents to model helpful coping and to de-escalate strong emotions through remaining calm themselves.
School – parents should talk to the school teacher and let them know what is going on. Allow the child to take more regular breaks in the classroom if this helps.
Social – find a positive activity for the child to engage with on a regular basis, exercise is great for helping release serotonin.
Step-ladder approach – If there is something particularly scary, work towards it in smaller steps.
Follow up the family and if not improving it can be helpful to refer to a child psychologist or occupational therapist with training in mental health using the mental health treatment plan item numbers through Medicare. If concerned about developmental conditions, refer early to a developmental paediatrician as there are currently extended wait times.
Whilst waiting on extra support, use the BRAVE program online (through the University of Queensland).