The statistics on anxiety alone are enough to give you anxiety about anxiety. Factor in the trifecta of education, pressure to perform and everyday stress, and children throughout Asia get a hefty dose before they even turn five. Ultimately children with anxiety pay a hefty price on their overall performance, internal self-confidence and general happiness in the tender years of childhood. Anxiety can develop any time and progressively gets worse if untreated. The sooner a child receives help, the easier it is to treat.
Children are characterized as having anxiety if it affects their physical and mental health, social functioning, academic achievement, family relationships and overall quality of life. If untreated, it can lead to severe anxiety, which is unrealistic, out-of-proportion views that are unwanted and uncontrollable by the individual.
Symptoms – Early Primary Children
- Difficulty getting started on tasks
- Perfectionism: constantly seeking reassurance or getting stuck and unable to move on
- Doing the least amount of work
- Unwilling to take risks
- Often prefer maths because it has finite, explainable answers
- Trouble reading
- Frequent trips to the nurse
- Sensitive to correction
- Somatic complaints: heart palpitations, stomach aches and headaches
- Separation anxiety
Symptoms – Upper Primary Children
- Begin showing symptoms of obsessive-compulsive disorder (OCD)
- Social anxiety
- Generalised anxiety: excessive worry about life or constant worry that is above and beyond normal concern. Worry about things that can’t be changed. Lots of physical symptoms
- Separation anxiety: generally occurs before the age of ten. Tantrums when parents go out for an evening, constantly call, need a lot of reassurance
- Selective mutism: inability to speak outside of the home. Refuse to answer questions at school or speak to adults. Often nod or point to answer questions.
- Black and white thinking
- Phobias: spiders, flying, injections and the natural environment
Symptoms – Pre-Teen/Teenagers
- Social anxiety and excessive self-consciousness
- Pressure becomes more consistent at school
- Severe anxiety becomes worse
- OCD behaviours escalate if untreated
- Difficulty starting tasks
- Face becoming sad when corrected in any way
- Breaking items
- Frequent trips to bathroom, nurse, and/or absences from school
- Turning in homework late
- Excessive eraser marks on paper
- Getting stuck in repetitive patterns
- Checking for errors over and over again
- Stress can also be caused by going out, staying in and/or coming home
- Fear of kids not liking them
- Feeling like they aren’t smart a lot
- Kids who often don’t seek help are usually the ones most in need of a nurturing teacher
The first thing parents need to know is that anxiety cannot be eliminated, but it can be successfully managed. Secondly, although parents often want to jump in and solve the situation, anxiety needs guidance through problem solving and children need models on healthy ways to manage anxiety. Reinforcing fear through over-reactions, long cuddles, extra attention and rescuing will only escalate the problem. Helping the child work on flexibility and guiding the child to find his/her own flexible solutions will help the child face the situation without avoidance.
If your child is suffering academic anxiety, it is likely he/she will not seek help. It is imperative to try to get nurturing teachers. One small way to help a child is introducing the child to the teacher for the next school year. With a little bit of planning, this can start the relationship off correctly so the anxious child doesn’t spend the entire summer dwelling on whether or not the teacher will be nice.
For social anxiety, sports is a particularly great way for children to be involved in a social activity, get exercise and learn team-building skills that are all essential to life and reduce anxiety in social situations. Taking turns, learning to share, advocating for yourself, tolerating your own and others’ mistakes, acceptance and group cohesiveness are just a few benefits of team sports. If your child is too young for organized sports, playgrounds are great ways for children to explore. Alternatively, structure playdates with different children outside of school. School is social, but has the ultimate goal of learning and recess isn’t enough time to develop strong social interactions and bonds. Choose classes such as soccer, rugby, netball, field hockey or a sport that requires calling out and interaction throughout the activity.
For example, “Harry” refuses to talk to people he doesn’t know in group situations. He actively avoids social gatherings where he doesn’t know everyone. If he finds himself at a gathering he clings to his parents and has difficulty walking into the room. His parents are frustrated that he doesn’t listen and when forced he breaks into a tantrum until his parents take him away.
The solution is not to let Harry stop going into social situations, but to begin employing “exposure and response prevention,” commonly referred to as ERP. ERP is a systematic, graduated exposure to the anxiety-inducing activity until the anxiety stops. In Harry’s case, the first step might be walking five steps into the room. Next, he must walk into a room independently of his parents, followed by talking to one person and so forth until he reaches the ultimate goal of being able to walk into a room with strangers and say hello. For a child with OCD behaviours, that would mean touching or doing the thing causing the issue until desensitization occurs, such as touching a dirty door knob. The child must overlearn to retrain the brain.
Parents can model healthy management of anxiety by admitting when things are difficult and then sharing how they worked through the issue until it wasn’t a big deal anymore. The biggest thing parents can show children include staying calm and not showing disappointment when their child struggles. Reframing situations into positives is also helpful. For instance, if you have a wonderful picnic on the beach planned and a thunderstorm happens on the day that cancels the event, an anxious child might feel very negative about missing the beach party, start complaining that it always rains when there are fun plans, tears ensue because the child doesn’t get to see his/her friends and so on. Instead, focus on how the rain is good and suggest alternate plans. Offering suggestions can help the child out of a negative thinking pattern if there is something else on which the thoughts can focus.
- Get enough sleep! For information on how much sleep your child needs, see our article on Sleep for Success.
- Resist overscheduling
- Model healthy management of anxiety
- Ensure at least one unstructured social outing a week
- Reframe thoughts
- Prepare children for difficult situations by talking through what will happen
- Specific praise and encouragement for tackling problem areas
If your child is suffering from anxiety, now is the time to help him/her face the fears in order to be a productive and happier person. In some cases, medications are available, but medication alone is not enough to change negative thinking patterns. Encouragement, bravery and professional guidance can help overcome significant fears, phobias, behaviours and anxieties.
This article was written with the help of Dr. Melissa Ortega who treats and specialises in children and adolescents in Hong Kong.
Child Development Clinic
Dr. Melissa Ortega
Southside Family Health Centre
Island Health Family Practice
For more information, see the studies below:
Mayo-Wilson, Dias, Mavranezouli, Kew, et. all – 2014: Individual cognitive behavioural therapy (CBT) is the only class of psychological intervention to perform better than psychological placebo and pill placebo. It is associated with large effect sizes for treatment of anxiety disorders. Promotion of exercise and other psychological therapies including supportive therapy, mindfulness training and interpersonal psychotherapy did not show greater outcomes. Individual CBT was also the most cost effective treatment for patients with social anxiety disorder in the long-term and does not have the side effects of medication.
Lweinsohn, Gotlih & Seely – 1995 & Wittchen, Stein & Kessler – 1999: Research indicates social anxiety disorder precedes major depressive disorder and substance abuse disorder making youth more at risk for serious mental illness.