Recognising children’s anxiety disorders and acting early to target them can have a “really significant impact” on their lifelong mental health, says Professor Jennie Hudson, a psychologist at Macquarie University’s Centre for Emotional Health in Australia.
Anxiety is the most common mental disorder in young people and can lead to a higher risk of depression, suicide and drug problems, as well as limiting their ability to achieve their potential.
In Australia, half of all children and adolescents aged four to 17 with mental disorders had an anxiety disorder, the second Australian Child and Adolescent Survey of Mental Health and Wellbeing (2015) found.
In Aotearoa, the latest New Zealand Health Survey (2016) found that 24,000 children aged two to 14 were diagnosed with anxiety or depression. This is well up from 3,000 children just a decade earlier in 2006.
Until very recently, anxiety was often overlooked as a mental health problem, Hudson told a Generation Next educational seminar on the mental health and wellbeing of young people, which was webcast earlier this month.
It is possible that problems such as depression or behavioural issues seem more obvious to teachers and other professionals.
Yet out of all the mental disorders, anxiety disorders start the earliest and people seldom grow out of it.
A “lucky few” are shy children who grow up to be confident adults, but, “for the most part, if you have anxiety as a child, you’re much more likely to have it as an adolescent, as an adult, and throughout your life,” says Hudson.
Anxiety can often indicate future risk and this trajectory should not be ignored, she says.
“If a young person develops anxiety and then goes on to develop other serious mental health problems, then targeting the anxiety can have a really significant impact on their mental health throughout their life, if we act early and do something about it.”
Anyone can experience anxiety. But it becomes a disorder when it starts to interfere with a child’s life. It happens more frequently, more intensely and at times they cannot control.
There are several types of anxiety disorders, and children who present for treatment rarely present with just one.
Social anxiety disorder is one of the most common. It is normal for children or adolescents to worry about what others think of them, but a child with social anxiety disorder is consumed by such thoughts.
“They can’t think of anything else, they are always in their heads, thinking ‘what is that person thinking of me?’, ‘are they going to laugh at me?’, ‘what if I get it wrong?’.”
Parents of children with social anxiety often say their child has always been shy. “But it’s not just being shy when it really has an impact on the way they are interacting in their daily life.”
Generalised anxiety, which is constant worry about day-to-day things, commonly occurs with social anxiety.
We still don’t know why some people experience normal levels of anxiety while others develop problems, says Hudson.
Genetics accounts for around 30 to 40 per cent, meaning environment is thought to be responsible for the rest: “a pretty significant impact”.
The way parents and teachers react to children’s fears or anxieties can develop or maintain anxiety problems over time.
If you rush in and help, the child never gets to learn how threatening a situation is, or whether they can cope with it.
Hudson says that cognitive behavioural therapy remains the only proven, most effective treatment to work in young people.
Effective programmes like Macquarie’s Cool Kids teach skills to target the different components of anxiety, such as strategies to challenge negative thoughts and tackling avoidance.
The ‘step ladder’ approach teaches children to overcome their fears – whether that’s speaking up in class, using lifts or making mistakes – by facing the scary situation in a gradual way. The child must experience some form of fear – staying in a lift for several minutes – so they learn that they can cope with it.
Other strategies involve praising courageous behaviour – shifting the attention away from the anxious behaviour – and encouraging children to take risks and make mistakes.
Developing long-term strategies to approach – the opposite of avoidance – is an important one for health and education professionals to think about.
A lot of things in our culture and schools encourage avoidance, such as encouraging kids to avoid things like stressful tests.
“While these strategies might be good in the short-term, reducing the anxiety immediately, in the long-term, they help the anxiety to stay around. Think about what long-term solutions you can put in place that encourage kids to approach, and learn new information.”
Professionals should intervene when “the anxiety is stopping the child from what they want to do or if the parents know the child is showing signs of distress.”
Monitor the child in different situations, she adds. If you do suspect anxiety it’s important to raise it with the parent or with the school.
“There’s lots of different help you can get from GPs, paediatricians and school counsellors.”