Childhood Anxiety with Dr. Angie Randell, Clinical Psychologist

Updated: Mar 30, 2021


"All children experience anxiety and fearfulness from time to time, and in most cases it is

transient or short-lived. However, when anxiety becomes too intense, frequent, or occurs at inappropriate times, it is extremely distressing and sometimes disabling".  Dr. Angie Randell



What is anxiety ?


Anxiety is a normal human response to stressful, unfamiliar or dangerous situations. It refers to a state of uneasiness, fear or worry. Anxiety is often helpful, as it protects us and enhances our performance under stress. For example, a fear of fire will protect a child from getting burnt, and anxiety before a running race can provide an additional boost of cortisol and adrenaline (from the fight and flight response) that can lead to peak performance. All children experience anxiety and fearfulness from time to time, and in most cases it is transient or short-lived. However, when anxiety becomes too intense, frequent, or occurs at inappropriate times, it is extremely distressing and sometimes disabling. 






How can a parent recognise anxiety in their child?


There are three main systems of anxiety, the physiological system (the body), behavioural system (what we do), and cognitive system (thoughts). Physiological symptoms of anxiety include muscle tension, faster breathing and heart rate, headaches, feeling hot and sweaty, dry mouth, nausea and tummy-aches. Anxious behaviours tend to be aimed at avoiding a feared situation. For example, your child may become more clingy, distractible or impulsive, seek reassurance, stall, or may throw a tantrum. Young children are not always able to put their thoughts into words, so it can be difficult to know exactly what is going through your child’s mind. They may talk about concerns about what is going to happen, and the feared outcomes are likely to be exaggerations. There may be phrases used like “I can’t do it”. 

The nature of anxieties and fears tend to change as children grow. Babies may be fearful of strangers and loud sounds, whereas toddlers are likely to experience separation anxiety. Pre-schoolers and early primary school children may be scared of the dark and fear supernatural things like ghosts or monsters, whereas in later childhood/adolescence, children may fear the possibility of real situations such as poor school performance, being disliked by peers, becoming sick/injured, or of natural disasters. Some fears may naturally disappear as your child grows, some may be replaced by another fear.






How do I know when anxiety is becoming a problem for my child?


If anxiety causes significant distress, or causes significant avoidance of activities your child would enjoy or needs to participate in, then it has become a problem. As children have many developmental tasks to achieve, it is important to ensure that anxiety does not interfere with them leading a normal life. If you are concerned that your child’s anxiety is holding them back from doing the things they want to do, getting adequate sleep, making friends, or participating in school, it is wise to seek professional help. 


Here is a list of anxiety disorders that psychologists and other health professionals treat in children: 

  • Separation anxiety- fear of being apart from care-givers. The fear may become so intense that the child refuses any separations, like school or sleep overs.

  • Generalised anxiety- excessive worry about numerous areas of life, e.g. school, health, family issues. The worry may be so intense it leads to general physical tension, difficulty sleeping and issues such as nausea and diarrhoea.

  • Social phobia – fear of social situations, due to being overly concerned about the judgements that other people may be making, and worry about doing something embarrassing.

  • Specific phobia – fear of a particular thing (e.g. dogs) or type of situation (e.g. small spaces) or event (e.g. vomiting).

  • Panic attacks- A panic attack occurs when many physical anxiety symptoms are experienced along with catastrophic thoughts like “I’m going crazy” or “I’m dying”. It can be thought of as a fear of fear.

  • Health anxiety – also referred to as hypochondriasis, this is an excessive fear about one’s own health. It can come along with an over awareness of physical symptoms, checking of physical symptoms and internet searching them. The child may become anxious when overhearing conversations about illness or injury

  • Obsessive-compulsive disorder - an obsession is when an unwanted and distressing thought, image or urge repeatedly comes into mind. The thought leads to such overwhelming anxiety that the person experiencing this will engage in some kind of behaviour or mental action to feel better. These compensatory actions are known as compulsions. For example, a child might have an obsession about having done the “wrong” thing, and may have associated compulsions of “confessing” or asking excessive questions about the morality of something seemingly neutral they have done.





What help is available? 


Anxiety disorders are the most common of all mental health complaints, and are very treatable. The most widely accepted form of therapy for anxiety is cognitive behavioural therapy. This has been researched thoroughly and shown to be effective. This form of therapy addresses the three systems of anxiety: physiological  (through teaching relaxation strategies that can calm the nervous system), cognitive (through learning how to catch negative thoughts and turn them into more realistic and helpful thoughts), and behavioural (through identifying avoidance behaviours and helping the child take steps to face feared situations).


If you are concerned about your child’s anxiety, it may be helpful to speak with your child’s school guidance officer, and your GP or paediatrician can assist you with a referral to a psychologist or other mental health specialist.




What can I do to help my child?


Let them know anxiety is normal and sometimes helpful

Something that escalates anxiety rapidly is when a fear of being anxious develops. Yes, that’s definitely a thing! Let kids know that anxiety is a normal response we all get and that it is there to protect us. Let them know it’s ok to feel it and that you can still do the things that create this feeling.


Let them know anxiety is sometimes a trick

Although it is often helpful, sometimes our brains trick us to feel scared, when everything is safe and ok. (For example, that strange sound at night that scared you was just a possum, not a robber getting in). So, even though the feeling makes it seem true that something bad is about to happen, sometimes it’s just a trick and we don’t have to believe it. 


Learn to calm yourself down

Anxiety tends to be contagious, but so is calmness. So it is important to notice your own feelings of anxiety, which may naturally tend to rise for you when your child is upset. You can help your child by working to stay calm yourself. Taking slower breaths can help you to do this, and relaxing your face with a little half smile can too.


Be a role model

You will have a tremendous influence by being a good role model about how you manage your own anxiety. You can do this by talking out loud some of your own unhelpful thoughts and then how you helped yourself get through and be brave. E.g. “I was really worried about giving a talk for my boss at work today, I started thinking I was going to mess it up! But then I told myself – I’m well prepared, I’ve done this before – and I did it and it went really well”.


Don’t fall in to the avoidance trap

Anxiety will naturally lead to a reluctance and avoidance of activities. This is because avoiding will help reduce anxiety in the short term. The problem is that avoidance does nothing to help build confidence, in fact, it tends to crush confidence. Children need to have experiences of getting through anxiety-provoking situations to help them realise their courage. Courage and bravery is what will ultimately beat the anxiety in the long term. 


Balance empathy and encouragement

Empathise with your child about how they are feeling. Even if the fear seems trivial, it is real to your child, and it is crucial not to belittle it. However it is equally important not to cater to the fears as this will only help them grow. Instead, provide gentle encouragement to approach feared situations, which may be best done in a gradual, step-by-step way.


Promote the idea of trusting yourself and going with the flow

Assisting your child to cope with uncertainty is a very important skill, and one in the long run that will be much more helpful than providing reassurance when your child is entering an unfamiliar situation. Of course, reassurance is helpful as it can give a level of structure and information about what to expect in a new situation… but if your child tends to ask a-million-and-one questions in new situations, consider whether answering every “what if” question about what might happen is really going to be confidence building. Instead, it might be a chance to emphasise to your child that they can’t always know things in advance and that is ok because they have the ability to learn and adapt in novel situations. 


Focus more on coping and being brave than on feared outcomes

Often anxiety will be worse in the anticipation of something, and will lead to many conversations about “what ifs”. Sometimes engaging these discussions can accidentally reinforce the idea that there’s something to be worried about. Try to place more emphasis on conversations about what your child can do to be brave, and on conversations you have after your child gets through anxiety-provoking situations. You can talk about how strong the anxious feeling was initially but that it reduced after a while, and they were brave to get through, how it wasn’t as bad as they were expecting, how anxious feelings can trick you like that...


Teach relaxation

You can also help your child reduce physiological symptoms of anxiety through deep breathing, relaxation, or doing a calming activity.


Teach helpful thoughts

You can help your child identify helpful thoughts and self-talk like “I can do it”, “I will be able to cope”, “I’ll be proud of myself for being brave about this”.





Recommended links:

https://childmind.org/

https://healthyfamilies.beyondblue.org.au/

https://www.brave-online.com/




Dr. Angie Randell is a a clinical psychologist with a PhD on the topic of child development. She has been working as a Psychologist since 2006, and in much of that time she has focused on working with children, adolescents and their families. She has an interest in development across the whole lifespan and has previously lectured in a Psychology course on this topic. Dr Randell is in the middle of building a website, www.drangierandell.com, where you will soon be able to visit and find out more about her and her work.


She currently works in private practice at Anxiety House in Bulimba, which prides itself on providing quality, evidenced based treatment programs for people of all ages experiencing anxiety and obsessive compulsive disorders. You can find out more about Anxiety House at www.anxietyhouse.com.au