Structures Contributing to Child Anxiety

Child anxiety is on the rise and has been for some time.

Child anxiety can start very early in a child’s development, with primary school being a vital time to establish coping skills in children to manage life’s stresses. While a small portion of child anxiety is caused by temperament or genetic factors, most is learned and can increase or decrease as a result of the interactions a child has with the significant adults in their life. What is important to note is that is that if you change the interactions, you can reduce the anxiety. The current research shows that children mostly learn anxious behaviour, that is, avoiding and not having-a-go; and anxious talking, that is, using words and phrases that don’t fit with what’s ‘objectively’ occurring. An example of this is labelling something as ‘traumatising’ when it’s simply challenging.

For some time, I have suspected that some social systems may be an indirect contributor to child anxiety. Parents, teachers and even some mental health practitioners are unwittingly contributing to making child anxiety worse by acting as a child’s rescuer when he or she is facing adversity.

‘Jumping -in’ for a child is one particular interaction that is inadvertently contributing to a rise in the level of anxiety in a child. The trick for parents and teachers is to know when and how to respond when hearing or seeing a child displaying anxious behaviour or anxious talk. Through a series of questions or comments, it is possible to help a child develop resilience.

This process involves significant adults - parents and teachers, learning some key micro-skills around what they can say or do in the moment and then repeating those micro-interventions over and over. Yeager and Walton (2011)1 report that a small number of modest micro-interventions can have large and lasting effects.  “Subtle and explicit messages from instructors [parents or teachers] - repeated over time - can affect children’s beliefs about the malleability of personal characteristics.”

Structures contributing to the rise of child anxiety.

An underlying theme in the various disability acts has been to support children and their families who have a permanent physical, or severe mental health impairment. Australian schools have rightly placed an emphasis on supporting and assisting children who are less advantaged. The problem has been, I believe, that some mental health issues that are largely treatable (like anxiety) - do not fall neatly under a disability umbrella. For example, at what point would we say that a child with anxiety has a permanent disability or an anxiety disorder? At what point does disability attenuate from being permanent, and needing ongoing support, to being something that is transient and able to be treated?

We have tended to group children with a disability with those who have a largely ‘recoverable’ mental illness. In the former, the main role of ‘helpers’ is to provide therapy in support for the child. In the latter, it is to provide therapy to bring the child back to good mental health.

Schools apply for disability funding in order to secure more staff/resources where needed. They complete data on the number of kids with disabilities, so the more kids are put on that list and, the more kids who stay on that list, the more funding that that school receives. This is worth our pause, because anxiety ‘disabilities’ amount to one of the largest determiners of that funding.[2] While additional support is understandably always appreciated, it is important for educators and schools to be aiming to reduce their students’ anxiety.

In the case of child anxiety, we know that it can mostly be treated and that children can come off a disability list. The problem is that I don’t see the removal of children from ‘the list’ occurring very often. When I was a community-based psychologist, I would say to the parents of a child who had autism, for example, “His condition may not transition to being a ‘typical’ eight-year-old however, we can work out how he can become the best version of who he is and, to help you (his parents) manage things.” In other words, it was a management process, not a treatment issue. This is not the case with child anxiety, which is very treatable, usually through family-management strategies.

There is more to address here. School leaders tell me they receive letters of advice from mental and allied health professionals excusing children from normal activities so that they don’t feel stressed. Despite the constant insistence from mental health professionals (allied and medical staff, OTs and GPs) that we should be concerned about the treatment of child anxiety, these types of excuses are against the best clinical advice, which is to not ‘accommodate’ child anxiety. The best clinical advice includes supporting children to have a go and to apply cognitive behavioural solutions, where the child is ‘challenged’ to manage his or her stress.

Unfortunately, most principals and teachers feel they can’t oppose mental health professionals, who advocate avoidance (not attending certain classes like sport, not being put into the same class with someone they don’t like etc.). A parallel problem is that an ‘avoidance approach’ is contraindicated in research on the treatment of child anxiety.[3] Unfortunately, over time, most child anxiety problems have been perceived as being untreatable, at least schools and systems have looked upon them as-if they are permanent. They’re not.

So where to from here?

Teaching children resilience building thinking structures to problem-solve and navigate anxious thoughts is a long-term solution to helping them develop capacity to manage life stressors and challenges. We want our children to face these inevitable challenges so they can build skills around managing their anxiety. Once children know what they are capable of, they can transfer that learning to future events.

When it comes to treatment, we know what works. A cognitive behavioural therapy approach is the only evidence-based approach that we have. Significant adults can teach the below resilience building thinking structures:

When your child shows they are anxious, don’t immediately jump in to fix it for them. Control your own compulsion to take away their struggle from them. Acknowledge how they are feeling and then talk to with them about how they can problem-solve their way through the worrying experience they are facing.

Work out what to do by way of scaffolding their thinking-through the issue at hand. Ask curious questions like, “If by some miracle you did a great job of giving your talk to the class, what are the steps you’d have to take to make that happen?”

When you notice the child catastrophising or experiencing a cognitive distortion, ask them to look for proof that goes both ways. Ask them to Imagine different, positive outcome and guide them through the steps they need to take for that outcome to come to fruition.

Michael Hawton’s new book, The Anxiety Coach, is available in bookstores now.

1 Yeager, D.S., Walton, G.M. (2011). Social-psychological interventions in education: They’re not magic. Review of Educational Research, 81(2), 267-301.2 Anxiety is the largest disability category.3 Leobwitz, E.