Anxiety in Children – What’s Normal? And When to Seek Help
by Jayke Parish - Provisional Psychologist, BSc, BSc-Psych(Hons)
August 2020
by Jayke Parish - Provisional Psychologist, BSc, BSc-Psych(Hons)
August 2020
Anxiety is something that all children experience from time to time - the fact is that everyone has anxiety to some extent and it is a normal emotion important for our safety and survival. So what is “normal anxiety” in children? And when does anxiety become a problem?
What is anxiety?
Anxiety is the brain’s response to real or perceived danger that can encompass stress, nervousness, worry and fear. Anxiety is a normal and highly important emotion that all humans experience, and it is vital for keeping us safe. Anxiety is produced by an area of the brain called the amygdala, which is our natural ‘alarm system’ that activates during real or perceived threat. The amygdala produces a response known as ‘fight, flight or freeze’ when threat is perceived, which allows us to quickly react to emergencies. Anxiety was vital for survival back in the caveman days as it helped them fight off or run away from predators to keep them safe.
There are three components of anxiety:
Cognitive:
Physical:
Behavioural:
There are three components of anxiety:
Cognitive:
- Thoughts of something bad happening or “racing thoughts”.
Physical:
- When entered into fight, flight or freeze mode, our body can experience changes including an increased heart rate, short rapid breathing and tense muscles.
Behavioural:
- When children enter ‘fight mode’, they may be observed as defiant or aggressive.
- During ‘flight mode’, children may withdraw, cry and abscond from situations that are causing distress.
- During ‘freeze mode’, children may shut down and not respond to instructions provided by their parents.
How can anxiety be helpful
Anxiety is still very healthy and important for survival today, as it alerts us of potential dangers and risky situations. Low levels of anxiety help with:
Motivation:
Identifying risky situations:
Motivation:
- Assists children and adolescents with motivation to engage in school work and complete assignments on time.
- Anxiety assists children and adolescents with motivation to socialise with peers and build meaningful friendships.
Identifying risky situations:
- For children, anxiety helps identify risky situations during play (e.g. the dangers of climbing trees).
- For adolescents, anxiety helps identify risky situations when driving or attending parties.
What is ‘normal’ anxiety in children and adolescents
Infancy:
Toddlers:
Early childhood (4 - 5 years):
Primary school age:
Adolescents:
- Stranger anxiety
Toddlers:
- Separation anxiety
- Fear of animals, thunderstorms, water and the dark
Early childhood (4 - 5 years):
- Fear of death or losing loved ones
- Separation anxiety
Primary school age:
- Fear of germs
- Specific object fears (e.g. monsters, ghosts, animals)
- School and performance anxiety
- Fear of traumatic events
Adolescents:
- School and performance anxiety
- Worry about social groups and social status
- Fear of negative evaluation and rejection from peers
When does anxiety become unhelpful
Anxiety becomes unhelpful when it interferes with everyday functioning, impacting on concentration, sleep, relationships and school performance. When anxiety becomes unhelpful an individual will often avoid anxiety provoking situations. For example, a child may refuse to separate from their parent for a play date, or an adolescent may refuse to attend social gatherings with friends, opting to remain at home. When an individual’s anxiety provoking situation is successfully avoided, they see this as a useful coping strategy and the behaviour is reinforced. This prevents individuals from being exposed to opportunities where they learn their anxiety is tolerable, therefore maintaining their anxiety.
What are the symptoms of anxiety in children?
- Irritability and restlessness (e.g. fidgeting and an inability to sit still)
- Fatigue
- Muscle tension or aches (often in the back, neck, shoulders or limbs)
- Troubles concentrating and completing homework
- Problems with getting to sleep (e.g. a child may need their parent or carer to remain with them until they fall asleep)
- Complaints of stomach pains, chest pains or a sore head
- Problems separating from parents/caregivers (often in younger children). For example, school refusal.
- Anger and meltdowns
- Avoidance behaviours (e.g. refusing to study for exams)
- Self-consciousness or sensitivity to criticism
- Worry about bad things happening in the future
Engaging with a Psychologist
It is important to seek assistance from a Psychologist when your child’s anxiety becomes maladaptive, and is interfering with their schooling, sleep, self-esteem or connectedness with peers. The most widely used intervention for anxiety is Cognitive Behavioural Therapy (CBT), that looks to identify the thoughts, feelings and behaviours that contribute to the maintenance of anxiety.
Anxious thoughts
These thoughts can be irrational, dysfunctional or unhelpful.
Anxious feelings
Anxious behaviour
Anxious thoughts
These thoughts can be irrational, dysfunctional or unhelpful.
- Overthinking: “What could happen?”, “Will Mum/Dad be safe when I am at school?”
- Catastrophic thinking: “Something bad will happen”, “Everyone will look at me”
- Intervention: “Learn to think realistically!” - Identify and challenge unhelpful thinking styles and identify more realistic alternatives.
Anxious feelings
- Sore stomach, headaches, tight muscles, increased heart rate, rapid breathing
- Intervention: Controlled breathing, progressive muscle relaxation, identifying emotions and where they present in the body.
Anxious behaviour
- Avoidance behaviours, such as: School refusal, not wanting to leave the house, avoiding stressful school work etc.
- Intervention: Graded exposure to anxiety provoking situations – “facing fears”
Sources
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics, 32(3), 483-524.
Lyneham, H.J., Abbott, M.J., Wignall, A. & Rapee, R.M., (2003). The Cool Kids Program – Parent’s Workbook. MUARU: Macquarie University, Sydney.
https://headspace.org.au
https://health.clevelandclinic.org/what-happens-to-your-body-during-the-fight-or-flight-response/
https://www.verywellmind.com/anxiety-symptoms-2633863
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics, 32(3), 483-524.
Lyneham, H.J., Abbott, M.J., Wignall, A. & Rapee, R.M., (2003). The Cool Kids Program – Parent’s Workbook. MUARU: Macquarie University, Sydney.
https://headspace.org.au
https://health.clevelandclinic.org/what-happens-to-your-body-during-the-fight-or-flight-response/
https://www.verywellmind.com/anxiety-symptoms-2633863