This Cognita Be Well Comments resource was written by written by Dr Bettina Hohnen, Clinical Psychologist, Educator and Author and Beth Kerr, Group Director of Wellbeing for Cognita.
It draws upon established research as well as findings related to the global Covid-19 pandemic, and forms part of a wider Be Well Comments series by Cognita.
Understanding Anxiety in Children and Young People
In its most extreme form, anxiety is a clinical disorder that impacts around 7% of children and adults worldwide. It has grown in recent years, particularly in connection with the global pandemic. A 2021 review suggested an increase in the prevalence of anxiety since the beginning of the Covid pandemic, with 25-40% of the child and adolescent population experiencing heightened feelings of anxiety.
What is Anxiety?
Anxiety is a term that describes a plethora of feelings from uneasiness to worry, stress to fear and even panic. Experiencing anxiety is not the same as having a diagnosis of clinical anxiety, but if that anxiety is persistent and impacts on daily life, then it might be time to seek additional help and support. Anxiety can have the potential to reduce a child’s enjoyment of life and opportunities for growth and development.
What anxiety feels like: our body’s response
Fear is a normal and natural feeling. It’s an emotional alarm system and when triggered at the right time, it keeps us safe. Anxiety has a cognitive (thought) component. Anxiety happens when thoughts take on a life of their own, telling us something bad is going to happen in the future. Our mind registers this as a real threat and sends signals for the body to prepare for action.
The result is a series of specific physiological changes that cause our breathing and heart rate to increase in speed, our blood to flow quickly round the body and our muscles to tense. In the case of a real threat, these are helpful because our body is ready to protect us, but when there is no actual threat we can also experience dizziness, shaking, dry mouth, sweating and nausea.
If we don’t understand what is going on, these symptoms can cause more anxiety as we may believe we are ill – or even having a heart attack. Understanding what happens to our bodies when we are anxious is a crucial first step to managing it.
Different types of anxiety
Anxiety takes different forms, all with slightly different peak ages of onset and presenting symptoms. This is a helpful guide but remember that every child is individual, and if you are concerned about your child, then seek help from your family doctor.
Type of anxiety
Average age of onset*
Marked fear about a specific object or situation (such as dogs or vomiting)
Exposure therapy is the treatment of choice, under professional supervision in extreme cases
Marked fear of being scrutinised or negatively evaluated in social situations
Talking therapies are recommended for social anxiety e.g. Cognitive Behavioural Therapy (CBT), and it often reduces as adolescence progresses
Obsessive Compulsive Disorder (OCD)
Obsessive, unpleasant thoughts linked to compulsions which repeat and cannot be controlled
Treatment using Cognitive Behavioural Therapy is highly effective and strongly recommended as soon as the compulsions impact functioning
Generalised Anxiety Disorder (GAD)
Extreme, pervasive and uncontrollable worry about many activities and events
Cognitive Behavioural Therapy is the initial recommended treatment, but medication can also be prescribed for more severe cases
*Data source: Solmi et al 2021. **These are typical treatments for different types of anxiety, but are not in any way a definitive list.
When to worry
Occasionally feeling anxious is normal – joining a new school, going away for the first time, meeting a new social group or speaking in public. However, if feelings of anxiety regularly cause significant distress or start to impact on a child’s ability to carry out daily life – such as withdrawing or avoiding places or contact with friends or family, feeling unable to go to school, or needing to do things (wash hands repeatedly) to feel ok – these may be signs of an anxiety disorder.
The other time to be concerned is when a parent feels they must make adjustments to accommodate the anxiety, that are not age appropriate. For example, a 10-year-old child not being able to go upstairs by themselves, or a teenager needing to sleep in their parents’ bed. Such ‘family accommodations’ are present in more than 90% of cases of parents with anxious children. This offers short-term relief but it maintains the anxiety in the long-term so it’s important to stop making them.
If you are concerned about your child’s anxiety, please seek professional advice from your family doctor. There are very effective treatments available to help, including psychological therapies which do not involve medication.
Books for Children:
- My Anxiety Handbook: Getting Back on Track by Sue Knowles, Bridie Gallagher & Phoebe McEwen
- Outsmarting Worry: An Older Kid’s Guide to Managing Anxiety by Dawn Huebner (older children)
- What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner (younger children)
- What To Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCD by Dawn Huebner (OCD specific)
Relaxation, Sleep & Meditation Apps designed for Parents and Children:
Books for Parents:
- The Incredible Teenage Brain: Everything you need to know to unlock your teen’s potential by Bettina Hohnen, Jane Gilmour & Tara Murphy
- How to Have Incredible Conversations With Your Child: A book to use together. A place to make conversation. A way to build your relationship. By Jane Gilmour & Bettina Hohnen (due out October 2021)
- Helping Your Child with Fears and Worries 2nd Edition: A self-help guide for parents by Cathy Creswell and Lucy Willetts
- Parent-Led CBT for Child Anxiety: Helping Parents Help Their Kids by Cathy Creswell et al
Proactive tips to help with general anxiety:
- Normalise difficult feelings. They are part of life. If a child can’t name their emotions, then they have no tools to understand or deal with their experience.
- Explain to your child how anxiety presents itself. Understanding what is happening in their body will reduce fear when symptoms strike.
- Support, don’t enable. Avoidance, accommodation and repeated reassurance may provide short-term relief, but will only maintain symptoms long term. Recognise when this is happening and support your child to push through and overcome the anxiety.
- Know your own triggers. What pushes your buttons? If you mirror your child’s reaction when they are anxious, or conversely minimise their experience, they may experience heightened anxiety, or withdraw from you.
- Have regular ‘worry time’. If your child tends to be anxious, try having 10-15 minutes a day when all worries can be aired. This can be as effective as medication for some children.
Tips to deal with in-the-moment panic and worry:
- Track what’s happening for you. It is hard to sit with your child when they are struggling, and their anxiety might be presenting itself as anger, but they need you to stay calm.
- Listen, empathise, validate. This can feel quite passive, but while in the throes of fear a child needs someone to listen (without interrupting), empathise (“this is hard”) and validate
- (“I can see this feels really overwhelming”). Don’t minimise or try to fix the problem in that moment.
- Support them to cope. Low-level distraction, changing the environment or focusing on breathing can all help as the emotion naturally reduces.
Tips to work through later:
- When everyone is calm, talk it through without judgement or blame.
- Differentiate what can and can’t change or be controlled.
- Make a plan for next time and remember we can’t use our mind to control our in-the-moment fear, but slowing down our breathing or changing our environment can help.
- Empower them with kindness. “I know this is hard for you and I am sure you can do it.”
- Be consistent with the plan. In time, the anxiety will reduce.
This advice is available as a downloadable resource alongside the rest of the Be Well series, at www.cognita.com/cognita-be-well.