Anxiety

The following is an excerpt from the ebooklet Working with children who are anxious by Murray Evely and Zoe Ganim.

Anxiety is an emotion that most people experience at some time in their lives. It is the feeling of apprehension that comes from the belief that something bad will happen that you will be unable to manage or control. Anxiety becomes a problem for children when it is experienced most days for a prolonged period of time [1] Generally, for at least 4 weeks but can be up to 6 months, depending on the type of anxiety. ; and interferes with daily functioning with regard to learning, play, sleep and enjoyment of life.

Followed closely by challenging behaviour, Australian school psychologists have identified anxiety as the most common issue encountered in their work with students and their families in primary school settings.[2] O’Grady, L., Quayle, A., Martin, L.M., Cavanagh, S., (June, 2011) Tackling mental health in primary schools. InPsych,The Bulletin of the ...continue

One in five children and adolescents have a range of elevated symptoms of anxiety.[3] Barrett, P., (October, 2014) Treatment guidance for common health disorders: Childhood anxiety disorders. InPsych, The Bulletin of the Australian ...continue Many are not recognised, treated or appropriately supported.[4] Orygen Youth Health (n.d) Anxiety Disorders and Young People. Factsheet. Parkville, Victoria. This is probably because children who display the more subtle behavioural signs associated with anxiety, such as avoidance and hesitance [5] Rapee, R., (2008) co-author of Helping your anxious child, New Harbinger Publications, USA, quoted by Moo, M., (2010) How to help your anxious ...continue, perfectionism and being overly compliant are less likely to draw adult attention compared with children who are disruptive in the classroom. However,anxiety can present as anger or aggression particularly in adolescents, and children with Autism Spectrum Disorder.

There is often no single cause for anxiety. Common risk factors include having a parent with anxiety, ongoing stressful events, health issues, learning disabilities and temperament. Appendix 1 provides an overview of factors that can lead to anxiety.

All children worry at times

Children may worry about possible future events, such as failing a test, being humiliated, or having a parent die. They may also worry about what they have said or done in the past, such as an argument with a parent, sibling or friend, and the impact it may have on them now and in the future.

How is anxiety different from stress or worry?

Stress is experienced when personal and situational demands place undue pressure on the resources that help a person to cope, such as emotional control, physical health and sense of connectedness with others. Prolonged stress can lead to a number of psychological and physical illnesses, including anxiety.[6] Endler, N. S., Stress, anxiety and coping: the multidimensional interaction model. Canadian Psychology, Vol. 38. No.3 August, 1997, p136

The main difference between anxiety and worry is the frequency and severity of symptoms. Anxious children will worry excessively each day for at least four weeks [7] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5h ed). Washington, DC: Author. In children, this ...continue in ways that significantly interfere with daily living, and result in ongoing physical or psychological symptoms. Children with high levels of anxiety are often unable to identify the causes of their anxiety.

Symptoms of anxiety

When children are anxious they perceive a threat to their safety or wellbeing. This turns on an ‘alarm response’ in the body that activates the sympathetic nervous system. The sympathetic nervous system primes the body to survive; focusing attention on fighting or escaping from the threat – often referred to as the ‘fight, flight or freeze’ response.

Indicators that children may be experiencing anxiety:
Physiological
  • Increase in heart rate
  • Nausea or ‘butterflies in tummy’
  • Poor appetite
  • Tense muscles
  • Rapid or difficulty breathing
Behavioural
  • Avoidance of the feared situation
  • Anxious affect: frowns, worried or distracted looks, darting eyes, poor posture
  • ‘Freezing’ or unable to complete a task or action
  • Withdrawal from others
  • Difficulty complying with social norms
  • Aggression
Psychological
  • Excessive worry about a situation and the ability to cope with it
  • Feelings of being unsafe, vulnerable and hyper-sensitive
  • Irrational thinking (‘If I don’t get into district finals this year, I’ll never get into a district final!)
  • Interpreting neutral or ambiguous situations as threatening or dangerous (‘The teacher wants to see me at the end of class. I bet I’m in trouble and I will get detention.’)
  • Anticipating a negative outcome for future events (‘I’m going to fail the test.’)
  • Sweating
  • Headaches or pain
  • Diarrhoea
  • Body shakes
  • Lump in the throat

 

 

  • Being passive, unassertive
  • Bossiness, being over-controlling
  • Difficulty expressing themselves
  • Difficulty concentrating
  • Fidgeting or restlessness
  • Clinging to others
  • Crying
  • Tiredness from difficulty sleeping
  • Exaggerating or misinterpreting the level of threat or danger in a situation (‘John’s yelling is really bad. I need to run away.’)
  • Over-estimating the likelihood of something going wrong (‘What if I get sick and faint on the bus?’)
  • Under-estimating ability to cope with the situation alone (‘I need Mum; I can’t cope with this!’)

Anxiety can affect a child’s learning

Anxiety is not always a problem. Mild anxiety can serve as a motivational tool encouraging children to do more, or learn new things.[8] Albano, Causey & Carter (2001) Fear and Anxiety in Children. In C. E. Walker & M. C. Roberts (Eds.), Handbook of Clinical Child Psychology ...continue High levels of anxiety on the other hand have a significant negative impact on learning and reduce cognitive capacity. This means the child’s ability to think logically and rationally and to solve problems is diminished.

The physical and psychological symptoms associated with anxiety make it very difficult for the child to focus on anything but their anxious thoughts and accompanying physical responses, such as feeling sick or having an increased heartbeat. As a result, anxiety affects memory and concentration and thus interferes with learning engagement. It also has a negative impact on relationships with peers, which can lead to a decreased sense of self worth.

Anxiety can lead to task avoidance and lack of confidence. A child’s self-doubt about their capacity as a learner may reduce their school performance and engagement.

Highly anxious children are primed to pick up any small ‘risk’ or ‘danger’. As a result, they have difficulty relaxing and learning through active listening and observation. Moreover, when tasks require physical and mental effort beyond their capabilities, high levels of anxiety can cause overload, leading to panic, fear, anger, withdrawal and tears; and, in some cases to aggression and violence.

Anxious children are more likely to drop out of school during mid to late secondary years. Nearly half of anxious adults report having left education early, with about a quarter subsequently indicating anxiety as the primary reason.[9] Gamble, A., (n.d.) Anxiety and Education. Impact, Recognition & Management Strategies. Centre for Emotional Health, Macquarie University, ...continue

Indicators that children may have high levels of anxiety:

  • Give up easily.
  • Need lots of encouragement or prompting to begin and to complete tasks.
  • Ask for frequent reassurance that they are on the right track from the teacher or peers.
  • Want to do things perfectly, so they may:
  • Take a long time to complete schoolwork.
  • Be so dissatisfied with their written work that they rip it up.
  • Constantly write and re-write sentences or words.
  • Excessively rub out or correct their work.
  • Hand in assignments late.
  • Put off starting assignments until the last minute.
  • Be easily distressed, stressed or startled.
  • Worry more than other children.
  • Be frequently absent or ill, and are likely to visit the sick bay more frequently than other children. Some may repeatedly miss school on Mondays or the first day of term due to anxiety about leaving home and going to school after the weekend, or longer periods.
  • Avoid feared situations. Some children may prefer to get into trouble or stay at home rather than face a fear, such as giving a speech or participating in an incursion or excursion.
  • Be reluctant to attend school. This is often evident at school drop-off where the child will have difficulties separating from their parent.
  • Be unable to explain why they are anxious, or why they acted out.
  • Avoid some academic and social activities while performing well in others. They may prefer structured tasks with clear rules and criteria over open-ended tasks because of a lack of confidence in the quality of their work.
  • Rarely or never volunteer to answer questions, read aloud, or write on the board.
  • Be prone to bullying and peer victimisation.[10] Hudson, J., Anxiety Disorders in Children: Aetiology, Assessment and Treatment. Keynote Address, Anxiety in Children. Royal Children’s Hospital ...continue
  • Have difficulty concentrating and attending due to frequent worrying. This may present as:
  • Not following instructions.
  • Forgetting previously learned information.
  • Not completing tasks.
  • Forgetting what is required.
  • Trying to please people and apologising frequently.
  • Appearing unhappy.

Contact parents if you are concerned

Contact parents if you are concerned that a child may have a problem with anxiety. A referral to a doctor or psychologist may be recommended to assist the child to cope. In some cases, these professionals may diagnose an anxiety disorder, and create a treatment plan specific to the child. See Appendix 2 for a list of anxiety disorders. Anxiety is often a precursor of depression.

Children who experience family violence

Some anxious children have a faulty understanding of their emotions and why they experience these feelings. However, for children who experience family violence, the emotional trauma and perceived threat can be real. Family violence is child abuse. Child protection agencies will need to be involved. If a student or parent discloses information that indicates the student is exposed to family violence or is at risk of or is experiencing significant harm or abuse, then follow through with mandatory reporting as required. See Reporting child abuse: A guide for teachers.

Strategies to support the child who is anxious

Teachers can play a key role in helping to prevent, reduce or moderate a child’s feelings of worry and anxiety.

Promote help-seeking behaviour

Many anxious children and adolescents do not seek help so it is important to encourage help-seeking behaviours and a sense of connection with others in all students from an early age.

  • Ensure students will ask for help when instructions or a task have not been understood. Understanding expectations and believing the task is within one’s capabilities can help to reduce anxiety.
    • Before setting students to work, encourage those who would like to hear the information one more time to listen again. Teachers can also nominate those they believe may benefit from additional instruction. Revise and review with small groups or individuals as needed. Ensure this is accepted practice and not embarrassing.
    • Constantly move around the classroom monitoring who would benefit from additional support from the teacher, a learning buddy, or assistive technology.
    • Tune in’ to anxious facial expressions. Quietly say, ‘This work can be confusing. I’m happy to help. Show me where you’re up to or stuck.’
    • Be aware of frequent reassurance seeking behaviour. Some anxious children may exhibit an excessive need to ask for help. To the question, ‘Is this right?’ you can redirect and reassure the child by saying, ‘What have you done so far?’, ‘What might you do next?’ or ‘Let’s focus on how you are solving the problem rather than on whether or not you are right? Tell me what you are thinking.’
  • Ensure your class knows who they can go to for help when they feel stressed, anxious or overwhelmed, and what to say. Help-seeking should be validated as something successful people do, rather than an indicator of weakness. Simple help-seeking activities include:

 

ISBN 978-1-921908-35-4

Copyright © Murray Evely and Zoe Ganim 2016

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