As a parent, it can be a tough job to work out whether your child has an anxiety disorder or they’re just dealing with the challenges of growing up. As a paediatrician, I face this dilemma daily in my clinic. I’ll try to help you decide the difference between a healthy state of anxiety and an unhealthy one, and where to go next.
All children have anxiety, and a little bit is normal and even healthy to motivate them or get things done. A bit of nervousness for an exam drives adrenaline to improve performance. But when anxiety becomes overwhelming it can get in the way of normal everyday functioning; it’s not normal for your child to be so nervous that they refuse to go to school. The telltale signs of unhealthy anxiety in younger children are if they’re irritable or tearful without obvious cause, if they have difficulty sleeping or suffer lots of bad dreams, or they have started wetting the bed again. In older children, look out for angry outbursts, a lack of confidence, difficulty concentrating, and avoiding everyday activities such as going to school or seeing friends. While all of these can be signs of other things, if a change in behaviour is triggered by the possibility of an upcoming activity or event, anxiety is a very likely cause.
Growing up is tough, we all remember that. Children meet many challenges and obstacles and they’re constantly learning to negotiate a social world, full of rules and expectations. Children, like adults, have certain fixed points in their personality, and some children are just naturally more prone to worrying and being cautious than others. So there may not be a definite cause for their anxiety or behaviour. The difference is if this behaviour has suddenly changed. This may be prompted by a distressing event, causing anxieties to surface and become more prominent, taking centre-stage in their life. Common triggers include a change in environment such as moving home or school, and a change in family dynamics such as conflict, divorce or bereavement. Teenagers are also more prone than any other age to social anxiety related to their peers, making excuses not to go out or avoiding their friends.
Be there to listen. Create as many opportunities as you can for your child to open up when they want to. Ask how they are doing regularly and create an environment where talking about your feelings is the norm at home. Stay involved in their lives. Show interest in the things that are important to them. This helps to show value in their interests, as well as see where your child is having any problems and be there to support. Take what they say seriously. Feelings are real to the person who is feeling them. Don’t belittle what your child is feeling just because they are young. Something that feels massive in their life should be regarded as massive. Support them through difficulties. Stay supportive when your child is at their most difficult. This can often be the time when they act out or are combative, but it is when they need your support the most. Encourage their interests. Supporting your child to be involved in a number of different activities can be extremely supportive of their mental health. It allows them to explore life and relationships with the interest being the easy distraction. Build positive routines. Routine can bring great benefits to mental health. Targeting sleep, eating and exercise is a particularly effective way to anchor routine in a child’s life. We know how hard this can be with young people but even small improvements can have profound effects for the better.
If you have concerns, seek out the full picture of your child’s behaviour. Speaking to other people involved in your child’s life – their friends’ parents, grandparents or teachers – brings you more information. It also takes the focus away from your own relationship with your child, where the situation can become complex, breeding a cycle of anxiety and anxiety about anxiety. You should seek help if you think your child’s anxieties are severe, are persisting for several weeks, or they get in the way of their everyday life. There are great information sources online from charities such as Young Minds (www.youngminds.org.uk). These can be a good place to start, letting you read how other parents have felt and giving you access to practical advice. If you would like to speak to someone in person then the two people you should speak to are your child's doctor, who can direct you to the right NHS services in your area, and your child’s teacher, who can offer support at school and keep an eye out for any changes in behaviour. Tackling mental health in children is extremely difficult, but the first step is recognising it. * Written by Dr Tom Maggs, General Manager of Caidr and Paediatrician