Expert insights on understanding and managing anxiety in children
|Published
Child and adolescent mental health is crucial for a strong, vibrant, and caring society. Yet, South Africa’s youth are nearing a breaking point. Many children and adolescents face mental health challenges and struggle to access the care and support they need.
Being mentally healthy during childhood means reaching developmental and emotional milestones, learning healthy social skills, and coping with problems. Mentally healthy children enjoy a positive quality of life and function well at home, in school and in their communities.
In 2022, the University of Cape Town’s (UCT) Children’s Institute (CI) published the South African Child Gauge, focusing specifically on children’s mental health.
The report revealed that South African children face extraordinarily high levels of adversity, increasing their risk of developing mental health issues.
Shockingly, two-thirds (63%) of South African children live below the upper-bound poverty line, and nearly half (42%) have experienced violence, including physical (35%) and sexual abuse (35%).
In some parts of the country, almost all children have either witnessed or experienced violence in their homes, schools, or communities.
To better understand anxiety in children and how parents and guardians can manage it effectively, Independent Media Lifestyle reached out to experts for their insights and advice.
According to Lori Graham-Robertson, an occupational therapist at PlaySense and Parenting Consultant at soSerene, anxiety is a normal human emotion that often gets a lot of negative attention.
"Anxiety is there to keep us safe and allow us to make quick decisions when we are in danger. If a bookshelf is falling on our heads, we need it to move out of the way. We don’t want to be thinking about moving, we just need to move," she explains.
However, after the danger is over, the brain needs to return to a state of balance. The problem arises when we start worrying about things we can’t control.
Graham-Robertson adds, "The question we need to ask is, is this anxiety serving a purpose? If not, then it becomes dysfunctional and a problem."
Anxiety can become a "hungry" emotion—the more you feed it or think about it, the hungrier it gets. This can lead to avoiding more and more places, people, and experiences "just in case" something bad happens.
"We have that same spike in adrenaline and fear response even when we see a spot where there could be a spider," she says.
This avoidance can overwhelm a person or a child, leading to avoidance behaviour. Graham-Robertson quotes Dan Siegal, stating, "Neurons that fire together wire together."
This means that the feeling of anxiety or being worried becomes linked to the behaviour of avoiding.
“The more this avoidance is practised and the more the person is kept "safe", the more things become avoided.
Janine Kendall, a counselling psychologist and spokesperson for SACAP, holds a master’s degree in counselling psychology, explains that anxiety manifests differently in children compared to adults due to several key factors, including developmental context, sources of anxiety, cognitive differences, and the overall impact of anxiety on the individual.
Children's anxiety often appears different because of their developmental stage. Unlike adults, children might not have the vocabulary or emotional awareness to express their anxiety.
Instead, they may show it through behaviours like clinginess, tantrums, irritability, or physical complaints such as stomach aches and headaches.
The sources of anxiety for children also differ. Common triggers for kids include fear of separation from parents (separation anxiety), academic pressures, social situations, and specific phobias like fear of the dark, being abducted, or monsters.
Adults, on the other hand, often experience anxiety due to more complex issues like financial concerns, job stress and relationships.
Children’s cognitive development affects how they perceive anxiety-inducing situations. Their ability to understand and rationalise fears is limited compared to adults, which can make their anxiety seem more intense and less predictable.
Children with anxiety can often be misdiagnosed because they may not show the typical symptoms associated with adult anxiety. It's crucial for teachers and parents to recognise the signs of anxiety early on so that appropriate treatment can be sought.
Untreated anxiety in childhood can lead to long-term mental health issues, potentially resulting in chronic anxiety and other disorders in adulthood, says Kendall.
Kendell explains how to differentiate between normal worries and clinically significant anxiety in children. She breaks down the symptoms into three main categories: emotional, physical, and behavioural.
Emotional symptoms:
- Excessive worry or fear about future events.
- Constant feelings of nervousness or tension.
- Difficulty concentrating or mind going blank.
- Irritability and mood swings.
Physical symptoms:
- Frequent stomach aches or headaches without a medical cause.
- Restlessness or difficulty sitting still.
- Trouble sleeping or nightmares.
- Rapid heartbeat or sweating.
Behavioural Symptoms:
- Avoidance of activities or social situations.
- Excessive clinginess to parents or caregivers.
- Outbursts or tantrums when facing anxiety-provoking situations.
- Seeking constant reassurance
Parents can tell the difference between normal worries and significant anxiety by observing how it impacts their child’s daily life. Normal worries are usually short-lived and tied to specific situations, like exams or the first day of school.
They resolve quickly and children tend to feel comforted by parents.
In contrast, clinically significant anxiety is persistent, excessive, and out of proportion to the situation.
It interferes with daily functioning, such as school performance and social interactions, and physical symptoms like headaches or stomach aches linger. Reassurance provides little to no relief for children with significant anxiety.
According Graham-Robertson, it’s crucial for parents to model calm behaviour and manage their own stress levels.
She explains, "Children mimic the behaviour they see. If they see a parent unable to cope with a situation, their first thought is, 'If my parent can't cope with this, what hope do I have?'"
When parents display anxiety, it signals to the child that a place, person, or situation is unsafe, triggering an anxiety response in the child's mirror neurons.
Conversely, parents who model managing emotions and overcoming challenges instil feelings of empowerment and confidence in their children.
According to Kendell, schools and educators can play a vital role in supporting children with anxiety disorders through several key strategies:
Creating a supportive environment
Educators should undergo training to recognize signs of anxiety in students. By fostering a safe and inclusive atmosphere, schools can help anxious children feel more secure and understood.
Implementing accommodations
Schools can make practical adjustments such as offering extended test times, modifying assignments, and providing quiet spaces. These accommodations help alleviate stress and enable anxious students to manage their symptoms effectively.
Promoting social-emotional learning (SEL)
Integrating SEL programs into the curriculum is crucial. These programmes teach coping strategies, emotional regulation techniques, and mindfulness practices that are beneficial for managing anxiety.
Encouraging communication
Regular communication among parents, teachers, and counselors is essential. This ensures consistent support and monitoring of the child's progress.
As Graham-Robertson emphasises, "Connection is the antidote for anxiety. When a child feels connected to someone, they release oxytocin, which helps counteract cortisol, the stress hormone released during long-term stress and anxiety."