What is childhood anxiety?
Anxiety can affect children and young people in a variety of different ways. Dr. Michele McKenner talks about the different types of anxiety, how it can affect children and the treatments that are available. She also gives advice on what parents should look out for and what they can do to help.
Transcript
Who are you?
Hi, I'm Dr.
Michele McKenner, and I'm a clinical psychologist.
You can come and ask me questions about anxiety in children
and find out how best to support your child.
What is anxiety?
So anxiety is a feeling of worry or fear or unease.
And we often experience it
as different physical sensations in our bodies accompanied
by maybe some worrying thoughts.
And of course anxiety is a very normal response
to a stressful situation,
but it's when it becomes very constant
and it's really interfering with everyday life
that you might start to think it's problematic
and it's in that kind of situation that you might want to go
and see your GP to get some advice and to be assessed.
What are some different types of anxiety disorders?
There are quite a few different types of anxiety disorder
with different symptoms and characteristics.
Generalised anxiety disorder or GAD is quite a common one.
You also have obsessive compulsive disorder or OCD,
and then you can have separation anxiety, social anxiety,
health anxiety.
And then there's post-traumatic stress disorder
or PTSD is also a type of anxiety disorder,
as are things like panic or phobias.
So there's quite a range of different anxiety disorders.
Do children get anxiety disorders?
So yes, children
and young people of all ages do get anxiety disorders
and they can get any of the different types
of anxiety disorder
and sometimes they can get more than one
disorder at the same time.
Which anxiety disorders are most common in children?
So mental health conditions are
relatively common in children.
It's thought around one in five children
or young people could experience a mental health difficulty
in any one year.
And it's the mood disorders that are most common, such
as depression and anxiety.
And then in terms of, say,
younger children might be more likely
to get separation anxiety and older young people, children
and young people might be more likely
to experience social anxiety, say.
But the important thing is to go
and see your GP, who can then point you in the right
direction and offer support.
What causes anxiety in children and young people?
So as with all mental health conditions, we don't know exactly
what causes anxiety,
but it's likely to be a number of different factors,
including probably a combination of genetics
and environmental factors.
So there could be factors such as your personality.
It could be experiencing something traumatic or distressing.
It could be a significant change that happens in a child's
or young person's life, such
as parents separating or changing school.
It could be other family worries,
it could be financial or housing.
It could be difficulties in friendship groups.
Any of those sort of issues can contribute to
a child developing an anxiety disorder.
Is anxiety genetic?
So as with all mental health conditions,
it's not entirely genetic.
It's multi, it's what we call multifactorial.
So genes might play a part,
but there will also be lots
of different environmental factors that could also be
contributing.
Is anxiety associated with any other conditions?
So children with underlying neurodevelopmental conditions
such as attention deficit hyperactivity disorder or ADHD
or autism spectrum conditions are more likely
to experience anxiety,
particularly if they're not getting the support they need
around those underlying conditions.
And then also children
who maybe have an underlying physical health difficulty
or disability that can also contribute
to experiencing anxiety.
Has COVID-19 and lockdown made anxiety in children worse?
So the pandemic and those sort of periods
of lockdown was really a time when we all felt like we were
in our own little bubbles,
and that did have a negative effect on some people's mental
health, including children and young people.
If you think about it in terms of a child's development,
it's a time when children do
rely on interacting with their peers.
That's a sort of an important part of the way in which
children and young people continue to develop, particularly
during adolescence. As restrictions eased,
hopefully some children will have seen an improvement in
their mental health, but that's not necessarily the case.
And then conversely, you've got another group of children
and young people who were maybe really anxious, ready
and struggling to get to school,
and they could have found lockdown actually
to be quite a relief, and they then perhaps struggled
to reintegrate back into school life and normal life.
The important thing is you as a parent
know your child better than anybody,
and if you've noticed mood changes
or behavioural changes, do go
and seek out some support to try
and understand whether their mental health
is still being impacted.
What is self-harm?
Self-harm is when somebody hurts themselves on purpose,
and often this is done as a way
of managing really overwhelming feelings or experiences.
And those feelings and experiences could be associated
with a mental health condition, such as anxiety,
and people might feel
that hurting themselves is the only way that they can cope
with these very overwhelming feelings.
Another reason they might do it is they might feel very numb
and then they might self-harm in order to try
and feel something.
Do children self-harm?
Unfortunately children do self-harm.
That can take lots of different forms,
and it can be for different reasons,
and obviously that's very distressing
for a parent to think about.
But the important thing is there are sources of support
out there to help you support your child
with this behaviour.
I'm worried my child is self-harming, what should I look out for?
There are lots of different ways in which
children can self-harm.
So that could be cutting, it could be hitting themselves,
it could be banging their head
or another part of their body against a wall
or pulling out their hair.
Lots of different ways that children can engage in
self-harming behaviours.
If you are worried, you think your child might be
engaging in this behaviour, some things to look out
for could be unexplained injuries on their bodies.
So are there cuts and bruises
and things that you can't quite explain?
The other thing to look out for is
your child covering themselves up in a way
that feels unusual.
So they might be wearing very long sleeves in the summer
or long trousers.
They might be avoiding getting undressed in front of you
or in front of other people.
They might avoid swimming for the same reason.
And then the other thing to look out for, I suppose,
is changes in how they seem.
So are they particularly argumentative
or do they seem very low depressed and hopeless,
or are they blaming themselves for things?
So these are all kind of characteristics
that you can look out for as a parent.
And if you are worried
that your child might be engaging in self-harming
behaviours, you do go and talk to your GP
and they'll be able to help and guide you.
I'm concerned my child is self-harming - what should I do?
So, as self-harm is often a way of coping
with really overwhelming feelings,
trying to sort of understand what those underlying feelings
that your child is experiencing is a really
important first step.
Things you can do include offering that emotional support
to your child, trying to open up a conversation,
not to be judgmental.
Your child is already likely to be feeling some shame
and guilt around this kind of cycle of behaviour.
You can let your child know that if they can come to you, if
they're feeling the urge to self-harm,
and you might be able to help them ride that urge.
The other thing you can do with your child is try
and come up with a sort of toolbox of different strategies
that they could maybe experiment with to use instead
of self-harm.
Remembering that different things work for different people.
Some people find a sort of soothing box is really helpful,
like a sensory, soothing box.
People find holding an ice cube something very cold,
or putting your hand in a bucket
of ice water can be helpful.
It could be punching a pillow
or very vigorous exercise.
Some people find taking a shower, for somebody
it might be a very cold shower that they find helpful,
or writing things down on a piece of paper
and then tearing that paper up.
There's lots of different things that your child can try
and see if it's just a helpful way
of managing those difficult feelings.
And the important thing is if you do think your child is
self-harming, it can be really helpful to go
and see your GP to get some guidance or support.
And if there's a very serious risk of harm,
obviously do contact the emergency services.
I'm concerned my child might be self-harming, how do I speak to them about this?
So trying to open up a sort of relaxed, open conversation
with your child on this topic,
I know it can feel really tricky.
Choosing the context in which you do this,
so probably not face to face, not in your child's bedroom.
That could feel too intense
and too much like a big, serious conversation.
So maybe when you are outside
and walking, for example, trying
to remain really open, curious
and nonjudgmental, I think be tentative in your approach.
Bear in mind that your child might not be ready
to discuss this when you first broach the topic.
Letting them know that the door is open
so they can come back to you and discuss it at another time.
Or if they don't feel comfortable discussing it,
they could maybe write some things down.
They could write a letter. So these are all sort of ways
to try and open up
what can feel like a really difficult topic of conversation.
And remembering that self-harm is usually a way of coping
with these very difficult feelings
that feel unmanageable for your child.
So trying to understand with your child
what those feelings are
and seeing if there are any alternative ways of
managing those feelings,
and just asking them if there's anything you
or another trusted adult can do to help them.
How can I start a conversation with my child about feelings of anxiety?
I think it can feel quite daunting for parents,
understanding and knowing how to broach a topic such
as mental health with their child.
And I think the way in which you go about it is quite
important and can be quite helpful.
So trying to avoid a sort of very intense face-to-face,
eye contact context is helpful.
Lots of children find it easier to speak, for example,
when they're engaged in an activity.
So then you are avoiding that face-to-face,
and you have something else that you are focused on.
That also allows for if there are pauses
or silences that can feel less awkward
because you've got something that you are doing.
I think sometimes as well,
children can actually access their thinking a bit more
easily when they're engaged in an activity.
But if we think about sort of icebreaker questions,
perhaps when your child comes home from something,
you can just start by asking them how their day was,
what were some good things that happened in their day?
Were there any challenging things
that happened in their day?
You could be asking them about a specific event.
If they've had a test or a sports competition
or some kind of social event
that you think they perhaps were worried about.
You can ask them how that went.
Again, were there some positives
or were there some challenges associated with that?
And I think always really important
to hold in mind this idea of listening
and allowing your child to feel heard.
That in and of itself can be a really kind
of beneficial experience for your child.
Not jumping too quickly to solutions, just really listening
to their experience and how they feel about something.
How did they feel at that particular challenging moment
of their test or their sporting competition.
And then I think you can sort of follow up
with more probing questions if the conversation's flowing
easily, asking them about feelings, asking them about
is there something that you wish had happened in a different
way, or something that you wish you had done differently.
And maybe asking if there's anything that you could do
to help or anyone else could do
to help them if there are some challenges.
And remembering as well, keep the lines
of communication open.
Make sure that your child knows that they can come back
to you at any time.
Or if potentially it's easier for them to talk
to another adult, another trusted adult, then
that option is open to them as well.
How do I get professional help for my child with their anxiety?
So if the anxiety gets to a point where it's sort
of really interfering with everyday life,
then I think it is a good idea
to seek some support for your child.
A great place to start is always your GP.
The GP will really be able to kind of delve further into
what your child is feeling or experiencing
and also be able to perhaps distinguish if there's
other conditions that have overlapping symptoms
and just make sure that anxiety does seem
to be the primary presenting problem.
You might see your GP with your child,
or you might see your GP on your own,
or your child might see the GP on their own depending on the
age and of the child
and what's appropriate. In terms of what happens after that,
if you have private healthcare, that can be a way
of getting additional support,
or some children might not want to go
and see a doctor, in which case there might be a local youth
counselling service that you could go to.
And also, schools often have options within the school,
which can be great for children.
It perhaps interferes with their life
less if they're seeing somebody
for support within the school and within the school day.
What role has social media played on anxiety disorders within children?
So I think we don't really
yet know the answer to this question.
There needs to be more research
and I suppose longer term studies
assessing the impact of social media
on children's mental health.
There are potentially, there are positives
and negatives associated with social media.
Positives could include that greater connectivity
and finding like-minded peers out there.
A broader opportunity for that.
Potential negatives could include, obviously cyber bullying
is another way in which a child can experience bullying
and perhaps difficult for the parent to know
that that's going on.
Social comparison could be something
that could be contributing to anxiety.
Perhaps children simply,
if they end up spending all their time on social media
rather than connecting with people in real life, then
that could be contributing to social anxiety, for example.
But I think fundamentally as a parent, you always want
to be keeping an eye on your child
or young person to see
have there been any changes in their mood
or changes in their behaviour that are worrying.
And if there have, then you want to be able to try
and open up conversations about that,
make your child feel comfortable that they can bring
challenges to you that have occurred on social media
as in any other part of their life.
How can I protect my child from the potential impact of social media?
I think there will be very different views on
how many restrictions to impose on your child, on
what age should a child start using social media.
These sorts of issues, I think,
vary dependent on different parents and different families.
There's not necessarily one right answer on that.
I think a really important thing is just
that your child feels comfortable that if there's anything
that doesn't feel right, anything
that they see on social media
or any interactions, any material that they're exposed to
that makes them feel uncomfortable, that they feel able
to bring that to you
or to another trusted adult so that they're not so scared
that they're going to be punished
or judged for having accessed this material
or spoken to this individual, that they're
therefore afraid to bring it to the attention of an adult.
So I think there's a balance to be struck there.
All children are curious.
They will potentially end up finding things
that we would prefer them not to find.
But what you want is for them to feel able
to let you know if they do come across something
that's disturbing or worrying in any way.
Where can I go for more information and support about anxiety in children?
There's quite a lot of questions explored here
that you can also listen to the answers.
There's also more information on the Bupa website.
There are some really helpful charities
that explore children's mental health and wellbeing.
For example, Young Minds is a really good one.
There's also the NSPCC.
You can always check in with your school,
your child's school
to see if they can point you in the direction
or if they have any support systems.
Sometimes there's counselling offered within the school,
and also there might be local community organisations
that can offer support for mental health difficulties
for children and young people.
How can I understand my child's anxiety better?
I think it can be difficult for parents
to understand their child's experience of anxiety,
especially if it's not something
that they've gone through themselves.
It can feel as though you're both in sort
of separate bubbles and
how do we get through to one another?
I think just learning more about anxiety,
the different types of anxiety is really helpful.
And then just trying to start an open
and empathic conversation with your child to really try
and listen to their experiences.
Not jumping too quickly to try and solve,
but just really having that kind of open, empathic ear.
I think that trying to understand
what the different triggers are.
So for example then if you know
that you're going into a situation which has the potential
to trigger anxiety in your child, you can be prepared for
that and you can be supportive. I think, trying
to understand whether there are things
that help in that situation.
So if your child is struggling with anxiety, what can you
as a parent do to help them soothe
and to support them in that situation?
What should I do if my child is anxious?
So anxiety is a normal response
to a stressful situation.
So for example, if a child is preparing for an exam
or something like that, to feel anxious is
a pretty normal response.
It's when your child's anxiety is sort of getting
to be constant and is starting to interfere
with everyday life that there's reason for you to worry.
And I think at that point it probably is worth going
to your GP and just getting them to assess
where they think your child is at
and whether they might have an anxiety disorder
that needs some more formal support or treatment.
My child has anxiety - is there anything I should avoid saying or doing?
So as a parent, when your child is anxious,
it's only natural to want to reassure them.
That's the instinctive thing that you do as a parent,
but I think it can be a good idea to reflect on
how you go about reassuring your child.
On the one hand, you don't want to be dismissive,
you don't want to sort of brush things off
and say, oh, you're fine,
because obviously your child is experiencing some quite
challenging and distressing physical symptoms
and worrying thoughts.
On the other hand, you don't want to over reassure
because that can end up reinforcing your child's anxiety
and making them think there really is something
that they need to be worrying about.
The other important thing is not to get sucked into
avoiding all the triggers
that might potentially bring about anxiety for your child.
Whilst that's a sort of short term solution,
it will reduce distress in the short term, it the long term,
it will maintain the anxiety,
it just sort of allows it to keep growing.
Ideally, what you want to do is
if your child isn't too distressed, if you can sit
with them in the situation
and help them to manage those feelings
and sensations that crop up, that's going
to be absolutely ideal
and help them to kind of build that resilience.
And then the last thing I would say is just be a bit mindful
of your own behaviour
and the language that you use, that you are not sort
of modelling a very anxious response in different
situations.
My child's anxiety is affecting the rest of my family, what can I do?
I think it's really helpful if everybody is
as well informed as they can be around whatever anxiety
disorder your child is experiencing.
So obviously if it's for siblings
or younger children, then making sure that
that's in an age appropriate format.
There are some books out there, for example,
that might explain to a young child what's going on
for their older brother who has anxiety.
So I think people being well-informed is helpful.
I think one thing that can happen is
that family life can end up revolving around the anxiety.
So trying to make sure
that family members aren't overly sucked in to sort
of doing everything in a way that fits
with the very anxious concerns of the child.
Trying to resist that as much as possible.
And I think finally obviously the sooner you can get some
support for your anxious child, hopefully
that will reduce the impact that
that's having on the rest of the family.
Really just trying to get that child's support from
outside the family so that it takes some of
that focus away from family life.
What is generalised anxiety disorder (GAD)?
So generalised anxiety disorder is really characterised by
a lot of different worries about all sorts
of different things sort of every day.
So I think children
and young people who experience GAD are just sort
of slightly constantly worried
and can't remember the last time they felt relaxed.
So it's just this sense of worry that is
with them throughout the day about all sorts
of different things.
Can children get GAD?
Children and young people can get generalised
anxiety disorder.
As with all mental health conditions,
we don't exactly know the cause
or why it tends to be multifactorial.
It could be partly related to genetics,
but it will also be other things in the environment,
in the personality, the temperament of that child
or young person that brings about this condition of lots
of generalised worrying.
How can I tell the difference between normal feelings of anxiety and an anxiety disorder?
So it's very normal to feel anxious in response
to particular stressful situations.
That's something that we all experience.
So for children and young people, it might be
that they feel anxious about an exam that's coming up,
or if there's a sporting competition
that they're really invested in,
those might be times when we would expect them
to feel a bit of anxiety.
When anxiety really starts to sort of take over
and interfere with day-to-day life, that's when we start
to worry that there's an issue.
So if, for example, anxiety is getting in the way
of children going to school
or hanging out with their friends,
or just doing activities that they normally enjoy,
that's the point at which you're thinking, gosh,
maybe there is an anxiety disorder here that I need
to seek some support for.
What causes GAD?
As with other mental health conditions, GAD, the causes
of GAD tend to be multifactorial.
So it's not just one thing.
So genetics can definitely play a part
and the temperament of your child can be very significant.
Is your child shy or avoidant or nervous?
But there will also be lots of environmental factors.
So things that are going on, stressors in your child's life.
So for example, are there some significant changes
that are happening, changing school or moving house?
Are there difficulties within the family?
Are parents separating,
for example. Other factors
could include what's the sort of the environment
that your child is in?
Are there lots of anxious people around
who are modelling a sort of anxious way of responding to
and approaching the world?
So yes, as I mentioned, it's multifactorial.
Lots of different things that can combine together
to create generalised anxiety disorder.
What are the signs and symptoms of GAD in children?
I think you can sort of roughly think of
or separate out the different signs
and symptoms into three categories, so you can look out
for different behaviour changes in your child.
You can also think about sort of physical signs
and I guess psychological signs as well.
So behaviour changes:
I would be looking out for a child
who was previously seemed perhaps quite confident,
who is now expressing a lot of self-doubt
and self-criticism,
who is regularly seeking reassurance from you,
asking anxious questions,
expressing worry, that kind of thing.
In terms of physical changes, anxiety
as a disorder is associated with a lot
of physical symptoms or changes.
So for example, you can have a racing heart,
you can have shallow breathing, you can have sweaty palms.
So I think sometimes these signs are actually observable
by you as a parent
because obviously you know your child well
and you might notice if your child is looking really tense
and sort of hyperventilating, you might notice
that your child is sort of rushing
to the toilet much more frequently.
All things that you can consider when you are trying
to notice is there some anxiety in my child.
And then there might be other things such
as difficulty sleeping, difficulty concentrating,
perhaps your child has become more argumentative
or is having angry outbursts.
So any of these sorts of changes,
it's perhaps something for you to consider:
could my child be experiencing generalised anxiety disorder?
What are the treatments for children experiencing GAD?
So there are treatments available to support children
with generalised anxiety disorder.
Exactly what that's going to be will depend on the age
of your child, the severity of the condition
that they're experiencing.
Your GP will be able to guide you.
There are psychological therapies,
so your child might see a counsellor
who can help them understand what's going on.
A really valuable part of any treatment
for generalised anxiety disorder is really helping them
to understand what anxiety is
and how it works, what we might call psychoeducation.
You might undergo a treatment,
a psychological therapy called cognitive behavioural
therapy, CBT, which just helps children understand the links
between their thoughts, their feelings, their sense,
the physical sensations
that they're experiencing and their behaviour.
And then you can try and change one of those.
You can pick at one of those elements to try
and change the experience of the anxiety and try
and bring the anxiety down.
And then in more severe cases, there might be a prescription
for medication of some sort,
and that would normally be by a specialist in that field.
So normally a consultant child
and adolescent psychiatrist
who would help you decide whether
that would be the most appropriate treatment
for your child in that particular case.
What support can parents offer to children who are experiencing GAD?
So the first thing is, it probably is a good idea to go
and see your GP and see if it's appropriate for you
to seek additional support.
If your child is experiencing GAD, it's good
to get in there early and try
and make sure that you are giving them appropriate support.
The other thing you can do as a parent is
to sort of stay calm.
Obviously it's distressing to see your child struggling,
but try and stay calm.
Try not to show your own anxiety in that situation.
And then lots of just the really simple things that you know anyway,
in terms of parenting your child. Trying to make sure
that they're getting a good night's sleep,
that their diet is good, that they are
getting some exercise, all the sort of routines
and structures that help your child to feel safe.
Just trying to make sure that you are really supporting all
of that to stay in place.
Really helping them to notice what makes me feel better,
what are the things that I can do
to help myself feel better.
Sometimes the child needs that parental guidance to sort
of notice what is helping them
to feel better from one day to the next.
How can I support my child in the moment when they are very anxious?
So it can be quite distressing for parents if they can see
that their child is feeling really overwhelmed by anxiety.
But there are some things that you can do in the moment.
One thing that's really helpful is a slow deep breathing
exercise because this will counter your child's fight
or flight response, which is causing the body
to produce chemicals such as adrenaline
and cortisol that are feeding into some
of these quite unpleasant physical symptoms
that your child is experiencing.
So one good one that you can do, there are lots
of different ones out there, but one good one you can do is
to slowly trace the fingers of your hand
and basically you breathe in as you go up the finger
and breathe out as you go down, and you do that slowly
and it's just quite a nice way of sort
of controlling the rhythm of your breathing.
Another really good exercise
that you can try in the moment is using the five senses
to kind of come bring yourself into the present,
contact the present.
So this one is five things you can see,
four things you can hear, three things that you can touch
or that you can sense with the sense of touch,
two things that you can smell
and one thing that you can taste,
and that's something that you and your child can
do together in the moment.
Just really connecting with your senses
and what you can perceive.
Those are both exercises that should help.
Might not work immediately,
but should help to bring those anxiety levels down
to a slightly more manageable level.
What is obsessive compulsive disorder (OCD)?
So OCD or obsessive compulsive disorder is characterised
by two sort of sets of symptoms or behaviours.
The first is obsessions,
and that is intrusive, unwanted thoughts
or images that can feel very anxiety provoking
to the person experiencing them.
And then the second part comes into play,
which is the compulsions.
And that is a behaviour, often a ritualistic behaviour
that you engage in to try
and get rid of the unwanted obsession.
So the obsessional thought
or image that is provoking the anxiety.
Can children get OCD?
So, yeah, children and young people can get OCD.
It tends to happen perhaps slightly later, so
with slightly older children.
But unfortunately, it is absolutely possible for children
and young people to experience
obsessive compulsive disorder.
What causes OCD?
So as with other mental health conditions,
we don't know exactly what causes OCD,
but it's likely to be multifactorial.
So different things that will influence whether
or not you get OCD.
That will include genetics.
There's likely to be a genetic component,
but there will also be environmental factors
that contribute to that.
So adverse life events,
or perhaps growing up in an environment where everything is
very meticulous
or very stressful,
all these different factors can come together to contribute
to a child developing OCD.
What are some examples of 'obsessions' and 'compulsions' in children?
So the first thing to say is that there is a huge range,
huge variety in terms of the obsessions
or compulsions that your child could be experiencing.
So I'll just touch on a few examples here.
So obsessions are these very intrusive, frightening worries
and thoughts, not necessarily rational
that the child is experiencing.
It could be, for example, that something terrible is going
to happen perhaps to a loved one.
So a sort of excessive fear around that.
It could be around contamination.
So becoming very preoccupied with germs.
Some children and young people, this is not hugely uncommon,
will have really dark thoughts about are they going
to do something terrible?
Are they going to be violent towards somebody else
or towards themselves?
Which is obviously, you can imagine really alarming,
intrusive thought to be having.
And then a preoccupation, a really intense preoccupation
around order or things being done in a very particular way.
These are all sort of quite common
obsessions that you could have.
And then compulsions are these sort
of ritualistic behaviours that the child
or young person will engage in to try
and neutralise the thought or to make the thought go away
and reduce those feelings of anxiety.
So sometimes they can feel quite logical.
So if you are very preoccupied with germs
and contamination, then you might want
to be constantly washing your hands.
That could be the compulsion,
but at other times they can feel quite random.
It could be tapping
or making sure
that you are not treading on the cracks in the pavement,
or it could be counting.
Sometimes these behaviours take place inside the mind,
so they're not necessarily obviously observable.
Or you might just notice that your child seems very lost in
thought for a period of time.
The important thing to remember is
if you do notice a real shift in your child,
and you do think that your child might be experiencing OCD
and it's really seeming to start getting in the way
of everyday life
because it can do with OCD,
then it's important to seek support.
Go and talk to your GP.
They will be able to try
and ask the right questions to unpick what it is
that's going on for your child.
What other ways can OCD affect my child's behaviour?
So OCD can affect your
child's behaviour in different ways.
OCD itself can take up quite a lot of time and energy.
So sometimes what you find is that children
and young people are late to things.
They're spending a lot of time engaging in some
of these ritualistic behaviours.
Similarly, they might have to leave when they're at school.
They might have to leave the classroom
because they've got to go away
and engage in some of these rituals.
Other ways in which OCD can affect your behaviour
might be similar to the ways that any anxiety disorder
or mental health condition could affect your child.
They might be withdrawing from things
that they previously enjoyed, not spending as much time
with their peers, just seeming more anxious,
seeking reassurance from you a lot more.
So if you notice these sorts of behaviour changes,
it's a good idea to go and seek support and go
and explore whether your child is indeed suffering from this
kind of a disorder.
How can I tell the difference between normal thoughts and behaviours and OCD?
So obsessional thoughts
and sort of particular rituals can occur as part
of normal child development.
So your child will have a vivid imagination
and they may be experiencing all sorts of different kind
of thoughts that can pop into their heads
and aren't causing them a great deal of distress.
And similarly, it's normal to have rituals
and routines as part of your child's everyday life
that aren't then interfering
with them getting on with things.
I think the point at which you might start
to feel worried is when these things are interfering
with your child's life and your child's wellbeing.
So if your child is engaging in some sort of a ritual
as a way of coping with neutralising
an unpleasant obsessional thought, then
that starts to become problematic.
And if these rituals are becoming really time consuming
or overly preoccupying
and absorbing your child, again, that's when you're starting
to wonder whether there's a disorder at work here.
So I think keeping an eye on any changes in
your child's behaviour.
Are they withdrawing? Are they distressed?
Are they overly preoccupied?
Are they struggling to concentrate?
And then if that's the case, you can go to your GP
and really just investigate further.
Is being clean and tidy a sign of OCD?
So I would say no, not necessarily.
I think this is a bit of a myth
that you hear a lot in the media, for example.
So if you have a particular type of OCD, which is
where you are preoccupied with contamination
or with order, then you might go to extreme lengths
to maintain hygiene or to tidy everything up.
But just being ordinarily clean
and tidy is not a sign of OCD.
What are the treatments for children experiencing OCD?
There are effective treatments that can support children
who are experiencing OCD.
The type will depend on your child's age
and the severity of the condition.
So the two main ones: talking therapies,
it's cognitive behaviour therapy,
and in particular a sort of version of CBT,
which is called exposure response prevention.
And the idea is that you are gently
and in a graded fashion, encouraging your child
to expose themselves to the feared situation
and then to stop themselves responding to that
by engaging in the ritualistic compulsive behaviour.
So the compulsive behaviour will bring the anxiety down in
the short term, but in the long term it reinforces it.
So you're trying to prevent them from engaging in
that compulsive behaviour
and then noticing that they will feel some uncomfortable
feelings, but if they just wait,
those feelings will start to come down.
And you do that in a graded fashion.
So you might start with something that feels relatively easy
and then work up to harder things.
The other treatment, if your child is experiencing quite
severe OCD treatment resistant OCD,
where maybe CBT hasn't worked
or hasn't worked enough, is you might find
that your child is prescribed medication,
and that would normally be a specialist
who gets involved in prescribing for that sort of condition.
What support can parents offer to children who are experiencing OCD?
As a parent, if your child is experiencing OCD,
the first thing that you want to do is probably to go
and speak to your GP
and seek some kind of professional support with it, and try
and do that as early as possible so
that your child gets the help that they need.
And a therapist working with your child may ask you
to be involved in that treatment programme
and one of the reasons for this is
that often, family members get sucked into sort
of accommodating the OCD,
because obviously if your child is distressed
and there's something that you can quickly do to bring
that distress down, it's very natural
that you might just quickly engage in a ritual
rather than have
to witness your child getting very distressed.
But part of recovering from OCD is everybody
not engaging in those sort of ritualistic behaviours.
And so that's a way in which you can help your child as well
as part of the treatment.
The other things that you can do are the very natural things
that you would do in any situation if you noticed
that your child was experiencing anxiety or distress.
So being empathic, listening to them,
making sure they feel heard, validating their feelings,
it can be really challenging
to do the exposure response prevention work.
So you are trying to be their champion and really praise
and reward their efforts,
because it does involve really facing up to
and experiencing some challenging feelings,
and just being really supportive, being a cheerleader
for your child as they go through this process of trying
to kind of fight back against OCD.
I'm worried my child could act upon violent or sexual thoughts, what should I do?
So people with OCD are really unlikely to act upon some
of these quite disturbing, intrusive thoughts
that they're experiencing.
In a way, it's almost as if the last thing
that they could ever imagine themselves doing is precisely
the intrusive thought that pops into their mind,
and that's why they experience it as so distressing
and anxiety provoking.
Having said that, of course, if you are really worried
that you think your child might act in a way that is risky
to others or risky to themselves, and you see signs
or behaviours that might indicate that,
then do seek support.
Do contact emergency services if there's any immediate risk
of harm.
What is separation anxiety?
So separation anxiety occurs when babies
or very young children become really quite anxious
or distressed when they're separated from
their primary caregiver
or somebody in the family that they are used
to spending a lot of time with.
And this is really a sort of normal part of development.
So as a baby of around six months old starts
to become more aware of their surroundings
and the people that they spend lots of time with
and that they rely on, as that awareness grows,
it can become quite anxiety provoking when they're then
aware that they are apart from one
of those primary caregivers, whether it's their parent
or a grandparent or a sibling.
So this is a normal part of development
and normally we would expect it to start to subside
around the age of three or by the age of three.
But if it's very prolonged
or the child is really, extremely distressed
or it's really getting in the way of day-to-day life,
that's when you might start to think, oh,
I wonder whether I need a bit of extra support
and whether my child is experiencing a sort
of a separation anxiety disorder rather than just a normal
part of that child's development.
Can children get separation anxiety?
Children and young people,
in fact, can get separation anxiety.
It's a part of normal development between the ages
of about six months
and three years, that as that
young child becomes more aware of the surroundings
and the primary caregivers, it then also becomes more aware
of that separation when they're apart from those
primary caregivers.
But when that separation anxiety becomes much more extreme,
or of course when it continues well past three years of age,
potentially - more rarely,
but potentially into later childhood
and even the teenage years,
that's when there's perhaps cause for concern
and we might consider it more
of a separation anxiety disorder.
And it's at that point that I would recommend you seek some
support for that, potentially go
and see your GP as a good starting point.
What causes separation anxiety?
Separation anxiety can just be a very normal
part of development.
So as the infant becomes increasingly aware
of the surroundings
and of the primary caregivers, the people
that the infant is most used to spending lots of time with
and relies on, as that awareness grows,
so does the sense of separation from that person when
that person is not near them,
and they can then present with this anxiety, this distress,
crying, seeming very anxious when they're away from
one of these loved ones.
And it can be a sign of the great bond that has formed
between the infant and the family members
or the carers who are looking after that infant.
As with all mental health conditions,
we don't know the exact causes of, in terms
of when separation anxiety becomes problematic,
becomes a sort of a disorder, it's likely
to be multifactorial, lots of different factors.
There may be some genetic influence.
There may also be factors in that child's environment
that could be influencing separation anxiety.
For example, if a family member is poorly
or if there's some sort of traumatic event, for example,
a loss, then perhaps that child is more likely
to feel a separation more keenly
and more acutely than another child.
So it's a variety of factors that can contribute
to bringing about this separation anxiety disorder.
What are the signs and symptoms of separation anxiety?
Babies and young children experiencing separation anxiety
will likely cry, appear distressed, and be very clingy.
But you might also get similar signs in older children
who experience separation anxiety alongside
they will perhaps be able to explain to you as well
what it is they're thinking and feeling.
So other signs that you could look out for are children
who are avoidant of going to school or going to play dates
or birthday parties, for example, or children
and young people who report lots of sort
of unexplained physical ailments.
So they might have stomach ache or a headache.
They might sort of say, I don't want to go somewhere
because I have a headache or a stomach ache.
Other ways in which you might notice it is the child
is similar to the young clingy infant.
The child is very keen to know where you are at all times,
perhaps following you around the house.
Children who get anticipatory anxiety
because they know that you are going away
or you're going out, or children who are old enough
and don't want to be left home alone.
So if you start to notice a sort of cluster of these kinds
of characteristics, it's probably a good idea to go
and see your GP and seek support.
How can I tell the difference between normal behaviour and separation anxiety?
So it's very normal for a younger child
to feel separation anxiety when they leave you.
So this is a normal part of a child's development up
until about three years of age.
And it's also really normal
when a child is starting something new,
for example, going to a new school
or when they're going somewhere new for the first time,
and it feels like quite a big transition for them
to feel some separation anxiety at that point.
I would say that that's fairly normal as well.
Where it starts to become, you start
to worry a little bit is if the distress is very extreme
and perhaps feels disproportionate, it carries on
for quite a long time, so you might expect them to adjust
to the new place, the new school
that they've started at.
If it's really interfering with day-to-day life,
so they don't want to go to school at all, they stop doing
ordinary things because they're
so anxious about being apart from you
and if it's stopping you from going to work, for example.
These are sort of examples of behaviours
and situations where you might think, okay, here,
there seems to be something problematic
and I want to seek additional support.
What are the treatments for children experiencing separation anxiety?
There are treatments for separation anxiety.
The type of treatment offered will depend on the age
of your child, the severity of the symptoms, but your doctor
or your therapist will be able to explain
which treatment feels most appropriate.
Your child might see a counsellor
who will help them make sense of what's happening
and help them to figure out strategies for overcoming some
of these anxieties and fears.
Or your child might engage
with a therapy called cognitive behavioural therapy
or CBT, which helps the child understand the links
between thoughts, feelings, sensations, and behaviours.
And there might be a bit of graded exposure so
that your child can habituate, can get used to longer,
more prolonged periods of separation from their loved one,
and so they can grow their confidence
and become accustomed to those feelings
that come up when they are apart from their loved one.
If your child
or young person's separation anxiety is quite severe,
or the talking therapy isn't enough, there may be medication
that's prescribed, and that would usually be
by someone who's an expert, a specialist in that field.
What support can parents offer to children who are experiencing separation anxiety?
It can be really difficult
for a parent whose child is experiencing separation anxiety
because essentially every time you are trying to leave
that child, you are witnessing a lot
of distress in your child
and obviously that's a really difficult thing
for a parent to experience.
But there are things that you can do to help, particularly
with younger children, they may find it difficult to
understand and label what's happening to them,
so you can really help them with that.
So you can be labelling feelings
and really validating feelings that it is really difficult
for them when you are dropping them off
at school, for example.
The other thing that you can do is you can try
and gradually build up your child's tolerance, so the amount
of time that you spend away from them,
that can be a really helpful thing to do.
The other thing you can do is you can try
and have a really positive goodbye.
So obviously it's tricky
because you are anticipating the reaction from the child,
but if you try and stay calm and try
and hide your own feelings of anxiety and distress,
and just do a really cheerful positive goodbye.
And then another thing that you can do is just talk about
the things that you'll do when you are back together again
to just remind them that it's for a limited period of time
and then you're going to come back together.
What is social anxiety?
Social anxiety -
also sometimes known as social phobia - is a kind
of longstanding fear around interactions with other people.
And it's more than just shyness,
it's really where a person ends up
avoiding social situations
because they're so preoccupied with how they're going
to be perceived by others.
Are they going to be embarrassed?
Are they going to be judged? Are they going to be rejected?
And so really, it can end up interfering with a child
or young person's day-to-day life
because they don't want to engage in these ordinary
social interactions
and indeed social interactions that that child
or young person wants to be a part of,
but their anxiety, their fear gets in the way of that.
Can children get social anxiety?
Children and young people can get social anxiety.
It usually starts a little bit later,
slightly older children and teenagers as they're more aware
of those sort of peer interactions
and how they might come across to their peers.
What causes social anxiety?
As with other mental health conditions,
we don't know exactly what causes social anxiety.
It's likely to be a combination of factors coming together
to cause social anxiety.
Genetics may play a part,
but there's also likely to be experiences
and environmental factors that will contribute.
If your child experiences a humiliation
or some sort of really traumatic experience socially,
that could provide quite a rapid trigger for social anxiety.
Other triggers might be sort of slower acting.
Your child might have just a shyer temperament,
your child might be growing up in an environment
where there's quite a lot of anxiety being modelled,
so they see that approach to things.
If your child experiences bullying, for example,
that, over time, could contribute to social anxiety disorder.
If your child has something unusual related
to their appearance, they might become very self-conscious
and that could contribute to social anxiety disorder.
So it's a range of factors that could come together
to cause this disorder.
What are the signs and symptoms of social anxiety?
If you notice that your child is starting
to get really anxious and distressed in social settings
or perhaps in anticipation of social settings,
that might be a sign that you look out for.
If you notice that your child,
they're mumbling when they're perhaps in a social setting
or they're kind of looking down,
they're avoiding eye contact, their sort of body language
is not very confident, is really kind of shrinking away.
If your child talks a lot about self-consciousness, about
really expressing concerns about how they're perceived
by others to a degree that feels disproportionate
and they're very acutely embarrassed in situations, which
of course is a sort of normal part of adolescence,
but if it becomes excessive, then again,
that could be a sign
that your child is experiencing social anxiety disorder.
If they're avoiding going to social events,
perhaps they used to go happily to birthday parties,
but now they're tending to withdraw, their sort
of social circle perhaps seems to be shrinking.
If you start to notice a lot of these signs,
it would be a good idea to go
and explore getting some support,
and a good starting point is always to go and see your GP.
How can I tell the difference between 'shyness' and social anxiety?
It's normal for children to be shy
or a little bit anxious from time to time.
For example, your child might feel shy
or anxious when they're starting somewhere new,
like they're starting a new school, for example.
And also, if we think about shy children,
they might still be motivated to go
and engage in social activities,
but they might be a little bit quiet
and shy at the beginning, and then hopefully they'll warm up
after a little bit and start to feel more comfortable.
If your child is socially anxious, they may start to want
to avoid social activities altogether.
They might get really anxious even in
anticipation of a social event,
and then that anxiety might mount once they're at the event,
and it might stay with them afterwards as well,
because they might be ruminating,
turning over in their minds these perceived judgments
or embarrassments that they think they've experienced
at the social event, which perhaps to you as a parent,
don't seem disproportionate or irrational.
And so that's when you might start
to think this is more than just ordinary shyness.
What are the treatments for children experiencing social anxiety?
There are treatments for children experiencing
social anxiety.
The type of treatment will depend on the severity
of the symptoms and perhaps on the age of the child as well.
Different treatments include counselling
where a counsellor will try and talk to your child
and help them make sense of what's going on
and why they're feeling the way they're feeling.
Or a child might engage
with some cognitive behavioural therapy, CBT, which
helps a child understand the links between their thoughts,
their feelings, the sensations in their bodies,
and their behaviour, and perhaps change the way they behave
and the way they think about things.
And it might also involve trying to do a bit
of graded exposure, so build up that tolerance
of different social situations.
If the child
or young persons is experiencing symptoms
that are quite severe
and perhaps the talking therapy alone isn't working
or not working well enough,
then there could be some medication prescribed.
And that would usually be by a specialist who works
with children in this field, like a consultant child
and adolescent psychiatrist.
What support can parents offer to children who are experiencing social anxiety?
It can be difficult for a parent when their child is
experiencing social anxiety.
It's hard to witness this distress in your child in social
situations, and it can be difficult for a child
to speak about it as well.
They can feel embarrassed or ashamed to talk about it,
and you can almost feel as though you are each in your
separate bubbles, and it's hard to know how to get through
to your child when you are having these conversations.
But a great place to start is just really trying
to have an open, curious, empathic conversation.
So really letting your child know that you understand
how hard it is for them, validating their feelings,
really listening to what they have to say.
That's a really good way of letting them know
that they can come to you for support.
Other things that you can do, you can try
and support the child to build that tolerance
to different social situations.
So gradually having longer and longer social interactions
or more complicated or scary social interactions.
Sometimes, if you've got a sort of a friend who can act
as a buddy, who can provide support when your child goes
to some sort of social activity.
Just generally trying
to build your child's confidence just more broadly in life.
And one thing to say is perhaps if you are in a social
setting, don't speak for your child
because it's important for your child to build
that resilience and that confidence to speak for themselves.
My child has anxiety disorder - How can I approach my employer regarding my child's anxiety?
If your child's anxious
and you need perhaps a bit
of extra flexibility in terms of your work.
I guess the first thing is hopefully you can speak
to your manager and try and explain the situation.
Potentially, if it's proving challenging
or there's a lot of flexibility required,
you could, for example, try
and get a letter of support, perhaps from your GP
or from mental health practitioner that's working
with your child, just to explain and evidence what it is
that's going on.
Am I entitled to any support or help from my employer?
Anxiety disorders in children are really common,
so I would say have that initial conversation
with your manager so
that they can point you in the right direction,
they can guide you on
what's available in your particular place of employment.
Can my employer support my child in any way?
If your child has an anxiety disorder,
I'd say the first step is to go and see your GP to try
and make sure that they point you in the direction of
what support is going to be most appropriate.
Your employer may have resources
or schemes that could support you, so it's worth checking in
to see what's available through them.
I’m struggling with my mental health due to my child's anxiety, where can I go to for support?
I think it's really normal and understandable
that if your child is anxious, that that starts
to affect your wellbeing as well.
I think that's a common experience for parents.
So if you do feel that your mental health is suffering,
I think the first port of call is to go
and see your GP to find out what support is available.
There may also be support available through your employer,
so it's definitely worth finding out
what they can offer if there is a private health insurance
scheme or other resources that are available potentially
through their website, for example.
How do I access the Bupa Mental Health services?
So if you have health insurance with Bupa, the best thing
to do is to contact the Bupa Mental Health Support team
and they will guide you through the process.
What are the different types of childhood anxiety?
We all feel anxious at times, including children and young people. Anxiety is a normal feeling. But when anxiety goes on for a long time, this may become an anxiety disorder. Anxiety and anxiety disorders are common in children. Childhood anxiety might be a result of worries in school or at home. In this article, I discuss different childhood anxiety types, symptoms, and treatment.
What age does childhood anxiety start?
Anxiety can affect children from when they are only a few months old. Separation anxiety is common in very young children. This is when a child feels extremely stressed when separated from a parent or caregiver.
A child with separation anxiety may be very clingy. This usually develops at age 6 to 12 months but should normally get better by the time they are 3 years old. Separation anxiety is rare in older children but may affect them in some situations.
As children grow older, they may have different worries that lead to anxiety. For example, they might get nervous about an exam. This is a normal feeling and will pass. However, if a child’s anxiety is making life difficult then this may be a sign of an anxiety disorder.
Types of childhood anxiety
One type of anxiety that can affect children is generalised anxiety disorder (GAD). This is when children have had worries for more than six months. The anxiety will be about many different things.
Younger children might have specific fears (phobias). They might have a fear of the dark, monsters, or animals. Teenagers might have anxiety due to worries about school and friends. Teenagers can also have phobias. One phobia that may make it hard to attend school or go to social activities is agoraphobia (fear of open or crowded spaces).
Young children and teenagers may also have panic attacks. A panic attack makes it difficult to breathe. Frequent panic attacks may be a sign of a panic disorder, which is a type of anxiety disorder.
Another type of anxiety that affects children and teenagers is social anxiety disorder. This is also called social phobia. Children may feel anxious about meeting and talking to people, especially outside of family. They may be extremely worried about what they do or say and how others think of them. Things that may be difficult for a socially anxious child are:
- classroom activities
- attending parties or clubs
- school performances or presentations
What are the main causes of childhood anxiety?
There are many different reasons that might lead to anxiety in children. Causes of childhood anxiety include:
- family history of anxiety
- physical illness or disability
- family problems such as divorce, arguments, or parental illness
- school worries such as schoolwork or bullying (including cyberbullying on social media)
It’s also possible that there is no specific cause for their anxiety. But this doesn’t mean that the anxiety isn’t real.
What are the symptoms of anxiety in children?
Signs of anxiety in children can be both physical and mental. And symptoms may depend on what specific anxiety disorder a child has. Physical symptoms of anxiety include feeling tense, shaky, and restless. A young child with anxiety may have the following symptoms:
- nightmares
- clinginess
- headaches or tummy aches
- eating or sleeping problems
In teenagers, anxiety symptoms might include:
- problems with concentration
- eating or sleeping problems
- negative thoughts
- not wanting to see friends or go to school
- concerns with appearance
- short temper
- feeling that something bad will happen
How is anxiety in children treated?
If you’re worried about any symptoms your child is showing, speaking to a GP can help. Your GP can also refer your child to the NHS Child and adolescent mental health services (CAMHS). The CAMHS service helps young people who are struggling with various mental health conditions like anxiety.
Anxiety in children is diagnosed by a therapist. They will ask your child questions about what is causing them to feel anxious.
Treatments for anxiety disorders include talking therapies such as cognitive behavioural therapy (CBT). CBT focuses on how our thoughts can impact our feelings and behaviour and works to try and change these patterns of thinking.
Medications may be prescribed depending on the severity of symptoms. Drug treatment is mainly for obsessive compulsive disorder (OCD) or panic attacks.
How do you calm a child’s anxiety?
Ways to help a child with anxiety include letting them know you’re there for them. You could also try activities together such as yoga, deep breathing, and mindfulness. Try to find some grounding techniques as these help to distract your child from what’s making them anxious. For example, if your child is anxious about school, you could play ‘I Spy’ on the way to take their mind off it.
If your child finds it hard to talk about anxiety at home, you could encourage them to talk to a GP, Childline or someone at school. Charities like Young Minds, stem4 and Mind also offer mental health support and services for children and young people.
Looking for more support? Our Family Mental HealthLine connects you with mental health nurses for advice and guidance about your child's mental wellbeing.
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