Outline of this ebooklet

This ebooklet is part of a two-book series. This ebooklet aims to about help prevent and reduce anxiety. The second Psych4Schools ebooklet, Working with children who are anxious, outlines strategies to support the child diagnosed with an anxiety disorder and those who are anxious.

How is anxiety different from worry or stress?

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.[1]

All children worry at times. They 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 arguing with a parent, sibling or friend, and the impact it may have now and in the future.

The main difference between anxiety and worry is the frequency and severity of symptoms. Anxious children worry excessively each day over a period of four weeks or more [2] in ways that significantly interfere with daily living and result in persistent physical or psychological symptoms. Children with high levels of anxiety are often unable to identify the causes of their anxiety.

Anxiety can affect learning

Anxiety is not always a problem. Mild anxiety can serve as a motivational tool encouraging children to do more or learn new things.[1] High levels of anxiety on the other hand, significantly impede learning and reduce cognitive capacity. This means the 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 nausea or having an increased heartbeat. As a result, anxiety affects memory and concentration and thus interferes with learning. It also disrupts 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 react to 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. In some cases, aggression and violence may follow.

Anxious children are more likely to drop out of school during mid to late secondary years. Nearly half of anxious adults report leaving education early, with about a quarter subsequently indicating anxiety as the primary reason.[1]

Anxiety is often a precursor to depression. Contact parents if you are concerned that a child may have a problem with anxiety, is often unhappy, or reports having problems with sleep. A referral to a doctor or psychologist may be recommended to parents to assist the child. In some cases, the practitioner may diagnose an anxiety disorder, and create a tailored treatment plan for the child.

For a brief description of the anxiety disorders most commonly experienced by primary and secondary school students see Common ways anxiety can present in children, in the Anxiety resources package in the Member’s area.

Indicators that a child may be experiencing anxiety

When children are anxious, they perceive a threat to their safety or wellbeing. This generates 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. This is often referred to as the fight, flight or freeze response. Experiencing several of the following conditions and behaviours may indicate that a child is experiencing anxiety.

Physiological

• Increase in heart rate
• Nausea or ‘butterflies in tummy’
• Poor appetite
• Tense muscles
• Rapid or difficulty breathing
• Sweating
• Headaches or pain
• Diarrhoea
• Body shakes
• Lump in the throat

Behavioural

• Avoiding of the feared situation
• Frowning or giving worried or distracted looks, using darting eye movements, slouching or adopting a withdrawn posture
• ‘Freezing’ and being unable to complete a task or action
• Withdrawing from others
• Having difficulty complying with social norms
• Acting aggressively
• Being passive or unassertive
• Being bossiness, or over-controlling
• Having difficulty expressing themselves
• Having difficulty concentrating
• Fidgeting or restlessness
• Clinging to others
• Crying

Psychological

• Worrying excessive about a situation and ability to cope
• Feeling unsafe, vulnerable and hyper-sensitive
• Displaying 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’ll get detention.’)
• Anticipating a negative outcome for future events (‘I’m going to fail the test.’
• 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!’

Indicators that a child may be experiencing elevated levels of anxiety

• Needs a lot of encouragement or prompting to begin and to complete tasks
• Gives up easily
• Asks for frequent reassurance from the teacher or peers that they are on the right track
• Wants to do things perfectly, so they may:
• Take a long time to complete schoolwork
• Be so dissatisfied with their work that they rip it up or delete it
• Constantly write and re-write sentences or words
• Excessively rub out or correct their written work
• Put off starting assignments until the last minute
• Hand in assignments late.
• Is easily distressed, stressed or startled
• Worries more than other children
• Is frequently absent or ill or visits the sick bay more often 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 away from school
• Avoids feared situations. Some 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
• Is reluctance to attend school. This is often evident at school drop-off where the child will have difficulties separating from their parent
• Is unable to explain why they are anxious, or why they acted out
• Avoids some academic and social activities while performing well in others. They may prefer structured tasks with clear criteria over open-ended tasks because of a lack of confidence in the quality of their work
• Rarely or never volunteers to answer questions, read aloud, or write on the board
• Is prone to bullying and peer victimisation[1]
• Has difficulty concentrating and attending due to frequent worrying. This may present as:
• Not following instructions
• Forgetting previously learned information
• Forgetting what is required
• Trying to please people and apologising frequently
• Frequently appearing to be unhappy
• Falling asleep at school and/or reporting difficulties with sleep.

School refusal

‘School refusal’ is marked by repeated absences from school on an ongoing basis with the child usually staying home. It is typically linked to anxiety and often associated with early separation anxiety and/or generalised anxiety disorder (persistent worrying across a range of issues). School refusal may become an entrenched problem. It is more difficult to address in the later years of schooling if the anxiety is based on a distant anxious memory and staying at home has become a comfortable habit. Often a psychologist (with parent approval) needs to intervene.

Every child who refuses school requires an individual program that involves parents/carers, teachers and professional service providers. The child cannot be simply forced to attend school; a gradual reintroduction is usually necessary.

For further information and strategies see Psych4Schools ebooklet Working with children who refuse to go to school (School refusal).

Children who live in anxious families

About 50% of anxious children have an anxious parent.[1] Children with an anxious parent may lack role modelling in productive coping skills and rational ways of thinking.

For strategies to assist anxious families see Working with anxious parents, in the Anxiety resources package in the Member’s area.

[1] Rapee, R.M., Wignall, A., Hudson, J.L., and Schniering, C.A., (2000) Treating anxious children and adolescents: An evidence-based approach. New Harbinger Publications, Oakland, USA

[1] Hudson, J., Anxiety Disorders in Children: Aetiology, Assessment and Treatment. Keynote Address, Anxiety in Children. Royal Children’s Hospital Psychology Seminar, Melbourne, July 2009.

[1] Gamble, A., (n.d.) Anxiety and Education. Impact, Recognition & Management Strategies. Centre for Emotional Health, Macquarie University, Sydney. Power Point presentation. http://www.cheri.com.au/CHERIAnxandEd_final.pdf.pdf

[1] Albano, Causey & Carter (2001) Fear and Anxiety in Children. In C. E. Walker & M. C. Roberts (Eds.), Handbook of Clinical Child Psychology (3rd ed., pp. 291- 316) New York: John Wiley & Sons.

[1] Endler, N. S., Stress, anxiety and coping: the multidimensional interaction model. Canadian Psychology, Vol. 38. No.3 August 1997, p136

[2] American Psychiatric Association, (2013) Diagnostic and statistical manual of mental disorders (5th ed) Washington, DC: Author. In children, this anxiety may be anywhere from 4 weeks to six months depending on the anxiety disorder.

ISBN 978-1-921908-46-0 Copyright © Murray Evely and Zoe Ganim 2019. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. Click hereto read copyright details, summaryof the licence and terms and conditions to use and reproduce our digital materials granted to authorised users.