by Kasey Edwards, Sydney Morning Herald, interview with Georgina Manning
A new approach to treating childhood anxiety being trialled by Yale Medical School has flipped the standard treatment by focusing on parents rather than children.
The Supportive Parenting for Anxious Childhood Emotions (SPACE) study starts from the premise that over 97 per cent of parents who have an anxious child accommodate their child’s anxiety by changing their own behaviours to help their child not feel anxious.
"Even with the best treatments currently available, about half of all children remain highly anxious after treatment," says Dr Eli Lebowitz from Yale Medical School.
“Anxious children naturally rely on parents when they are feeling scared, frightened or stressed and parents naturally want to help their children feel better,” says Dr Eli Lebowitz who is Director Program for Anxiety Disorders from the Yale Medical School Child Study Center.
“But sometimes the things we do as parents to help our children feel less anxious in the moment can actually make them less likely to overcome the anxiety over time."
My first response to hearing about the study was “Great — now we can add our kid’s anxiety to the long list of things modern-day mothers are doing wrong”.
Fortunately, Dr Lebowitz is emphatic that his program is not an exercise in blaming parents.
“It is very important to emphasise that parents are not the cause of childhood anxiety disorders,” says Dr Lebowitz.
“It is simply that childhood anxiety is a problem of truly staggering proportions and even with the best treatments currently available, about half of all cases remain highly anxious after treatment. So we are always looking for more and different ways of helping anxious children and their families."
Beyond Blue reports seven per cent of children aged 4 to 17 years in Australia suffered from an anxiety disorder in the past 12 months.
The incidence of childhood anxiety is alarming. Beyond Blue reports that seven per cent of children aged 4 to 17 years in Australia suffered from an anxiety disorder in the past 12 months. Further, one in five of all young people aged 11 to 17 years experience high or very high levels of psychological distress.
Melbourne-based child anxiety expert and director of Wellbeing for Kids Georgina Manning agrees that new approaches to treating anxiety in children are needed — and that includes helping parents to understand that accommodating their child’s anxiety can also enable it.
“I have coached many parents to support them to make sure their child still goes to camp, even though they feel anxious, to speak at assembly even if they don’t want to, to go back to school after a hard day with friends the day before and so on,” says Manning who also runs a program for parents to support their anxious children, called Peaceful Parents.
As any parent knows, there is nothing worse than seeing your child in distress. It's hardly surprising that we want to minimise it.
But protecting children from the immediate distress they are feeling may lead to even greater anxiety in the future by inadvertently reinforcing the belief that the problem the child fears really is as bad as they think it is. Our intervention also dis-empowers them because we are essentially telling our children that they are not skilled or strong enough to deal with the problem on their own.
“The more we encourage avoidance, the more we are saying to our child that the thing they are anxious about should be avoided because firstly they won’t be able to cope and secondly, the problem or situation is too hard for a child to manage,” says Manning.
Rushing in too soon to protect our children from distress is also unsustainable. Life gets hard some times, we all feel uncomfortable emotions, and our kids need to develop the capacity to deal with these unpleasant feelings and confront their fears. This doesn’t mean that we turn off our empathy and tell our kids that they are effectively on their own now.
“It is vital that parents can tune into their child’s emotions, understand how they feel, name the emotion for the child, but not necessarily ‘fix’ the emotion,” says Manning.
If you do have an anxious child, the advice of Yale’s Dr Lewbowitz is to start small. Pick one way you might be accommodating your child’s anxiety and plan specific changes to your approach.
While it may be painful for both your child and you at first, you may be giving your child the life-long gift of learning to master their anxiety
by Delvin Yasa, Interview with Georgina Manning
Lucy* is only eight years old but she’s never been a big sleeper. Lying in bed at night, thoughts of death, failure and world injustice (her words) keep her sweating under her quilt until the early hours of the morning. When sleep does claim her, if only for a couple of hours at a time, she dreams about her family dying, her cats going missing, or her favourite toys being broken. It’s been that way since she was a baby, says her exhausted mother Pat*, who reveals they’ve been to no less than three psychologists, two counsellors, a host of GPs and one incredibly expensive psychiatrist to get to the bottom of what’s troubling her daughter.
“They’ve tried to put her on medication to reduce her anxiety, but I don’t want her to be medicated,” says Pat.
“I just want her to be happy and untroubled like other kids her own age.”
What Pat may not realise is that while she may want her daughter to be ‘untroubled’ like other kids, the number of Lucy’s peers who would be classed as ‘carefree’ are rapidly decreasing – so much so that studies now show that almost one in seven 4 – 17 year olds are battling or have battled a mental health disorder in the past year (equivalent to approximately 560,000 Australian children).
And while anxiety is largely hereditary (most experts agree inherited anxiety is linked to 30 – 40 per cent of anxiety disorders), counsellor and director of Wellbeing For Kids, Georgina Manning, says much of it is learned by watching mum and dad.
“Families today are stressed and busy, with no time to slow down and relax together and that frantic pace can set a dangerous undercurrent,” she says. “Through our behaviours and reactions to events and situations, kids today are growing up believing the world is a dark place and something to be frightened of.” A culture of little-to-no boundaries, a reinforcement of non-resilient behaviour and having too many choices help to create the perfect storm, she adds.
It’s worth noting that having a little bit of anxiety – particularly during stressful times such as exams, changing schools or teachers, or having a friend move away – is normal. A survival mechanism evolved over thousands of years to identify possible threats and prepare the body’s ‘fight or flight’ defence, a little bit of anxiety helps keep us safe. It’s only when the body’s panic response gets stuck and floods the body with adrenaline (panic) even though there’s no threat in sight that the anxiety can quickly turn into an anxiety disorder, which can present in one or a few of the following ways:
Generalised anxiety disorder
One of the more common anxiety disorders, children with generalised anxiety will worry excessively about everything, like Lucy. Physical symptoms often play their own role and can include regular headaches, stomach aches, muscle tension or tiredness.
Obsessive Compulsive Disorder
For kids with OCD, anxiety takes the form of obsessions and compulsions, such as counting, washing hands or rearranging toys in a particular way. They often become upset if their behaviour is interrupted or their routine changed.
Often occurring for no apparent reason, panic attacks can strike anywhere and at any time, with sudden physical symptoms which can include fainting, a shortness of breath, dizziness, numbness, sweatiness and a pounding heart.
Phobias are when your child develops intense fears of something that wouldn’t normally be classed as dangerous, such as dogs, gaps in curtains, heights, flying or particular objects such as buttons.
This is a fear of social situations or speaking and interacting with others – particularly if a parent is not with them. In rare cases, kids with severe anxiety can also suffer from selective mutism which is where kids refuse to speak in situations they find too overwhelming.
Studies show early assessment and professional support is hugely beneficial for children suffering from an anxiety disorder, so keep an eye out for one or more of the following signs:
If you notice your child is suffering from one or a few of these, Manning suggests starting an honest dialogue in your household about what anxiety is and what it feels like. “Your child might have noticed that they feel a little differently to other kids he or she plays with so you want to reassure them that a little of bit of worry can actually be normal and helpful,” she explains.
“Ask them about the thoughts they have when they’re feeling anxious, so that you’re both turning towards what’s causing the anxiety rather than turning away from it.” The idea is to talk with your child in a supportive and non-judgmental way so that they always feel safe and free to share.
Helping your child face their fears rather than becoming an avoidance enabler will also assist them in the long-run, says Manning who explains gradual exposure holds the key in conquering fears and phobias. “If a child is terrified about speaking at a school assembly, for example, many parents will keep them home that day so that they don’t have to,” she says. “It’s short-term relief, but over time you’re just teaching them avoidance rather than developing confidence, resilience and strategies on how to cope with the difficulties of life and one thing we know is that children who build resilience tend to have lower anxiety levels in the long-run.”
Role modelling confident behaviours yourself is also important as ‘an anxious parent is an anxious child’, she says.
“If a parent is worried about exams or whether their child is going to get bullied, the child will soon follow suit and even if you’re not talking about your thoughts in the company of your child, rest assured they will still pick up on how you’re really feeling.” For this very reason, first-borns – often the product of much fussing and mollycoddling - tend to be more anxious than their younger brothers and sisters. “Parents are far more easygoing with the subsequent offspring and it shows in their demeanour.”
Listen to your kids and ask lots of questions about how they’re feeling. If their worries or behaviours continue for a number of weeks, or begin to affect their day-to-day activities, sleep or schooling, contact your GP to get a referral to speak with a children’s mental health specialist. “Sometimes your fears may not be warranted and your appointment can merely help reassure you on what is normal and what is not,” Manning says. “But if further investigation is needed, you’ll know your child is in very safe hands.”
If you require assistance with childhood anxiety, please call Kids Helpline on 1800 55 1800 or Lifeline on 13 11 14.
They studied a group of 312 families and discovered that mums and dads who used more so-called challenging parent behaviour (CPB) had kids whose anxiety levels were significantly less than others.
Previous research has established links between how over-controlling, or helicopter-style, parenting can heighten anxiety in kids. The study by researchers from Sydney’s Macquarie University and University of Amsterdam, however, focused on parenting behaviour that may actually protect children from becoming anxious.
One of the study’s co-authors, Rebecca Lazarus, says behaviours that can have a protective effective on kids include giving them a fright, teasing, rough-and- tumble play, as well as encouraging them to be assertive and take risks. “The idea behind CPB is it gives children exposure to safe risk, so things that might be a bit anxiety provoking but lets them know that it’s actually ok,” Ms Lazarus said. “It’s this repeated exposure to things that might feel unsafe that reduces their anxiety and they learn they can cope by themselves.”Ms Lazarus said many other studies had shown that mums and dads who use “cotton wool” style parenting and restrict their kids from doing things that are age- appropriate put their youngsters at risk of developing anxiety. “That gives children the message that the world is a scary place and I need protection from it,” she said.
Seven per cent of Aussie kids aged between four and 17 are estimated to have anxiety issues. Ms Lazarus, a Phd candidate who worked at Macquarie’s Centre for Emotional Health when the study was conducted, said there are many simple everyday ways parents can display CPB to help their kids. “It could be things like encouraging the child if they are cautious about approaching something, so like a dog in a park. They might be frightened of dogs, but you can encourage them by showing them how you approach a dog and let it sniff your hand,” she said. “It also includes competitions like running races or playing games with kids. It’s all safe and gentle but it lets kids have that experience at losing and what that feels like.”
While Ms Lazarus and her fellow researchers suggested in their study, that was published in the Journal of Clinical Child & Adolescent Psychology, more studies were needed into CPB as a possible treatment for anxiety in children.