Anxiety

Feeling anxious is a survival response to situations where there are dangers or threats, however some people react more intensely to such situations.
Students in a classroom

Anxiety is more than feeling stressed or worried

It’s estimated that one in 14 children and young people experience anxiety, which can result from a range of contributing factors including difficult life experiences.

It’s not your role to diagnose a mental health issue, but to notice those children who might be on edge or worried most of the time, as they may be experiencing anxiety.

In the first instance, these children and young people can benefit through social and emotional learning skills that build resilience and coping skills.

They can also benefit from the support of important people in their lives such as family members, peers, and other educators.

If there is further support needed, then by working with your colleagues and the family, you might look to refer the child or young person to a health professional.

Whether a diagnosis is made, by a health professional, will depend on how often, how easily and how intensely a child experiences the emotional symptoms of anxiety and how much it interferes with everyday living. 

A child or young person may be diagnosed by a health professional with an anxiety condition if:

  • they feel more anxious than others their age and level
  • their anxious feelings are consistently very intense
  • feelings persist well after the stressful event has passed
  • they’re so distressed that it interferes with their capacity to learn, socialise and do everyday things.

There are a range of effective treatments and supports available for those experiencing anxiety, focusing on how to enable them to manage their condition.

  • What signs should I look out for?

    Feeling anxious is a survival response to situations where there are dangers or threats: it helps us to respond efficiently. However, some people react more quickly or more intensely to such situations.

    The physical symptoms of anxiety (increased heart rate, perhaps, or faster breathing) are more easily triggered in children and young people with anxious temperaments which often mean they’ll react more to threats in the environment. This appears to be partly an inherited characteristic; however, everyone responds differently. An anxious child or young person is just as likely to have dominant, big personality as to be shy and retiring.

    Age is an important factor

    There are similarities but also key differences in the way anxiety may manifest throughout development from early childhood to adolescence. For example, if a baby cries when an unfamiliar person wants to hold them, their fear seems perfectly normal for this age. But if a 12-year-old withdraws or refuses to talk to new people and avoids situation where it may be expected, this may be evidence of a more serious anxiety issue. No matter the age, both children and young people can have difficulty finding the words to express what they are feeling – their behaviour may be the best clue.

    Early childhood

    Young children are in the early stages of learning how to recognise, understand and respond appropriately to their emotions. Anxiety disorders are less likely to be formally identified in children under five partly because certain fears are considered normal – for instance, fear of the dark, visiting unfamiliar places or separating from a family member.

    Behaviours that might indicate they’re experiencing higher levels of anxiety than average could include:

    • taking a long time to calm or settle following separation from a family member on a regular basis
    • frequent tantrums that are more regular or severe than others of the same age
    • low interest or significant reluctance to interact in social situations
    • unwillingness to get involved in unfamiliar activities
    • significant difficulty or distress during change or transitions
    • clingy behaviour or inability to separate from a favourite educator.

    Many children in early childhood will display one or more of the above behaviours; however, if it happens on a regular basis and interferes with the child’s ability to learn and engage in social relationships, then it’s a sign they need additional support. It’s also a great opportunity to intervene early and give children the skills to cope with anxiety as they grow.

    Primary school years

    As children’s thinking skills expand and become more abstract, they can develop fears of imaginary creatures and monsters. They may also worry about school work, tests and their social relationships. As they grow older, they may have anxiety about family relationships or global issues such as war or famine.

    The following behaviours might indicate a primary school-age child is experiencing higher levels of anxiety than average:

    • Wanting things to be perfect. For example, a child or young person may be so dissatisfied with their own work that they’ll tear it up and redo it several times.
    • Reluctance to ask for help. Sometimes anxiety creates an obstacle that prevents children and young people asking for help from the educator about a problem with learning. Those who ask too much for reassurance may also be overly anxious.
    • Difficulty joining in. Children and young people with high levels of anxiety may be afraid to join in class discussion, take part in sport or games or go to school camp.
    • Requests to go to sick bay. Anxious children and young people often complain of stomach aches and headaches.
    • Challenging behaviour. Sometimes children and individuals will ‘act up’ because they are so overwhelmed by a task or situation.

    Adolescence

    During adolescence, common sources of anxiety include starting secondary school, fitting in with peers, exam stress, body image and family relationships. Worrying about these things isn’t necessarily a sign of a mental health condition. But individuals may need additional support if they experience the following:

    • appearing withdrawn and reluctant to participate in classroom activities or social situations
    • oversensitivity to criticism or feedback, being a perfectionist and fear of failure
    • missing classes or excusing themselves to go to the toilet on a regular basis
    • negative thinking and always expecting the worst
    • challenging behaviour – sometimes children and young people may misbehave either because they’re unable to identify or express that they’re experiencing anxiety or to deliberately mask other emotions.

    Looking beyond behaviour to try to identify what might be underneath can help you respond with understanding. Anxiety can be difficult to spot because it presents in many ways. The important point is to notice that there’s a concern and seek further advice and assistance.

  • How do anxiety conditions develop?

    An anxiety condition isn't caused by a single factor but a combination of things. Various factors play a role, including personality, difficult life experiences and physical health.

    Family history of mental health conditions

    Some people who experience anxiety conditions may have a genetic predisposition towards anxiety; they can sometimes run in a family. However, having a family member experience anxiety or other mental health condition doesn't mean you'll automatically develop anxiety. 

    Personality factors

    Research suggests that people with certain personality traits are more likely to have anxiety. For example, children and young people who are perfectionists, easily flustered, timid, inhibited, lack self-esteem or want to control everything sometimes develop anxiety during childhood, adolescence or as adults.

    A learnt response

    Learning may also play a part in the development of an anxiety disorder. As they grow anxious, children and young people may learn that the world is a dangerous place. They may learn that it is easy to get hurt either physically or socially. They may not learn positive ways to cope and depend more and more on unhelpful ways of dealing with situations that cause them anxiety.

    Sometimes families may contribute to children and young people’s natural cautiousness by being over-protective. While unintentional, this might encourage individuals to avoid situations they feel anxious about. This is why it can be really helpful to involve families in considering how you can work together to support the child or young person.

    Ongoing stressful events

    Sometimes stressful events trigger problems with anxiety. Children and young people who experience more stressful events over their lifetime than others or who have gone through particularly traumatic events may experience increased anxiety.

    Possible triggers for children and young people include:

    • transitions (such as starting at a new learning environment)
    • change in living arrangements
    • family relationship problems
    • major emotional shock following a stressful or traumatic event
    • being the recipient of bullying
    • verbal, sexual, physical or emotional abuse or trauma
    • death or loss of a loved one.

    Physical health problems

    Chronic physical illness can also contribute to anxiety conditions or impact on the treatment of either the anxiety or the physical illness itself. Common chronic conditions associated with anxiety include diabetes, asthma and hypertension and heart disease. It can be useful to visit a general practitioner (GP) to see if there may be a medical cause for a person’s feelings of anxiety.

    Other mental health conditions

    While some people experience an anxiety condition on its own, others may experience multiple anxiety conditions, or other mental health conditions. Depression and anxiety conditions often occur together. It's important to check for and get assistance for these at the same time.

    Substance use

    Some young people who experience anxiety may use alcohol or other drugs as a way of managing their condition. In some cases, this may lead to people developing a substance-use problem along with their anxiety condition. Alcohol and substance use can aggravate anxiety conditions, particularly as the effects of the substance wear off. It's important to check for and get assistance for any substance use conditions at the same time.

  • What can you do?

    In the learning environment, for children and young people whose anxiety is less severe, social and emotional learning (SEL) programs that build resilience and coping strategies can be very helpful as part of a whole-service or whole-school approach.

    As an individual educator, there are also many helpful ways you can support children and young people experiencing anxiety. Here are some ideas that you can adapt:

    • Give children and young people language to label how they’re feeling, so they can learn to identify their emotions. For example, say “It looks like you might be feeling a bit worried. Sometimes when I feel worried, my tummy feels wobbly.”
    • Give notice prior to transitions like starting or stopping activities or moving rooms, to help them prepare for change.
    • Support families to develop consistent ‘goodbye’ routines for drop-off to create a sense of predictability. Maybe a special bear hug and a reminder that they’ll see each other again that afternoon.
    • You can help children and young people understand that being anxious, particularly when confronting new situations, is ‘normal’, but also that there are strategies for managing anxious feelings.
    • Help them recognise their own internal cues that they’re becoming anxious. For example, if they have a racing heart or are unable to think, identify and practise strategies that help them to manage their anxiety and calm down. Deep breathing may help.
    • Use a step-by-step approach. Break tasks down into small manageable chunks, moving up a step when an individual can cope without anxiety. For example, presenting a project to an educator; presenting a project to an educator and two friends; presenting a project to a small group, and so on.
    • Help children and young people recall situations where they’ve succeeded despite being anxious, to strengthen their self-belief they can cope with and manage their anxiety.
    • Help them understand that avoiding those things that make them anxious, while useful as a short-term fix, is likely to make things harder in the future.
    • Encourage them to have a go at things that are new and to understand that it takes time to learn new skills or behaviours.
    • Help them to recognise their own self-talk when approaching new situations and to develop some positive coping statements to stop the self-defeating talk.
    • Set realistic expectations for challenges and assist children and young people to manage stress associated with tasks.
    • Talk about effective and helpful strategies you use to manage anxiety or stress. For example: talking to friends, positive self-talk, exercise and other relaxation strategies.

    Be You Professional Learning

    Check out content on SEL and teaching for resilience in the Learning Resilience domain.

    Learn about how to inquire sensitively with children, young people, families and colleagues about your concerns in the Inquire module.

  • Support from health professionals

    A range of health professionals and services offer information, treatment and support for anxiety conditions, as well as strategies people can try to help themselves. Effective treatment helps children and young people learn how to control their anxiety, so it doesn’t control them. The type of treatment will depend on the type of anxiety they're experiencing.

    Again, it’s not your role to refer, but it can be useful to better understand the types of treatments they might be using.

    Psychological treatment

    Psychological treatment can help a person change their thinking patterns so they're able to keep their anxiety under control and reduce irrational worries. There are several types of effective psychological treatments for anxiety, as well as different delivery options – some people prefer to work one on one with a professional, while others get more out of a group environment. A growing number of online programs, or e-therapies, are also available.

    Psychological support for anxiety typically involves reducing avoidance and using effective coping skills, such as relaxation and learning how to replace unhelpful thoughts with positive self-talk. In younger children, support may focus more on behavioural and parental approaches – for example, helping families respond helpfully to anxious behaviours.

    Learn more about psychological treatment for anxiety here.

    Medical treatments

    Research shows that psychological therapies are the most effective treatment option for people with anxiety. However, if symptoms are severe, some medical treatments may be helpful.

    For instance, some types of antidepressant medication can help people to manage anxiety, even if they’re not experiencing symptoms of depression. According to research, when people have an anxiety condition, specific changes occur in their brain's chemicals. Antidepressant medication is designed to correct the imbalance of chemical messages between nerve cells (neurones) in the brain.

    Learn more about medical treatments for anxiety here.

  • References

    Egger, H.L., & Angold, A. (2006). Common emotional and behavioral disorders in preschool children: Presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry, 47, 331–337.

    James, A.C., James, G., Cowdrey, F.A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2013, 6, CD004690.

    Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M., Ainley, J., Zubrick, S.R. (2015). The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Department of Health, Canberra.

    Paulus, F.W., Backes, A., Sander, C.S., Weber, M., & Gontard, A. (2015). Anxiety disorders and behavioral inhibition in preschool children: A population-based study. Child Psychiatry and Human Development, 46, 150–157.

    Polanczyk, G.V., Salum, G.A., Sugaya, L.S., Caye, A., & Rohde, L.A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology And Psychiatry, 56, 345–365.