Anxiety in our children: What do they have to worry about anyway?

PFSP Perspectives

November 7, 2017

Dr. Sharron Spicer, Assessment Physician, PFSP

Contributed by: Sharron L. Spicer, MD | Assessment Physician, PFSP

Physician health has gained a lot of attention over the past decade in the professional and lay media. We are recognizing the paradox that some of the traits that make good doctors may also pose risks to physicians’ own well-being. It has become widely known that many physicians struggle with underlying perfectionism and anxiety that can contribute to depression, anxiety disorders, addictions and other mental health conditions. Not surprisingly, many of our colleagues’ children also demonstrate some of these same tendencies.

This observation is borne out in my conversations with other physicians. I am amazed by the number of times that a coffee or lunch with colleagues has led us to mutually confide about our children’s struggles with mental health issues, school and learning difficulties, and the social demands of today’s world.

As we begin another school year, it seems a good time to reflect on the challenges that our children face with managing stress within the school context. School is the workplace of children and youth. Along with gathering the usual back-to-school supplies to fit in their backpacks, let’s consider how to equip them for the anxiety they may face.

What contributes to childhood anxiety?

Stress is a normal, even healthy, part of life for all of us. Yet for some, anxiety can be overwhelming. There is an epidemic of anxiety in young people of our society. About 8% of youth have a diagnosed anxiety disorder. That’s about two per classroom. Or, put another way, if you know more than 12 kids, chances are good that at least one of them struggles with anxiety.

The face of anxiety is not always a worried child. Anxious kids can be inattentive, have emotional lability, resist change, struggle with social interactions or have trouble sleeping. Some may externalize with disruptive features, while other may show more internalizing features. Children with other emotional or learning issues, such as attention deficit disorder, giftedness or learning disabilities, may be more susceptible to anxiety.

As with many characteristics, psychological features are affected by a multitude of biological and social or environmental factors; both “nature” and “nurture” impact personality. I am not a behavioral researcher per se, other than being an observer of human behavior as a pediatrician, a physician leader, a parent and an active community member. My own observations have led me to wonder about the social influences that have contributed to the dramatic rise of anxiety in youth.

Twenge et al. (2010) points out that within the social environment, the individual family unit is less predictive of individual variation than cultural influences. They further suggest that a cultural shift over the past half century toward extrinsic goals (such as money, status and narcissistic pursuits) over intrinsic goals (such as competence, affiliation and autonomy) is strongly correlated with the increase in psychopathology among high school and college-aged youth.

Here are some of my observations about the stresses that youth face more than ever before.

The stress of competition

From a young age, many of our children’s pursuits are achievement-oriented: lessons, performances, tournaments and competitions. These pursuits have roles in shaping character and promoting delayed gratification. Yet we need to be sure that enjoyment comes from engaging, not just achieving.

As kids move into adolescence, competition can become more subtle but more powerful; social media can intensify their perceptions of their social status based on body image, number of friends or followers and the exploits described or exaggerated by other teens. With adolescents developing their own sense of self, they usually compare themselves unfavorably to their peers or celebrities when they use social media as their reference.

The stress of overload

Children have long days at school; many attend pre- or after-school care or have long bus rides. They often have many extra-curricular activities, homework and other academic demands. If you feel frazzled driving them from place-to-place, think about whether they have the same degree of stress from participating in those activities.

The stress of isolation

Our children’s social worlds are more fragmented than I recall from my own childhood. It is less common for children to have close connections with grandparents or extended family; for those families who do, it can ease child care in the younger years and add a layer of social connection. It seems that groups such as schools, teams and clubs are now spread out and draw from larger pools of people. No longer is the neighborhood the natural meeting place for social connections. Families are smaller and young people may spend more time at home without parents or siblings. Connections via social media do not replace relational connectedness.

The stress of social consciousness

Children are introduced early to social causes. When my daughter was in kindergarten, one of the classroom assistants brought in her father for Terry Fox Day. Like Terry, he had had a leg amputated after a cancer diagnosis. Demonstrating his prosthesis to the wide-eyed youngsters no doubt made the experience real for them – so real, in fact, that for the next year, my daughter’s bedtime prayers included, “Please, God, don’t let me get cancer.” Not long afterwards, the girls of her Brownies unit were introduced to an animal fostering program. Their naïve hearts were torn by the thoughts of poor abandoned puppies needing rescuing.

Yes, we are raising a generation of children with a social conscience – but is it at the cost of burdening them early with too much knowledge of what is bad in the world?

Managing anxiety

Whether a normal degree of worry or one severe enough to have a diagnosis, some of the tips for managing anxiety are the same.

1. Promote good sleep habits. Nobody does well when sleep deprived, kids especially. Shut off the electronics one to two hours before bedtime. Keep phones and devices out of the bedroom. Make reading a part of the bedtime routine. Ensure your child has enough time for sleeping, especially when academic and extra-curricular activities may consume many of the after-school hours. Caution teens about the use of caffeine; it is not a substitute for sleep and its side effects can mimic or increase the physical manifestations of anxiety.

2. Ensure good nutrition. If your household is anything like ours, breakfast is a rushed affair. Smoothies are a great morning option. Easy to make with some yogurt, frozen fruit or green vegetables, a spoonful of nut butter and a bit of milk or soy, they’re acceptable to kids for their taste and to parents for their nutrition. School lunches are a challenge. You need to find nutritional choices, ensure it stays cool (or hot) until lunch, is easy to unwrap (first-grade fingers might have trouble opening certain containers), complies with peanut-free polices and isn’t too weird for a kid to eat in front of their friends. Plan with your kids about what works for them. If an evening meal is the only time your family eats together, make it a time to have a good protein source and add those healthy fruits and vegetables. Maybe the leftovers can go in their and your lunches the next day. Involve the family in menu selection, food prep and clean up.

3. Keep time for children (and you) to play. We need to be sure that our kids have time to relax, play, explore and satisfy their curiosity. The benefits of exercise, laughter and imagination are not just for kids; you will benefit, too.

4. Use online resources. A plethora of web-based material is available for children and youth. One reliable source of information is AnxietyBC® (youth.anxietybc.com). Many online games and apps coach kids in the basics of cognitive behavioral therapy.

5. Don’t be shy about seeking professional help. Just as we physicians can benefit from the objective advice of health professionals, so can our kids. Your family doctor or pediatrician is a good place to start. Other therapists, such as psychologists, have advanced training in cognitive strategies to help children with emotional regulation and they can also offer in-depth testing to identify factors such as learning and attention difficulties, giftedness, depression and anxiety disorders. The Physician and Family Support Program offers services to eligible physicians’ immediate family members.

6. Work with your child’s school and teacher to identify strategies to use when stress is mounting. For example, they might arrange that the student can seek a quiet place, listen to music or have a burst of exercise to manage stress. Academic demands or test environments might be altered. Open communication with the teacher about their observations and concerns is important. When anxiety becomes a significant issue, an individual program plan created by the school with student and parent input might be helpful.

7. Help kids find their “tribe.” Giving kids opportunities to connect in meaningful ways with peers and trusted adults can be very enriching. This can help them develop a sense of individuality and self-esteem while being connected to something broader than themselves. Many clubs have opportunities for youth to teach younger members or provide community service. These opportunities can add to the intrinsic rewards that foster fulfillment.

8. Seek out supportive adult role models for your children. It’s good for kids to have positive adult influences apart from their parents. Grandparents or other extended family, coaches, teachers or youth leaders can provide positive influences and may give credibility that teens don’t seem to find in their parents.

9. Share your challenges with sympathetic and like-minded parents. Having the suggestions and support of other parents can be very supportive. Just be careful to keep the details of your kids’ lives private, especially as they get older.

10. Be patient with your kids and yourself. Believe it or not, their anxiety is not just a means to push your buttons. Take consolation that while your parenting has not likely caused their anxiety, it is an effective tool to help them manage it.

Dr. Spicer is a pediatrician in Calgary. She is a recent alumnus of the CanREACH Primary Paediatric Psychopharmacology Program.

References available upon request.

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