School is an important time in a child’s life. It’s a time for making friends, learning new things and exploring the world independently. For most children, school is enjoyable and becomes part of the weekly routine with little worry. However, for some, school is the one place they would rather avoid.
School refusal behaviour is defined as substantial child-motivated refusal to attend school and/or difficulties remaining in school for an entire day. While it can affect children from age 5-17, it most commonly occurs in children aged 10 – 13, or during times of transition as children enter new schools. A child may display intense negative reactions to school such as crying, clinging and tantrums. They may complain of stomach aches and headaches and plead to stay home. These maladies disappear once they are allowed to stay home. An older child, under duress may attend school but leave later in the day, or truant altogether. Not because of boredom or delinquent reasons, but because of genuine anxiety. The source of anxiety could stem from an overwhelming dread of being separated from a parent, being bullied, a fear of failure at school, poor social relationships, or a cry for attention. Children who are undergoing family conflict or who have underlying mood or anxiety disorders have also known to display school refusal behaviour. In some instances, school refusal may resolve with little intervention. However, any school refusal behaviour that lasts for more than two weeks should be considered substantial, and needful of help. The longer it is left unaddressed, the more likely it is to have a significant disruption in the child’s education and development. Help is available for this common and highly treatable behaviour. Typically a psychologist is able to assess the underlying root of the anxiety and help the child and parents integrate coping and stress reduction techniques, anxious thought challenging, building a gradual tolerance to the feared situations. Seeing a psychologist can help parents understand and manage their child’s refusal to go to school, thus decreasing the stress placed on the child and the family, and increasing the likelihood of an enjoyable and memorable school career.
When does teasing become bullying? When does rough play become bullying? When does mean-spirited comments become bullying?
By definition "Bullying" is repeated verbal, physical, social or psychological behaviour that is harmful and involves the misuse of power by an individual or group towards one or more persons (www.bullyingnoway.gov.au). Single incidents of conflict between two children, or frequent conflict between two friends would be considered a natural part of developing socially. Bullying has the intention of intentionally bringing another child down to humiliation or hurt so as to boost the position or morale of the bully. There is usually little gesture of remorse or repair.
Cyberbullying is a recent phenomenon that happens more often than we like. Examples of cyberbullying can include:
•repeated hang up calls
•sending insulting or threatening text messages
•publishing someone's personal or embarrassing information online
•creating hate sites or starting social exclusion campaigns on social networking sites.
Any form of bullying is harmful to children. Children can learn to stand up to bullies and make themselves less of a target. They do need an intentional effort and unwavering support during this time. If your child is being bullied take action with the input of teachers, school authorities and a therapist.
I got a phone call one afternoon from a mother who was anxious about her child’s anxiety. I could hear the desperation in her voice as she related that she had run out of ideas to assure her child that he was going to be alright. Though previously able to comfort and help her son, she felt that she was out of her depths to help him through this particular worry. When I listened in more closely to what she was saying, I realised that her anxiety for her child had surpassed the child’s anxiety. She was now feeling helpless and predicting catastrophes for how this unresolved anxiety in her child would lead to future phobias and undermine his overall resiliency. I felt a great deal of compassion for this mother and I pictured her standing in a corner of her home trying to be strong for her child and trying to find a professional to help her work it out. She was lost in his anxiety. In this article I will not attempt to outline the theory, mechanisms and forms of anxiety. I will instead try to distil it down to the most common anxiety presentations we see and the common ways we tackle anxiety in general, in the hope that it will give some initial prompters to what you can do when your child feels anxious.
Being in Clinical practice and working with children I have come to see that in the primary school years children become aware that the world that they live in is not always safe or predictable. Their imagination catches up to the reality of their unfolding world, and they begin to articulate “what ifs”. This can also be where a lack of life experience and information is a breeding ground for their imagination to fill in the blanks. They are aware that there are winners and losers. They are aware of different family situations – some mummies and daddies do not live together, some are not alive. Increasingly the complexity of what they see interacts with what they can predict will happen, in their imagination. Anxiety that spirals out of control has these mechanisms: physiological responses due to heightened levels of stress hormones circulating in the body, over-evaluation of the Reality and Likelihood that a catastrophe will happen, avoidance of any further situations which will provoke these physical or cognitive vulnerabilities and seeking reassurance from parents or adults in their world to help bring their anxiety down. Avoidance prevents children from testing out their fears and seeing whether or not their predictions do indeed come true. A reliance on reassurance seeking breeds a dependency on others, instead of learning coping and soothing mechanisms which can be relied upon whether alone, in school, or away from home.
So firstly, take heart. It is likely that your child’s anxiety is something that has been experienced by another child at some point. Here are some general tips to help a child with anxiety:
1. Find out what the anxiety is: I draw a Worry Sponge Brain and ask kids to fill it up (in pictures or words) with all the worries that their brain has soaked up. I also get them to colour in how much of their brain is soaked in worry. It gives an indication not just of what, but how much anxiety a child is storing up.
2. Find out the predicted outcome: Before we can help them, we need to also know what they predict is the catastrophic outcome. You can ask a child to draw out a comic strip of what they think is going to happen at the end if their worry comes true
3. Taking back my body: Help children to see that when they feel anxious their minds have decided that a dinosaur threat is in front of them and is bossing their body around with those anxiety sensations (shallow breathing, tingly hands, sweaty palms, butterfly stomach) because it thinks we need to fight it or run away from it. However, because there is no dinosaur out to eat them, they can take back their body and relax it back to calm. Here deep breathing and some simple stretching exercises can help the body to relax back down to a resting state.
4. Delay the worry: I say worries are like pesky flies. The more we swat them, the more they come back at us, and the more they do that the more we focus on it. Soon the pesky flies are all we can think about. Instead, create a Worry Box with a note pad beside it, where children can write down the worries as they come, deposit it in the box and not hold it in their head. Every time the worry comes back they can simply write it down and put it in the box. Delaying the worry this way helps a child feel like they have acknowledged the worry and done something with it and not have to deal with it straight away.
5. Fill-in-the-blanks: Particularly for anxieties that have a realistic basis (thunderstorms and floods do exist), help them to work out how LIKELY this will happen. You may point out that you live on a hill and there has been no reported flooding in your area in the last 10 years, for example. You might point out that houses are built to withstand great forces – and demonstrate this by thumping around and checking for vibrations. You may simply just give them the information that seems missing in their hypothesis and predictions. One child who had a terrorism worry was not convinced that it would never happen, but was satisfied to learn that after 9/11 great steps were taken to revise and Improve security measures in Australia.
6. Graded Exposure: Particularly for anxieties where there isn’t a realistic basis (fear of the dark, for example) it is helpful for children to work out how to evaluate perceived threats. Here you set up gentle experiments together to test out if their prediction of a bad outcome will definitely happen. Together with your child staying in a dark room for 5 minutes and then switching on the lights and seeing that everything in the room is exactly the same, then building the time up until they can see that time in the dark does not change the room or introduce any new threats, and therefore it is the same in the light, or in the dark.
7. Remembering and Re-scripting: For anxieties where there is a worry they will be evaluated negatively or fail somehow. In exam anxiety children tend to minimise their past successes and magnify their impending failures. Helping them to remember past tests where they thought they were going to fail but didn’t, and identifying what steps they took in the past that helped them to prepare brings their focus back to what they can do, and how they have managed in the past. This re-scripting gives children a renewed sense of control and helps to focus the natural stress response into concrete steps.
8. Gut, instincts and probable responses: This is probably not a very scientific way to describe this step, however, it’s handy. Childhood is a time when we can encourage young ones to see that their best unprepared attempt is actually going to be ok. Give it a go, take a risk, because you are not stepping out from point zero. They forget that they have had many years of experience working things out and coming up with great responses. For example, many children worry about reading out loud in class. They worry that they will suddenly lose all prior foundations, and make major pronunciation mistakes, and everyone will laugh at them. Of course even the best of us make reading errors. However, even when this happens we can see that we just continue to read, get on with it and recover. So, spontaneously in session, I might whip out a very technical piece of writing, like from a science journal (for older kids), or from the newspaper and ask them to read it to me. By doing a few of these, they come to see that their best attempts to sound out words and read, actually isn’t too shabby, and that the actual percentage of words they had to sound out was quite small in the entire piece of writing. They might even see that fudging some words actually sounds quite plausible!
If the anxiety in your child has reached the level of frequent school refusal, panic attacks, impacted sleep, decrease in appetite, or significant changes in his behaviour and social interactions, and you are concerned that he is not himself, then seek help. A visit to your local GP or a chat with your school counsellor is a good place to start.
The fluttery feelings, quivering bottom lip, wringing hands, sweaty palms and the buildup to a gut-wrenching cry or out of control meltdown. Could be over tiredness. Could be hunger. Could also be anxiety. Anxiety in children is quite common. As children develop an awareness of their world beyond the brightly coloured stories they read and TV they watch, they begin to realise that not everything has a happy ending. They begin to realise they cannot always control the endings to their real life stories. They start to speculate that the things they hear about in the news could probably come true for them. Worrying about potential dangers and feeling nervous about unpredictable outcomes are part of the process of growing up, learning how to soothe themselves, engage in positive self-talk and problem-solve.
Nevertheless, there are times when anxiety interferes with a child's ability to participate in school, in their sleep and eating routines, and causes significant disruption in their everyday life. This could be the time to speak with the school counsellor and teachers to ascertain if they too have picked up this change in your child. It may also mean seeking professional opinion and advice from your family doctor, and if needed, a Psychologist.
There is actually a range of anxiety issues a child can be experiencing. Here is a brief run-down of the more commonly presenting issues:
Separation Anxiety Disorder: Anxiety over separating from primary caregivers and loved ones where the child believes that their parent/caregiver may die or have "something bad" happen to them. At certain ages this is considered a developmental phase. Certainly during the toddler and pre-school ages it is not uncommon. If a school aged child, however, experiences significant distress over separating from caregivers to the point of school refusal, inability to let parents go to work or to get the groceries and this anxiety impacts not only on the child's functioning but the overall ability of the family to function, Separation Anxiety may be the issue.
Generalised Anxiety Disorder: This is a form of anxiety where children worry excessively about a range of everyday occurrences to the point of sleep disruption, overwhelming feelings of fear and anxiety and avoidance of places and situations related to the worry. Children may worry about making mistakes, getting in trouble at school, seeing things on the news, being late, getting sick and even dying. In general, these worries happen in clusters and do not fade away with time.
Specific Phobias: While it is not uncommon for children to have fear of the dark, dogs and thunder, specific phobias can get in the way of a child having a full and quality life. In the case of needle phobias, it can actually prevent them from receiving immunisation or treatment that could be lifesaving. Some of the more common ones we see, which act as a barrier to children growing and living freely would include fear of flying (hard to take that family holiday), fear of the dark (in older children this makes sleepovers and camps tricky), fear of vomtting (some children start to reduce their eating as a way to prevent choking and vomiting) and crippling fear of household "guests" (spiders, cockroaches and the like, which means they refuse to walk into a particular room or visit certain places).
Obsessive Compulsive Disorder: This is not as common, but can appear in childhood. Early intervention leads to optimal outcomes, and so I highlight it. Typically, children have some sort of obsessive thought which leads them to believe that a catastrophe will occur if they do not perform certain rituals. This could be a fear that they will harm others (for example, contaminate others with a life threatening disease, cause a serious accident to occur) or that they themselves will come to some harm. Some obsessions do not have this catastrophic quality, and may instead lead them to feel just "not right". Children may engage in repetitive behaviours as a means to curb these thoughts. Excessive handwashing, superstitious counting, arranging of things, or particular rules for walking or doing things in a certain order are part of a repertoire of possible compulsions. When these thoughts (obsessions) and rituals (compulsions) start to take a hold of a child's life such that it overwhelms them, it could be Obsessive Compulsive Disorder.
The rule of thumb is - if anxiety is taking up a lot of your child's time and emotional resources - seek help. Anxiety disorders in children are easily treated and can resolve with psychological therapy.
What do you think when you hear the word “teenager”? Do you automatically picture a sullen, withdrawn, child who only grunts at you? Truth is, many parents dread the teenage years and expect their loveable son or daughter to disappear, but this is not a given. Teenagers like adults are all unique and not every child turns into a sullen and silent being during those years. This is a period of much hormonal change, and a time when a child is beginning to assert his or her independence from their parents in order to reach adulthood. However, there are still many who do this whilst maintaining a good relationship with their parents.
So what can you do to prepare for the teenage years?
1. To begin with don’t expect your child to fulfil the stereotype of a teenager; recognise that your child is an individual and get to know your child’s personality, their interests, likes and how to connect with your child accordingly.
2. Pick your battles. Teenagers are forming their own identities and won’t always conform to an adult’s expectations of how they should dress, what they should do etc. Be clear about your values and the values of your family and stand your ground on what really matters, but let go of the things that don’t matter as much.
3. Don’t assume that moodiness and withdrawal in your child is just teenage angst. If your child changes dramatically and / or withdraws not only from parents but also from friends and activities it is best to seek help by consulting your GP.
4. Finally, don’t get yourself tied up in knots trying to parent you teenager in the “best way”. Sometimes it is best to simply trust your instincts! You know your child and your family, you know what matters most to you and what you want to instil in your children so sometimes it is best to “go with your gut!”
Location 1: 130 Duffy Avenue, Westleigh 2120
Location2: Suite 112, 33 Lexington Drive, Bella Vista 2153
Ph: 1800 832 588
Location2: Suite 112, 33 Lexington Drive, Bella Vista 2153
Ph: 1800 832 588
Copyright Centre For Effective Living © 2016
Hornsby and Hills Psychologists. Pennant Hills, Thornleigh, Normanhurst, Beecroft, Turramurra, Baulkham Hills, Castle Hill, Bella Vista, Norwest Areas.