Generalised Anxiety Disorder in kids
What is Generalised Anxiety in Children?
Generalised anxiety is a tendency to worry about many areas of life. Children with high levels of generalised anxiety are often described as “worriers” or “worrywarts”. They worry excessively about many areas such as schoolwork (getting things right, being on time), family relationships and family finances, friendships, health, safety (burglars) and new situations. These children are often overlooked because they can be very conscientious in the classroom and it is difficult to know that they are constantly worrying. Some of the signs of consistent worry are daydreaming, stomachaches, headaches, tiredness and inattention. They will often ask lots of question over and over in a new situation “What is going to happen?” or “What if….?” and they may spend a lot of time getting to sleep at night as they are worrying about the events of the next day. About 2-5% of children develop Generalised Anxiety Disorder and this is usually considered when worries occur more days than not and the child finds it very difficult to stop worrying (Schniering, Hudson & Rapee, 2000). It is normal for children to have periods when they worry a lot but if the constant worrying persists for longer than 6 months then it is worth seeking help. Although some pre- school children may develop generalised anxiety, it does not typically emerge until a child reaches school age.
What can I do if my child has generalised anxiety?
Stepladders for generalised anxiety
Here is an example of a stepladder for an 8-year-old child who is fearful of being late. The child was least worried about being late to visit friends and most worried about being late to school. This child would also ask many repetitive questions to his parents about being late (like “What is the time? Are we going to be late? What will happen if I’m late?”) Thus the stepladder gradually reduces the number of reassurance seeking questions that the child is able to ask.
Each stepladder needs to be set up so that it matches the child’s level of worry/fear. The steps in the stepladder below may be too slow/easy or too fast/hard for some children. It will all depend on your child’s level of worry. It is often difficult to develop stepladders for general worries and it takes some good knowledge of your child’s worries and some creativity to help them to face the situation they are worried about (e.g., making a mistake)
Encourage and reward my child to
- Arrive only 5 minutes early to music class (Allowed to ask two questions about being late)
- Arrive on time to Andrew’s house (Allowed to ask two questions)
- Arrive 5 minutes late to visit Jo’s house (Allowed to ask two questions)
- Arrive at school five minutes before the bell goes (Allowed to ask one question)
- Be late to my music lesson by one minute. (Allowed to ask one question)
- Arrive at school one minute before the bell goes (Allowed to ask one question)
- Be 15 minutes late to visit Andrew’s house (Not allowed to ask any questions)
- Arrive at school as the bell goes (Not allowed to ask any questions)
- Arrive 5 minutes late to music (Not allowed to ask any questions).
- Arrive at school 10 minutes after the bell (Not allowed to ask any questions).
Coping skills for the stepladders
Toddlers (1-3 years): Repeat a phrase to the child “I can do it”
Younger children (3-6 years): Help the child to come up with a phrase he/she could say to themselves when they are in the situation such as “I can be brave” “I am safe” “I will be ok”
Older children (7+ years): You can help your child learn more quickly during the stepladders by helping them to think more realistically in the situation. Encourage your child to ask himself/herself: “Have I ever failed a test before?”, “How likely is that the bus will crash on the school excursion?”, or “What’s the worst thing that can happen if I forget my library books?”
Other helpful tips for worriers
Gradually reduce the number of reassurance seeking questions (e.g., “what is going to happen?”) your child is able to ask you. If you have already answered your child’s question, encourage the child to think about the situation, come up with the answers, and rely on their own judgment. It may help the child to write the answer down. Try to remain patient. You can reduce the number of reassurance seeking questions as part of a stepladder.
Some children use lucky charms, special clothes or a special object as a way of making a situation safe (e.g., “If I carry my phone in my pocket then I will be able to find out if something bad has happened to Mum” or “It will be okay as long as I can wear my blue pants”). This is okay in the initial steps of a stepladder but the child also needs to be able to face the situation without these comfort items to know that the situation is safe and that they can handle it on their own.
Sometimes if may be useful for the school to know about your child’s worries, particularly in advance of events such as school excursions, camps, or carnivals. This may help to prevent others in your child’s environment from either i) pushing your child too quickly to face situations or ii) encouraging the child’s avoidance (like giving them more time to get their schoolwork “just right”). On the other hand, it can sometimes be good practice not to tell the teachers. This way when the child faces the steps on his/her stepladder (like forgetting her
Providing constant reassurance to your worried child and allowing them to avoid the situations they worry about will exacerbate the problem. Gently encourage your child to face the situations he/she fears (using step ladders).
No matter how frustrated you feel, avoid criticising your child or making subtle negative remarks about his/her worry or reassurance seeking.