If you are feeling ‘anxious’ about this important subject, time to hear from the voice that matters. We present a candid chat with Dr. Ron Rapee, distinguished professor of psychology at Macquarie University, Australia. Dr. Rapee specializes in childhood anxiety disorders
“My child started experiencing these short but sudden episodes of shortness of breath, chest pain, and dizziness. During the attacks, she would start to cry uncontrollably and clutch me tightly,” says Tania, a mom to a 6-year old girl. The little girl was diagnosed with having panic disorder, a condition in which children experience recurrent panic attacks that come ‘out-of-the-blue’. She is now undergoing psychotherapy."
Anxiety disorders are the most commonly experienced mental health conditions in children across the world. If left untreated, they carry the risk of adverse consequences such as decreased academic performance, poor social skills, and harmful behaviors like substance abuse. So, how can you identify if your child is going through an anxiety disorder and what you should do about it.
To talk about this, we have one of the most distinguished global voices on childhood anxiety disorders, Dr. Ron Rapee, a renowned professor of psychology and the lead author of Helping Your Anxious Child: A Step-By-Step Guide for Parents.
When we reached out to Prof Rapee for a conversation, he readily agreed, despite his busy schedule. His suggestions reveal how important it is for parents to respond appropriately to their child’s anxiety.
Here are excerpts from a truly engaging conversation. It’s a ParentCircle Exclusive:
Q. Thank you, Dr. Rapee for agreeing to do this interview with us. It is an honor for us to be interacting with you. First up, a majority of your research is based on anxiety disorders in children. How common are anxiety conditions in children the world over?
A. Anxiety disorders affect around 5-10% of young people and these figures are quite consistent across the world. This makes anxiety disorders the most common form of mental disorder.
Q. That’s a fairly high number considering anxiety disorders in children are often (mis)labelled as ‘misbehaviour’ by parents. How could parents attempt to screen out behaviors masked as anxiety in their children?
A. Anxious children try to avoid doing things because those things genuinely frighten them. They are not avoiding these things because they are lazy or because they couldn’t be bothered – they really are frightening to them. Of course, sometimes children will do some pretty desperate behaviors to get out of doing something they are afraid of. This can include throwing tantrums or breaking objects or even hitting someone. Also, there are times when avoiding doing something might be caused by a combination of factors such as fear and laziness. So, there will be times when it might be hard for parents to know exactly why their child wants to avoid it.
Having said that, parents know their children. They can usually tell if a child is genuinely afraid of something. In addition, parents can look at the pattern of avoidance – for example, does the child only seem to avoid doing that thing when it suits her, or does she always want to avoid it? Does she avoid doing something, even when doing it might be fun? Can she tell you why she doesn’t want to do it – and does that reason sound like she is really afraid that something ‘bad’ would happen (even if it doesn’t sound realistic to you)?
Q. How can we differentiate anxiety that is normal from anxiety that is disordered in children?
A. Anxiety is a normal emotion that can protect us from harm. Everyone gets anxious sometimes. But when a child gets consistently anxious about something, to a level that is more than most children and out of proportion to reality, and most importantly, when that anxiety affects the child’s life (stops them from doing important things), then we refer to it as an anxiety disorder.
Q. How is shyness different from anxiety considering some of the behavioral signs (e.g., clinging to the caregiver) are the same?
A. Shyness is a form of anxiety. There are a number of different ways that anxiety can express itself. The three most common forms in young people are separation anxiety (a fear of being away from a caregiver); generalized anxiety (a tendency to worry about a range of possible negative outcomes); and social anxiety (basically extreme shyness and refers to a fear that the young person will do something to make other people think badly of them).
Q. Is it true that children who are anxious get picked on and bullied more?
A. Anxious children are more likely than many other children to be the targets of bullying. Having a good friend or a group of friends can often protect a child from being bullied. Anxious children often have fewer friends than others and so, they more likely to be bullied while also finding it harder to get the protection of good friends.
Q. Today, we see the phenomenon of helicopter parenting, where parents are constantly hovering around their children, overseeing every aspect of their life. Does that have implications for the child?
A. We have to be very careful not to ‘blame’ parents for the anxiety that their children experience. Having a worried and sensitive child often makes loving parents want to step in and help their child so that they don’t experience distress. While this is extremely understandable, parents can sometimes fall into a pattern where they feel the need to regularly help their child. But, doing so makes it harder for the child to learn that they can cope and that they are capable of doing things themselves. Helping parents to gradually step back and allow their child to face more and more situations is often a major component of treatment for child anxiety.
Q. In your book ‘Helping your Anxious Child’, you talk about practising ‘detective thinking’ to recognise irrational worries. That’s an interesting concept. Can you explain a bit more?
A. Detective Thinking is one of the core techniques that we use to help anxious children to build confidence and manage their anxiety. In brief, it involves teaching children to recognize their worried thoughts, which are often extreme (see flowchart). We then teach them to ‘act like a detective’ and to look for clues about whether those thoughts are realistic or not. Sometimes, worrying thoughts might be realistic and in such cases, anxiety is a very useful feeling (like when it stops a child from walking into a dangerous neighborhood). But in many cases, the fears are not based on reality and therefore, by learning to look for clues or evidence, children can decide which of their thoughts might be unrealistic. They can then replace them with more realistic thoughts. In turn, this helps them feel less afraid.
Q. You also talk about gently and gradually exposing children to challenging situations…
A. The technique called ‘exposure’ or ‘facing fears’ is the cornerstone of all scientifically tested treatments for anxiety. It is entirely common sense but needs to be done in structured and systematic ways to show the best benefits. In simple words, it involves having children gradually face the situations or objects that they fear. By doing so, they learn that the ‘terrible outcome’ they were expecting, actually doesn’t happen and that they can cope.
A good example might be a child who is afraid of sleeping in their own bed and he sleeps each night with his parents. For such a child, a hierarchy would be drafted starting from least to the most anxiety-provoking situation. For him the least anxious situation might be, say, sleeping on a cot next to his parents in the same room. The most anxious might be sleeping in his own room alone. For this child, the therapist would start off by exposure to the least anxious situation and continue to expose him to this situation, while at the same time helping him cope with the anxiety that is produced. The exposure would continue every night until the child reports that he is able to sleep on a cot next to his parents without feeling anxious. Then the therapist would proceed on to the next step of the hierarchy and initial exposure to that situation. And so on.
Q. What are the 5 most important things parents can do while dealing with their child’s anxiety?
A. Let your child make his own mistakes. Children learn best through experience and making occasional mistakes. Being trusted to ‘have a go yourself’ is the best way to build confidence in their own abilities.
Don’t stop your child from taking risks.
Talk openly about your own anxieties and show your child how you cope with them. Trying to hide your anxieties and pretending that you are perfectly calm at all times gives anxious children the message that anxiety is embarrassing and shouldn’t be spoken about. Instead, if you allow your child to see you coping with your own fears, you give the message that anxieties can be managed.
Show your child you love her unconditionally, no matter what her strengths.
Don’t criticize or minimize your child’s fears even though they may seem like nothing to you. The things that anxious children fear are very real to them. Let your child know you understand and don’t make him feel like it is wrong or ‘bad’ to be afraid.
Q. You have devised the popular Cool Kids Program for children with anxiety conditions. How does the program help children and their parents?
A. Cool Kids is a skills-based program that teaches children (aged 7-17) and their parents, effective ways of managing the child’s anxiety. The program was developed more than 20 years ago and is now used in more than 25 countries worldwide. The main strategies that we teach include:
1) thinking more realistically;
2) gradually facing your fears and;
3) teaching parents different ways of interacting with their children.
Over a number of scientific trials, Cool Kids has been shown to work – around a year after starting treatment, up to 75% of kids are completely free of their main anxiety disorder.
Q. You’re involved in a project to investigate the influence of social media on adolescent mental health. Are there any early findings or trends that worry you?
A. Social media use has received a lot of bad press in recent years and there are a lot of fears around whether it has negative effects on young people’s mental health. The first thing to say is that there is no simple negative impact of social media. It is certainly not true that spending a lot of time in social media causes children to become depressed, withdrawn, or anxious. In fact, a lot of the time that children spend on social media is good for them. It reinforces their friendships and gives them a feeling of being supported by their peers. However, certain ways of using social media might be problematic. Some children use social media primarily to compare themselves to others and to keep checking how they ‘measure up’. It seems that these ways of using social media can have negative effects on mental health and can lead young people to feel more depressed, anxious, and have worse body image.
Q. This interview is intended for a global audience of corporate mums. Do you have any advice for them with regard to handling their own workplace anxiety?
A. I guess a good work-life balance can easily be forgotten in the chase for the corporate dream. It’s really important to keep a good balance, to take time out to look after yourself, and above all, to spend quality (enjoyable) time with your children. Parents should not feel guilty taking time to spend with their child. It is only a few years before they are grown.
Prof. Ron Rapee Hall of Fame
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