Anxiety Awareness Day: A guide to effectively recognise and address anxiety in children and teenagers

"Anxiety is a normal and often temporary emotional state characterised by feelings of unease, worry and fear," says Dr. Satish Kumar C R, consultant, and clinical psychologist at Manipal Hospital. He says that anxiety is a natural response to stress or perceived threats and it can vary in intensity and duration from person to person. However, when anxiety becomes excessive, persistent and begins to interfere with daily life, it may be classified as an anxiety disorder.

The lifetime occurrence of anxiety disorders varies between 3% and 19% across different countries, according to the World Mental Health Survey (WMHS). Data by the organisation also suggests anxiety disorders can initially emerge in children aged four to eight years old. The pandemic has led to enhanced anxiety and stress levels across ages, and continents but often remains untreated due to the stigma around mental health. To combat this, Anxiety Awareness Day is observed on June 10 every year across the globe. The primary aim of this observance is to spread awareness and encourage understanding of anxiety disorders, and how the impact lives.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association, seven anxiety disorders specific to children are recognised. Anxiety disorders are a group of mental health conditions that involve excessive and irrational anxiety and fear. Anxiety disorders encompass several common types, including generalised anxiety disorder (GAD), panic disorder, social anxiety disorder, specific phobias, and post-traumatic stress disorder (PTSD). Some children also have separation anxiety which includes fear about being away from home or parents.

When asked about what triggers anxiety, he says, "Triggers for anxiety are often sudden changes in their lives, academic challenges in school, bullying and dysfunctional family or traumatic experiences. Parents who have anxiety and are over protective and over possessive can contribute to child's anxiety."

The mental health expert also cites excessive social media usage as a cause, as it shapes self-perception and emotions. He elaborates, "In many cases children and teenagers develop negative self-image which contributes to anxiety and feelings of social isolation. It is important to note that the most common psychological issues in children and adolescents today are anxiety disorders which are associated with poor academic performance as well as impairment in day to day functioning that can be passed on into adulthood."

Anxiety in children and teenagers

Kumar insists that it's not easy to identify the difference between nervousness and anxiety disorders in children and teens. For example, they can be nervous about their schoolwork and exams, typically this is temporary and fades away when the stressful situation is over.

If you have concerns that your child may be grappling with anxiety, it is crucial to obtain professional assistance from a mental health practitioner who specialises in working with children and teenagers.

Anxiety can be caused by various factors and might lead to difficulties in daily life. Creating a supportive environment at home and promoting open communication are important for their well-being.

Symptoms of anxiety

Anxiety in children is characterised by throwing tantrums, nervousness, shyness, avoidant behaviour and, or physical symptoms, such as body ache and digestive issues.

Children are greatly influenced by many stressors at school and family. They may isolate themselves from others and develop fearfulness and do not participate in any social activities.

Common symptoms in children and adolescents

1. Difficulty in concentration
2. Racing or pounding heart
3. Excessive worrying or feeling restless
4. Disturbed sleep and bad dreams
5. Irritability
6. Fatigue or feeling easily tired
7. Sweating, clamminess, or hot flashes
8. Restlessness
9. Crying spells
10. Gastrointestinal problems like stomach-aches, nausea, or diarrhoea
11. Physical issues- often feeling of being sick

For teenagers most of the issues are due to academic performance and pressure to perform well at school and other activities. They also have body image issues connected to physical development.

Anxiety symptoms in teenagers
1. Routine-related worries
2. Racing thoughts or constant overthinking
3. Changes in appetite or weight
4. Social withdrawal
5. Temper tantrums
6. Irritability or easily becoming agitated
7. Poor academic performance
8. Absenteeism at school
9. Disturbed sleep
10. Substance abuse
11. Avoidance of certain situations or activities due to fear or discomfort
12. Physical symptoms like headaches, stomach-aches, tension

It's important to note that experiencing occasional anxiety is normal during the teenage years. However, if these symptoms persist it may significantly impact daily life, or cause distress. Early intervention and appropriate support can make a significant difference in managing anxiety and promoting a child's well-being.

Lifestyle changes for those with anxiety disorders

Lifestyle changes for children, adolescents and teenagers with anxiety disorders can help manage their symptoms and improve their overall well-being.

Regular exercise: Exercise promotes the release of endorphins, which can boost mood and reduce stress.

Healthy sleep habits: Setting a regular sleep schedule, reducing technology devices use before sleeping, spending time as a family before sleeping and talking about the day and challenges faced during the day.

Balanced diet: Consumption of nutritious foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoid excessive consumption of sugary foods and drinks, as they can contribute to mood swings and energy crashes.

Stress management techniques: Teach your child various stress management techniques that can help them cope with anxiety. These may include deep breathing exercises, progressive muscle relaxation, mindfulness meditation, or engaging in hobbies that promote relaxation.

Limiting caffeine and stimulants: Caffeine and other stimulants can exacerbate anxiety symptoms. Encourage your child to reduce or avoid the consumption of caffeinated beverages like coffee, energy drinks, or soda.

Supportive social environment: Encourage your child to maintain supportive relationships with family, friends, and peers.

Time panagement and prioritisation: Help your child develop effective time management skills to reduce stress. Teach them to break tasks into manageable steps, set realistic goals and prioritise their activities.

Encouraging healthy coping strategies: Guide your child to develop healthy coping strategies that work for them. These may include journaling, engaging in creative outlets, listening to calming music, or practicing yoga.

7 ways in which parents can help

1. Communication
Parents should respond to the child in calm and hopeful way. The way parents respond to their child's thoughts and behaviours can have a significant impact on their ability to cope with their problems. Asking children to express their feelings and worries, instead of asking them to forget and ignore and be supportive and reassuring towards their situation. Parents should be encouraging and show compassion towards children without expecting them to face their problems by themselves. Research has showed that maternal empathy has a significant effect on improving anxiety and distress in children.

Most of the times anxiety triggering situations can be identified and avoided but it is also important to help children develop effective coping strategies as well. Providing positive feedback encourages the child to feel more self-confident in dealing with stressful situations, parents can say "I'm very proud of the way you handle the situation."

2. Positive role model
The way parents deal with the problems influence children in dealing with their problems. Parents should remain calm and patient when dealing with challenging situations. Parents with good self-care can help their children do the same.

When parents practice yoga, meditation, or breathing exercises, their children are likely to practice them as well. Parents should avoid self-criticism and self-defeating behaviour and avoid negative self-image talks during stress.

3. Reduce/avoid screen time
Not depending on social media/gaming or technology devices as a solution for anxiety. Spending time with family/friends or going to a happy place like a beach, park etc. to find solace.

4. Be aware of the expectations you set
Teens can often feel overwhelmed by academic expectations. the pressure to succeed at school and vocational activities. Parents should keep goals realistic in helping their children towards academic improvement without having unrealistic expectation to be the best in everything they do.

5. Building self-esteem
To build a teen's strength by focusing on their positive attributes by complimenting them on their thoughtfulness, kindness or their behaviour with others. Praise their intellectual qualities which makes them stand out. Building resilience and self-confidence can help them improve problem solving abilities. Motivate them to practice their interests in music, sports etc and acknowledge their efforts and outcomes.

Focusing more of whatever is in their control and practicing them regularly can build their self-esteem. They should be taught to ignore and not focus on whatever is not in their control which only causes more anxiety in them. Improving social skills and seeking help whenever required. They should feel free to talk and express themselves and reach out to people for help.

6. Reassurance
Reminding them that it will be over soon and trying to shift the focus on something else around them. Practicing happiness activities like playing games, watching TV, or doing breathing and relaxation techniques or other things they enjoy.

7. Seeking professional help
Rather than assuming that the child will overcome his anxiety, it's really important to start taking small steps as soon as possible to help your child deal with their symptoms. Anxiety can be treated with proper help. When parents are unable to help the child deal with their stressful situation it's important to seek professional help.

Cognitive behavioural therapy (CBT) is most commonly used for treating anxiety in children and teens. CBT aims at changing the way children think and behave. Parents may also be part of the therapy approach most of the times. They help in improving valuable coping mechanisms for children and teens.