Fighting fears and anxiety

We offer child friendly, skills based strategies to help parents and children address fears and anxieties that prevent a child’s engagement in important activities or areas of their life.  We have a collaborative approach and work closely with parents and children together to harness a fresh approach to feared areas which may include, separation anxiety, specific phobias, social anxiety, general anxiety, obsessive compulsive disorder.

Fear and anxiety in children is normal, and an essential mechanism by which children learn about the world as its most vulnerable members.  Typically, a child’s anxiety or fear of new situations or people will lessen as they experience them more often.  However, some children find it more difficult to reduce their anxiety, and remain scared or fearful of certain situations, even after having experienced them on numerous occasions without any negative consequence.  Some children may experience a broad range of fears that don’t appear to reduce significantly, and others may only have difficulty with one specific fear.  When a fear or anxiety is stopping your child from participating in specific activities or important areas of their life, psychological intervention can give you and your child, new skills (and courage) to address these areas and reduce avoidance of these important areas.

All children are born with a capacity to learn about fear and experience anxiety, because it is a protective mechanism that promotes survival.  However, equally important is the capacity to ‘unlearn’ fear, when enough ‘safety signals’ are provided to indicate that a situation or object will not result in danger.  Many children will learn this through the natural course of life experience, however some children require more practice or planned experiences to establish feelings of safety.  It is when the intensity of a child’s fear or anxiety is unreasonable given the situation and recurs persistently, leading to their inability to participate in developmentally appropriate activities that some support and intervention can be required.

A child may experience a range of different types of anxiety and parents are often unsure at what point anxiety is a normal part of development, which will reduce naturally with time, or that a child will ‘grow out of it’, and when anxiety has become invasive and requires assistance with psychological therapy.  Below, are the details of a range of anxieties and associated characteristics.

General anxiety

A child with general anxiety displays a range of significant worries that are pervasive and difficult to stop.  It may seem like your child is worrying about everything, and attempts to avoid situations or objects that they fear, often seeking excessive reassurance from others.  They may appear perfectionistic, often spending a disproportionate amount of time completing tasks/projects, preparing for events, or making decisions, in an effort to prevent a ‘bad’ or less than ‘perfect’ outcome.  Symptoms can be particularly exacerbated in unfamiliar situations, because these children tend to prefer routine and know what to expect.  When something does ‘go wrong’, these children can appear to catastrophise, attributing far worse outcomes to a situation than might be considered reasonable.

These worries are often associated with physiological complaints such as; nausea, headaches, difficulty sleeping, or falling asleep.

Case Study:

Angela worries a lot about schoolwork.  Her teacher’s report that she is very attentive in class, but is reluctant to attempt things, that she is not sure she can complete successfully.  She also becomes distressed, when she doesn’t know the answer to something, and recently has had difficulty receiving teacher feedback on her literacy tasks.  Angela receives top marks for her schoolwork, although this is sustained through excessive preparation at home, with the whole family often staying up late, to assist her with complicated projects, and ensuring she has 100% accuracy in her maths tasks.  Angela is often unable to sleep or eat the night before a spelling test or speech.  Angela’s parents are proud of her performance, but often note they would be happier if Angela received lower marks and could reduce her anxiety and excessive effort.

Separation anxiety

Separation anxiety, is a common fear that parents observe from a very early stage in their child’s development.  It is characterised, by the presence of heightened fear and anxiety, when separating from a caregiver or parent.  Because this is such a normal childhood fear, parents are often uncertain, when the level of separation anxiety is no longer consistent with their child’s development.  A child with excessive separation anxiety may feel uncomfortable remaining alone in a certain area of their house, or refuse to fall asleep alone in bed.  As a result, these children may insist on being accompanied to certain locations at home, call out repeatedly to ascertain the location of a parent, and be unable to fall asleep without the company of a parent.  A child with separation fears may continue to have difficulty separating from their parent at school a year or more after their commencement of childcare or primary school.  This anxiety is associated with significant fears for their own, or their parent’s safety, excessive worries about potential dangers, such as being kidnapped or ‘taken’ by burglars, or the possibility of serious illness striking themselves, or their parent.

The anxiety typically interferes with normal life function by preventing the child from engaging in a number of areas of their life, that they would typically enjoy under different circumstances, such as social occasions like birthday parties and sleep overs, or extra-curricular activities.  This can lead to significant life disruption, particularly when it begins to impact their school attendance.

Specific Phobia

Fear in childhood is common and may include things like darkness, blood, or heights and the nature of the fear will vary with age, however, these are typically short lived and don’t prevent the child from participating in desired activities, or interfere with life functioning.  A child with significant interference arising from a feared item or situation may be experiencing a specific phobia.  Interference may be a child who avoids visiting a friends’ house due to a family pet, or is unable to attend a doctor’s appointment for fear of needles.  Specific phobia is characterised by 1.) fear that arises (cued) by the presentation or anticipation of the feared situation/object, 2.) immediate and intense anxiety if exposed to the feared item, 3.) persistent avoidance of the feared item that interferes with the child’s daily functioning.

Parents are often perplexed by the occurrence of a specific fear or phobia in the absence of any significant traumatising or aversive event, but research indicates that adults and parents are equally likely to report fears and phobias in the absence of a triggering event as in circumstances when an obviously traumatising event can be recalled.  In water/swimming phobias, parents often report that the fear was apparent from the very first occasion their child was exposed to water.  Similarly, parents report that a sibling, experiencing the same traumatising experience, developed no such associated fear or phobia.  These findings may be indicative of temperamental differences or variable fear learning, however, further research is required to satisfactorily answer these questions.

Best practice treatment involves a progressive and gradual exposure to the feared situation.  A staggered approach to the feared item allows the child to experience a low intensity context of their fear and build their confidence until they achieve their goal of approaching the feared item under more natural circumstances.

Social anxiety

Children experiencing social anxiety experience a persistent and overwhelming fear of being negatively evaluated during social interactions or public performances.  They routinely avoid tasks or activities that involve interactions with unfamiliar people or large groups of behaviour, and are often reluctant to engage in any interaction that requires assertive behaviour, such as requesting information or ‘standing up’ for themselves.

These children may avoid eye contact with unfamiliar people and locate themselves away from the larger groups.  These children may often experience physiological symptoms, such as nausea prior to attending situations requiring social interaction such as parties or school.

In very severe cases, a child may refuse to attend school on an ongoing basis.  Some children may specifically fear public performances, and refuse to participate in activities, such as school presentations or speeches, or sports competitions.  Experiencing acute worry and anxiety prior to the performance, including physiological disturbances such as difficulty sleeping, nausea and headaches.

Obsessive Compulsive Disorder (OCD)

OCD is an anxiety disorder characterised by unwanted thoughts, images or impulses, which are intrusive and involuntary (obsessions), and children are subsequently compelled to complete ritualistic or repetitive physical or mental acts (compulsions).  In young children, the disorder may appear to be dominated by compulsions in the absence of obsessions and a child may be unable to identify any reason behind their compulsions.  Current studies indicate that 1 in 100 children and adolescents experience clinically significant symptoms of OCD.  The negative consequences of OCD are extensive, with children experiencing suboptimal academic performance, lower participation in social interactions, reduced life outcomes (i.e., employment, education, marriage).  Without treatment of paediatric onset OCD, the disorder is often maintained into adulthood where it is more entrenched and difficult to treat.  Fortunately, the previous two decades have led to extensive research regarding the most effective treatment for child-onset OCD, and current conclusions have identified cognitive behavioural therapy alone, or in combination with pharmacotherapy, as the most effective treatment for this condition.

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