A leading expert on anxiety, Dr Lynn Miller has conducted research on different models of anxiety prevention programs in schools. She is an Associate Professor in the Education and Counseling Psychology and Special Education department at UBC, and a child and family counselor.  The Heart-Mind Online team sat down with Lynn to talk about anxiety in youth.

HM Online: What are some of the common symptoms of anxiety in children and teens?

Lynn:   Anxiety symptoms can be grouped into three broad categories: physical symptoms, thinking patterns, and behaviours. Physically, anxiety symptoms can be felt from head to toe: light headedness, frequent tearfulness, flushing/blushing, feeling hot, digestive distress (tummy aches, frequent urination, diarrhea), muscle fatigue, tingling sensation in limbs, chest tightness, racing heart, sweating, clammy hands/feet, dry mouth, or other unexplained odd physical sensations.

Thinking patterns typically are marked by overestimating some sort of environmental threat (for example, a teacher’s response) and underestimating one’s ability to deal effectively with the threat. There is negative self talk (“I can’t do it”; “I will say or do the wrong thing and embarrass myself”) and doubts about oneself. They can be hypervigilant to threat in their life, and actually seem to “tune out” others, as they ruminate about a worry.

Behaviourally, anxiety’s hallmark is avoidance: kids will refuse to engage in typical activities or will do so with extreme distress. For instance, anxious children and teens may dread going to school[1] (or refuse to go to school), will want to go to sleepovers but cannot stay the night, will have difficulty raising their hand in class, will avoid sleeping in their own bed, will not go to another child’s house for a play date, will not go into the basement alone, or will even refuse to hand in homework that is already completed. Kids will try to avoid all kinds of things; from subtle activities such as not participating in a classroom discussion to big things such as having difficulty going to school.

HM Online: How can parents, and teachers, who may not have the training or background in the matter, learn to recognize anxiety in their child?

Lynn: The physical symptoms are a clear indicator that this child might be feeling anxious. The anxiety symptoms described above vary from person to person, and may be mild or intense.  The child or teen can even look as if he or she were having flu-like symptoms. Another clue for adult caregivers is avoidance; if a child is expected to participate but is showing a lot of resistance or avoidance, the first thought should be, “Is this anxiety? What might this child be fearing?”  Another good basic question is, “Is this child more fearful or anxious than other kids his or her age?”

HM Online: Have the rates of anxiety disorders in children and teens been consistent over the decades or is this something we've only begun to see in children and teens recently?

Lynn: We believe the rates of anxiety in children, teens and adults have been fairly consistent over the years. What may be happening is that we are better at recognizing not only the symptoms of anxiety, and how much interference it causes. Anxiety can interfere significantly with the ability to initiate or maintain friendships, with the ability to go to school (or work) and participate with ease, or can cause significant disruption to the home environment (family arguments, change in family routines).

HM Online: Is it more stressful to be a child or teen now than it was for previous generations?

Lynn: Stress will make anxiety symptoms worse. I suspect that all of us find life today pretty stressful, and perhaps part of the increase in stress comes from having 24/7 access to the world via technology. Children and teens are very keen to be “connected”, and at the same time they can be very sensitive to the emotional state of important adults. Adaptive responses to stress will be key for anxious people especially – making sure they get enough sleep, are getting enough exercise, are eating healthy diets, and are “unplugging”  - can all go a long way to reducing stress.  

HM Online: Are there things that parents can do to help their children avoid becoming anxious?

Lynn: This is a tricky question. We all have anxiety, and in moderate amounts, anxiety actually will enhance performance.  So, we don’t want anxiety to go away, as it keeps us alive and alert to threat or danger in our environment.  What we can do is teach skills to children, youth, and adults, who will help them, cope with excessive anxiety.

Parents can be taught to recognize signs of excessive anxiety and be alert to avoidance, and to help their child practice being calm and brave no matter where that child is. Parents intuitively may be overprotecting their child, when they should be encouraging risk taking in safe environments. Talking about anxiety is also a first step. The skills associated with anxiety management (controlled breathing, progressive muscle relaxation, positive thinking, problem solving, facing fears) can all be taught and reinforced on a daily basis. Parents are also important to help encourage realistic expectations, refrain from overscheduling/pressure, establish downtime and routines of connection. Time as a family helps to create a sense of safety and security from which the child ventures forth with more confidence .

HM Online: What is the treatment for a child once they are diagnosed with an Anxiety Disorder?

Lynn: Psychological treatment is quite well established, and usually is conducted over 8-10 weeks. Cognitive behavior therapy (CBT) is considered the treatment of choice and is supported by thousands of research studies demonstrating its effectiveness. The skills associated with learning to manage anxiety, noted above, can be taught individually or in group format. Importantly, the adults in the child’s life also need to be taught these skills, in order to reinforce and continue to practice the skills at home. Medications can also be useful, although the Canadian Medical Association recommends a first trial of CBT before medications are considered.