It is normal for children to feel anxious or scared at times. In children, anxiety can be evidenced by physical complaints (such as recurrent headaches, stomach aches, complaints of nausea or recurrent vomiting), excessive perfectionism, excessive reassurance seeking, emotional outbursts at times of change, recurrent nightmares, difficulty going to sleep or waking throughout the night. Anxiety can also be associated with lowered mood.
Practitioners at Brisbane Specialist Suites help children and their families learn how to manage a range of anxiety disorders including:
- Separation Anxiety Disorder
- School refusal
- Specific Phobias
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
- Post-Traumatic Stress Disorder
Other conditions which may also be associated with anxiety include:
- Toilet training difficulties
- Persistent bed-wetting
- Fussy eating
- Vocal or Motor Tics
Anxiety disorders can impact a child’s capacity to move through developmentally appropriate milestones, attend school, or cope with family life. Anxiety may persist into adulthood if not appropriately treated.
When do we need to seek treatment?
We recommend requesting Specialist assessment when your child’s anxiety is:
- Not responsive to calm reassurance
- Associated with marked distress (crying or tantrums that persist)
- Associated with difficulties sleeping, insomnia or loss of appetite (particularly if weight loss is present)
- Associated with functional impairment i.e., the child in question cannot go to school, refuses to attend play-dates or parties, or refuses to leave home due to anxiety
- Associated with thoughts of harming oneself or lowered (or depressed) mood
- Causes a significant disruption to family functioning
What is involved in assessment?
Whether you see a Psychiatrist or Psychologist first, a comprehensive assessment should always involve a detailed history from parents and/or caregivers. This will involve both parents or guardians. The involvement of both guardians is particularly important if the child in question is required to live between two households. This part of the assessment will focus on:
- Observations of your child in multiple settings (at home, at school, at extra-curricular activities)
- Family history of anxiety or other medical conditions
- Past medical history of the child in question (taking a “bio-psycho-social approach” including developmental and medical history)
- Interventional strategies that have been trialed to date by caregivers and professionals
Your Specialist will also request collateral information from prior treatment providers (GP, psychologist) as well as school (teacher, guidance officer or school chaplain).
The second part of the assessment will involve an interview with your child. Your child may be interviewed alone, which is common practice. Whilst taking a history, your Specialist should also screen your child for any co-existing learning or language disorder which might impact on their capacity to self-soothe and participate in school-or peer-based activities.
Depending on the history, your Specialist may recommend blood tests to exclude possible co-existing medical conditions that can typically manifest with anxiety symptoms. This is particularly important if you are considering medication.
What treatment can we expect?
Good practice dictates that first line treatment should consist of regular psychological treatment from an appropriately skilled Psychologist, Psychotherapist or Child Psychiatrist with experience with children of this age. Psychotherapeutic sessions will generally occur weekly or fortnightly, and generally use principles from Cognitive Behavioural Therapy.
Caregivers are encouraged to be strong participants in their child’s therapy. Your Specialist at Brisbane Specialist Suites will teach caregivers skills so that they may have the knowledge to reinforce strategies at home.
Medication is only considered when psychological strategies have failed, or when anxiety is of such severity that the child is unable to participate in psychological treatment or has serious thoughts of self-harm. Medication should only be considered under the supervision of a Child & Adolescent Psychiatrist.
What is Cognitive Behavioural Therapy?
Cognitive behavioural therapy (CBT) is based upon two components:
- The “Cognitive” part focuses on helping your child to take notice of, and track their thought patterns when feeling anxious. Once these have been mapped out, your child is then taught how to challenge automatic thoughts (by replacing unhelpful thinking) and to regulate their emotions using techniques such as mindfulness and attention training, or self-management training.
- The “Behavioural” part focuses on practical behavioural strategies to manage anxiety. This may include activities to self-soothe when they experience unpleasant feelings (such as relaxation skills), but also may include strategies to challenge themselves and fight their fear (such as leaving the house, or attending a play date or school).
It is essential that these skills are delivered in a developmentally appropriate way by an appropriately skilled Specialist.