This is the most common form of anxiety. The young child will be overly clingy and will take a long time to settle when away from parents. Most children by the age of three can accept the temporary absence of a parent. But with separation anxiety disorder this persists in intensity and frequency. At home the child will follow the parent(s) around the house and require repeated reassurance. During the night independent sleep is difficult or impossible. The older child will similarly be ‘attached’ to a parent, usually the Mother and will worry that something bad will happen to their parents or siblings. School refusal is not uncommon. Stomach aches, headaches are a common complaint and older children may develop panic attacks in certain situations.

Is basically as it sounds. Overwhelming unrealistic worries about health, school, their parents, and peers will dominate the child who has generalised anxiety. They will have problems focusing on schoolwork and require extraordinary reassurance. These children can sometimes be overly ‘adult’ and they are ‘perfect’ school students sometimes. At home the parents are exasperated as these children have bottled all their emotions up to ‘soldier on’ during school and at will unleash at home. Teachers are quite surprised to hear the problems the parents are experiencing. These children will often complain of headaches and abdominal pains and ‘feel sick’.

Represents avoidance of situations that may result in ridicule or embarrassment. The child is overly shy, thinking ‘what if’ thoughts. This can result in them avoiding exams, or oral presentations and hence detrimentally affect school. This anxiety is also seen in generalised anxiety. However the child with social anxiety only, will have no symptoms when they are with familiar family and peers.  In some cases school refusal occurs.  The older child with school refusal will most likely have Social anxiety, whereas the younger child will have separation anxiety.

This anxiety can occur with generalised anxiety. The obsessions involve unwelcome thoughts or intrusions that can be distressing and may often involve bodily wastes or secretions. The compulsions are the need to perform a particular behaviour to alleviate a self defined anxiety. For example repeated hand washing, checking or repeated touching  behaviour. At times of stress (bedtime, preparing for school), some children touch certain objects, say certain words, or wash their hands repeatedly. OCD is diagnosed when the thoughts or rituals cause distress, consume time, or interfere with occupational or social functioning.

Having a stable adult, who provides a positive attachment is essential if any treatment is going to be successful. Paediatricians and child mental health experts agree that there is little point in embarking on treatment if those who are responsible have their own mental health issues that impact on the child. Someone who provides safety, a role model, and security needs to be involved to ensure therapy works. Setting this up can sometimes be all that is required to ensure a child’s anxiety lessens to the point where life and self esteem improves. This may require some difficult decisions. For example a susceptible child may develop severe separation anxiety due to bullying by either peers or a teacher and unless this situation is dealt with there is little point in spending time and money on counselling or other therapies. If there is no agreeable solution then moving the child to another environment maybe all that is needed. Treatment for residual anxiety will be far more effective when the environment is supportive. Finally ensure sleep is adequate and diet is healthy.  Caffeine has been found to  increase anxiety in some children and eliminating such drinks will help with both sleep and the anxiety.

This flows on from environment. Firstly ensuring boundaries, and appropriate warmth is essential. But parenting the anxious child will present it’s own challenges. Luckily there are a great deal of resources and tips available both online and in print. Teaching how to parent these children is difficult and each child will present with unique challenges. Many parents will feel such empathy for their children’s feelings that they try and help them avoid these stressful situations, which can at times reinforce the anxiety and lessens the ability of the child to learn independence and resilience.  For example if a child has significant anxiety at school drop off the parent needs to set small goals which are achievable and rewardable. In this instance there is reward for dropping off at the door of the classroom rather than being delivered to the teacher. The next week the child is left a short distance from the classroom door, and so forth until the child proudly exits the car and walks into the school independently. These small goals help the child show that they can be independent which helps with their self esteem. This stepladder approach can be applied to many anxiety causing situations.  Some more examples are found on at raisingchildren.net.au

Dealing with  negative explosive behaviour can be more challenging. This  is due to the child being unable to manage their own emotions, which bubble over and present as crying, meltdowns, door slamming and violence to parents or siblings. This is a kind of flight or fight response  can invoke a similar emotion in parents who may react in ways they later regret. In short the reaction of the parent should be similar to that of a soccer referee. Firm time out to allow the controlling of emotions is essential. For the older child and adolescent here are a few dos and don’t

• • Do provide a consequence that is easy to manage and will make the child think about their actions
  • Do point to the bedroom without engaging in arguments or discussion
  • Do ensure a fresh start a short time later (not the end of the week)
  • Don’t Yell, smack or threaten
  • Don’t lecture, nag or repeatedly engage the child.

This is easier said than done and sometimes it is worth getting professional advice. Consequences and time out are important and should be immediate and also redeemable and refundable.  One method which is outlined by child psychiatrist Dr Brenda Heyworth in her book [ilink url=”http://www.itsajungle.com”]’Its a Jungle'[/ilink]  is a simple rule involving the concept of ‘5 or 24’. This means that the child needs to go their room, for a few minutes (5) or a consequence of significance will be invoked for 24 hours.  After the 5 minutes there is a ‘fresh start’.  The child may want to stay in his or her room (fine) or might come out cranky (this is fine too) or may come out apologetic. If the behaviour is repeated then the 5mins is repeated. However if the child refuses then the ’24’ rule is invoked.  Nowadays this could mean losing internet use, or mobile phone for 24 hours.  For the younger child it may mean removing a favorite gadget or toy.  This is well explained in her book and is highly recommended to parents of children who are providing extraordinary parenting challenges.

In addition rewarding appropriate emotional responses with positive consequences is also extremely important. Catching them ‘being good’ encourages a child to take a more responsible emotional path.

Helping children with anxiety is the bread and butter of child psychologists as it is the most common mental health disorder. The psychologist will assess the anxiety, establish some goals then work with the child and parent towards lessening this anxiety. Cognitive Behaviourial Therapy and managing worries, anxieties, phobias and improving resilience should be the goals of such therapy. This may requires a number of sessions and in Australia there is funding through medicare which will offset the cost of seeing a psychologist. This treatment works when the following occurs.

• The child enjoys the sessions and is able to utilise the strategies
• The parent backs up therapy with appropriate environment and parenting

These sessions are particularly useful if the child is keen for help, the parent and caregivers have a positive outlook and there is persistence and consistency.  On the other hand if the child is incapable of engaging, or the parent is hoping that the psychologist is there to ‘fix it’ then this is unlikely to result in a positive outcome.

A paediatrician is sometimes useful where the situation is complex or where simple techniques and psychology has not improved the situation. A paediatrician will re-assess and escalate management and occasionally consider a trial of medication.