Anxiety - recognising the signs in your child and providing help and support

Rachel Cullen is a Speech and Language Therapist and is Head of Mental Health and Wellbeing at Abingdon House School - www.abingdonghouseschool.co.uk Here, Rachel shares her insights about anxiety - what it is, how to recognise the signs, and how to provide help and support for your child.

There is an ever-growing body of evidence suggesting that levels of mental health difficulties in children are increasing. Rates of probable mental health disorders among six to 16-year-olds is now one in six, up from one in nine in 2017. One in 14 children have tried to end their own life by the age of 17.

In children with learning differences, the statistics are even more stark: they are four times more likely to develop a mental health issue in their lifetime and research shows that around 80% of autistic children experience at least one mental health difficulty. There is also evidence that a significant majority of children with clinical levels of mental health need are not being seen by mental health services. As a result schools are under increasing pressure to provide mental health support themselves.

The importance of a good home-to-school relationship

Research also shows that parents contact teachers more than any other professional about their child’s mental health difficulties. It is therefore clear that providing mental health support in schools is crucial, and that schools are becoming the frontline provider of mental health support for many children.

This is reflected in two significant government initiatives that have been implemented in the last 5 years: mental health first aid training for every secondary school and, more recently, grants for schools and colleges to train a senior mental health lead in every school.

Early intervention greatly improves the likelihood of a positive outcome and recovery. In order for early intervention to be successful we first need to identify problems as they arise and secondly implement interventions.

What is anxiety, and when does it become a cause for concern?

As one of the most common mental health conditions, affecting as many as one in six young people, anxiety is often the difficulty that we see most commonly in our schools.

Anxiety can take many forms in children and young people, and it is something that each of us experiences at low levels as part of normal life. When thoughts of anxiety, fear or panic are repeatedly present over several weeks or months, and/or they are beginning to impact on a young person’s ability to access or enjoy day-to-day life, intervention is needed.

What are the signs of anxiety that we might see in our children and young people?

Often our students, particularly the younger ones, are not able to tell us that they are feeling anxious or even identify that they are experiencing signs of anxiety. Our knowledge and understanding of what is ‘normal’ for your young person can help us to identify when something might be amiss.

Reports of headaches or feeling sick, or sudden increases in feeling tearful or irritable, can all be indicators of something that needs to be explored further. Like anything, each person experiences things differently but some commons signs of anxiety may also include:

• Constantly feeling nervous, panicky or frightened

• Feeling down or depressed

• Having difficulty sleeping

• Lack of appetite

• Inability to focus

• Tiredness and irritability

• Palpitations (heart racing)

• Dry mouth

• Trembling

• Faintness

• Headaches, stomach cramps and/or diarrhoea

• Fidgeting and frequent use of the toilet

• Having frequent outbursts of anger

• Having difficulty paying attention

• Avoiding everyday activities, e.g. attending school

• Recurrent thoughts that bad things are going to happen

• Inability to let go of negative thoughts.

What can we do to support our children and young people who are experiencing anxiety?

1. Normalise anxiety

Feeling anxious is normal, and it is important children and young people understand this. Anxiety stops being ‘normal’ when it interferes with everyday life on more days than not, for a prolonged period of time.

2. Keep pupils in school

It is better for a young person to be in school - even for a short time each day, rather than not at all - so consider ways in which your child’s school can support attendance:

• Offering a reduced timetable

• Allocating somewhere quiet to eat lunch

• Maintaining regular contact between the school and parents

• Providing opportunities for the young person express what they feel they need

• Finding the things that might make school easier for the student (e.g. taking sensory breaks, listening to music).
  

3. Encourage self-help

As well as supporting our young people, it is also important that we give them skills and strategies to support their own mental health. For example:

• Take five Taking 5 minutes to sit still and take in the present moment e.g. sights, sounds, smells (sometimes this is called mindfulness)

• Routine Many children and young people benefit hugely from knowing what the routine and structure of the day is, both at home and at school. Having a predictable routine can reduce anxiety.

• Communication Not all children and young people are comfortable with, or able to talk about their emotions. Find alternative ways for them to communicate, such as drawing, writing or email. Drawing or writing a worry and throwing it away can be a really useful strategy for many young people.

• Find coping mechanisms that work Help your child to develop a ‘tool box’ of strategies they can turn to when needed. This could be a playlist of music, practising breathing techniques, making use of colouring pages, reading a favourite book, repeating positive phrases or giving access to a sensory toy.
  

4. Explaining big changes in advance

Students with anxiety may react strongly, and/or negatively, to sudden change – it may help to offer an explanation for any big changes in routines in advance, talking about what is going to happen and why.

5. Focus on listening and not talking

If your child has come to you it’s because they trust you and feel a need to share their difficulties with someone. Let them talk.

Ask occasional open questions if you need to in order to encourage them to keep exploring their feelings and opening up to you. Just letting them say what they’re thinking will make a huge difference and marks a huge first step in recovery. Up until now they may not have admitted even to themselves that there is a problem.

Don’t feel an urge to over-analyse the situation or try to offer answers. This all comes later. For now your role is simply one of a supportive listener. So make sure you’re listening!

6. Don’t pretend to understand

The concept of a mental health difficulty such as an anxiety disorder can feel completely alien if you’ve never experienced these difficulties first hand. Listen hard to what they’re saying and encourage them to talk and you’ll slowly start to understand what steps they might be ready to take in order to start making some changes.

7. Offer support

Never leave this kind of conversation without agreeing on the next steps.

This might be continuing the conversation with a trusted staff member at school, or contacting mental health services. Whatever happens, you should have some form of next steps to carry out after the conversation because this will help the young person to realise that you’re working with them to move things forward.

8. Acknowledge how hard it is to discuss these issues

It can take a young person weeks or even months to admit (even to themselves) that they have a problem, let alone share that with anyone else. Acknowledging both how brave they have been, and how glad you are they chose to speak to you, conveys a positive message of support to the young person.

9. Never break your promises

Above all else, a child wants to know they can trust you. That means if they want you to keep their issues confidential and you can’t, then you must be honest.

Explain that, whilst you can’t keep it a secret, you can ensure that only those who need to know about it in order to help will know about the situation. You can also be honest about the fact you don’t have all the answers or aren’t exactly sure what will happen next. Consider yourself your child’s ally rather than their saviour and think about which next steps you can take together.

What does positive mental health support look like in school?

In the school where I work, we take our role in supporting mental health and wellbeing very seriously.

We believe that promoting and supporting positive mental health should underpin everything we do. We know that good mental health is the foundation of learning and social development and are incredibly fortunate to have an amazing team to support the wellbeing of our pupils.

Here are some ideas that schools or youth and community groups may wish to consider to support the mental wellbeing of their young people:

• Members of staff trained in Youth and Adult Mental Health First Aid

• Make use of the Zones of Regulation framework

• Pupil voice and/or student/youth council

• Wellbeing surveys

• Support for events and themed weeks e.g. NSPCC ‘Stay Safe Speak Up’, Diversity Week, Anti-Bullying Week, Black History Month

• Physical Wellbeing, including exercise and healthy eating

• Mental Wellbeing, including yoga, mindfulness, mindful colouring, walking, tea and chat, teacher story

• Therapy

• Calm areas/zones

• Make time for animals - dogs in particular can have a calming effect.

Rachel Cullen is a Speech and Language Therapist and is Head of Mental Health and Wellbeing at Abingdon House School, a specialist Prep and Senior School for children aged 5-19 years. Abingdon House School is part of Cavendish Education, a small family of schools specialising in supporting students with learning differences.