Behaviour: anxiety
Wednesday, August 29, 2001
Dealing with children's anxieties so they can move on into maturity requires tact and understanding by adults
What do we mean when we say that a child is anxious? How serious is it and how should we intervene, if at all? As adults we experience anxiety when threatened, for example, by the loss of a loved one, when our personal safety is at risk or when we feel under pressure to achieve or to meet deadlines.
In the same way that these anxieties may be overwhelming to one individual but not to another, children's anxieties are significant to them and need to be recognised as such. How the child presents his anxieties and manages them is crucial in determining how he will be able to overcome them in order to move on developmentally.
WHAT IS ANXIETY?
Anxiety is an instinctive response to danger. The infant reacts to situations of danger by experiencing fear - whether it is because he suddenly loses sight of his caregiver, or because of a loud and unexpected noise he hears. Over time, as these situations are repeated, the fear slowly diminishes. The child begins to anticipate the danger and, in turn, to prepare for it. When he is faced with the dangerous situation again, anticipatory anxiety is experienced. This helps him to prepare for the event and to manage it.
Nicholas, aged two years and ten months, reacted to starting nursery and separating from his mother by crying and needing her to stay with him. For the next few days, he clung to her and cried when she took him to the nursery. At home, Nicholas was beginning to anticipate the feared event (separating from his mother) and prepared for it by becoming anxious before the event took place. Whenever his mother got his nursery 'uniform' ready he began to cry. This anticipatory anxiety helped him to manage the painful separation from her. After she left him at nursery, the nursery nurse reported that he soon settled, and over the next few weeks, Nicholas realised that his mother would return to pick him up. His anxiety receded.
SURPRISING SYMPTOMS
There are many common fears in childhood, such as loss of love from parents or a fear of being harmed, which leave children feeling anxious. Children have different means of presenting their anxieties and worries. Repeated tummy aches, nail biting, 'accidents' (wetting), fears and nightmares about monsters, spiders and animals, are all typical indicators of anxiety.
Other children, however, may not show or present their own anxieties in such an obvious manner. Instead, they are often the ones who are hardly noticed because they are 'quiet' or more worryingly 'withdrawn'. Also, a child who is aggressive towards another child or an adult may feel anxious afterwards. This is because he realises that he is unable to control his own aggression, and he will be relieved when an adult steps in and puts a stop to something he cannot stop himself.
Finally, the anxiety presented may not always be directly related to the 'real fear', as the following example shows. Natalie, aged three-and-a-half, began to hit and push other children in the nursery. Clear boundaries and an explanation by her teacher that she did not want her to hurt others or herself helped Natalie to feel safer. At home, however, she told her mother that she did not want to go to nursery any longer because of the 'spiders'. It seemed that her fear of her own aggression had been transferred to another object. Over time, as she learned to control her anger, Natalie's fear subsided, as well as her aggression. The fear of spiders was not really a fear of spiders but an indication that something was unmanageable.
COPING STRATEGIES
Despite their increasing independence, nursery-aged children continue to depend on their parents and on adults to alleviate their fears. In moments of unexpected and unusual stress, such as going to the dentist or doctor, flying on a plane or the birth of a sibling, mummy or daddy's comfort and reassurance is still needed. However, young children are also very creative in their ability to deal with their anxieties. They learn to master them by preparing and repeating the dreaded event over and over again; they may 'play dentist' at nursery, with other children taking the role of the 'patient'. This enables them to be in control, rather than feeling helpless.
Imaginary companions are also a helpful means for children to present and manage their worries - as in, 'It's not me who is scared of monsters, it's my twin (imaginary) sister, she's so silly, there are no monsters, but she does not believe me.'
However, it can occasionally happen that a child's anxiety does not subside and the coping strategies that he uses can become rigid and unhelpful, or that he adopts a strategy which masks how he is actually feeling. In these cases it may be worth suggesting that the family seek advice from a GP or from a child psychologist.
Anna, aged four, was playing on the swings when she suddenly lost her balance and fell. She 'froze', gathered herself quickly and smiled to the teacher. It was surprising that the fall that caught her teacher's attention did not result in tears and a wish for comforting. Over time, however, with the help and support of her trusted teacher, Anna began to allow herself to present her 'hurts' without fearing that she would be reprimanded for being a 'baby'.
THE GROWN-UP RESPONSE
Reassurance from parents or other adults is, of course, the first way of helping children with their anxieties and worries. Children look up to adults they trust as the strong and powerful beings who can take their pains and worries away. Taking the time to listen to their worries or their nightmares and fears helps them feel that they are not on their own and that someone else shares their concerns. A balance should be maintained, however, between telling a child there is nothing to worry about - which will only make them feel alone with their worries - and telling a child how dreadful and very worrying it all is - which can only heighten their anxiety.
Nursery-aged children don't always talk about their worries, often because they don't have the vocabulary to do so or because they are not aware of what they are worried about. The child who regresses following the birth of a sibling and begins to wet at nursery, for example, may need to feel less pressured to be 'grown up', so a sympathetic approach by adults will be more helpful.
If carers and parents help children to manage a certain amount of discomfort and frustration from an early age, this will help stand them in good stead in future moments of stress and anxiety.
This article is based on a Nursery World 'Behaviour' series by psychologists at the Anna Freud Centre in north London, a registered charity, offering treatment, training and research into emotional development in childhood