UBC counselling psychology professor Lynn Miller says it’s understandable that people don't want to do things they dislike. As an example, she tells the Georgia Straight over the phone that kids will sometimes try to avoid going to school, the dentist, or a birthday party.
But she says that when children become filled with fear and dig in and resist, parents should seek input from a teacher, a school counsellor, or a mental-health expert about whether anxiety may be the root cause of this behaviour. She points out that, on a biological level, anxiety is characterized by an overwhelming flood of neurotransmitters and hormones, including cortisol, which can elevate stress to unmanageable levels.
“Anxiety is also known as a fight-or-flight response,” Miller says. “The majority of people will flee if they can.”
When Miller began her career, she had no idea she was on a path to becoming an expert in childhood anxiety. She just wanted to prevent kids from having difficulty at school. She says she soon realized that psychological issues were often a major factor undermining children’s success.
According to Miller, anxiety is the most common mental-health problem facing people of all ages. “Anxiety masquerades as a whole bunch of other things,” she emphasizes.
Miller, director of the Anxiety Projects Lab at UBC, estimates that approximately 10 percent of school-age children and adolescents have enough anxiety symptoms to interfere with how they function at home, with friends, or at school. She recommends that parents ask themselves if their child is more frightened or worried than other kids his or her age.
“It is very often misdiagnosed as ADHD [attention deficit hyperactivity disorder],” Miller says. “Comparatively, anxiety is four times more common than ADHD.”
Problems can arise when children experiencing anxiety are prescribed drugs like Ritalin and Dexedrine, which are meant to treat ADHD. Miller says these medications “make things worse in a big hurry” for kids who are anxious because they stimulate the nervous system, leaving them feeling more out of control.
She notes that certain physical symptoms are associated with anxiety in children. She says that among elementary-aged kids, the most common is a persistent stomachache. For adolescents, frequent headaches are often an indicator. Another sign of anxiety is a reluctance to go to sleep due to a fear of what might happen the following day. She advises turning off electronic devices around young children two hours before they go to bed.
“We want kids to be getting a lot of sleep at all school ages,” Miller says. “Lots of times, that’s vastly underevaluated when people are thinking, ‘Why is my child struggling?’ Really, sleep is a huge [common] denominator for everybody.”
She also points out that when a child’s fight-or-flight response escalates, they may have a “meltdown”, which can leave them feeling humiliated afterward. (For more information on anxiety in young people, see the Anxiety B.C. website.)
Miller says kids can benefit from medications that interrupt the onslaught of stress-elevating neurotransmitters and hormones. But she emphasizes that the Canadian Psychiatric Association and the Canadian Medical Association both advise that psychological help should be the first course of action.
Cognitive behavioural therapy, which is often used to treat anxiety, focuses on the links between thoughts and actions. The goal is often to help kids stop applying negative meanings to certain events, like going to school. Unfortunately, sessions with psychologists and other types of counsellors who conduct CBT treatment aren’t covered by provincial medical insurance, but some private plans will pay for it. Some practitioners charge on a sliding scale.
There are periods in young people’s lives when they’re at higher risk for developing anxiety, Miller says. Kindergarten can be a stressful time because it’s a child’s first exposure to a classroom setting. Grades 4 and 5 are also challenging, because the curriculum starts focusing on abstract as opposed to concrete thinking.
“Then, the final explosion of symptoms would be around the entrance to puberty,” she adds.
Younger children tend to demonstrate anxiety through their behaviour, perhaps by crying or refusing to engage in activities. Miller says that older kids are often better at articulating their anxiety, which sometimes manifests itself as perfectionism.
According to Miller, adolescents with anxiety have higher rates of alcohol use, since alcohol is a depressant that calms them down. However, she says they “really hate marijuana” and mind-altering stimulants because these leave anxiety sufferers feeling less in control. Researchers have also linked teenage anxiety to a higher risk for suicide.
“The number one predictor for adolescent suicide is untreated anxiety,” she says. “We used to think it was just depression. Actually, for kids who don’t get treatment for anxiety, about half of them will go on to develop depression.”
Miller says that anxiety is probably the most treatable psychological problem. Several years ago, she played an instrumental role in B.C.’s Ministry of Children and Family Development becoming the first provincial ministry in Canada to adopt the Friends for Life anxiety-prevention program.
It’s an evidence-based approach designed to help teachers, leaders of youth groups, and parents better understand how to help young people cope with this condition. B.C. offers free training to those who commit to implementing the program.
It’s one reason Miller says that teachers are often the most adept at spotting anxiety problems in children—even more than parents are.
“You can largely prevent an anxiety problem from turning into a disorder,” Miller says.