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Anxiety

Information and resources to support children and young people with anxiety in education and care.

Anxiety disorders are one of the most common difficulties facing children and adolescents. Around 7% of young Australians aged between 4 and 17 experience an anxiety disorder. 

Anxiety can present in a variety of ways because it is based on a physiological response to a real or perceived threat in the environment, a response that maximizes the body’s ability to either face or escape danger – ‘fight or flight’. It is important to note that for many people with anxiety disorders, particularly those that are untreated or not yet in a solid treatment routine, whether the threat is physically real or not makes little to no difference to the anxiety response.

Some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.

Normal anxiety and fears differ from anxiety disorders. When considering if a child has anxiety that requires support you can consider:

  • does it interfere with the child’s ability to function and do things that would be expected for their stage of development or with things they enjoy
  • is it age appropriate
  • it is getting worse
  • does it take a long time for them to feel better
  • are there other things ie change in habits, avoiding certain situations, becoming clingy or withdrawn.

Where there are concerns about a child’s anxiety the family should be encouraged to seek help from a health professional. Early intervention for anxiety is important.

What does anxiety feel like?

Children and young people experiencing anxiety can feel both physical and emotional symptoms including:

  • racing heart beat
  • rapid breathing
  • being teary and irritable
  • being sweaty and breathless
  • ‘butterflies’ in your stomach
  • pains and discomfort in your body.

For some children and young people with atypical interoception there may not be unawareness of any of the above sensations. These children and young people will appear fine until they experience a ‘fight/flight’ moment which can appear as not just fight or flight but also ‘flop, drop or freeze’.

Many children and young people on the autism spectrum also have high levels of anxiety, and often have atypical interoception. Their anxiety can present as task or even school avoidance.

Types of anxiety disorders

Types of anxiety disorders common in children include:

  • generalised anxiety disorder - excessive worry about anything and everything
  • social anxiety - anxiety in social situations often from fear of doing something wrong or being judged or criticised by others
  • separation anxiety - excessive anxiety about being separated from home or a person where there is a strong emotional attachment ie parent, carer, sibling
  • specific phobias - intense fear of objects or situations ie dogs, heights, blood
  • panic disorder - periods of intense fear which happen suddenly or when there is no sign of danger

Detailed fact sheets and strategies to assist children are linked to each specific disorder above.  

Education implications of anxiety

Children and young people CANNOT learn when they are highly anxious.

A high level of anxiety can interfere with aspects of cognition that are critical for successful learning and performance:

  • paying attention to what needs to be learned
  • processing information effectively (eg organising or elaborating on it)
  • retrieving information and demonstrating skills that have previously been learned 

The inability to recognise anxiety in children and young people can result in assumptions. Children and young people with anxiety may become easily frustrated resulting in anger, tantrums or meltdowns. A child who is disruptive, oppositional or aggressive may be reacting to unrecognised anxiety.   

Fears of embarrassment, humiliation or failing can result in school avoidance. Getting behind in work to numerous absences often creates a cycle of fear of failure, increased anxiety, and avoidance, which leads to more absences.

Anxiety in children and young people may be recognised by:

  • inattention and restlessness
  • concentration difficulties
  • excessive absences, school refusal, truancy
  • disruptive behaviour
  • fixation on an issue causing anxiety
  • trouble answering questions in class
  • excessively seeking reassurance
  • fear about particular activities 
  • mistakes, routine changes or new situations cause distress
  • frequent stomachaches or headaches
  • perfectionism
  • procrastination
  • unexplained headaches, nausea, stomachaches, or even vomiting
  • avoiding socializing or group work.

Managing anxiety in education and care

Education and care staff can notice signs of anxiety by observing changes in a child’s behaviour or repeated behaviours from the list above. Education and care services have a duty of care to address any school-based triggers that may be impacting on children’s mental health and wellbeing.

KidsMatter has resources and information to support education and care services to manage children and young people with anxiety.

Black Dog Institute has a range of free school resources that are evidence-based and have been developed to assist secondary educators to build mental health and wellbeing education into lessons.

Friends Resilience have developed a range of age specific programs for education and care services to guide the social and emotional development of children and young people through teaching them resilience:

Interoception 

Many children and young people with anxiety have low levels of interoception, which means they are unable to understand or connect with their bodies in ways that would enable them to self-regulate. It is important to integrate the teaching of interoception activities to develop interoceptive awareness.  

An interoception support plan HSP421 (DOC KB) may be completed by the education or care service, family and the child or young person (where possible). This will provide a detailed understanding of the interoception issues and support the development of individualised strategies to increase interoception.

Refer to interoception 101 (PDF 3MB) for strategies to incorporate interoception into class activities.

Sensory needs

As children and young people with anxiety are sensitive, sensory processing disorder (SPD) and anxiety often go hand in hand. Not every child with anxiety has SPD, and not every child with SPD has anxiety, but a large proportion do. SPD in children with anxiety is often missed. SPD can cause a child or young person to feel overwhelmed and this can result in anxiety about situations that trigger their sensitives.  

It is important to understand their sensory needs and implement strategies to enable a positive experience in the education or care setting. 

A sensory overview support plan HSP431 (DOC 389KB) may be completed by the education or care service, family and the child or young person (where possible). This will provide detailed a detailed understanding of the sensory issues and support the development of strategies to minimise sensory seeking or avoidance that can result in anxiety.

Regulation scale

The regulation scale HSP432 (DOC 182KB)  is a tool that can be used for any child or young person to identify what is happening around them that is impacting on their mood change, what signals their body is giving them, and ways to respond to their body’s signals that will help them manage the change in mood. 

The child or young person should be involved as much as possible in developing the scale, with input from parents and staff to support them. 

The scale can evolve and change over time as the child develops better interoceptive awareness and expands their vocabulary (non-verbal/verbal). This scale is designed to be used in conjunction with interoception activities so the child is working towards meaningful development of interoception skills. 

Interoception is the foundation for developing emotional regulation skills and some children will require explicit teaching to develop these. Some children (especially those who have experienced trauma and/or neglect) struggle to manage mood changes which may be associated with a minor increase in stress levels (new learning, trying something different). For these children, minor stress may induce uncomfortable feelings which trigger a ‘flight, fight, freeze’ response. These children require support to differentiate between feeling slightly challenged/minor discomfort and feeling unsafe/in danger so they can respond differently.

Some examples of completed regulation scales include:

Care plan

A non-specific care plan HSP110 (DOC 166KB) can be completed by a health professional in consultation with parents or legal guardians for children requiring support to manage their anxiety. 

Health support agreement

health support agreement HSP120 (DOC 243KB) and safety and risk management plan HSP121 (DOC 147KB) can be completed where a parent indicates their child suffers from anxiety and requires additional support and assistance. There does not need to be a care plan completed by a health professional in place. The support agreement is completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service. 

The Health Support Agreement should clearly identify cultural, spiritual and language needs. 

Educational adjustments

Educational adjustments are designed to support children and young people on an individualised basis. Adjustments should be determined by the parents and education and care service and documented in the support agreement. 

WayAhead have developed Small Steps: strategies to support anxious children in the classroom which may assist education and care services to support children and young people with anxiety.

Examples of adjustments may include

  • identification of high risk activities and times and so develop strategies to reduce the anxiety
  • preferential seating
  • exit plan - permitting a child to leave the classroom if anxiety becomes unmanageable, with a prearranged designated safe place where they can be supervised by education and care staff
  • early communication with the child about any change in routine 
  • extended time for tests and exams
  • alternative evaluation or assessment processes ie substitute assessment for children that experience anxiety with oral presentations may include presentation to only the teacher and a small group of friends rather than the whole class
  • access to external support ie HeadSpace
  • teaching of stress management skills ie relaxation and problem solving
  • include interoception activities in the daily routine, especially prior to stressful tasks.

Supporting children with anxiety

The Department for Education has developed an interoception curriculum that can help children and young people with anxiety improve their emotional awareness and self-regulation:

  • Interoception 101 (PDF 303MB)  - interoception explanation, interoception tracking sheet and interoception activities 
  • HSP421 Interoception support plan (DOC KB)

A  sensory overview support plan HSP431 may be developed by child or young person, their family and/or the education or care service to provide an understanding of any sensory issues and develop strategies to minimise sensory seeking or avoidance, and assist in the development of a support plan.

The Women’s and Children’s Health Network Child and Youth Health have developed information specifically for children about anxiety

ReachOut is Australia’s leading online mental health organisation for young people. Resources are available for young people, parents and schools:

Beyondblue are advocates for positive change, and a better deal for people experiencing anxiety, depression and suicide risk. Resources available on their website include:

Headspace is the national youth mental health foundation dedicated to improving the wellbeing of young Australians.  Resources available on their website include
•    Online programs and apps for young people experiencing anxiety

Black Dog Institute has clinical resources, information and fact sheets about anxiety; including online self-testing, current treatments and wellbeing.

The Centre for Emotional Health is a practicing research clinic established in 2007 in the Macquarie University. They are internationally renowned for their research into anxiety with a special focus on children and families. Their website includes information, resources and questionnaires that may assist education and care services to support children with anxiety including:

The Centre for Emotional Health has range on online programs and services for parents and teenagers

Resources

Care plans

HSP110  Non-specific care plan (DOC 166KB)

Support plans

Health support agreement

Planning and management tools

 

Contact

Disability Policy and Programs

Phone: 8226 1769
Email: education.specialeducation [at] sa.gov.au