Since last fall, dozens of local area schools and organizations have hosted screenings of the documentary Angst, directed by Seattle resident and filmmaker Matt Skerritt. The hour-long film explores the disturbing uptick in anxiety in children; its causes, effects and how to deal with it. Anxiety is a hot topic, to say the least. To date, Angst has had 450 screenings in 11 countries since October 2017.
For Skerritt, whose daughter suffers from anxiety, making Angst was a good way for him to understand the topic. Before his daughter was diagnosed with general anxiety disorder (GAD), he and his wife thought that she may have been struggling with attention-deficit/hyperactivity disorder (ADHD), not anxiety, based on some of her symptoms.
“She was so smart and capable, I didn’t always believe her when she said she had anxiety,” says Skerritt, who admits he didn’t necessarily handle his daughter’s anxiety well at the onset.
While worry is a natural part of life, kids with acute anxiety are often dysfunctional with worry. Some have physical symptoms such as headaches or stomach pains. Others may exhibit anger, aggression, restlessness and impulse control. Trouble concentrating, procrastination and withdrawal from social activities are other signs of anxiety.
While boys tend to externalize their anxiety more with kicking, cursing and angry outbursts, girls often internalize, with symptoms like stomach aches, becoming withdrawn or trouble sleeping. Complicating matters further, anxiety often co-occurs with other disorders, including depression, eating disorders, sleep disorders and ADHD.
Is anxiety really on the rise? Why?
According to the National Institute of Mental Health, nearly one-third of adolescents ages 13 to 18 will struggle with an anxiety disorder at some point in their lives. That number may seem high, but most experts say it’s actually lower than what’s actually occurring because there’s no current nor comprehensive data around anxiety disorders in younger children. Many experts agree it’s on the rise for children of all ages.
Occasional anxiety is a normal part of the human condition, and in small doses is good for us: it may drive us to finish a project, take a big decision seriously, or avoid a dangerous situation. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety doesn’t go away and may worsen over time. The feelings and physical symptoms of anxiety can interfere with the ability to do normal daily activities, and the time and energy spent avoiding anxiety can begin to take over a child’s life.
Dr. Laura Kastner, a clinical psychologist at the University of Washington and author of Getting to Calm, The Early Years, encourages parents to examine the frequency, intensity and persistence of their child’s anxiety for clues about when to seek help: “Everyone has fears and worries, but if they are persistent and intense and affecting a child’s ability to participate in everyday life, then you should speak with a healthcare provider.”
At the Adolescent Medicine Care Team at Seattle Children's Hospital, Dr. Cora Breuner says she regularly sees patients who first come in because of chest pain, headache, diarrhea or eating disorders, where the underlying issue ends up being anxiety.
“I absolutely do believe anxiety is occurring more often,” says Dr. Breuner, who may see as many as 30 kids a day. “I also believe that as healthcare experts we are better at diagnosing it. The more you see, the better you get at being able to gauge the situation.”
Dr. Judy Ferguson, a national certified school psychologist with the Seattle School District who has 20 years of experience working with children in schools, agrees: “There is absolutely no question in my mind that anxiety in children is increasing. Without a doubt, it is noticeably more palpable to me over the last five years.”
If that’s true, then why?
Too much of everything. “Most people get a bit of a zing, a rush of dopamine from cramming the schedule and ‘Keeping up with the Joneses,’ but the constant adrenaline stream all day is like poison to our system,” says Dr. Kastner. “Families had a calmer schedule 40 years ago. In modern society, there is less downtime, constant streams of information coming at us. Some of the most profound things you can do for your child are not glamorous: a calm home, less media, more sleep, and get your child outside and in nature.”
Anxious parenting. Research shows that anxiety disorders run in families, and have a biological basis, much like diabetes, allergies and other disorders. Anxious parenting can create an anxious child. Dr. Kastner encourages parents to take a serious look at how their own behavior may be contributing to their child’s anxiety. “It’s impossible to parse the nature and nurture,” she says. “Some sources of anxiety are biological, while others may be environmental or social. That said, if mom is anxious, she may parent in an anxious way. When a parent knows that they have a predilection to anxiety, it’s important for them to work hard to override their own anxiety about their child’s anxiety.”
A fear of (any) failure. “For a long time now, we have been a trophy culture in the name of self-esteem,” says Dr. Ferguson. “We don’t give kids a lot of opportunities to handle small failures and losses. “Getting a B is OK. Crying because you don’t win a contest is OK. Happiness all the time is the expectation, that’s not realistic. Some days are the bummer and that is OK; It will ultimately help them cope with struggles as they grow.”
An overwhelming need to succeed. Similar to a fear of failure, but often the result of an underlying drumbeat of pressure from well-meaning parents concerned for their child’s future success. Dr. Kastner points to the shrinking middle class and the pressures that parents feel to make sure their child is ‘set up for success.’ Drs. Breuner and Ferguson both said they’ve seen a significant increase in young children being overly worried about college acceptance, not having perfect grades, or excelling at a sport. “I’ve interviewed kids for 20 years now, and I can tell you there is a ton more pressure on kids to perform,” Ferguson says. “Kids feel watched all the time and constantly supervised. Kids perform for their parents;, it’s innate how much they want to please, even if they don’t show it.”
What parents should (and shouldn’t) do to help
Dealing with anxiety requires parental education to help parents make wise choices.
When Dr. Breuner hears a parent say, “My daughter is anxious, I’m thinking about homeschooling her,” her advice is always “Don’t. “
“I remind parents that they must teach your kids social skills,” she says, “unless [they] plan to have them live in [their] garage and play video games for the rest of their lives.”
“A big natural pitfall of well-meaning parents is that they want to help their child avoid the situation that is causing anxiety,” says Dr. Ferguson. “It is a really disastrous thing when really well-meaning parents remove their child from class or school. That can make the child feel isolated, lose confidence and ultimately increase the anxiety or depression, and they don’t get to learn coping skills.”
Dr. Breuner says either therapy — where a child focuses on how to cope with anxiety in the best way for him or her, or therapy in combination with medication, have proven to provide the best results: “You don’t need to go for 10 years, you can get a lot of great cognitive behaviors down in five to six sessions that can make a real impact.”
She also recommends unplugging from social media: “Designate a time, every evening, as a family, to shut off — this includes parents — and wait until morning to turn it all back on. Be consistent about it, seven days a week.”
When an anxious child is worked up, distract and refocus his or her attention, take a five-minute break from studying to read a fun book, talk to a friend, go outside and play; engage in a new activity. Distraction allows a child’s amygdala (the fight-or-flight part of the brain triggered by an anxiety break) to calm down. But use this for short-term management of anxiety, not prolonged periods. Avoidance of stressful situations may reinforce a negative thought process and fear.
Parents can’t ignore anxiety away.
“As Mr. Rogers used to say, feelings should be mentionable and manageable. Not validating them is the same as being dismissive, which makes things worse,” says Dr. Kastner.
“That said, once acknowledged, the next step is coping. It becomes the child’s responsibility to learn healthy coping habits (reading, jumping rope, creating art, etc). It is the parents’ job to assist and support — not rescue, not avoid challenge nor fixing. Instead, supporting them as they face fears and approaching challenges.”
Living with anxiety
Alison is a smart, sweet and loving 10-year-old. She’s a doting big sister, an avid reader and a self-taught unicyclist. She was also diagnosed with GAD the summer after second grade.
“I started to worry more and more,” says Alison. “About everything, like getting sick or getting hurt. I was having trouble falling asleep and waking up in the middle of the night, and then waking my mom up because I couldn’t sleep.”
That summer, Alison suffered two full-blown panic attacks. Catherine, Alison’s mom, remembered her waking them up one night when she was hyperventilating and practically hysterical, convinced she wasn’t able to walk straight, even though her parents saw nothing physically wrong.
Her pediatrician referred them to a psychologist who specializes in children and adolescents. After just one visit, Alison was already looking forward to going back. For the last few weeks of the summer, she went two times a week to help get things under control before the school year, then settled into weekly sessions.
Together they tackled things that seemed to be a source of anxiety for Alison, such as the fear of going to the doctor when she was sick or hurt. At the psychologist’s suggestion, they made arrangements for the school nurse to have Alison come by once a week for a visit at a time that was not disruptive to her school schedule. The nurse would get called down and come in to just talk with Alison or ask questions, slowly getting more comfortable with the idea. They also put more routines and structure in place, which has been shown to help kids with anxiety.
They moved up Alison’s lights-out time, and created a schedule she could maintain, prioritizing a regular sleep schedule over certain kinds of travel and social activities. Alison also worked on breathing exercises and meditation she could do on her own when she needed to wind down.
A year later the sessions went to every other week, and both Alison and her mom feel like she now has great tools in place to help her manage anxiety.
In another instance of managing anxiety, Jen’s daughter Sarah began having panic attacks in the third and fourth grade.
“The panic attacks seemed to be triggered by overstimulus, and she just couldn’t come out of it,” says Jen.
The anxiety and panic attacks would manifest into tantrums that would spiral into complete meltdowns that Sarah couldn’t just come out of, often triggered by jet lag, small spaces or big crowds. It began to adversely affect her interactions with some kids at school, and at one point, Sarah herself became frightened by her own actions, which was a wake-up call for both her and her parents.
For Sarah, managing anxiety has meant dietary changes that seemed to improve her mood, making a good sleep schedule a priority and seeing a therapist.
“It’s important for us to help her know that it’s OK to see a therapist, and to talk openly about her journey. We want to empower her,” says Jen. “She knows this is something she will always have to manage, but she knows we believe she can do it.”
Her advice to other parents of anxious children is to model good self-care, show them how to take care of themselves with healthy sleep and eating habits, and help them establish a routine that works for them. She also says it’s important to focus on the good moments, not just the negative, and to name what has gone well, like praising them for doing great with sleep or managing their worry.
- Access the “Symptom Checker” developed by the Child Mind Institute at angstmovie.com
- To find out if there is a public screening of Angst near you, visit angstmovie.com/find-a-screening/
- The makers of the documentary Angst have also created an amazing online resource for parents, including a helpful website, books and videos, as well as common questions about anxiety and ways to find a therapist. angstmovie.com/resources/
- Anxious children (ages 5 to 17) and their parents can participate in Seattle Children’s Psychiatry and Behavioral Medicine Anxiety Program, which offers concurrent groups for parents and children (based on age group) around anxiety management techniques. seattlechildrens.org or 206-987-2164
Books for parents
- Parenting Your Anxious Child with Mindfulness and Acceptance by Christopher McCurry, Ph.D.
- Helping Your Anxious Child by Ronald Rapee, Ph.D.
- Getting to Calm, The Early Years by Laura S. Kastner, Ph.D.
- Getting to Calm: Cool-Headed Strategies for Parenting Tweens + Teens by Laura S. Kastner, Ph.D.
Books for children
- I Bet I Won't Fret: A Workbook to Help Children with Generalized Anxiety Disorder by Timothy A. Sisemore, Ph.D.
- What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety (What to Do Guides for Kids) by Dawn Huebner, Ph.D.