Gabriel RAFI - Neuropsychologist

Anxiety in adolescents and children: understanding and supporting

Anxiety in adolescents and children: understanding and supporting
Photo by Kelly Sikkema / Unsplash

Emotional management for a person who suffers from anxiety requires an approach that is caring, structured and adapted to the age and emotional situation.

We will see together how emotions work and how the brain cares to best manage all these emotions.

Several things to know and keep in mind:

- An emotion does not disappear by itself ! So when we are affected by an emotion, we absolutely must externalize it otherwise it stays within us. Thinking that things will pass over time is a mistake. We must then absolutely identify the emotion felt and externalize it if we want to get rid of it.

- We are not always aware of the emotions we are feeling. The brain is totally permeable to emotions and different stimuli. But we are not always aware of this and we cannot control whether we are affected or not. It's like being cold or hot. Some people will get cold more easily than others; it's a fact. The body then has to make us understand (tremors, cold ears, runny nose, etc.) and then we realize “how cold” we are.

- Emotion has an impact on reality but not always and reality will also have an impact on emotion. Perhaps by even reading this example of felt temperature you have felt cold in the meantime even though it is not cold... Here we will learn to use the reality of the situation to be able to dissociate it from the emotion felt. Example: I'm afraid of failing my exam but that doesn't mean I'm going to fail my exam. So emotion will not have to have any impact on reality.

- An emotion takes up space as long as it stays in the head. It therefore disrupts the proper functioning of the brain. The central part of the brain is the area in charge of emotions and I will show you how emotions flow from one area to another and the consequences of poor neural circuitry on intellectual and cognitive performance.

- If we want to sleep better, it would necessarily be better to manage emotions during the day. We prioritize our emotions and we accept that a problem has not yet been resolved BUT the brain must at least have thought of an emotional response in the meantime. Uncertainty creates anxiety, and anxiety exhausts the brain. An exhausted brain is a brain that inevitably tends towards a depressive state... A depressive state is a brain that is no longer operational to be able to properly find solutions and function well.

Anxiety

Anxiety is increasingly affecting young people of all ages, affecting their well-being, relationships, and even their academic performance. According to several studies, anxiety disorders are among the most common mental health problems in children and adolescents, often exacerbated by hormonal changes, academic demands, and social pressure. We will see together the potential causes of anxiety in young people and will see practical tools to help parents better support their child.

Goal : Understanding Anxiety in Children and Adolescents

1. What is anxiety?

Anxiety is a natural response to stress, a protective mechanism that occurs when the individual feels threatened. While a certain level of anxiety is normal, it becomes problematic when it is excessive, persistent, and interferes with daily life. In children and adolescents, this can manifest itself as disproportionate worries, fear, or panic attacks.

2. Causes of Anxiety in Young People

The factors that can lead to anxiety in children and adolescents are varied:

- Biological factors: some studies suggest a genetic predisposition to anxiety, with families where several members can be affected.

- Environmental factors: difficult life events, such as parental separation, school pressure, or experiences of bullying, can contribute to a state of anxiety.

- Developmental factors: in adolescents, the physical and emotional transformations due to puberty increase sensitivity to judgments and criticism, thus amplifying anxiety.

3. Signs of Anxiety in Children and Adolescents

Signs of anxiety can vary by age, but they often include:

- Emotions: fear, nervousness, irritability.

- Behaviors: avoidance of social situations, lack of concentration, tantrums.

- Physical symptoms: stomach aches, muscle pain, trembling, sweating.

- Cognitive symptoms: racing thoughts, over-anticipating problems.

Tools for Managing Anxiety in Children and Adolescents

Not all methods necessarily work. There is no need to worry. There are several levels of anxiety and there are also several reasons that lead to anxiety. A HP profile for example who presents anxiety will not be able to erase his anxiety just with relaxation or breathing techniques. An ADHD profile who has developed anxiety will not be able to remove his anxiety just with breathing techniques but it can help him at the time. Then the real work will be to make him understand why he developed this anxiety and help him to better manage this anxiety without it bringing him other difficulties (the judgment of others, a tendency to give up, …)

1. Compassionate Communication

Listening and open communication are essential. Inviting children to express their emotions and concerns, without judging or minimizing their feelings, builds trust and allows parents to understand the source of their anxiety. Here are some ideas:

Ask open-ended questions: "How are you feeling? Can you tell me about what's worrying you?"

Avoid minimizing feelings: Phrases like "It's not that bad" or "Don't worry about it" can increase feelings of incomprehension.

Recognize and validate emotions: Reassure children that what they are feeling is normal.

2. Relaxation and breathing techniques

Relaxation techniques are effective in managing anxiety, especially in calming panic attacks.

Deep breathing exercises and progressive muscle relaxation methods help children regain control of their body and mind.

Example of a breathing exercise:

The most famous one is Abdominal breathing: Have your child take a deep breath in through their nose, expanding their stomach, and then slowly release the air through their mouth. Repeating this exercise three to five times helps calm the heart rate and ease anxiety.

3. Teach mindfulness

Mindfulness involves bringing a child’s attention back to the present moment, without judgment. This practice helps young people take a step back and not let themselves be overwhelmed by their anxious thoughts.

Example of a mindfulness exercise:

Calm jar: Fill a jar with water, oil, and glitter. When shaken, the glitter swirls, representing inner chaos. By watching the glitter settle, the child learns to gradually calm down, visualizing that his or her thoughts can also calm down.

4. Structure the daily routine

Children and adolescents with anxiety disorders benefit from a structured routine, which helps them anticipate their days. A reassuring schedule, with moments of relaxation and leisure, helps reduce stress and unexpected surprises.

Plan time for sleep and meals: Regular sleep and balanced meals improve emotional management.

Limit screens: Time spent in front of screens, especially before bed, can worsen anxiety.

5. Encourage expression through play or creative activities

Young children, in particular, express themselves best through play or creative activities. Drawing, playing, painting or writing are effective ways to help them externalize their emotions. Writing a journal: Ask the child to write down what worries them, or to keep a gratitude journal where they note the good moments of their day.

Role play: Play together to help them overcome anxiety-provoking situations and show them how to manage them in a safe environment.

6. Seek professional help if necessary

If anxiety becomes too severe, to the point of seriously affecting the child's daily life, it may be helpful to consult a professional (psychologist, child psychiatrist, therapist specializing in anxiety). Cognitive behavioral therapy (CBT), in particular, has proven effective in helping children and adolescents change their anxious thoughts and behaviors.

How to react to a panic attack?

A panic attack is an intense and frightening experience for a child. It is characterized by palpitations, sweating, trembling, and a feeling of terror. Here is how parents can intervene:

Stay calm: The parent's calm attitude helps the child calm down.

Guided breathing: Ask the child to focus on his or her breathing (as mentioned in the previous section).

Create an anchor: Invite the child to touch a familiar object, look at something reassuring, or even recall a calming memory.

Verbal reassurance: Remind the child that the attack will pass and that he or she is safe.

The panic attack itself is usually scary and the person having a panic attack starts to be afraid of the intensity of the attack and does not know how far it will go. I like to remind people that everything that happens in your brain, the brain already knows it so there is no need to be afraid. It is as if the fears were already written in a book in our brain and we were just turning the pages, it can be scary at the time but there is no reason for it to be even more scary because the brain controls this book of emotions.

Essential and personalized support

Supporting an anxious child or adolescent requires patience, listening and understanding. As parents, it is essential to remember that each child is unique, and what works for one may not be effective for another. Cultivating a safe and open environment for dialogue is a first step towards better anxiety management, and consulting a health professional can offer strategies and additional follow-up to help the child overcome their difficulties.

The brain is logical

Now let’s have a look in a little more detail on how anxiety works.

The brain is logical. So even if sometimes we have atypical profiles that favor the overreaction of certain emotions, the brain itself remains logical in relation to what we give it as information.

Things to remember: Knowledge of what is happening in our brain and our degree of awareness of what is happening in our brain. Faced with emotions, it will always be better to know how the brain works to identify emotions and actions, to know how to read behind each emotion and to succeed in externalizing the emotion felt to avoid accumulation and to avoid our unconscious playing tricks on us.

Here’s detailed information on anxiety in children and adolescents, supported by recent scientific studies, as well as evidence-based tools and approaches to help parents support their children.

1. Understanding the causes and impact of anxiety

Biological and genetic factors

Anxiety has a genetic component: research has shown that there is an inherited predisposition. A 2020 study published in The Journal of the American Academy of Child & Adolescent Psychiatry shows that children who have a parent with anxiety disorders are more likely to develop these disorders themselves. Researchers have observed that genetic inheritance can influence stress sensitivity and physiological responses to stressful events (Goldstein et al., 2020).

Environmental and social factors

Stressful life events, such as family separations, bereavement, or school bullying, are also associated with an increase in anxiety disorders in children and adolescents. A literature review in Child and Adolescent Mental Health indicates that experiences of bullying are particularly correlated with anxiety symptoms, with lasting effects even into adulthood (Moore and Woodcock, 2017).

Academic pressure and perfectionism

Academic pressure is a major factor in anxiety, particularly for adolescents. A study published in Educational Psychology (2018) reveals that young people with a perfectionist profile are more likely to experience anxiety and stress because of their high expectations and fear of failure (Flett, Hewitt, et al., 2018). These young people tend to internalize academic pressure, which exposes them more to anxiety disorders.

2. Signs and manifestations of anxiety in youth

According to an article in Pediatrics (2019), the manifestations of anxiety can vary, but the most common signs include avoidance behaviors, somatic symptoms (such as stomach aches), and sleep disturbances. Researchers note that anxiety in children is often underdiagnosed because symptoms may be interpreted as behavioral disorders rather than anxiety (Pine et al., 2019).

3. Research-based anxiety management tools

Communication and emotional validation

Compassionate communication and active listening have been shown to have positive effects on youth with anxiety. A study published in Developmental Psychology (2017) indicates that children whose parents use an empathetic approach and validate their emotions have better emotional regulation. This approach helps build emotional safety, which is essential for selfregulation of anxiety (Morelen & Shaffer, 2017).

Practical tips:

- Use empathetic statements, such as “I understand that you’re feeling anxious, and that’s okay. I’m here to help you.”

- Ask open-ended questions and create a space to talk without judgment.

- Breathing and progressive muscle relaxation techniques

- Relaxation and breathing techniques are also supported by scientific research. Abdominal breathing, for example, activates the parasympathetic nervous system, which helps reduce panic symptoms. A study in Behavior Research and Therapy (2018) found that diaphragmatic breathing exercises significantly reduced anxiety in adolescents, particularly in school-based interventions (Brown & Gerbarg, 2018).

Practical exercise:

Square breathing: inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, and hold again for 4 seconds. This method stabilizes the heartbeat and helps reduce anxiety. However, it does not work or works very little with people who have high potential.

Mindfulness-based approaches

Mindfulness is increasingly integrated into child therapies. According to a randomized controlled trial in the Journal of Clinical Child and Adolescent Psychology (2020), the practice of mindfulness significantly reduces anxiety symptoms in young people aged 10 to 17. Mindfulness techniques help young people focus on the present moment, thereby reducing anxious thoughts and ruminations (Kuyken et al., 2020).

Mindfulness exercise:

Sensory anchoring: ask the child to identify five things they see, four things they can touch, three things they hear, two things they can smell, and one thing they can taste. This exercise refocuses attention on the immediate environment, thus reducing the impact of anxious thoughts and allows the child to dissociate the emotion felt from the reality of the situation. The person therefore understands that their felt emotion may not be totally in phase with the reality of the situation.

Structuring the daily routine and regulating screens

Structuring daily life is beneficial, as indicated by a study in Sleep Health (2019), which highlights the importance of regular sleep to regulate emotions in adolescents suffering from anxiety disorders. The study shows that regular sleep habits reduce anxiety and increase emotional resilience (Gruber et al., 2019).

Screens also have a significant impact: their excessive use is correlated with higher levels of anxiety, especially in adolescents, as demonstrated by a study in JAMA Pediatrics (2020). Limiting exposure to screens, especially in the evening, not only improves sleep quality, but also anxiety management (Twenge and Campbell, 2020). Here too, it will be necessary to distinguish between children who ultimately need to be able to spend more time on screens and children who only ask for it out of sheer whim. There are also children who will find refuge in screens because they are trying to avoid the difficulties associated with school.

Some tips

In general, let’s try to keep in mind that the child does not do it on purpose to bother the adult with his emotions. If sometimes his behavior is problematic, it is because he is the first one concerned by these difficulties. Our work will then be to help him to better manage things, step by step, to make him learn to be autonomous, step by step, and for that our goal will be to facilitate the child's daily life to lead him to succeed and then increase the level of expectation and requirement little by little according to the child's evolution.

Here some tips :

To encourage the child to show all his/her abilities and to be sure that he/she won’t have too much stress or anger at home or at school, it might be useful to :

- reduce the frequency of instructions and eliminate unnecessary commands

- increase the use of commenting descriptions, reflections, praises and empathy (comments about feelings)

- reduce all negative feedback and criticisms.

- build predictable daily routines and routines/step with activities, reducing the need for extra instructions

- work on building a positive relationship with the child before making demands on him/her

- The child is, as any other children, more likely to comply when he/she feels secure, understood and liked

- check the child's mood and responsivity (engage him /her in conversation), ensuring he/she is following simple instructions, before giving more complex or challenging ones

- provide a rationale before a request/command (not after)

- give choices wherever possible, allowing the child to feel empowered

- give the child daily opportunities where he/she can be in control of a social situation, leading an activity, or taking on a responsibility/role

- reward the child with praise, attention and other positive experiences following high levels of cooperation

- help the child anticipate moments that could be potential triggers (listening to one instruction and finishing it, managing his/her fears or frustration, ..). Help him/her to talk about what he/she might find difficult on those situations and what resources he/she has to deal with them as well as strategies that he/she can have access to in case he/she feels frustrated or upset

- always give him/her right about his/her feelings and then help him/her to express them in a good way

In general, let's say that we will have to pay attention on several points :

--> Use the positive reinforcement method

As a parent, you may never have heard of positive reinforcement. It is about having a behavior repeated so that the child adopts it more easily. It is a “temporary” method to accustom the child to adopting a new behavior.

Behavior reinforcement is a positive education consisting of encouraging your child rather than punishing him. You have to find the right balance. How does this method actually work?

--> Spend time with your child

It may seem obvious to you, but spending time with your child strengthens the bond between you. Every child needs to feel important to their parents. These are privileged moments spent together. This goes through an outing, a game or a friendly meal with him. To satisfy this need, do not hesitate to: remind the child that you are there to listen when he needs it : show signs of affection and create a climate of trust

--> Value your child by congratulating him on a daily basis

Stay positive on a daily basis: your words must formulate affirmative sentences. If the child has made an effort but made a mistake, it is important to recognize it. Failure is part of success and your child must understand this: the fear of making a mistake can lead to discouragement on his part.

--> Try to keep calm

It must be admitted, sometimes it can happen that our emotions invade us and encourage us to raise our voices over our child. When the anger is there:

- keep silent for a while and breathe to calm yourself down

- speak calmly and avoid shouting to make yourself heard

- try to understand your child's difficulties and the reason for this behavior

--> Suggest activities that empower him

To best apply our advice, we offer a list of positive reinforcement activities:

- The rules of life at home: gaining autonomy

- The family council: fostering communication

- The Windmill of Feelings: Better Understanding Your Child's Feelings

- The mirror game: listening and focusing on what the other is saying

By using these methods, we tend to a better environment where boundaries are clear and the child himself feels more secure and reassured.

1) Success breeds success. Getting into the habit of noticing times when the child responds in an acceptable way and giving him positive reinforcement (for example, praising their behavior or effort) is more likely to encourage him to repeat that behavior.

Many studies have shown that rewarding good behavior is very effective in teaching children good behavior.

-> What can you do?

- Focus on The child's good behavior. Instead of perceiving him as a "problem child", consider him rather as a "good child".

- Try to ignore the bad behavior but praise the good.

- Let the child hear you speak well of him.

2) Clear expectations are needed. Some studies have found that parents' expectations have a significant impact on the behavior and future of their children. How you express yourself is important. Telling a child to “be nice” is way too vague. What does it mean to "be kind?" Be specific: “I want you to share your legos with your mom when we play together”, "I want you to listen to me when I'm talking"

Another example: Telling your child that he can play video games when he's done his homework may cause conflict when you ask him to stop playing. Indeed, he is likely to consider that you are taking away his “hard-earned privileges“. To avoid this, be specific: “you can play for 30 minutes once your homework is done“.

Being clear about your behavioral “priorities” also makes behavior modification easier.

-> What are your top priorities? What can you ignore?

3) Prioritize logical consequences. Consequences can only work if they are age-appropriate and relevant. You won't gain anything with consequences that are too harsh – they only reinforce your child's resentment towards you.

Be clear about your expectations, and even clearer about the consequences. Warn your child, then enforce the consequences: "If I have to ask you one more time to turn the volume down, I'll have to turn off the TV." Of course, the consequences must be applied, otherwise they are useless.

Logical consequences are those that are related to the behavior when possible:

Ride your bike without a helmet - no more cycling for X days

Refuse to eat – no after-hours snacks

To make something dirty deliberately - to clean

4) A journey of a thousand miles begins with a single step. Changing a child's behavior is not easy. Progress often comes in small steps. It's much easier to focus on one specific behavior you want to change, before moving on to another when your goals are achieved.

5) React immediately after specific behavior but without over reacting. Research suggests that when we punish or reward immediately after the specific behavior we want to suppress or reinforce, it increases our chances of success. The child should be aware of the reasons for positive or negative reinforcement.

Hope it will help you.

Gabriel RAFI

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