DURING the day, Elizabeth Whelan was the perfect child. Eager to please, intelligent, and determined, the then seven-year-old breezed through second class. At night, though, she became fearful and distressed.
"She'd never had problems at bedtime before," remembers her mother Susan. "In the beginning it really didn't trigger any concern, but she became more insistent and she'd get more upset.
"Over a period of weeks it got progressively worse and she would start getting upset if I didn't stay in the room so I started doing it for a couple of minutes. Then she wouldn't go to sleep because she was worried I'd leave.
"By the time we got a month down the track, she was distressed at bedtime and there was nothing I could do. If I stayed she got upset, if I left she got upset. If I let her read for 10 more minutes, she got upset. She seemed to be getting upset in advance."
Initially, Whelan thought it was a matter of her daughter's age and a desire to test boundaries by acting out. Her husband Jason's job as an engineer took him away from home frequently and she thought this could have been a factor. Elizabeth's behaviour steadily became more dramatic. "During the day she was fine, but in a week I'd have three nights where she'd be up to 11 o'clock hysterically crying," says Whelan.
On one particular night, any semblance of normality came crashing down. "I locked myself in my bedroom out of frustration and she was screaming, banging on the door," says Whelan. "It was 10 o'clock at night and I rang a friend who has a son who is autistic. She was the only person I could think of who might have some advice. I didn't know how to deal with Elizabeth's behaviour."
Her friend calmly advised her to do whatever she had to so they could both get to sleep, even if that meant being in the same bed. She urged her to contact the family's GP the next day after getting a good night's sleep.
"It took a couple of days for the appointment and I was all prepared for having to convince my GP," says Whelan. "I was expecting her to say, 'It's a stage, you're making a big deal out of nothing'. Halfway through my explanation, she said, 'Do you want to go and see someone?' I think I may have cried. I was so relieved that someone could see this wasn't just a kid who didn't want to go to bed."
A psychologist diagnosed Elizabeth with anxiety and over six appointments helped her develop coping strategies. Whelan gained valuable insight into what was causing her daughter's distress: the stillness of bedtime meant she was not able to distract herself from worrying.
"A lot of the things she was worried about - when we finally managed to get to it - were things like, 'This friend and that friend aren't talking to one another, I should have helped them more'.
"She was putting a lot of effort into her relationships during the day and then at night she'd fall apart. What was driving her anxiety was trying to be her best and make everyone happy. She was exhausted."
IT is not uncommon for the signs of anxiety to be misinterpreted and misunderstood in children, especially given the complexity of the disorder. Anxiety is a general term for various disorders including generalised anxiety, obsessive compulsive disorder, separation anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder. It is the most common psychological complaint among children (the prevalence among primary school children is 9 per cent and it ranges from 12 to 17 per cent in adolescents).
"Often parents will think that their child is just shy or will grow out of it," says the deputy director of Macquarie University's Centre for Emotional Health, Professor Jennifer Hudson. "To some extent this is the case, but we know now from lots of longitudinal research that anxiety in childhood predicts anxiety in later life.
"It is considered a gateway disorder so if you have it as a child, you are likely to have a range of disorders in adolescence and later in life. Because we have good treatments for children, the idea of 'wait and see' isn't such a good strategy."
Anxiety is a feature of the human condition, but it becomes problematic when it is constant and when fears and worries interfere with a child's everyday activities and relationships and prevent them from enjoying their life.
The signs of anxiety can be physical, such as frequent stomach or back aches, shallow breathing, dizziness and sweating. Children can have difficulty concentrating, and become withdrawn and irritable.
Says Dr Vanessa Cobham from The University of Queensland's school of psychology: "For parents, it's about figuring out that fine line between what's developmentally appropriate and falls within the very broad parameters of normal development and what has moved beyond that to cause significant distress.
"If a 13-year-old can't go on a sleepover or school camp in our culture, that would be considered as quite significant interference in their life. We get concerned when there is also excessive worrying that is causing significant distress and impairment. We're talking about kids who experience uncontrolled worry. They can't distract themselves and can't be distracted. They can't turn their minds off."
Matthew Jespen, who specialises in child, family and adolescent psychology, assists children as young as eight who have been diagnosed with anxiety. "Broadly speaking, there's two ways children respond to stressors in their life - by internalising or acting out," says the Newcastle clinical psychologist. "The signs can be misinterpreted as defiance and aggression, and it's a bit like the chicken or the egg; kids who are acting out could end up being anxious if they're breaking rules and subject to school and family discipline. Other kids act out because they aren't able to express their worries or fears any other way."
Research about the causes of anxiety disorders points to genetic and environmental factors, though a recent study of the intergenerational transmission of anxiety published in American Journal of Psychiatry compared identical and non-identical adolescent twins and found that genes appeared to make little or no difference.
"For both anxiety and neuroticism, the models provide support for significant direct environmental transmission from parents to their offspring," the study concluded. "... Direct environmental transmission is in line with development theories of anxiety suggesting that children and adolescents learn anxious behaviours from their parents through a number of pathways such as modelling".
"We were all a bit surprised by the findings, which are fascinating," says Professor Hudson. "Other twin studies have shown that about 30 per cent of anxiety symptoms are because of genes, which still leaves a lot of room for environmental factors.
"One of the reasons for the findings [published in AJP] could be that the measures used to assess anxiety in adults are quite different to those used for children."
In terms of the increasing prevalence of anxiety among Australian children, there is no "good data" available. "There's definitely anecdotal evidence that the prevalence is increasing," says Hudson, "but is that because we're more comfortable talking about it?"
There is no evidence to suggest that the prevalence of anxiety in adults has increased, either.
But do today's parents worry more? "Again, anecdotally, parents seem to believe the world is a more threatening place," says Hudson. "The evidence shows that children with anxiety are shaped by the environment they are in, which
includes those closest to them."
Dr Cobham believes the cause of anxiety, "whatever way you cut it, isn't all about biology and isn't all about parenting. I think it's a complex interaction of the two."
One factor that is not in dispute is the role parents can play in helping their anxious child. "It's not about blaming parents because they are in a great position to influence the outcomes for their child," adds Cobham.
ELIZABETH Whelan is now a typical teenager. The Merewether High School student's struggle with anxiety is behind her, though her mother is convinced the strategies she learnt at seven continue to be of benefit.
"The most wonderful thing the psychologist did was to give me a way to talk to Elizabeth about what was happening," says Whelan. "I occasionally have to say to her, 'Is this your problem to worry about?' Part of what the GP said was, if this is her nature to be a little bit anxious, we are much better getting professional advice and helping her develop calming strategies when she's seven.
"It's now become part of who she is - to balance this part of her personality and to stop when she's heading down the path of worry. She knows how to take a step back."
When Whelan was at her most desperate, she felt that she was the only parent in her circle to have a child with anxiety. Her predicament has inspired her to write a picture book, Don't Think About Purple Elephants, to help other parents and children, especially at bedtime.
The book is illustrated by Hunter artist Gwynneth Jones and sits neatly alongside Lessons of a LAC (Little Anxiety Creature), another picture book about anxiety by two Newcastle mums - Lynn Jenkins, a clinical psychologist, and illustrator Kirrili Lonergan.
Both books help children feel less alone while dealing with their anxiety, but they help parents, too.
"Since the book was published, it's taken me a little by surprise the number of people who have said, 'my son', 'my best friend's child', 'my niece' - is anxious'," says Whelan. "I had no idea it was so common. When I was going through it, no one talked about it."
Helping to remove any stigma for children and their families can only be a good thing.
"Elizabeth has a friend who is seeing a counsellor now and she is so cruisey about it," observes Whelan. "There's no stigma for her and to me that's another benefit coming through. She can see that sometimes you just need to go an talk to someone who knows how to help and there's nothing wrong with that."
Children and young people experiencing anxiety may display a number of behavioural symptoms including:
* in young children – clinging to parents; tantrums
* refusing to go to school
* withdrawing from friends and family
* avoiding particular objects/situations
* substance misuse
* seeking reassurance
* negativity; pessimism
The following three steps can assist you to help your child with anxiety:
* Encourage them to talk about their anxiety. Share the things that as a child you were anxious about and ask them what their biggest worry is. By modeling your own calm acceptance of anxiety you will be assisting them to remain calm about theirs.
* Teach your child about anxiety and its purpose. Educate yourself about anxiety and its adaptive role in helping humans survive (flight-fight-freeze). Explain the physical changes in the human body when danger is perceived (sweaty hands, blood to extremities, rapid heartbeat, shallow breathing etc.). By explaining these you are helping to normalise anxiety as well as assisting your child to identify and understand the way their own body reacts when anxious.
* Learn to manage your own anxiety, thus role modeling to your child that it can be achieved, which in turn helps reduce their anxieties.
* Encourage good eating (reduce caffeinated, high-sugar drinks and foods), regular exercise, hobbies, sufficient sleep and connection with friends. When young people are well-rested and relaxed, they will be in a better mental state to handle fears or worries.
* Let your children know who they can call on for support if needed. This will make them feel less anxious about the future.
* Visit your GP if you suspect that your child is suffering from an anxiety disorder.
Source: Kids Helpline. For more information see kidshelp.com.au/grownups/news-research/hot-topics/anxiety.php