The first things you notice about Jordan* are her stunning green eyes, broad smile and self-assured manner. By any standard, she is an attractive and engaging 15-year-old. So it comes as some surprise to discover that this popular and accomplished teenager (A-team hockey, orchestra, drama – get the picture?) had two panic attacks at school last term.
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Fortunately, Jordan’s 17-year-old brother attends the same prestigious high school in Cape Town and, with a breathing routine taught to him by the psychologist Jordan has been seeing for the past five months, he was able to help calm his sister. During a previous incident earlier in the year when the attack was more severe, Jordan had to be taken to her doctor.
This scenario may sound extreme and parents with no experience of anxiety might imagine it’s rare. But panic attacks like those experienced by Jordan, alongside what is clinically termed generalised anxiety disorder, are all too common in our schools and, indeed, our homes. What is equally surprising is that it’s not just teenagers navigating the turbulent waters of adolescence who are victims of anxiety disorders.
Children as young as five are suffering to such an extent that it impacts normal functioning. Today, according to the South African Depression and Anxiety Group, as many as eight percent to 11% of children and adolescents suffer from an anxiety disorder that affects their ability to get on with their lives. Indeed, adults are not immune. Anxiety has overtaken depression as the most common mental-health condition. If you don’t suffer yourself, you’ll probably know more than a few people who do.
While Gauteng child and adolescent psychiatrist Dr Helen Clark says there is a considerable increase in the number of young people experiencing anxiety, she says children have always suffered but in the past it was under-diagnosed. ‘Adults simply didn’t expect children to be anxious and dismissed it. We think of children as happy little people who run around and play, and who are not aware of, or troubled by, the stressors affecting adults,’ says Clark.
Sadly, this is both outdated and unrealistic. ‘Children live in the same world that we do and it is a very stressed world,’ she says. It is a place – South Africans are acutely aware – where children are exposed to horrific levels of violence, crime, hate, abuse, economic hardship, unemployment, and political and social instability. Before social media and 24-hour television, it may have been possible to shelter children from some of the world’s cruel realities. Today, that’s impossible. Children cannot ignore such stressors any more than we can, says Clark.
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Global crisis
But while we may feel South African children have it tougher than in other countries, they are not alone. Children’s anxiety levels are skyrocketing globally. The UK’s Childline service, which is run by the National Society for the Prevention of Cruelty to Children, received 35% more calls in 2017 than in the previous year. Many of those calls were from children expressing anxiety about global affairs, including Brexit, the US leadership and the conflict in Syria.
The Anxiety and Depression Association of America reports that 25,1% of children between the ages of 13 and 18 suffer from anxiety disorders. The numbers are similar elsewhere. Added to these external stressors, 21st-century children also experience unprecedented pressure to perform. Never has it seemed so necessary to get an 80+% aggregate, to be head of a school society or leader of the latest volunteer project. Children experience pressure in the classroom, on the sports field, in extra murals and, perhaps most critically, socially.
Today, it’s all too visible if you are not in one of the popular crowds, if your name is absent from a WhatsApp party invite or if you have only a handful of ‘followers’. A young person doesn’t need to be experiencing cyberbullying to feel the pointed end of social media’s sharp talons. Today, the rejection, cruelty and, among girls in particular, hardened bitchiness that takes place on social media is unlike anything previous generations had to contend with.
By any standards, South Africa is a tough, competitive nation. For those kids with the resilience to handle it, the environment can be motivating. For the less self-assured, especially those with a genetic predisposition who are pushed by parents, family, friends, teachers and, indeed, by themselves, to attain exceptional levels of achievement, they can hit emotional breaking point.
Being aware
But how do we know if our child is suffering from normal worries or a clinical anxiety disorder? When does clinging, avoidant behaviour develop into separation anxiety disorder? When do a teenager’s worries about future events and her actions in the past become general anxiety disorder? Children can develop fears and phobias at any age, but they are particularly common during early childhood and later on in puberty.
It’s only natural for children and young people to feel worried sometimes, but when they are plagued by constant fears that result in panic attacks, making them not want to leave the house, we need to provide support, says Clark. So how do we help our kids? According to mental-health professionals, the first step lies at home. The goal is to equip our children with the fortitude and resilience to survive in this modern world. And we need to begin early in childhood. This, hard though it is to hear, is not currently happening as it needs to.
Unsurprisingly, it is as a result of the modern world. ‘The family and parents are supposed to be present to nurture and protect their children, but the reality is that the family as an institution is disintegrating,’ says Clark. ‘The family can no longer protect its children.’ Think separation, divorce, single-parent families, long commutes, domestic conflict and violence, geographical dislocation, death, both parents working….
‘Parents are so busy trying to provide the basics – food, clothes, a roof over their head and school fees – that they don’t have time to realise that their children are distressed,’ says Clark. Michelle Schoon, founder of the Kids Who Can Community (see below), says she feels that parents – and teachers – fail to understand the importance of emotional intelligence. ‘We live in a society where caring parents will go to extraordinary lengths to develop their children’s intellectual abilities and spend a small fortune on all kinds of extracurricular activities. But what about preparing our children for coping with life itself? We need to teach them how to handle conflict, sadness and stress too.’ Schoon says parents must be aware of what children are feeling, must be connected and must spend enough time with them so that they see the signs of anxiety. ‘If you believe your child is experiencing stress, first and foremost teach your child to calm down. Teach them to breathe deeply and slowly. Then assess what is going on in their lives that may have caused this anxiety.
Has there been any change? Even the slightest change, like a new teacher, can cause anxiety. Are they being bullied? Most of all, acknowledge how your child is feeling and show your support by asking them to share how they are feeling and where in their bodies they feel it, and then see if they are able to explain why.’ According to educational psychologist Julie-Anne Roberts, it’s common for children with anxiety disorders to be experiencing problems in the home setting.
‘Continual fighting between parents, recent parental divorce or parental illnesses are all factors that provoke anxiety in children,’ she says. ‘Parents need to work on modelling a calm approach in their own lives, and setting a good example for their children,’ she says. Our children depend on us for emotional support and guidance, and are greatly influenced by ‘parental inadequacies’. If we establish faulty communication with our children, for example constantly seeking reassurance from them or using excessive threats to control them, damaging patterns and anxious emotions can be reinforced, she says.
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Giving support
Where possible, the most crucial aspect in the management of anxiety is to identify and deal with the cause. This is, all too frequently, very difficult to address, says Clark. Sometimes, intervention by a parent is simply not enough and it is necessary to enlist help. This could be a teacher, nurse or a mental-health professional such as a psychologist, social worker or psychiatrist. The idea is to give the child the space to address their anxiety and work through ways to develop coping skills and a sense of mastery over their distress. Sometimes, parents and other family members receive counselling too.
They can learn how to create a safe space for the child, and organise the dynamics in the home to make them structured and predictable. In older children, exposure techniques, social-skills training, relaxation therapy and Cognitive Behavioural Therapy can all work well to relieve anxiety. Whereas older children and adolescents can talk to a therapist, young children do this through play therapy. Medication is never a first-line intervention in the management of anxiety in children, says Clark.
Conservative measures should always be attempted first. Medication is considered when other interventions are not, or are only partially, effective or where the symptoms of anxiety are particularly severe and interfere with the overall functioning of the child. ‘It may also be considered if the child is beginning to develop an associated depressive picture,’ says Clark. Medication is registered for children over the age of six and the most commonly prescribed are the selective serotonin reuptake inhibitors, which are generally well tolerated, says Clark.
Sadly, in a country like SA, where resources like psychologists are few in all but the most affluent settings, often the only treatment children have access to is medication prescribed by state services. Most children have no access to mental-health services. In the end, the responsibility to help our kids lies with parents and teachers. We often only realise how serious a child’s anxiety is when, like Jordan, the child has a panic attack at school, by which time the anxiety is externalised and the child feels different and set apart.
Social worker Jackie Opperman believes that today it is not unrealistic for schools to assume all children experience anxiety issues. ‘They should handle classes accordingly with simple basic exercises that are fun but could make the world of difference, including deep breathing, drawing feelings and five-minute meditation. Children are very open to this. It’s we adults who judge.’
* Name has been changed
Important numbers
1. The South African Depression and Anxiety Group (SADAG) has a counselling line for parents and teachers, daily from 8am to 8pm. Call 011 234 4837.
2. Childline South Africa has a toll-free line for children and adults to call anytime. Call 080 005 5555.
Know the signs
Children with anxiety disorders often display specific behaviour:
Panic Disorder (PD)
Children feel terror suddenly and unpredictably. Panic-attack symptoms include rapid pulse, chest pains, shortness of breath, dizziness, nausea, numbness, trembling and a fear of going crazy or dying. PD is the most common and best understood of the anxiety disorders.
Social Phobia
Children become extremely upset, embarrassed and timid in the presence of strangers. They often cry, throw tantrums, freeze or withdraw.
Generalised Anxiety Disorder (GAD)
Children with GAD tend to be very self-conscious and worry about future events, possible injuries, group activities and past behaviour. They often become preoccupied with their competence in various tasks and other people’s opinions of their performance. They worry about meeting expectations and deadlines.
Agoraphobia
Intense anxiety about using public transport, being in open spaces, being in enclosed spaces, being in a crowd or being alone outside of home.
Separation Anxiety Disorder (SAD)
Children experience excessive anxiety, even panic, when they are separated from home or a parent. They often fear they will get lost or that their parent will have an accident. SAD can be accompanied by headaches or nausea. Separation anxiety disorder sometimes takes the form of school phobia or refusal to attend.
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How to help at home
Michelle Schoon, founder of the Kids Who Can Community, offers this advice:
1. Make talking about feelings part of your daily routine.
2. Replay a situation that may have caused your child stress to find solutions to better respond to a similar situation in the future.
3. Guide them, but allow your children to find their own solutions when it comes to conflict.
4. Telling your child not to worry doesn’t help. Allow your child to worry openly, in limited doses. Create a daily ritual called ‘Worry Time’ that lasts 10 to 15 minutes. During this time, encourage your child to release their worries in writing.
5. Create a step-by-step check list to calm down. What should your child do when they first feel anxiety coming on? If breathing helps, the first step is to pause and breathe. Next, evaluate the situation. In the end, create a hard-copy check list for your child to refer to when they feel anxious.
6. Practise self-compassion. Let go of debilitating self-criticism and forgive yourself. You are your child’s champion and can help them overcome their anxiety.
Kids Who Can
Mother of three sons Michelle Schoon founded the Kids Who Can Community (www.kidswhocancommunity.co.za) in Cape Town in 2011. Facilitators run practical courses and workshops for children to empower them to create their own healthy, calm and joyful lives.
‘Our aim is to provide children with a safe, fun space to learn about themselves, what they like and dislike, and how they feel about things, and to learn how to manage what life throws at them in a healthy, effective way. Each lesson is structured in the same way so that the children enjoy the comfort of knowing what to expect as they become familiar with the class format. Repetition and practice ensure that the empowering techniques of affirmations, visualisations and breathing are integrated into their lives.’
‘The group dynamic supports children to feel more comfortable sharing their feelings. Listening to others helps them feel safe and know that they are not the only ones feeling this way. We teach tools and techniques such as belly breathing, visualisation and positive thinking. These are tools they can use for the rest of their lives.’
PHOTO: iStock/skynesher
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