Question 1

Are levels of anxiety in children and adolescent increasing or are we just more aware and able to see it?

Ronald Rapee · Accepted Answer

This is a really tough question and one that I am unable to answer. It is very hard to compare anxiety levels across eras because detection methods change, measures change, and language changes. There have been a few studies using the same measure over time that suggest some small increases in anxiety. But of course, this might still be due to definitions and language changing so that kids respond differently to the same measure in different years. But there is no doubt that our recognition of anxiety (and other mental health problems) has increased greatly over time, and we are definitely more aware of its existence and importance.

Question 2

How can parents help kids deal with the uncertainty of life right now?

Ronald Rapee · Accepted Answer

The main point is to remember that anxiety is a normal and natural reaction to life’s dangers and uncertainties – so you can’t take it all away. However, you can help kids who are worrying by using some of the questions in answer 2 above – start to help them to look at the facts realistically and logically. And most importantly, listen to their fears, encourage them to express them and don’t judge. Most importantly – never tell them that they, or their worries, are silly.

Question 3

What should you do if kids anxiety seems to manifest as a tummy upset? They are feeling nervous, their tummy feels upset, then they are nervous about being sick, which exacerbates the upset feeling? Are there strategies to short-circuit it?

Ronald Rapee · Accepted Answer

The physical symptoms of anxiety are real – so they shouldn’t be ignored. But they will decrease if a child can move their attention away from them and onto other (interesting) things. So yes, they can be short-circuited by distraction and helping the child to concentrate on something else. But at the end of the day, the tummy aches are telling you that the child has some basic fears and worries, and these should be dealt with through a good anxiety program.

Question 4

What is the best thing for parents to say to a kid who is spiralling with "what if.... x bad thing happens?" thinking?

Ronald Rapee · Accepted Answer

If the child is at least around 7 or 8 years or older, you can begin to encourage them to “look at the facts”. In other words, you can teach them over time to check out their worries by thinking about realistic evidence – they can learn to ask themselves questions like “has it ever happened before”, “do I know other kids who have had this happen – how bad was that for them”; “what would I say to someone else with this thought”; “what are some other possibilities here”.

Question 5

How to help children with anxiety about getting their vaccine shot?

Ronald Rapee · Accepted Answer

It depends on what the anxiety is about – most likely, it will have something to do with a fear of getting a needle. There are some good needle phobia programs around. Mostly, they focus heavily on exposure (see the answer to q. 1) – that is, gradually and systematically, facing the trigger for the fear (i.e., learning gradually to be ok with needles). If the anxiety is about a different trigger (e.g., a fear of getting sick), then the exposure needs to focus on the appropriate trigger.

Question 6

Most of my clients cannot speak. How I can differentiate signs of anxiety and problem behavior, for example, avoidance?

Ronald Rapee · Accepted Answer

Anxious avoidance and “naughty” behaviour can often look quite similar on the surface, but they are motivated by very different aims. Anxious avoidance is motivated by a belief that the world is dangerous and that I will be hurt (or embarrassed) if I face x. Naughty behaviour is motivated by goals and rewards – that is, “by doing x, I will get more reward than if I do y”. The easiest way to discriminate these is by asking – but if you can’t ask (e.g., the child can’t speak, is too young, doesn’t understand), then the therapist needs to make a best guess based on the contexts in which the behaviour occurs. For example, if a child doesn’t want to go to school but they are willing to go to school when their parent goes with them, then that might suggest a fear of being away from the parent. However, if a child doesn’t want to go to school but is happy to go on sports carnival day or when there is a special band playing, then it is more likely a lack of interest in school work.

Question 7

At what age can you start teaching children to manage their anxiety, and what are some of the first strategies to try?

Ronald Rapee · Accepted Answer

The most tried and true method to help people (of all ages) to overcome their fears and anxieties is what we call “exposure”. Quite simply, exposure is a common-sense strategy in which you consistently and systematically encourage the person to face the situations or triggers that they fear. We have used this strategy with children as young as 3 years of age. Our preschool program, Cool Little Kids (https://coollittlekids.org.au/login), is a comprehensive program to help reduce fears and prevent later problems in children from 3-6 years of age – it is primarily centred around exposure.

Question 8

What can help 8-12y old children with social anxiety to develop confidence and build self-esteem?

Ronald Rapee · Accepted Answer

There are good programs to reduce social anxiety in children – mostly focusing on the sorts of strategies I have referred to above – exposure and logical thinking. For example, our program, Cool Kids (https://coolkids.org.au/login), helps children (and their caregivers) to build what we call “stepladders” where they lay out the triggers for their worries in a systematic way and then gradually begin to intentionally face these fears. For example, they might begin by giving a talk to themselves in their room, then move on to giving a talk to their close family, then maybe to family and friends, then to kids in their class and so on. At the same time, we teach a technique called “detective thinking,” where we teach the child ways of “checking out” the evidence for their fears. For example, “will kids really laugh at me if I wear the “wrong” clothes; and even if they do, is that the end of the world” and so on. Generally, over 3-6 months, we see some nice improvements in confidence and self-esteem.

Question 9

Ron, Are we seeing an increase in eco-anxiety and are there any recommended resources that might help?

Ronald Rapee · Accepted Answer

Yes, some of the more recent surveys are telling us that climate fears are becoming one of the top topics of concern for young people. On the one hand, to help your child with excessive fears, see my response above to the question about life’s uncertainties. On the other hand, a little anxiety about climate change is not a bad thing. In Australia, we have a Prime Minister who minimizes the impact of climate change. Some time ago, he was quoted in a newspaper for saying that we should stop talking so much about climate change because we are just increasing children’s anxieties. As an anxiety expert, I wrote to him to say that this is a good thing – people should be worried about climate change – because worry is the only thing that will produce action.

Helping Children Manage Anxiety