Children and anxiety: an early intervention program

A team of researchers from Macquarie University has found that early intervention with parents of children at risk of anxiety and related disorders can potentially make the difference in whether a child will go on to develop anxiety-related illnesses later.

According to Dr Ron Rapee, Director of the Centre for Emotional Health at Macquarie University, anxiety disorders are among the most common forms of mental illness in early to middle childhood.

"Developmentally", says Dr Rapee, "the common pattern is for anxiety to precede depression. Depression begins to show a dramatic increase around middle adolescence with children and adolescents who already have an anxiety disorder, at greater risk of developing depression during adolescence and early adulthood."

However, the Macquarie study found that the trajectory can be reversed, with a parent focused intervention at an early stage when children first begin to exhibit characteristics of anxiety. The study also showed that three years after parents received the intervention their children were still showing lower frequency and severity of anxiety disorders.

Dr Ron Rapee talked with KidsLife about child anxiety and the treatment program developed by the Macquarie research team.

What are some of the characteristics seen in children at risk of developing anxiety?

The children that we looked at in this study were very young (preschool age) and are referred to as 'behaviourally inhibited'. They react to new situations by withdrawing and holding back. They are often shy and don't talk very much, especially in new situations or with strangers. And they will often already show lots of fears and worries.

Are there genetic or environmental risks in the development of childhood anxiety?

Both. There is no doubt that genes play a strong role. We often see that one or both parents of anxious children are also inhibited themselves. This does not necessarily mean that they have serious anxiety problems or disorders. Rather the parents may be somewhat shy, tense or be worriers.

But genes are not enough. For these shy and inhibited young children to develop later anxiety disorders, requires certain environmental conditions. This might include aspects of the ways their parents handle them, their experiences with peers, or specific events that happen to them as they are growing up.

What part does parenting play?

We think that parenting is quite important. Inhibited children naturally try and avoid or withdraw from anything that they find the least bit frightening. By withdrawing in this way, they never learn that the situation is actually safe and they can cope with it. Parents who buy into this avoidance and help their children to avoid can actually make the anxiety worse. It is very understandable that a loving parent will want to protect and comfort their child, but under some circumstances, this can increase their fears.

Are children at greater risk of developing anxiety if parents are anxious?

Yes. As we discuss above, anxious children will often have anxious parents. But when a child has both an inhibited temperament and a severely anxious parent, they are at greater risk for developing later problems with anxiety.

Who is the treatment program designed for?

This particular program, discussed here, is actually a type of prevention. It is aimed at parents of preschool aged children who are showing the early signs of anxiety. Many of these children will not go on to develop anxiety problems anyway. But a proportion will. By learning how to better help their child, parents can lessen the chances of their child later developing anxiety problems.

In general terms, what is involved in participating in the program?

Parents attend six group sessions run by a clinical psychologist. They learn specific skills and exercises that they can use with their child to build the child's confidence. They need to practise hard throughout the program, and start to put the new skills into practice throughout the child's life.

Where can parents get more information?

At the moment the program (called Cool Little Kids) is not being run on a regular basis. Mental health professionals can get copies of the manuals to run Cool Little Kids from the Centre for Emotional Health at Macquarie University. Parents who are worried about their child's anxiety should see a qualified mental health professional (such as a clinical psychologist).

A similar program called Creating Confident Kids is being run on a regular basis at Macquarie University in Sydney. The Centre for Emotional Health at Macquarie University also runs regular treatment programs (called Cool Kids) for older children and adolescents suffering anxiety disorders.

For more information: www.emotionalhealthclinic.com.au