Dr Andrés Fonseca is a consultant psychiatrist with 16 years of clinical experience. He holds an MSc in psychiatric research methodology from UCL and is honorary lecturer at UCL (division of psychiatry) and University of Roehampton (psychology department). He is co-founder and CEO of Thrive, a company that develops software to improve mental health combining computerised cognitive behavioural therapy and other eTherapy techniques with games and game dynamics to enhance engagement. Here is one of Dr Fonseca’s recent articles on anxiety in pre-schoolers. I hope it helps in your understanding of the children in your care.
Most people think that younger children can’t have anxiety. They think that because children do not have much of a life experience, what do they have to be anxious about? The truth is very different. Almost 20% of pre-schoolers (aged 3 to 4) have an anxiety condition. Anxiety can be linked with depression and problems with behaviour and sleeping. Due to this, it is important to treat the condition as early as possible. A study published in the ‘Journal of Clinical Child and Adolescent Psychology’ explores diagnosis of anxiety in pre-schoolers using structured interviews. This included both the pre-schoolers and their parents. The authors, led by Lea Dougherty from University of Maryland College Park, looked at whether there was an anxiety disorder or not and then they looked at what other things might be linked to there being a diagnosis of anxiety.
The structured interview was designed to collect information ranging from parenting techniques to family history of mental health conditions. It was also designed to screen for anxiety disorders in this group of children. Using this data Lea and her team explored the links between certain factors and anxiety disorders in pre-schoolers. The interviews could detect the presence of any anxiety disorder, ranging from separation anxiety disorder to selective mutism which alters communication in certain social settings. The interviews could also diagnose Obsessive Compulsive Disorder (a condition where the child has intrusive thoughts, repetitive, unwanted thoughts). The interviewers also screened for Attention Deficit Hyperactivity Disorder. ADHD is made up of problems focusing and directing attention and hyperactivity. The interviews also assessed 41 events that could be traumatic for a child, including sleep related problems such as nightmares. Only the parents were interviewed using the structured schedule.
The pre-schoolers took part in a two-hour study using various scenarios designed to detect if the child has an anxious disposition or not. The researchers prompt the child to show a range of emotion and behaviours through these scenarios. The study included leaving the participants in a room with a stranger and playing with new, exciting toys. The episodes were each recorded through a one-way mirror for later coding. Coding is the process of labelling the observations made by the researchers so that the data can be compared and analyzed.
Over 90% of the parents and preschool participants returned for another lab session. This was to assess child and parent interaction. This included six tasks ranging from book reading to block building. Over 400 mothers and 400 fathers also completed a questionnaire based on parenting style.
Lea and her colleagues interviewed 541 three to four-year-old children and their parents. From this group, 106 of them (19.6%) had an anxiety disorder. Pre-schoolers with anxiety disorders were more likely to have depression, sleep problems, behavioural issues and Oppositional Defiant Disorder. ODD is a condition which is diagnosed in children showing defiant and disobedient behaviour for longer than six months. Lea and her team found that children with and without anxiety disorders were not different in terms of age, gender, ethnicity and parental marriage status. This suggests that these factors do not play a key part in whether the child will have anxiety. Children with anxiety were also more prone to sadness.
In terms of parenting, those parents who had children with an anxiety disorder were seen to be less supportive. This is compared to the parents of children with no anxiety disorder. Lea and her team also showed that the children with anxiety were more likely to have been through more stress in the previous 6 months. Of all the children who had an anxiety disorder, 32 of them had a phobia, 57 had anxiety with no specific phobia and 17 of them had both an anxiety disorder and a phobia. There were five main factors which Lea and her team thought contributed to anxiety in pre-schoolers: childhood depression, sleep problems, time spent in day care, stressful life events and behaviour problems. Based on this study the way we parent our children can go a long way in protecting them from anxiety disorders. Supportive parenting can improve emotional wellbeing and help them to manage their behaviour.
Children aged 3 – 4 years of age can have serious anxiety. If left untreated, some anxiety disorders can worsen. Behavioural, sleep problems and depression can also affect these young kids if anxiety is not managed. Hopefully by being aware that anxiety can seriously affect children and that it can have bad consequences we can start taking steps to prevent it.
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