It’s not always easy to identify childhood anxiety. In this interview, Dr Marilyn Campbell, a psychologist, teacher and professor at the Queensland University of Technology, says we must consider all behaviours, and avoid assigning premature labels so that children with anxiety are given the right support as early as possible.

What are some of the social misconceptions out there about anxiety?

There are many misconceptions about anxiety in the general population. I think the most problematic one is this idea that anxiety is always ‘bad’. Most people know what anxiety is, but they only ever think of it in negative terms. They don’t realise that we need a certain amount of anxiety to get us through the day. Having no anxiety means we wouldn’t get out of bed in the morning. Too much isn’t good, but none is worse.

I once did some research with some primary school teachers, where we gave them scenarios involving anxious kids and asked which they would refer on to a professional. We found that the teachers would only refer the mild cases of anxiety for a follow-up and none of the serious ones. This was really surprising. We went on to realise that it’s generally not easy to identify anxiety, and teachers are not supposed to be mental health diagnosticians. Kids don’t tend to tell you that they are feeling anxious, so you have to look at their behaviours – that’s all you can do – and form a holistic picture of the child.

What kind of behaviours might indicate childhood anxiety?

Most people think all anxious children are shy and retiring. This is just not true. People with anxiety are just as likely to have dominant, big personalities and, in fact, looking at behaviours as ‘internalising’ or ‘externalising’ probably isn’t that helpful as there are just so many ways kids can behave. If a child is forced to swim, for instance, they can have a tantrum because they are either genuinely fearful of the water or because they are willful and don’t feel like it. You need to look at the entire picture of behaviour and what that’s telling you before assigning labels.

I find that people are very quick to label a child with Attention Deficit Disorder (ADD) or Autism Spectrum Disorder (ASD) first, and not consider anxiety. Procrastination, looking out the window, not concentrating in class etcetera can just as easily indicate anxiety. I have a feeling that some kids who are labelled with ADD could really be anxious. With primary teachers, I like to encourage them to watch all their kids, especially the ‘good’ ones in their class that they might not think about - there might be clues in perfectionistic behaviour or how they take criticism.

Do you have an example of a child being prematurely or incorrectly labelled?

Yes. I once had a client in Year Five who was getting into all sorts of trouble at school. Punishments weren’t working and it was thought he might have ADD. So, I played with him – which you need to do with kids, especially boys, and let them lead – and spent time with him over several weeks. One day, I tried reading him one of my books on separation disorder, Cilla the Worried Gorilla. Well, he got really upset and stormed out of the room! I eventually diagnosed him with having separation anxiety and no one believed me! But, after consulting with the child’s parents, it emerged that he was really worried his dad, who worked as a courier, would be killed on the job.

Are there any gender differences when it comes to childhood anxiety?

There are many more girls diagnosed with an anxiety disorder than boys. I think this could be because it’s more socially-acceptable for females to talk about their feelings and emotions and they are more likely to speak up about any issues. However, most kids who are taken to clinicians are boys. I wonder if boys aren’t admitting there is a problem because they don’t want to be seen as ‘wimps’ and are trying to protect themselves and not give in. Generally, though, adults are more worried about anxious boys than girls.     

What part does over-protective parenting play in the incidence of childhood anxiety?

I would say quite a big part. Parents who have an anxiety disorder are often inadvertently overly-protective of their children. We know anxiety disorders are familial, and quite likely genetic, so this kind of parent will have a huge impact on how their child sees the world (ie that it is a fearful place).

Parents who tend to be over-protective can ‘over-help’ their kids and often don’t realise they are doing it. Say, if a parent says, “Let me tie your shoelaces,” their child might think, “I must be stupid because mum thinks I can’t tie my shoelaces.” This sends a message of doubt, which the child takes on board. The child starts to believe they can’t be effective and, eventually, becomes distressed until a parent steps in. It becomes a vicious cycle. Parents with anxiety can’t stand to see their child distressed, but kids need to be distressed to develop resilience. They also need to be encouraged to independently problem-solve.

Another way parents can inadvertently send fear and doubt-based messages is in over-controlling their children. Parents who often worry that their child will be kidnapped if they’re out of their sight might not let them walk to school, play with friends at the park, or go anywhere unsupervised.

What are the most common childhood anxiety disorders and how easily are they recognised?

A specific phobia (say, a fear of the dark, of snakes, or of heights) is one of the most common childhood anxiety disorders. Generalised Anxiety Disorders are also really prevalent - that’s when kids worry about everything. Then there’s social phobia, when a child worries about how they seem to their peers and to adults and they get concerned about receiving any negative evaluation. I don’t find categorising anxiety in children to be terribly helpful, though, as the diagnostic overlap and incidence of comorbidity is extreme.

The big problem for people is recognising when a child’s ‘normal’ anxiety becomes disordered into excessive anxiety and doing something about it. The younger a child, the harder it is to recognise anxiety, as young children are normally more fearful. It would have to be fairly extreme anxiety to be picked up in early childhood. The older the child is, the more likely it is that severe anxiety will be recognised. It’s often not noticed until a parent or supervising adult realizes the child hasn’t grown out of it, which is why early intervention is always so much better.

See Dr Marilyn Campbell's range of books on anxiety written for children, families and teachers.

You may also like to refer to the KidsMatter family information sheets on anxiety