Supporting parents of pre-teen children with mild-to-moderate anxiety

What is this resource about?

This practice guide provides information about anxiety in the pre-teen years (9-12 years). It aims to help practitioners in generalist services to better support parents who have a child experiencing mild-moderate anxiety.

For the purposes of this guide, pre-teens are defined as aged between 9-12 years, although slightly older or younger children may also face challenges that are relevant to this age group (e.g. early puberty). Parents are defined as a person undertaking the role of parenting and includes caregivers (e.g. grandparents, foster carers, kinship carers).

The resource covers:

• What is anxiety?
• What is happening for pre-teens?
• What are the signs of anxiety?
• What does anxiety involve?
• Is this ‘just a phase’ or are support services needed?
• How can practitioners support a parent caring for a pre-teen with anxiety?
• When and how can practitioners make effective referrals to a mental health service?
• How can parents support a child experiencing anxiety?

Who is this resource for?

This resource is for practitioners working with the parents of pre-teens who may be experiencing mild-moderate levels of anxiety. Practitioners may work in adult-focused agencies such as welfare, family support, health, drug and alcohol services, or other relevant services (e.g. GPs and paediatricians). These services can play a significant role in promoting children’s wellbeing and health by supporting parents in their parenting.

The two parent guides attached to this resource (Gathering information about your child’s experience of anxiety and Supporting your child) include specific strategies that can be employed by parents to identify and support mild-moderate anxiety.

If the parent (or child) tells you that the child:

• has experienced child abuse
• has experienced bullying
• is currently thinking or has recently had thoughts of ending their life or hurting themselves
• is currently or has previously attempted to harm themselves or other people
• has experienced a traumatic event

refer to your agency’s mandatory report guidelines, talk to your supervisor and/or refer this family to a child mental health service. If the child is in immediate danger, contact emergency services on 000.

What is anxiety?

Anxiety is our body’s natural response to a potential stress or threat. Anxiety can be useful – for example, someone feeling anxious about missing an early morning flight might pack their bag the night before and set an early alarm to avoid missing their flight.

There are also times when feeling anxious can protect us from danger. For example, when someone notices a snake nearby, feeling anxious will mean that they move far away from the snake to protect themselves.

Experiencing anxiety every now and again is a normal part of the human experience and most of the time these feelings come and go, and do not last long. Anxiety becomes a problem when it impacts on our wellbeing and prevents us from doing things that are important to us.

Children also experience anxiety. When children have worries that don’t go away, get worse or interfere with their daily life, it could be a sign of anxiety. Children may experience anxiety about different things as they develop. Young children may be anxious about separating from their parents and spending time with unfamiliar people. In the early school years, children may feel anxious about the dark, animals, monsters and ghosts.

There are a number of significant changes in a pre-teen’s life that can cause anxiety, such as primary to secondary school transition and the physical changes associated with puberty. While most children will adapt and cope well with these feelings, for others the experience is distressing and has significant impact on their wellbeing and that of their family. The way parents, and the services around families, respond to and support pre-teens with anxiety can make a positive difference for these children.

The pre-teen years have historically been considered a ‘latent’ period or a quiet time for development. Recent research, however, has drawn attention to the many physical, neurodevelopment and social changes that occur in these years (Evans-Whipp, Mundy, Canterford & Patton, 2017). Successful navigation of these changes, both by parents and children, positively influences later wellbeing.

Physical changes

Physical development at this age is highly variable. We often think of puberty as beginning with outwardly physical signs, such as breast development and growth of body hair. In fact, recent evidence points to puberty beginning as early as 6-8 years with the onset of the first, less visible pubertal processes (Dorn & Biro, 2011). The pubertal transition can result in increased body dissatisfaction in both males and females, especially those who mature earlier than their peers. Brain development is also highly active at this age, with a rapid period of reorganisation in the years leading up to adolescence (Hughes, Mundy, Romaniuk, Sawyer, Wake, Williams et al, 2018).

Primary to secondary school transition

Wellbeing in the middle years matters for learning and school engagement. Approximately 1 in 8 Year 7 students find the transition to secondary school difficult, in terms of academic studies, peer and teacher relationships and daily routines (Evans-Whipp et al, 2017). Children report that making new friends and missing old ones are the most difficult aspects of transition, and those prone to anxiety or worry are also at greater risk (Maguire & Yu, 2014). Parents report less confidence in managing the primary to secondary school transition than the transition from home/child-care into primary school (Wade, Almendingen & Robinson, 2019).

The transition from primary to secondary school usually means an adjustment from smaller, caring school environments with few teachers, to large and relatively impersonal ones with multiple teachers. This can create a developmental mismatch at a time when relationships with close, supportive adults are needed (Luthar & Ciciolla, 2016). The secondary school environment is also tailored to a student’s independence and personal responsibility, which may be confronting to parents who have been active participants in the primary school community.

Changes in family relationships

The pre-teen years herald a shift from dependent relationships with parents to an increasing desire for separation and individuation (Luthar & Ciciolla, 2016). Research suggests that this is the most challenging time for mothers as well, with maternal distress peaking and wellbeing reaching its lowest point when children are in the pre-teen phase. This is especially the case if parents are unfamiliar with developmental changes for this age group (Luthar & Ciciolla, 2016).

Pre-teens spend an increasing amount of time with peers and engaging in social events outside of the home, but parents are not replaced by peers. They continue to play a key role in guidance, advice, physical support and nurturing well into the young adult years (Vassallo, Smart & Price-Robertson, 2009).

Changes in social relationships

During the pre-teen years, children start to become highly concerned about their status in relation to peers (Luthar & Ciciolla, 2016) and interactions become more complex. Friendships are important but they can also be a source of anxiety and stress, and friendship instability is common in early adolescence (Poulin & Chan, 2010). School transition may involve the separation of friendship groups if children attend different schools.

Bullying is also highly prevalent in this age group – around 1 in 6 children aged 8-14 report at least one form of bullying weekly (Redmond et al, 2016). Exposure to bullying has a direct impact on children’s mental health (Singham, Viding & Schoeler, 2017).

Increasing use of technology

The use of devices in childhood is seen by parents as an increasing problem as their children become older. In a recent Victorian study, just over half of parents with 10-12 year old children felt they spend too much time on electronic devices, compared to just over a third for 6-9 year old children, and parents were moderately less likely to monitor or limit use (Wade, Almendingen & Robinson, 2019).

Social media use increases in the pre-teen years. One in six primary school-aged children have at least one social media account, and 1 in 8 use social media almost every day (Rhodes, 2017). Increasing use of social media brings both positives (e.g. feeling more connected to friends, more diverse friendships) and negatives (e.g. overwhelmed by the drama, pressure to look good to others, cyberbullying) (Anderson & Jiang, 2018). While prevalence of cyberbullying is difficult to determine, estimates indicate approximately 1 in 5 children have experienced it (Rhodes, 2017; Spears et al., 2014). Cyberbullying, like offline bullying, is associated with many mental health problems for children, including anxiety, depression and suicidal behaviours (Elgar, Napoletano, Saul, Dirks, Craig, Poteat et al., 2014).

Increasing awareness of and exposure to adverse events

As a result of cognitive growth and greater exposure to global issues via technology, pre-teens become increasingly aware of events both in their local and national (e.g. homelessness) and global communities (e.g. effects of climate change). Exposure to extreme weather events (e.g. drought) and the family stress and displacement that often accompany them, can increase children’s risk of mental health problems such as anxiety, depression and sleep disorders (Burke, Sanson & Van Hoorn, 2018). In-depth interviews with 10-12-year-olds in the US showed that more than 80% expressed strong feelings of fear, sadness and anger when discussing environmental problems (Strife, 2012).

How common is anxiety in pre-teens?

It is difficult to know the prevalence of anxiety in childhood. There is limited data, particularly on a national level. The 2015 Young Minds Matter survey on the national prevalence of mental health difficulties in children showed that of those aged 4-17 years, 7% of boys and 6.8% of girls had experienced an anxiety disorder in the previous 12 months (Lawrence, Johnson, Hafekost et. al., 2015). However, there is little insight regarding the prevalence of mild-moderate anxiety other than anecdotal evidence.

Studies show that some individuals inherit a temperament that makes them vulnerable to anxiety in later years. In one study, infants classified as ‘highly reactive’ (showing a combination of vigorous, frequent motor activity and frequent crying) were more than twice as likely to show anxious symptoms at 11 years old than those classified as ‘low reactive’ (infrequent motor activity, minimal crying) (Kagan, 2002). In other words, children who are prone to anxiety in later years may show indicative signs in infancy.

Summary

The combination of prevalence, developmental and psychosocial changes in the pre-teen years means that there is a rationale for greater awareness of and improved responses to anxiety signs and symptoms. Where anxiety is mild-moderate, there are simple strategies that universal services can adopt to support a child and their parent/s. This guide outlines these strategies.

When we experience anxiety, our body, feelings, actions and thoughts are affected. Pre-teens experience anxiety in a range of ways and at first it can be hard for adults to recognise anxiety in children of this age. Learning about how a child experiences anxiety will give their parents clues as to ways they can support their child, as well as when additional help may be needed.

The boxes below provide some examples of how children may experience and show anxiety.

How we think about an event, situation, person or object significantly influences our emotional experience and how we act. The image below illustrates how our thoughts, feelings, physical sensations and actions are linked to the experience of anxiety.

Example 1: Components of anxiety

Example 2: Peer group example

Example 3: Academic example

Anxiety occurs across a long continuum, from occasional ‘butterflies’ before a test, to feelings of panic which can be recurring and disabling. Even though most pre-teens who experience mild or occasional anxiety or worry will not need to see a mental health professional, parents’ responses to their child’s anxiety can make a big difference. Support and guidance from parents early on may mean that their child will not need to see a mental health professional in the future.

For children whose anxiety is significantly impacting their relationships, school achievement, wellbeing, and/or family functioning, seeking specialist support may be necessary. Learning more about the child’s experience of anxiety helps practitioners to decide when support from a mental health professional may be required.

This next section covers what practitioners can do or say with parents to gain a better understanding of their child’s experience, before deciding what action to take.

It’s important to gather information about the child’s experience of anxiety before making any decisions about the type of support. This information will help the practitioner and the parent to work through the decision tree in the next section. It’s important to ask questions about the:

• frequency
• intensity
• duration
• level of avoidance
• impact on the child.

Example questions practitioners can ask parents include:

• “Can you describe for me what happens when your child is feeling anxious? What sorts of things do they say or do?”
• “How often does your child get anxious?”
• “Do you think your child’s worries or fears are stopping them from pursuing activities or interests that they enjoy, spending time with their friends, going to school, or doing things as a family?”
• “If you were to rate the intensity of your child’s experience of anxiety on a scale of 0–10, with 0 being calm and relaxed with no anxiety, and 10 being terrified, how would you rate your child’s usual experience?”
• “How long does it take for your child to feel calm again after feeling anxious?”
• “How long has your child experienced anxiety?”
• “Do you know of any other children your child’s age who have similar experiences?”

It is important for children to share their experience of anxiety. Some parents may benefit from guidance about how to have these conversations with their child. You could say something like:

“Sounds like we need to get a better understanding of what’s happening for Ricky when he’s feeling anxious. I’ve got a handout here which outlines some tips about how you, or you and I together could get a better understanding from Ricky. Would you be interested in us working through this together?”

Related resource: Parent Guide 1: Gathering information about your child’s experience of anxiety

What do you do now?

Once you and the parent have an understanding of the child’s experience of anxiety, use the decision tree as a guide for what to do next.

This decision tree covers:

• when this resource is helpful for practitioners to gain an understanding of what is happening for the child, but no further action is required at that moment
• when this resource is helpful for practitioners in supporting a child with mild-moderate anxiety
• when parents should seek a GP referral to a mental health professional.

It should be worked through in collaboration with the parent.

Download printable version.

You do not need to be an expert in parenting or anxiety to help a client whose pre-teen is experiencing anxiety. By building a trusting, collaborative relationship and familiarising yourself with the information in this guide, you can make a positive impact. This section covers some ways that practitioners can:

• invite a parent into a conversation about anxiety
• explore the impact of anxiety on the child and the family
• understand how parents have been supporting their child
• offer strategies for how a parent may be able to help their child (see Parent Guide 2: Supporting your child for information)
• provide support to the parent.

What if parent anxiety is contributing to child anxiety?

It’s not uncommon for parents to be experiencing anxiety at the same time as their children. When parents are anxious around their children, it’s usually about the parent seeking to control the environment or situation in an effort to protect their children and to keep them safe.

By working with parents to understand how anxiety works, they may gain greater insight into their own experience, as well as that of their child. In some cases, parents reducing their anxiety response and demonstrating positive coping strategies may be important factors in reducing their child’s own experience of anxiety.

If the parent is experiencing a consistently high level of anxiety, a referral to mental health professional is advised.

What to do if child anxiety is contributing to parent anxiety

Children who experience anxiety can develop very convincing reasons why they should not do the things that they are anxious about. This can lead parents and other family members to feel anxious about those situations too, and then avoid doing those things that are anxiety-provoking. Over time, this increases child anxiety as they do not learn how to cope in those situations.

It is important for parents to keep encouraging and supporting their child’s gradual efforts to do the activities they feel anxious about. If the parent is experiencing a consistently high level of anxiety themselves, a referral to a mental health professional is advised.

Some children and parents may need mental health support due to their unique circumstances and the nature and level of anxiety. In these situations, your role is to support the family to engage with another service. The decision tree you saw earlier steps through some scenarios of when it’s important to refer to a specialist mental health provider. Here are some additional tips:

1. 1. Inform the family early on that you can provide some information and suggestions about anxiety, but that if their child is experiencing high or distressing levels of anxiety, they should seek advice from a mental health professional.
   2. If you feel that the family’s needs are outside of your professional expertise and it’s not possible to have regular supervision, refer the family to another service.
   3. Provide options to the family so they can decide the course of action that best suits them. Options include seeking a referral to a psychologist via their GP; referral to a psychologist at their school (some schools have visiting psychologists); contacting their local community health centre; or accessing services through Headspace (if the child is aged 12 or over).
   4. When sharing information or options with parents, ensure it is evidence-based. Helpful and reliable websites include Beyondblue, Raising Children Network, Headspace and ReachOut. A full list of resources can be found at the end of this guide.
   5. Family circumstances can change quickly. As you build a trusting relationship with a parent, they may share more information with you. If you have a reasonable belief that the parent or child are at risk of harm, seek guidance from a supervisor and follow your agency’s policies regarding mandatory notification to child protection, the police, child mental health services or adult mental health services.

References

Anderson, M. & Jiang, J. (2018). Teens’ social media habits and experiences. Retrieved from: https://www.pewinternet.org/2018/11/28/teens-social-media-habits-and-experiences/

Burke, S., Sanson, A. & Van Hoorn, J. (2018). The psychological effects of climate change on children. Current Psychiatry Reports, 20(35). Retrieved from: https://doi.org/10.1007/s11920-018-0896-9

Burns, J., Davenport, T., Durkin, L., Luscombe, G. & Hickie, I. (2010). The internet as a setting for mental health service utilisation by young people. Medical Journal of Australia, 192(1), 22.

Cohen, L. (2013). The opposite of worry: the playful parenting approach to childhood anxieties and fears. New York: Ballantine Books.

Dorn, L. & Biro, F. (2011). Puberty and its measurement: A decade in review. Journal of Research on Adolescence, 21, 180-195.

Elgar, F., Napoletano, A., Saul, G., Dirks, M., Craig, W., Poteat, V. et al. (2014). Cyberbullying victimization and mental health in adolescents and the moderating role of family dinners. JAMA Pediatrics, 168(11), 1015.

Evans-Whipp, T., Mundy., Canterford, L. & Patton, G. (2017). Student wellbeing, engagement and learning across the middle years. Retrieved from: https://docs.education.gov.au/system/files/doc/other/middleyearswellbeing_with_isbn.pdf

Hughes, E., Mundy, L., Romaniuk, H., Sawyer, S., Wake, M., Williams, J., Olds, T., Allen, N. & Patton, G. (2018). Body image dissatisfaction and the adrenarchal transition. Journal of Adolescent Health (online). Retrieved from: https://doi.org/10.1016/j.jadohealth.2018.05.025

Kagan, J. (2002). Childhood predictors of states of anxiety. Dialogues in Clinical Neuroscience, 4(3), 287-293.

Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M., Ainley, J., & Zubrick, S.R. (2015). The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra: Department of Health. Retrieved from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/$File/child2.pdf

Luthar, S. & Ciciolla, L. (2016). What it feels like to be a mother: Variations by children’s developmental stages. Developmental Psychology, 52(1), 143-154.

Maguire, B. & Yu, M. (2014). Transition to secondary school. In The Longitudinal Study of Australian Children: Annual statistical report 2014. Retrieved from: https://growingupinaustralia.gov.au/sites/default/files/asr2014.pdf

Poulin, F. & Chan, A. (2010). Friendship stability and change in childhood and adolescence. Developmental Review, 30, 257-272.

Rapee, R., Wignall, A., Spence, S., Cobham, V., & Lyneham, H. (2008). Helping your anxious child: A step-by-step guide for parents (second edition). Oakland: New Harbinger Publications.

Rhodes, A. (2017). Screen time and kids: What’s happening in our homes. Retrieved from: https://www.rchpoll.org.au/wp-content/uploads/2017/06/ACHP-Poll7_Detailed-Report-June21.pdf

Singham, T., Viding, E. & Schoeler, T. (2017). Concurrent and longitudinal contribution of exposure to bullying in childhood to mental health. JAMA Psychiatry, 74(11), 1112-1119.

Spears, B., Keeley, M., Bates, S. & Katz, I. (2014). Research on youth exposure to, and management of, cyberbullying incidents in Australia: Part A – Literature review on the estimated prevalence of cyberbullying involving Australian minors (SPRC Report 9/2014). Sydney: Social Policy Research Centre, UNSW.

Strife, S. (2012). Children’s environmental concerns: expressing ecophobia. Journal of Environmental Education, 43(1), 37-54.

Vassallo, S., Smart, D. & Price-Robertson, R. (2009). The roles that parents play in the lives of their young adult children. Family Matters, 82, 8-14.

Wade, C., Almendingen, A. & Robinson, E. (2019). Parenting pre-teens: A pivotal time for children and parents. Manuscript in preparation, Parenting Research Centre, Melbourne, Australia.

Waters, A. & Groth, T. (2016). The take action program: A user-friendly cognitive-behavioural program for practitioners working with anxious children. Samford Valley: Australian Academic Press.

Wilson, R. & Lyon, L. (2013). Anxious kids, anxious parents: 7 ways to stop the worry cycle and raise courageous and independent children. Deerfield Beach: Health Communications Inc.