More and more kids are returning to school with anxiety disorders

by Catherine Woulfe / 08 February, 2018
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When school goes back, anxiety disorders spike, but those afflicted by the commonest mental illnesses are finding ways to help themselves.

One day, Jess* realised she quite liked doing things twice. The car door: open, shut, open, shut. Seat belt: click, unclick, click, unclick.

“I really enjoyed doing everything in even numbers,” she recalls. “And I couldn’t stop myself from doing that. It really confused me, because I’d never felt like that before.”

Jess, then 15, became afraid of certain shirts and refused to touch the dining table. When she was out with friends, her mind would be elsewhere, working through the internal rituals she had created to make her feel safe.

At her worst, she skipped school, finding it altogether more sensible to spend the day in bed. Make the day a blank, Jess thought, don’t do anything to trigger the rituals, and maybe her mind could rest.

Of course, she asked Google. “I would look it up every day and be like, ‘Yeah, I think this is what’s happening to me …”

Finally, after four months of fighting with her increasingly worried, bemused mother, Jess let her in. “I broke down crying. I was like, ‘I’ve got OCD.’”

Two years on, Jess’s mum becomes tearful when she talks about the time her daughter kept the disorder to herself. Even after they worked out what was wrong, things got worse before they got better. It took months to find a therapist who “got it”, and starting an antidepressant medication temporarily added an extra layer of turmoil.

Jess missed a lot of school and once tried to throw herself from a moving car. “It wasn’t suicidal,” her mother says. “She just wanted to escape from the OCD.”

Then they found the right psychologist. In one of their first sessions, Jess says, he told her to get mad at the OCD. “Don’t be afraid of it – just tell it to f--- off.”

It fired Jess up. She started to take back control, to see OCD as a “little voice in my head that I have to stamp out”.

These days, she’s pretty good at stamping. “Every now and then when I get anxious, it creeps back in. But I have the tools to handle it.”

Her message to other young people struggling with anxiety is simple: “Talk to people,” she says. “Don’t think you’re alone.”

* Names of anxiety sufferers have been changed.

Child psychologist Emma Woodward: parents can help ease children back into the school year. Photo/Simon Young

Child psychologist Emma Woodward: parents can help ease children back into the school year. Photo/Simon Young

Modern plague

OCD (obsessive compulsive disorder) sits under the anxiety umbrella, alongside other maladies such as phobias, panic disorders and generalised anxiety, which is when you’re anxious all the time about everything. For many people with anxiety, including Jess, depression is also part of the picture; statistics often conflate the two.

Together, anxiety and depression are hitting a growing number of our children and young people. A Ministry of Health report released in November contained an estimate that 79,000 young New Zealanders are in “psychological distress”, which means they have “high or very high probability of anxiety or depressive disorder”.

That figure, up from 58,000 in just one year, equates to 12% of those aged 15-24. It’s a dramatic jump from the 5% of six years ago. And international evidence suggests strongly that the incidence of these disorders spikes sharply as children return for the new school year.

In the US, according to a New York Times story at the beginning of the northern school year, 41% of new college students reported “overwhelming anxiety”: in 2010, that figure was 29%; in 1985, 18%. Hospital admissions for suicidal teenagers have doubled over the past 10 years, with the highest rates occurring soon after school starts.

Yet even those figures don’t capture the younger-and-younger creep of anxiety observed by professionals, such as child psychologist Emma Woodward.

She says anxiety is now the main reason children and their families come to her Auckland practice, and at this time of year the numbers seeking treatment can rise, as children and teens returning to school struggle to cope.

Parents can help ease children into the change, Woodward says, by making sure stationery and uniforms are organised a week in advance, by having school friends over so the kids can reconnect and by talking through what the pick-up and drop-off routine will be.

It’s important to empathise – we all struggle with going back to work – and try not to “plant any seeds” with your own worry. But if you sense your child’s anxiety runs deep, talk to the school or seek professional help.

Woodward, along with many others, is noticing that the children coming to see her are younger than ever. She now sees children who are having panic attacks at just five years of age.

What does anxiety look like in young children? They might be extremely anxious about being away from their parents or excessively concerned with safety. They might always see the worst-case outcome in any situation. Some children will complain of headaches or sore stomachs – which can be a physical manifestation of the anxiety or a way for the child to express what’s happening. Others regress to bed-wetting or have nightmares and interrupted sleep. Some children get angry or irritable; some become selectively mute.

What’s crucial, Woodward says, is that all such behaviour is seen for what it is – communication – and that the child gets good understanding and support.

It’s okay for your child to be introverted, she says. “They don’t have to be any other way – your kid’s your kid, they’re fine as they are.” But by about the time they start school, if you’re noticing they react quite differently to situations from the way their peers do, it’s fair to start questioning whether anxiety is in play.

“You know your kid best. If your intuition says it’s wrong, then it’s probably wrong.”

Photo/Getty Images

Photo/Getty Images

Self-harm signs

The upsurge in anxiety has been matched by the increased discussion of one of its most alarming symptoms: self-harm. This is not new, but the numbers now are astonishing.

At Victoria University, self-harm expert (and Listener columnist) Marc Wilson has led a longitudinal project tracking thousands of teenagers from 13-18. Between 2012 and 2016, almost a third of those teens reported deliberately hurting themselves.

Neve hadn’t been to school for most of the previous 18 months by the time her mother first spoke to the Listener. Many of the 14-year-old’s friends were self-harming, and her parents were taking heart from how impressive their daughter had been in her support of them.

But one night, they were awakened by a policeman knocking at the door. Neve had herself been cutting for two years, it transpired. That night, feeling suicidal, she walked to the train tracks. She’d called police on the way there.

“She was talking to her friends online for three hours before leaving the house,” says her mother. “They convinced her to make the phone call. She called the suicide hotline but was on hold for half an hour, so gave up and called 111.”

Police got to Neve in time. But her mother is haunted by guilt, by what-ifs, by the vision of a train barrelling into her daughter.

“To be blunt for a moment, what the actual f--- is going on with our teenagers and the world they are experiencing?”

Genetic predisposition

Some children’s genes gear them to respond with greater anxiety to events in their lives. For others, a traumatic event can spark anxiety seemingly out of the blue. “A parental divorce, a death, a sudden move – all sorts of things can trigger it,” Woodward says.

This is playing out on a grand, sad scale in Christchurch, where a study of 300 children recently found that four in five were exhibiting signs of post-traumatic stress disorder.

Jess pegs her OCD to a specific event: the compulsions started after her parents separated and her father left, she says. But Woodward believes that much of what’s making young people anxious is the lack of downtime and “true human connection” in modern life.

One hypothesis about why anxiety is now hitting young children is that they are so often left in front of screens by busy parents. Woodward says young children “aren’t supposed to be quiet and not connected to somebody else for those periods of time”.

“There’s a massive opportunity cost of life-lesson learning in there. They’re zoned out from the real world, they’re in dopamine hijack and they’re not in a connected state. So, what we’re getting are these children who are growing chronologically but not emotionally.”

It’s those real human connections – not the ones mediated by technology – that developing brains need if they are to function effectively, Woodward says. And when they are squeezed out by screens, busy parents and a more, more, more mentality, there is a “subtle but malignant impact on the development of our children’s well-being”.

Precise answers on what’s ramping up anxiety are set to emerge from Growing Up in New Zealand, a longitudinal (at least 21-year) study of more than 6000 Kiwi kids that began when their mothers were pregnant. Parents were questioned three times face-to-face and twice by phone before their child turned two about all manner of matters to do with health, family/whānau life, environment and cultural identity, but now the children are eight, they are speaking directly to researchers. This means detailed data can be collected related to anxiety and what’s feeding it.

Study director Susan Morton says a focus is to work out how some children stay mentally healthy against the odds. “Really importantly, what does it mean in terms of what creates resilience? What works?”

When the children were younger, they were scored on “abnormal behaviours” that could be seen as indicating stress or withdrawal or anxiety. Screen time did seem to prime children for such behaviours, but Morton says, “In homes where boundaries are set and actually adhered to, those children actually end up not having the same patterns of abnormal behaviour. So it’s not just the hours of screen time per day.”

Growing Up in New Zealand study director Susan Morton with four of her subjects: some children stay mentally healthy against the odds. Photo/Dean Carruthers

Growing Up in New Zealand study director Susan Morton with four of her subjects: some children stay mentally healthy against the odds. Photo/Dean Carruthers

The poverty link

Anxiety hits all social classes, but unsurprisingly, poverty seems to be a significant driver. By the age of four and a half, says Morton, children who were constantly exposed to a disadvantaged environment were 16 times more likely to be demonstrating anxiety-related behaviours.

“You can have anxiety without poverty,” says Wellington psychologist Quentin Abraham, who works with young people and is the president of the New Zealand Psychological Society. “But I think if we could actually tackle poverty, we would reduce the mental-health burden in this country in a huge way.”

Put yourself in these kids’ shoes and it’s easy to see how poverty breeds anxiety. You may live in a cold, overcrowded home. Your parents, both shift workers, are often absent and always stressed. They may have their own mental-health problems.

Sometimes, you go hungry. You’re not eating enough fruit and vegetables and other healthy food, so your digestive health is likely to be poor – and that, we now know, affects your brain.

You may not feel safe in your neighbourhood and you’re acutely aware that the family can’t afford extras such as school camps.

This gives you an outsider, “loser” status that may attract bullying (New Zealand has the second-highest rate in the OECD of school bullying), which is itself a primer for anxiety. Just worrying about the prospect of being bullied can be as damaging as being bullied. Social media, of course, ensures there is no escape at home.

You get an after-school job to help Mum and Dad. You worry about how you will ever pay for tertiary study. Gradually, you take on a feeling of failure, pessimism and uselessness.

If this all starts when you are very young, your rapidly growing brain, exquisitely sensitive to its environment, is likely to make you even more susceptible to anxiety and other mental-health problems.

Housing instability

Abraham emphasises the importance to children of a sense of belonging, which can be eroded when families are bumped from one rented house to another. Two out of three children in the Growing Up study moved at least once before they were four and a half. About 10% moved three or four times in a one- or two-year period, and tenants in private rentals moved far more often than those in public housing. Each transition is tough on adults, let alone small children. Morton was shocked at her study’s further finding that by the time they were six, 12% of children had already shifted schools.

“This is an unexpectedly high level of mobility,” she says. “It’s a very insecure environment for children and from what we can see, I think it is creating stress, both for families and for the children.”

Last year, Natalie and her 10-year-old son Zac were asked to leave the rented home they loved. Zac could barely sleep. “For three months, he didn’t know where his home was going to be,” Natalie says. “It’s massive. It’s stressful. It was awful. And I felt like I failed as a parent.”

Zac says anxiety feels “like a big wave that kinda swamps you”. Diagnosed with generalised anxiety three years ago, he can tick off a list of related disorders: OCD, insomnia, panic attacks and sensory processing disorder (abnormal sensitivity to textures or sounds, for example). As a toddler, he would bang his head on the floor; he now hits himself hard when he’s frustrated or has done something he’s not proud of. Natalie has noticed mysterious welts on his arms and face. “But when he’s balanced and we have a simple life, we don’t have those things.”

Natalie and Zac’s new home is sunlit and has a view of the sea. Oregano hangs to dry above the dining table, and the place feels peaceful, its occupants houseproud. But, says Natalie, they are both struggling to settle.

“Zac really needs the stability of a home. Yes, this is a long-term rental and it should be for eight years. But, you know, at any point [if the landlord sells up], we’re three months away from being homeless.”

Quentin Abraham.

School pressure

The proportion of primary-school teachers who believe anxiety over National Standards is damaging some children’s learning has leapt by half, to 61%, in the past four years. The National Standards benchmarking regime is on the chopping block, but there is now trepidation over what may replace it.

The Listener reported in 2013 on widespread assessment-related anxiety in secondary schools. Two years later, the Education Review Office released an alarming report that echoed our findings, warning that “students in all schools were experiencing a very assessment-driven curriculum and assessment anxiety”. Prompted by rises in eating disorders and “traumatic incidents” among students, a few schools had overhauled their approach to assessment. But many had “major challenges” keeping students well, and others were, the ERO said bluntly, “overwhelmed”.

That year, in the regular Pisa (Programme for International Student Assessment) tests run by the OECD, 72% of our 15-year-olds – more than in any other OECD country – agreed with the statement “Even if I am very well-prepared for a test, I feel very anxious”.

Worse, their sense of belonging has been eroding: in 2003, only 8% of New Zealand students felt “like an outsider – or left out of things – at school”. By 2015, that had jumped to 22%, the eighth-highest among 35 OECD countries. Meanwhile, as in almost every other country, the proportion of our students who feel “I make friends easily at school” fell between 2012 and 2015 to 79%. The figures for some Western countries are beginning to match those of Japan and South Korea, where teenagers enduring more extreme forms of isolation live like virtual hermits.

Ask our young people what is the biggest challenge for them and their peers and, for the first time, they are saying stress, not alcohol. That’s the major finding of a recent Colmar Brunton survey of 400 New Zealanders aged 16-24, commissioned by Youthline.

For those in the grip of an anxiety disorder, stress can develop into what the anxious boy in Kate De Goldi’s novel The 10pm Question dubbed his “rodent voice”: nagging, twisty thoughts that the brain endlessly scrabbles and nibbles at.

So, what twisty thoughts does Woodward hear from anxious children and teens? “They tend to be around not being good enough,” she says. “Another one is letting people down, and I think that is partly because of pressure from school.”

It’s not that young people all want to be top of the class. Often, they just want jobs.

“The future is such a factor,” says Jess, whose teachers often talk about how we cannot know what jobs will still exist when their students are in the prime of their working life. “Our future is so unknown when adults talk about it.”

Climate change adds eco-anxiety to the mix. The American Psychological Association last year warned of a coming king tide of mental-health problems, as even those not directly affected by climate change are ground down by “unrelenting day-by-day despair”.

Jess’s school is very eco-conscious, which is great, she says, because it instils the need to care about the environment. “But it also means that we know about a lot of stuff that’s happening in the world, and we do worry about it.”

Woodward is already treating parents struggling with anxiety about climate change, “which means [their] children will probably start worrying about that too”, although she notes that children tend to be more optimistic and solutions-focused than adults.

An epidemic of uncertainty

Poverty, housing, bullying, jobs, the rising seas: it all comes back to uncertainty. As Jess puts it, “being terrified about stuff that’s going to happen. Or not going to happen.”

Woodward knows it’s not just kids feeling completely lost. “Our blueprint for parenting is now redundant compared with the blueprints our parents and our parents’ parents had. We don’t know the future we’re raising our children for. They’re talking about the point of singularity [the term being used to describe the moment when artificial intelligence triggers runaway and unfathomable change] being by the time my youngest is 13, and he’s a year old, so I’m kind of like …”

She takes a deep breath, blows it out. “The human brain thrives on certainty, and we don’t have that. So the only thing we can do is provide kids with resilience.”

The science on this is not complicated, Woodward says. And it’s not exactly something that you do. “It’s a culture or a dynamic that you try to instil in your family, that [children] absorb as they grow.”

From day one, connection is the key. Blobby time, Woodward calls it – an afternoon pottering in the garden with the kids, without your phone, poking at caterpillars, or going out as a family and doing stuff, with the proviso that it’s not rush-rush. Tip: don’t break the spell every 10 seconds to take a photo; you’re trying to build a safe base.

“Just be present in the moment. Be aware of the connection as it’s happening. Don’t expect it to be any different … Be appreciative and grateful for the moment as it is.”

She concedes the idea may seem laughable to parents who have only the bookends of each day to spend with their children. So she stresses the importance of carving out downtime at the weekend and protecting it. Buy it as a Christmas present, if that’s what it takes: rather than giving her boys toys, Woodward bought horse-riding lessons that she could enjoy with them.

She explains that parents’ maladaptive responses to stress can be passed on to their children. “Developing good coping strategies and starting with yourself is a really important way to build resilience in your kids and protect them from anxiety.”

The right to be wrong

A big part of such modelling is realising it’s okay to not be right all the time, to snap, to make wrong decisions. “It’s okay to be fallible and human – that’s how we raise decent kids.” This goes for teachers as well as parents: in Woodward’s work with schools, a lot of her job is persuading teachers to drop the facade of being an expert, she says.

The key is to demonstrate that you’re reflecting on your slip-ups and strategising to do better next time. If you catch yourself shouting at your kids, find a moment to sit down with them later on and say, “I’m not sure I dealt with that in the best way. I’m really sorry. I might have hurt your feelings.” Outline your plan for next time you get stressed: stop and take a few breaths.

There’s a lot of talking involved. But in moments of pressure, having a script can also give you some much-needed space to think: “Mummy’s feeling tired, and when people are feeling tired their brains don’t work properly and sometimes they make bad choices. So I’m just going to take five minutes now to make sure I make the right choice.”

Woodward has no time for the notion that we should force children to do things that scare them in order to build their resilience. It’s true that you can make children more anxious by over-coddling and limiting their exposure to risk, she says. The trick is to give them space and support – and not to remove the scary thing.

Say your child’s frozen at the top of a tall slide. “There’s nothing wrong with giving your kid a cuddle and saying, ‘Oh, it’s all right, sweetheart: we’ll try that again later.’” Maybe go off to the swings for a bit. Do try again later.

Such thoughtful parenting can be particularly difficult when children are already anxious, Woodward acknowledges, thanks to a neurological mirror system that fires when we observe behaviour in others. Often, this leaves anxious children “doubly deprived – deprived by their anxious response and then deprived by those around them who avoid them as it makes them feel uncomfortable, tired, anxious and drained”.

Try to be compassionate with yourself, she urges. Rather than thinking, “Oh, you idiot”, when you do something wrong, change the internal script to “Oh, that was unlike me. Next time, I’ll do better.” Say it out loud so your child hears, too.

For Natalie, Zac’s anxiety has been draining. It’s isolating, she says – some people blame her; others simply don’t understand how hard it can be for him.

And it’s relentless. “I’ll think he’s asleep, then at 10pm there’ll be this little voice, ‘Mama, what if I get reincarnated as a cow and not in a land where they’re sacred?’ You know, it’s like, oh my God.”

Her worst fear is that, when he hits adolescence, Zac will stop talking. That he will try to cope alone. But these two are ticking all Woodward’s boxes. Natalie pushes Zac when she can and backs off when he’s at capacity. They spend lots of long, quiet days at home and at the beach. They have minimal screen time and endless talks about their emotions and strategies and self-care. Zac is so steeped in it now, Natalie laughs, that if she’s a bit snappy, he will pat her on the shoulder and tell her to have a bath.

And there is so much more to her boy than anxiety. Zac is cuddly and emotionally articulate and loyal, Natalie says. He has a big group of mates and they spend their weekends haring around on bikes. Recently he helped plan a sports event for kids, and on the day, as Natalie was stepping forward to explain the rules and where the loos were, Zac waved her back and said, “I’ve got this.”

Another mother later came over to Natalie and said, “Your son is amazing. My son really struggles with anxiety and he’s really shy and I just can’t ever imagine him doing that, but I hope he can one day.”

“Oh,” Natalie said. “Let me tell you a story.”

This article was first published in the February 3, 2018 issue of the New Zealand Listener.

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