The Philippine Online Chronicles

In a few weeks time, children all over the Philippines will once again don their uniforms, carry their lunch boxes and bags and troop to school for another exciting school adventure. For many children, this is something to look forward to with joy and a little bit of trepidation.

For others, especially those who will be going to school for the first time, this stirs up strong feelings of anxiety and distress in them.

I remember the first time I handled a very anxious little girl in my preschool class. Every morning for the first five months of school Anna* would arrive crying and begging her mom or nanny to stay with her in school. This was despite the fact that it was her second year of preschool already. Her mom would try to psych her up on the drive to school and every day, Anna would tell her mom “Anna no cry. Anna big girl now.” But like clockwork, as soon as the car turned the corner to the school building, tears would begin to well up in her eyes.

To be fair to Anna, she enjoyed school a lot and would always talk about school to her parents. This deterred her parents from pulling her out of school to begin with. Over time, her crying lessened but she would still tear up and cling tight to her nanny’s hand. By the third month of school, she moved on to clinging to my hand. As long as I greeted her at the door when she arrived, she wouldn’t cry, just get teary. After the fifth month, she finally walked into school by herself beaming widely.

That is just one example of anxiety in children. Luckily for Anna, she was able to overcome her separation anxiety. Other kids are not as lucky.

Kids get anxious too

Because of children’s innate resilience, adults tend to dismiss or overlook these anxious feelings, especially when this does not manifest in crying spells. Other kids exhibit anxiety differently. Take the case of my brother, JJ. As a first grader, he was rushed to the hospital after vomiting blood which apparently was due to a bleeding ulcer. The cause: stress.

It was not obvious to us, his family, that he was anxious about school and was having difficulty coping with the very rigorous demands we (both the school and myself as his tutor) were placing on him because he never complained or reacted outwardly. Little did we know that he was internalizing these all until his body could not take it anymore.

Other red flags to watch out for that may indicate anxiety in children can include frequent stomach pains or headaches, restlessness, difficulty concentrating in class, withdrawal from others, irritability, muscle tension, disrupted sleep patterns, bedwetting, pessimism or negative thinking, anger or aggression, constant worrying, changes in feeding patterns, excessive clinginess, crying, and selective verbal interaction or selective mutism.

Why so scared?

For both JJ and Anna, school was a source of anxiety for them. There are a lot of other sources of stress and causes of anxiety which Katherine Lee outlines in an article. These are:

• Changes or disruptions in the family such as the dissolution of the marital relationship, family conflict, death of a family member, moving homes or relocating, and even the birth of a sibling.
• Over-packed schedules
• Self-inflicted pressure such as wanting to do well in school or trying to fit in. This also includes the child’s need to do things right and fear of making mistakes or not being good enough.
• Problems in school such as being bullied or having to meet up to social expectations.
• Terrible news or disasters. For example, children who experienced the flooding brought about by Typhoon Ondoy or were amongst the schools forced to shut down due to the A(H1N1) scare in the last school year may have experienced feelings of anxiety.
• Scary movies or stories

It’s more common than we think it is

Lala Alcala, a psychologist who does extensive Play Therapy with children, says that anxiety in children is quite common. This is brought about by the challenges that need to be tackled in every stage of development.

Anxiety and fear, however, are not necessarily interchangeable. She differentiates these as such:  “Fear is directed at something concrete, a ‘real and present’ danger so to speak. Coming face to face with an angry dog or seeing strangers approaching for instance could have real consequences to a child’s sense of safety and stability. On the other hand, anxiety is often a generalized, vague sort of fear, a foreboding or dread that something bad is going to happen but not really being clear about what this is. It can be paralyzing and may not serve a real protective purpose.” She further explains that both fears and anxieties serve a purpose in children’s lives as this fosters a sense of danger in them which allows them to protect them as they navigate through the world.

This article also points out that anxiety is a normal part of childhood. To some degree, it is a phase they go through. What makes it atypical is when it is prolonged and it begins to interfere with their lives. If this is the case, it is possible that the child may be suffering from an anxiety disorder.

For Ms. Alcala, she guides herself with 4 D’s in identifying the extent of anxiety in a child that may suggest that his or her feelings of anxiety have gotten out of hand or warrant professional intervention:

1. Disruption. This occurs when the anxiety interferes with the child’s daily routine or causes interruption from normal processes. An example is if the child needs to be pulled out of school due to the anxiety.
2. Disproportion. Are the reactions to the anxiety-provoking stimuli much greater than what the situation calls for? For example, in Anna’s case earlier, will seeing the school building cause her to hyperventilate to the point of vomiting?
3. Distress. Does being in the situation elicit excessive amounts of discomfort and adverse reaction to the child? If so, then this is a problem.
4. Duration.  As described earlier, feeling anxious about something is a phase almost everyone goes through. However, if this goes far beyond a short period of time with no signs of improvement or closure, this may be a problem.

Overcoming anxiety

Parents are key figures in helping a child overcome and cope with anxiety. A very important first step in helping them deal with these feelings is to not dismiss or minimize these feelings. Allow the child to know that it is okay to feel uneasy, scared or frightened about the situation. This can help make them feel affirmed and accepted.

Constant affirmation and giving praise is also helpful in dealing with anxiety, especially if the reason for the anxiety is anchored on insecurity and fear of not being good enough or perfect. Offer them comfort by assuring them that they can overcome whatever it is they are going through.

Establishing routines and structure can also help a child feel secure about himself/herself in the environment.  These routines can help limit feelings of uncertainty or confusion which may fuel anxiety. With this, he/she may have better handles in which to effectively anticipate upcoming events and activities. Observing this consistently is key in making this work.

Helping your child identify and communicate feelings verbally can also help alleviate stress. Helping them become attuned to their bodies, for example, can help them recognize and name feelings.

In school, teachers can be more sensitive to the needs of these anxious children. Rather than calling them out for individual recitation, for example, having the child work with a partner might be more effective in getting him or her to participate in class.

Other treatments for anxiety may include pharmacological interventions and psychotherapy.

Getting over fears can take some time. During this period, parents may feel frustrated about the child who may come across as difficult. It is important to remember, however, that becoming angry or criticizing the child for feeling the way they do will not solve the problem, rather, it can aggravate the anxiety further.

As the cliché goes, patience is a virtue.  Be patient with your child and, in time, with the right support from the home and in school, an anxious child can thrive.

*Name changed to protect privacy.

Photos: “Amelia's First Day of Kindergarten2.jpg” by scott anderson, c/o Flickr. Some Rights Reserved “All by myself” by arabian rose, c/o Flickr. Some Rights Reserved, “afraid of the duck” by Katrien Cattoor, c/o Flickr. Some Rights Reserved.

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Maria Andrea (Ria) S. Tirazona, M.S. (cand.), popularly known as Yapatoots in the online blogging and social  networking community, is a preschool teacher at Playschool International and part-time lecturer at the Psychology Department of De La Salle University. She is also an Associate Psychologist at PsychConsult, Inc, where she specializes in Psychological Assessment.  She holds a Bachelor's Degree in Family Life and Child Development from the University of the Philippines and is currently working on her thesis for her Master's Degree in Clinical Psychology at the De La Salle University. In her spare time she maintains several blogs, including www.theaccidentalteacher.com, www.fatgirlnomore.com and www.yapatoots.com.