Q: My seven-year-old doesn't want to go to school. How can I help her?
A: Having problems with fear and anxiety is the most common psychological or emotional difficulty experienced by children and parents.
Anxiety presents differently in kids than in adults. In order to help children with their anxiety parents need to slow down, listen and try to understand what's happening for their child. This takes a while to learn. The next task is to help children understand what they're going through.
School refusal is usually a sign that something's wrong rather than a problem in itself. It could be a fear of something bad happening to Mum and Dad when they're not there; or a fear of being bullied or teased if that has happened before.
When we talk to kids we talk about 'inside clues', or how their body feels, so they can identify when they are feeling anxious. They might feel sick in the tummy, aches and pains, a headache or feeling jittery.
There are 'outside clues' as well, referring to how they behave such as avoiding places or refusing some activities. Some kids can look like they are acting out, which can be difficult for parents, but what's really happening is the kid can't approach this situation because they're scared, and they don't have the verbal capacity to understand or to say what they're going through.
The next thing we would try to do is problem solve if there is a difficulty at school that would help explain their school refusal, such as a learning difficulty or bullying. Then we can address that concern.
We also help kids to reduce their fear by changing their thinking, because most fear comes from incorrect assessment of threat. Our favourite way to do this at my practice is to do 'detective thinking'. This is where we get the kids to ask, "what evidence do we have to say that those thoughts are true? And what evidence do we have to say they won't be? Can we do an experiment to test them out somehow?"
Finally, relaxation activities can help children deal with the feelings they are experiencing once they have identified the anxiety.
Teaching children how to understand and regulate their emotions takes quite a long time, and shouldn't be rushed.
Relaxation techniques for children
If someone's scared and it's a one-off, parents need to give them a hug, label their feelings ("it sounds like you are feeling scared because . . .") and provide reassurance. Tell them why they are safe; don't tell them they are being silly.
But when there's a persisting anxiety problem a little bit of reassurance doesn't help. Telling them they don't need to be afraid of the dark won't work. You need to work on long-term behavioural coaching like detective thinking, and 'fighting fear by facing fear'.
Parents need to patiently and gently coach them in these skills because kids can't do it on their own. To help them to calm down and reduce the physical tension in their body try the following techniques.
Make all your muscles stiff like a robot - then relax like floppy spaghetti whilst breathing out. Repeat that a few times.
Try breathing exercises like making a long "shhhh" sound like the wind blowing through the trees, or imagine smelling cookies out of the oven - breathe in slowly through your nose and a long sigh out.
These activities help them slow their breathing down and regulate their tension levels.
Good resources for child mental health include the Beyond Blue Healthy Families hub and the Macquarie University Cool Kids program (paid resource).
- Answer is provided by Sydney clinical psychologist Dr Chris Basten, through HealthShare, a digital company dedicated to improving the health of regional Australians. Submit questions, and find more answers, at healthshare.com.au.