It took a little Instagram square to get me thinking about the difference between worry and anxiety. I was taking a photograph of a worry doll to caption with ideas on how children can express worries and I started reflecting on some recent conversations about the maze of diagnosis and treatment options for children’s mental health concerns; in particular anxiety in children. The subject matter is too much for one blog post but I thought I would collate a few thoughts on the topic and share a few strategies to help children express worry and anxiety.
As much as we would all like mental health concerns to fit neat and tidy in a small box, they appear in all shapes, sizes and even sometimes disguises. I like to think of mental health as a continuum. Down one end of the continuum is health at its best and down the other end is illness at its worse. We all sit somewhere on the continuum and move along it all the time. Anxiety and worry can also be thought of as a continuum; low grade worry at one end and debilitating anxiety at the other. A continuum is defined by having two extremes and a less perceptibly different middle ground which together form a whole. In this instance worry and anxiety form a whole experience but they can also be differentiated.
So when I started this train of thought about anxiety and worry, I did what we all do: I googled. A definition on each should establish the conversation nicely I thought. The bizarre thing is that both anxiety and worry are used to describe each other, in one kind of ambiguous loop. So if we get to the nitty gritty of it,is there actually a difference or is it just a matter of context and language? That’s the thing about language it’s fluid and changing all the time. Social groups and cultures often attribute different meanings to words through their use. I think this is a really interesting consideration when it comes to mental health. As a general population are we using various descriptions as well as disorders interchangeably?
Have a think about how often you use the terms anxious or worried, are the experiences of these feelings distinguishable or the same? When I reflect on my own situation I clearly distinguish the two by how I experience the emotion. I worry in my head and I feel anxious in my body. This is relatively easy for me to distinguish because I have suffered quite badly from anxiety and panic attacks in the past. Shortness of breath, trembling and light headiness all signal anxiety whereas worry is marked by fruitless musings and concerns about a future event. But for someone less rehearsed in these emotions I wonder if it is less clear cut. Added to that the way words can be popularised and it’s not surprising the line is a little blurry. Anxiety isn’t the only victim of popularisation and generalisation, think about OCD and Bipolar. Both are serious and very challenging conditions that are often socially slung around to label someone who is being a little moody or pedantic and particular.
It’s quite sobering to consider that language may actually have an impact on the way we identify and regard mental health concerns. But that conversation aside, what can parents do to understand and accurately identify anxiety in children and support them. One of the answers is to know what is “normal” and what is cause for concern. Glasofer (2017) summarises the DSM-5 (the standardised diagnostic manual) criteria in her article on Generalised Anxiety Disorder. She suggests chronic experience or a diagnosable disorder can be distinguished from normal experience (including rough patches of life) by; significant distress, decreased quality of life and when the experience is uncontrollable and not explained by other conditions and events. The DSM-5 details that the disorder is characterized by anxiety and worry that is excessive, prolonged (for more than 6 months) and disproportionate to situation. Obviously I am not advocating to wait 6 months to get help for you anxious child, but if your thinking their anxiety could be caused by a underlying biology, expect to have to spend some considerable time sussing it alongside professionals first.
I am going to step diplomatically away from a diagnostic model for the remainder of this post and focus on the terms healthy and unhealthy. Which in their own right can be a tricky thing to measure. Particularly if your experience sits in the middle ground. Remember how I said mental health doesn’t fit into a neat box; well I just want to emphasise that’s because as humans we are complex creatures who’s internal world fluctuates all the time in conjunction with our physical experience. Whether in context of adulthood or childhood I find it productive to think less about the presence of symptoms and criteria and more about an individual’s ability to cope and flourish with the disposition they have. A child may be down towards the low-grade worry end of the continuum but be severely impacted in their social and emotional functioning, likewise a child with moderate anxiety may become apt at continuing to achieve and find fulfilment daily. What I am trying to get at is that it is the impact of symptoms themselves rather than their presence (underlying medical and abuse causes ruled out) that should trigger alarm bells for parents and guide treatment methods.
Finding treatments for mental health concerns can be a bit of shopping- grandma style. Grandma’s generally shop with these rules: 1. Try before you buy 2. go for comfort over fashion 3. know what your colour is 4. find a good shop assistant and 5. Invest in quality and quantity when your onto a good thing. Grandmothers know there is no quick and easy way to find the best cardigan or slacks in town; you must do the work and the research and be open to a bit of trial and error. They also know that trying to squeeze into a size 8 pair of skinny Jeans at 70 is a sin.
All humour aside, these can be useful tips when you begin putting out feelers for mental health support or treatment. It is important to find what works for your child and family; not everyone else. Don’t be afraid to try a few different types of counselors/therapists and don’t get swayed by fashion or other’s experiences. I feel like it is at this point that I should also mention the elephant-in the room of child mental health: medication. I firmly advocate for a conservative approach to medication but there are occasions when it is needed; with careful review and consideration. While medication can seem like an attractive solution, especially when it is prescribed short term, it comes with a host of social-emotional risks and essentially if it is miss-prescribed it is going to achieve very little. Medicating worry can be like squeezing into skinny jeans at 70; it just aint going to work.
So back to the worry doll and it’s caption. There are many, many ways to teach kids how to manage and express their worry. It is important to remember that humans aren’t born with coping strategies or skills in expressing themselves; it is all learned and developed. The benefits of expressing worry or anxiety in healthy ways is that it will assist development of empathy and problem solving skills, build healthy relational development, confidence and optimism amongst a few other things.
While I was rather excited to provide you with a long list of creative activities to do with children to help them identify, express and manage worry and anxiety I have been trumped by the amazing team at Coping Skills for Kids. Their resource list is extensive. They also have a useful article on identifying when you might need to get some professional help.
Some other rituals that can be introduced into family life is the worry doll. These are a Guatemalan tradition in which tiny dolls are tucked under a child’s pillow. Each night the child can tell them what their worries are and then the doll takes them away. Children can also tell their worries to worry bubbles and watch their worries float away. I also find that children manage emotions better when they are tangible. Imagining and then drawing or painting what feelings could look like can be useful. I sometimes imagine my anxiety as a monster! And lastly if your child loves books;The huge Bag of Worries by Virginia Ironside is an excellent picture book and one of my favorites. It teaches kids about the weight of worry and can be a great discussion starter.
If you have any other strategies for worry and anxiety in children; comment them below.
Glasofer, D. (2017) How Generalized Anxiety Disorder Is Diagnosed Using the DSM-5. Article retrieved from https://www.verywell.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147
American Psychiatric Association. (2013). American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Washington, D.C.