Anxiety

We first examined anxiety in a previous Newsletter (Number 234: Anxiety – 17 August 2020) however, it is time to re-examine this important topic!  The world, according to the news is not a safe place with COVID still raging, the war in Ukraine, floods and fires because of global warming, the list goes on.  Then consider other childhood events that add to this anxiety; things such as bullying, family break-ups, abuse and neglect - all at record levels and the stresses at today’s schools made worse with widespread absenteeism of teachers and the lack of consistent coverage of classes.  These situations are hard enough for adults but children are much more susceptible to suffer from anxiety in such conditions. 

 

Because of the sequential development of the brain during childhood, the very progressive organisation of their cognitive abilities, from an affective domination through to an intellectual makes it much more difficult to apply those cognitive support programs that are so popular in schools.

 

In 2015, 6.8% of children suffered from diagnosed anxiety disorders which would be an under representation of the real numbers as so many are not reported.  The Melbourne Child and School Psychological Services reports that ‘there is an epidemic of anxiety amongst children’!

 

To recap from the previous Newsletter a diagnosis of generalized anxiety is present if three or more of the following are experienced in a six-month period:

• • • Restlessness 
    • Fatigue 
    • Concentration Problems
    • Irritability 
    • Muscle Tension
    • Sleep Disorders

 

In general, anxiety is described in three ways:

• Panic Attacks – where there is an immediate fear that the child is facing a catastrophe and has nowhere to go.  These are generally short term and result in the child avoiding any situation that ignites that emotion.  However, these situations can be really traumatic and move well beyond anxiety.
• Social Anxiety – This is the fear and avoidance of any situation in which a child thinks they may be the centre of attention that can lead to their embarrassment.  It is no surprise that social anxiety is the predominant form of stress in children, especially adolescents. 
• Generalized Anxiety – This is where the child worries over everyday things for months at a time.  They are children who will avoid what we may consider to be mundane or are constantly seeking clarification or reassurance before they attempt any task.

 

Anxiety can be directly connected to fear and the stress that is a result of that fear.  However, this is not an appropriate response to a real-time threat but one that is imagined.  The ability to predict what will happen in the future has set us aside from other species.  We are capable of generating the same response if we think something will happen as when it does happen.  This predictability has kept us safe in a dangerous world. 

 

If for instance you are walking through a dark forest and you avoid an attack from a wild animal the next time you go into a dark bushland you will feel a bit anxious and if you hear a noise in those bushes I’m sure you wouldn’t go to investigate.  I daresay, for no real reason most of us have an inherited a sense of anxiety walking through a dark landscape!

 

This is described as anticipatory stress where we activate a stress-response because we anticipate a looming physical or social danger.  We generate the same response if we “think” we are about to be attacked when there is no real evidence!  If we apply this experience to the worrying situations outlined at the start of this essay it is little wonder the anxiety children suffer is a real problem for teachers. 

 

We have always advocated the need for creating calm and supportive classroom environments.  The illustration below demonstrates what happens when a child’s stress levels are elevated.

 

As can be seen the only time the child has full access to their cognitive ability is when they are calm.  As the stress levels elevate the child ‘gates-down’ on their ability to think in ways other than how they will defend themselves.  This general adaptive response is critical when faced with a real threat but is debilitating when the threat is imagined.  Anxious children rarely move past a condition of concrete thought, that is limited to what is already known because they are vigilant!  There is little capacity for creativity or the learning of new work.

 

To return to anxiety and the difficulties of dealing with this problem for children.  Three of the major assemblages of the brain’s structure are the amygdala, the hippocampus and the prefrontal lobes.  These have a major role in the management of our emotional state and therefore our level of anxiety.

 

The amygdala is a cluster of cells positioned either side of the brain towards the base.  Its main purpose is to regulate emotions.  This becomes very important when the individual is under threat.  The fear generated has the amygdala’s first reaction to be the initiation of the fight/flight response.

 

Unlike the amygdala which is functioning from birth if not before, the hippocampus doesn’t develop until about age three.  The broad function of the hippocampus is to link our emotional responses to various situations with an intellectual understanding. 

 

Part of these functions is to facilitate the creation of long-term memories, it has often been described as the brain’s ‘librarian’.  Another significant task is to link our emotional state with the prefrontal lobes where our reasoning occurs.  This means that the child’s ability to cognitively examine the situation that had provoked the stress is not available until about age three.  This does not mean there is no memory of the threat, there is an emotional association with that stimulus.  However, as the hippocampus develops it puts reason on to the association between the situation and the response.

 

Finally, the prefrontal lobes do not develop until about age eleven.  Much has been written about the teenage brain and most of these developments are because at this time the prefrontal lobes become influential enough to project solutions to difficult situations back onto the hippocampus and amygdala.  These advanced functions allow us to examine the situation with reference to our memories of what we have experienced in the past and predict what will happen in our current situation if we act in certain ways.  The more strongly we have developed these associations the more confident and therefore more composed we will be.  In essence, those who have had an assured childhood will be less susceptible to anxiety!

 

This process has been described by Joseph E. LeDoux an American neuroscientist.  The illustration is a modification of his theory.

What can be seen that an incoming stimulus goes through the cerebellum to the thalamus which then feeds to the various parts of the brain particularly the hippocampus and amygdala.  If it is an immediate threat the amygdala takes over, a lower threat can go through the hippocampus on to the prefrontal lobes which over-rule the immediate response. 

 

As can be seen, this ability to rationalise away anxiety is not available until early adulthood which means children are much more vulnerable to anxiety.  In the first three years there is no pathway for low level threat, infants are very emotionally driven!

 

As always, our focus is on those children who have suffered early childhood abuse and neglect and for these kids, anxiety is almost a given.  In a previous Newsletter (192. Early Childhood Trauma - 7 March 2022) we discussed the physical alterations of various parts of the brain.  The three areas of direct concern regarding anxiety are:

• The Amygdala which is sensitive to fear, has increased in size which makes the child more vigilant and therefore very anxious.
• The hippocampus is reported to have a 12% reduction in size which impacts on their ability to comprehend incoming stimulus and the formation of memories.
• Prefrontal lobes are 20% smaller and have lesions on the surface.  It is in this area of the brain, often referred to as ‘the executive’ where complex decisions are made.

These real changes to the capabilities of each part result in a tangible loss in their ability to deal with anxiety!

 

The conclusions to these Newsletters may appear repetitious but there is a reason for this.  To address anxiety, along with all other forms of neuro-atypical challenges such as early childhood PTSD requires the expertise of mental health professionals.  Teachers do not have these qualifications nor the time to address these on an individual basis.  However, we still have to manage these children in our classrooms.  We do this by providing a learning environment that minimises the probability of the student being stressed!  Therefore, we need to establish positive relationships with all our students and an environment that is structured, expectations are known and consequences, both positive and negative are consistent and persistent!