Noah was her easy child, a boy so perpetually happy his mother would call him her “ray of sunshine.”
“When people asked him ‘How are you?’ he would answer, ‘Great!’ He was always so enthusiastic,” says Julie, who requested that their real names not be used.
After the challenges of parenting her two older sons who had special needs, raising Noah was a breeze. Julie home-schooled all three of her sons, and when she noticed that Noah had problems sitting still, she simply created a learning environment where he could be on the move.
The problems began in Grade 5 when Noah entered the public school system. He found the more structured environment a bit of a challenge, but the bigger problem was the teacher, who would hand out detentions to kids who didn’t read one book a week, and required the students to copy all of the notes from the blackboard. “We’re talking five huge blackboards full of written information,” says Julie. “The teacher would finish on the chalkboard then walk around the classroom, yelling at kids who didn’t write quickly or neatly enough.”
As the weeks passed, Julie noticed Noah becoming more and more anxious. One day, he came home from school and told her his hand would shake so badly in class that he could barely hold his pencil. “This devastated [him] as he believed that he had both disappointed the teacher and failed at something he’d previously thought was a strength,” remembers Julie.
When school administrators didn’t address the problem to her satisfaction, Julie found an alternative school that was more supportive of her son’s needs. Much to her relief, Noah settled in and his appetite for learning returned.
Looking back, Julie realizes the early signs of an anxiety disorder were present in Noah but that she downplayed them. She’s plagued with guilt for not catching it sooner. “His brothers had real challenges, and I always thought life would be easy for him,” she says. “I so wanted that to be true.”
Anxiety disorders are the most common mental health problem among children and youth today, affecting an estimated six percent of them. The disorders most commonly affecting children include separation anxiety, social phobia and selective mutism. Some experts also include obsessive-compulsive disorder, panic disorder and post-traumatic stress disorder. Approximately 22 percent of people will be affected by an anxiety disorder in their lifetime.
Feeling anxious is a natural reaction to stress, and the children who experience butterfly flutters in their stomach before a test are responding normally. If children are unable to breath or become so dizzy they can’t stand up, they likely need help.
When caught in the early stages, anxiety can be easy to treat effectively. Most children respond well to cognitive behaviour therapy, an evidence-based counselling program that helps make patients more aware of their reaction to stress and teaches them to change their response.
But parents sometimes overlook the signs until the disorder becomes severe, says psychologist Dr. Susan Williams. Often, by the time she sees children, they’re experiencing feelings of anger and sadness, they’re having difficulty sleeping and their grades have dropped.
Williams is director of the Halton Centre for Cognitive Therapy and Stress Reduction in Oakville, Ont., and frequently gives presentations to parents and educators on anxiety in children and youth. When she started giving talks about 10 years ago, a typical crowd consisted of about 200 parents. More recently, she found herself staring out at a room packed with more than 600 parents.
“Kids are under more stress today,” she says. “High school students are especially under stress as they know there’s more competition to get into programs. They’re feeling the pressure, and they know there are fewer jobs.”
'Society rewards perfectionists and high-achieving people who have everything in its place.'
One of the reasons for the increase, says Williams, is because in
today’s highly competitive world, some of the very traits associated
with an anxiety disorder are being encouraged. “It can go undetected
because society rewards perfectionists and high-achieving people who
have everything in its place,” she says. “So when your child has a
perfectly tidy room all the time and she spends triple time on her
studies so she doesn’t make mistakes, parents will say she’s doing okay.
Really, though, the child is constantly worried about not being good
enough. She’s worried about the future, so she’s doing all that studying
and not seeing her friends.”
Parents also tend to downplay the
symptoms of anxiety with that simple phrase: “It’s just a stage.” That’s
something she hears a lot from the moms and dads of teens. “There’s a
belief that when a child goes into high school, grades will drop, that
this is normal — but it’s not,” she says.
Dr. Katy Kamkar, from
the Centre for Addiction and Mental Health in Toronto, says it’s
critical to get help early. “Seventy percent of mental health problems
have their onset in childhood,” says Kamkar, a clinical psychologist in
the centre’s psychological trauma program. Without treatment, some
anxiety disorders that begin in childhood can last a lifetime, she says.
This is why she stresses the importance of awareness and normalizing
“We need to focus more on mental health and early intervention so people come forward sooner,” she says.
not only due to lack of insight that parents aren’t getting their child
help but also because of a lack of access to treatment. That’s why the
Mental Health Commission of Canada recommended that anxiety prevention
programs be offered in school, where kids spend about six hours of their
In 2004, British Columbia became the first province in
Canada to offer an anxiety prevention program for all elementary
students. The 10- to 12-week program, called FRIENDS, teaches students
the tools to recognize when they’re feeling stressed and the skills to
identify the thoughts and beliefs that can lead to negative feelings. It
is delivered in three program levels: kindergarten and Grade 1, Grades 4
and 5, and Grades 6 and 7.
Many school boards, including the
Hamilton-Wentworth District School Board, have followed suit and
implemented similar programs. However, it appears unlikely that the
programs will be widely adopted elsewhere. According to a 2013 report by
the Mental Health Commission, “School boards in Canada do not yet have
the organizational conditions in place to deliver coordinated,
evidence-based strategies across the continuum of care.”
schools aren’t there to help our kids, what about community services and
programs? A report earlier this year by Children’s Mental Health
Ontario showed that over 6,500 children and teens were waiting more than
one year to access mental health services. Because of that long wait,
more kids and youth are ending up in the hospital. Over the last decade,
there’s been a 54 percent increase in emergency department visits in
Ontario and a 60 percent increase in hospitalizations for children and
youth seeking treatment for mental health issues.
Even when kids
get into treatment, some parents aren’t able to follow through. While
working as a clinical psychologist at the Children’s Hospital of Eastern
Ontario in Ottawa, Dr. Pat McGrath noticed that many parents — up to 60
percent — stopped bringing their child to treatment programs before
they were completed. He wondered why.
“I originally thought
parents weren’t motivated, but when I really looked at it, I discovered
there are a lot of good reasons they had stopped in terms of time and
money,” says McGrath, now a Canada Research Chair and a professor of
psychology, pediatrics and psychiatry at Dalhousie University in
Halifax. “If you have to take 10 Wednesday afternoons off and drive
across town, that can be challenging. Then there’s the cost of parking
and maybe buying a meal and paying for babysitting. You’re beginning to
get into a lot of costs and a lot of difficulties.”
of research, McGrath and a team developed the Strongest Families
Institute in Halifax, which provides a distance education program
designed on the premise that mental health services should be built
around the needs of the family.
The program, called Chase
Worries Away, allows the parents of six- to 17-year-olds to connect by
phone with trained coaches, who offer advice and emotional support at a
time convenient for the parent. It has been running for about nine years
and has a 92 percent completion rate.
“We make it very family
oriented. We don’t tell them they have to have their appointments
between 9 a.m. and 5 p.m. because that’s when they work,” says McGrath.
some families, however, getting help isn’t about lack of services. For
Rachel, it was about getting her husband on side when their twin boys,
Sam and Jack (all names changed), began showing signs of anxiety
disorders at around age 10. Sam became so obsessed with handwashing that
his skin became red and flaky; Jack worried excessively about getting
sick and about his parents separating.
Rachel educated herself on
mental health issues and advocated fiercely for services in their
school. However, without the support of her husband, her work was often
derailed. When she tried to set up counselling for her boys, he wouldn’t
show up to drive them. He also had anger issues, which he refused to
“Whenever Sam got into trouble at school and got
sent to the principal’s office, his dad would get so angry that Sam
would be monumentally afraid of him,” says Rachel, who lives in
Oakville. “That isn’t how you help a kid with an anxiety disorder.”
eventually had a major breakdown and then separated from her husband.
But she still feels guilty that she didn’t leave sooner. Conflict with
their sons was the central issue in the marriage. “It wasn’t until after
we split up, when the damage had already been done, that he came around
to getting help with his own anger issues,” says Rachel.
sons are now in their mid-30s and doing well. Both are married with good
jobs. They’re on the same anti-anxiety medication that they started on
as boys, and will be for some time. As Rachel says, “They both know it’s
not going to go away and that it needs to be managed.”
situation speaks to an important and often overlooked aspect of anxiety
disorders: creating a stress-free home environment for children is
critical. All children need healthy nutrition, a sense of routine and
social supports — along with people who love and support them
Maintaining that in today’s fast-paced world
where both parents work isn’t always easy. Parents need to look at the
environmental factors that may be contributing to stress in their daily
lives, says Kamkar. “If parents have a long commute, or their financial
situation changes, the entire family is impacted. Any stress the family
goes through will have an impact on everyone they live with, especially
That is particularly true if you’re living in
poverty. According to a 2008 McMaster University study, children who are
surrounded by the toxic stressors of poverty — the constant worry over
finances, parents juggling two jobs — are three times more likely than
children from non-impoverished homes to develop a mental health problem.
The study, by Dr. Ellen Lipman and Michael Boyle, showed that
the longer a family lives in poverty, the more severe the mental health
disadvantages of the children. So with all of these factors — whether
it’s time poverty or financial poverty — working against families today,
how do parents create a stress-free home environment?
with baby steps, says McGrath. Get your children outside playing more,
and have more family dinners together. Sometimes, it’s as simple as
turning off the TV and other screens. “Kids are listening to the news
when we are, and they’re taking it all in, but they lack the social
skills and emotional maturity to deal with it,” says McGrath.
Susan Williams: “Kids are getting phones at age 12, and we’re not
living in the moment as much. . . . We’re just constantly jumping from
text to text, and there’s this constant barrage of information. The
content of some of that information is much more significant and
distressing than it used to be. Just think of someone poking you. When
does the physiology of your body get to recover?”
Parents must become more aware of how they manage stress, because they are the main role models for their child.
Williams suggests indulging in a little downtime with your kids. “So
many parents are busy or distracted. . . . I tell them to get into their
child’s world for 10 minutes.” She adds that parents must become more
aware of how they manage stress, because they are the main role models
for their child. Studies show a child has a much higher chance of
developing an anxiety disorder if one or both parents are anxious. “Kids
learn how to deal with their anxiety by observing their parents.
Unfortunately, a lot of parents don’t know how to calm themselves down,
so they can’t calm their kids down,” says Williams. She adds that it’s
also important to let our children know it’s not a sign of weakness to
ask for help.
What Julie learned from parenting a child with an
anxiety disorder is that, like nearly all mental health problems, it is
for life. Getting a child diagnosed early is critical to preventing the
anxiety from becoming overblown. It also allows the parents to access
support for their child and to help the child manage symptoms,
especially during periods of stress.
Noah did well at his new
alternative school program. But when he reached high school, the
symptoms returned and intensified until he was completely paralyzed. “He
felt backed into a corner and was so overwhelmed that he was
practically unable to function,” says Julie.
One day he came home
from high school and crawled into his bedroom closet and slept there,
hiding from the world. “It was heartbreaking,” says Julie. “I was so
afraid he would hurt himself. In fact, there was a rope in his closet,
and one day — sobbing — I went in and removed it.”
counselling and lots of unconditional love and support, Noah found his
way out of the dark. But the take-away lesson for Julie was that he will
always have an anxiety disorder. “Every day, I ask him to take care of
himself. Just yesterday, I texted him a reminder that his current
circumstances are potentially dangerous for him and that he needs to be
mindful of getting lots of sleep, eating well and talking to us about
his mental health and how he’s feeling. It will need to be managed just
like diabetes or any other health challenge. Like any parent of any
child, my hope is that he can achieve and maintain wellness so that he
can enjoy the life he wants to live.”
Denise Davy is a freelance writer in Hamilton who specializes in mental health reporting.