Understanding Children’s Worry

Clinical, Developmental and Cognitive Psychological Perspectives

Charlotte Wilson

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781351227643
• Topic: Psychology
• Subtopic: Cognitive Psychology & Cognition
• Index: Psychology

This accessible guide offers a concise introduction to the science behind worry in children, summarising research from across psychology to explore the role of worry in a range of circumstances, from everyday worries to those that can seriously impact children's lives.

Wilson draws on theories from clinical, developmental and cognitive psychology to explain how children's worry is influenced by both developmental and systemic factors, examining the processes involved in pathological worry in a range of childhood anxiety disorders. Covering topics including different definitions of worry, the influence of children's development on worry, Generalised Anxiety Disorder (GAD) in children, and the role parents play in children's worry, this book offers a new model of worry in children with important implications for prevention and intervention strategies.

Understanding Children's Worry is valuable reading for students in clinical, educational and developmental psychology, and professionals in child mental health.

CHAPTER ONE
What is worry?

Definitions of worry

Geraldine was a 13 year old girl asking for help with her constant anxiety. When she met the clinical psychologist she explained that she worried all the time. When something unexpected happened her mind immediately leapt to all the different outcomes that might occur. Recently her father had been late home from work and she worried that he had been in a car accident and killed, she worried that he had lost his job and had just gone away, she worried that he didn’t love her and her sister anymore and had decided not to come home. These worries kept coming until he walked in the door, a little late because a meeting had run over. Geraldine explained that this happened all the time.

The Oxford English Dictionary defines worry as

1. A troubled state of mind arising from the frets and cares of life; harassing anxiety or solicitude.
2. An instance or case of this; a cause of, or matter for, anxiety; pl. cares, solicitudes.

It is a familiar phenomenon; nearly all adults report worrying at least from time to time, with up to 70% of children as young as seven to eight years old reporting the same (Muris et al., 1998; Muris, Merckelbach et al., 2000). In popular parlance, worry is synonymous with anxiety, nervousness, concern, fear, and uncertainty. However, even when we start to pull apart the differences between these different phenomena certain things appear to be specific about worry. If I am worrying about something, then inevitably I am thinking about it. It also probably has that sticky feeling as the thoughts go round and round in my head. Unlike fear or nervousness, where I might know exactly what I am afraid of, when I am worried I can start somewhere in my worry and end up somewhere completely different. It is these features of worry that researchers noted when it started to become clear that worry could be a topic worthy of study in its own right, as separate from fear. Early definitions of worry in the academic literature emphasised the distinctions between the somatic and acute experience of fear, and the repetitive, iterative nature of worry (Tallis, Davey, & Capuzzo, 1994). Worry was conceptualised as part of anxiety, but differentiable to fear. In these early definitions of worry the construct was considered to be appropriate across the range of worry, with the same definition being appropriate for worry that was considered to be normal, and worry that was part of a clinical condition. In the early 1980s an interest in pathological worry started to flourish with the work of Tom Borkovec and colleagues. Indeed it is Borkovec and colleagues’ 1983 definition of worry that persists in the literature on pathological worry. Borkovec defined worry as

a chain of thoughts and images, negatively affect-laden and relatively uncontrollable; it represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes; consequently, worry relates closely to the fear process.

Borkovec et al. (1983, p. 10)

This definition highlighted several aspects of worry. It highlighted the function of worry as being one of problem solving. It highlighted the negative affect associated with worry. Further research from Borkovec (1994) found that worry was predominantly verbal-linguistic. These three factors have driven a research agenda that has led to multiple theories of worry, several different but effective treatments for pathological worry, and a greater understanding of the role worry may play in a variety of psychological disorders. In each of these domains the research involving children has lagged behind research involving adults, but increasingly worry as a separate phenomenon is being recognised and researched across the life span. This chapter focuses on the following three factors: worry as problem solving, worry and negative affect, and worry as verbal-linguistic – ​in order to highlight similarities and differences between adult and child worry. The chapter concludes with a review of the proposed functions of worry and ways of measuring it.

Problem solving and worry

Worry has long been believed to have a problem-solving function, especially to those who engage in it regularly. Indeed there is a small but significant literature focusing on the role problem solving has in our understanding of adult worry. In one of the few studies of the content of everyday worry Tallis et al. (1994) found that both worriers and non-worriers report that problem solving is one of the main reasons they worry. Very little research has explored whether worry is an effective way of problem solving, but for those people for whom worry is problematic and interfering in their everyday life, it is clear that it isn’t a good strategy for them to choose. Something is clearly going wrong with using worry to solve problems.

Different aspects of problem solving have been explored in relation to worry. Initial hypotheses focused on faulty problem solving. Problem solving involves several stages, including identification of the problem, identification of possible solutions, choosing a solution, and enactment of the solution (Figure 1.1) (D’Zurilla & Goldfried, 1971).

Figure 1.1 Problem-solving stages.

If this process has gone wrong for chronic worriers any, or all, of these problem-solving steps might be faulty. Davey (1994) explored this problem by looking at worry and problem solving in adults. He tested whether people’s ability to use problem-solving steps to achieve a goal (using the Means End Problem Solving Inventory, MEPS; Platt & Spivack, 2006), and to find an effective solution were associated with their problem-solving confidence, approach-avoidance style in problem solving, and personal control (measured by the Problem Solving Inventory, PSI; Heppner & Petersen, 1982). Not only did Davey find that worry and anxiety were not related to problem-solving ability, he also found that problem-solving ability wasn’t related to problem-solving confidence. However, those participants with high levels of worry and anxiety showed poor problem-solving confidence (Davey, 1992, 1994). Davey concluded that what was going wrong in problem solving in worriers was not that they were poor problem solvers but rather that they had poor confidence in themselves. However, when thinking about worry and problem solving in children there is good reason to question whether there are problem-solving deficits. Problem solving in general will be affected by cognitive development, and perhaps even social and emotional development. Furthermore, children with psychological difficulties may have specific difficulties with different aspects of problem solving. For example, Dodge and Crick (1990) reformulated the D’Zurilla and Goldfried model of problem solving within a social information processing framework in order to explain social problem-solving deficits in children with aggressive behaviour. Although some differences emerge in these deficits at different ages (Crick & Dodge, 1996), it does appear that aggressive children do struggle with misattributing hostile intent to others and failing to choose proactive solutions and predicting that aggressive solutions will work out well (Crick & Dodge, 1994).

A few years later Daleiden and Vasey (1997) saw the parallels between the struggles aggressive children had with problem solving and the struggles anxious children displayed. They developed a model of what difficulties anxious children might have with problem solving. They proposed that children who are anxious show attentional biases that lead them to judge neutral situations as threatening, or within a problem-solving framework see problems where there are none. They proposed that anxious children may struggle with distractibility and therefore may not be able to think about a number of different solutions or to see a solution through to the end. They propose that anxious children may choose more avoidant solutions rather than actively engaging with the problem and may struggle to enact the solution they do choose. Therefore, although the adult literature suggests that it is not problem-solving ability that is associated with anxiety and worry, it might be that, due to developmental factors, children with high levels of anxiety and worry have poor problem-solving skills. All of these hypotheses have some evidence to support them. Anxious children do indeed show biases towards threat in the face of neutral/ambiguous stimuli (Gifford et al., 2008), they do find threat more distracting (Bar-Haim et al., 2007) and they do choose more avoidant solutions (Barrett et al., 1996). The failure to enact solutions is harder to test as it needs naturalistic observations; however, it is commonly seen by clinicians treating anxious children. What remains unclear however, is whether this is due to anxiety or whether it is specifically due to worry. Derakshan and Eysenck (2009) argue that it is the worry component of anxiety that impairs problem solving, but only one aspect of problem solving-the efficiency of processing the information. They argue that worry and/or anxiety has much less impact on the effectiveness of the performance of the solution. This would tend to be consistent with the few studies that have specifically tested the relationship between worry, anxiety and problem solving in children. To date, two studies have explored this relationship. Wilson and Hughes (2011) explored social problem solving in 6–​11 year olds using the Wally Problem Solving task (Webster-Stratton, 1990) developed for the Incredible Years programme (Webster-Stratton & Reid, 2003). Similarly to Davey, we found that there were no differences in children’s ability to provide a number of appropriate solutions to social problems when comparing high and low worriers but that children who reported high worry also reported low confidence in their ability to solve problems. Efficiency of processing was not measured, but there was no impact of anxiety or worry on the effectiveness of the solutions provided by the children. Extending this to a sample of children with high and low worry, Parkinson and Creswell (2011) found that there were no differences in problem-solving skills between high and low worried children using the Alternative Solutions Test (Caplan et al., 1986). In contrast, children’s confidence in their problem-solving abilities was significantly lower in the anxious group compared to the non-anxious group.

These studies do not allow a full exploration of real-life problem solving or of the efficiency of problem solving in anxious and worried children, but they do suggest that problem-solving confidence may be the key aspect of problem solving that is associated with high levels of worry in both children and adults. It could be hypothesised that this problem-solving confidence itself might be associated with poor processing efficiency: if problem solving feels hard to do, then this might impact problem-solving confidence more than finding a successful solution.

Negative problem orientation, a significant factor in several models of pathological worry or generalised anxiety disorder, is another aspect of problem solving that has been studied extensively in the context of worry. Given its role in models of pathological worry it is discussed in Chapter 4.

In conclusion, there may be more similarities than differences in adults and children when considering the relationship between worry and problem solving. It is likely that a high level of worry does not impact on how effective a problem solver someone is, but it might impact on the confidence they feel in their own problem solving and the efficiency of their problem solving. Worry may well function as a problem-solving strategy, but it may not be the best one to choose.

Negative affect and worry

Worry is often a problem because of the way it makes us feel. Even though the aim of worry may be to solve a problem, the fact we are thinking about potential threat increases our negative affect, and this relationship between worry and negative affect appears to hold across a wide range of cultures. However the relationship between worry and affect is somewhat more complicated than a simple linear relationship. Although worry orients us towards threat, the nature of worry as a verbal process (see below, this chapter) may serve to dampen the threat response. Indeed, in a review of five different models of pathological worry (generalised anxiety disorder) Behar and colleagues (Behar et al., 2009) propose that ‘all models share an emphasis on avoidance of internal affective experiences’ (avoidance models are discussed in Chapter 4). These avoided affective experiences include thoughts, beliefs, and feelings, but the common factor is that it is the affective experience that is avoided. Thus the contradiction within the worry process is that it makes us feel bad, but not as bad as truly engaging with the threat.

The evidence for the association between negative affect and worry is extensive in adults (Watson, 2005), but much sparser in children. Furthermore, some of the research in children’s affect and worry addresses our understanding of the relationship between them indirectly, making it difficult to make strong conclusions. For example, Woodruff-Borden and colleagues (Affrunti & Woodruff-Borden, 2016; Gramszlo et al., 2018; Gramszlo & Woodruff-Borden, 2015) explored the temperamental dimension of negative affectivity in relation to worry in children. This construct of temperamental negative affectivity refers to a personality feature that leads the individual to view the world as more negative and to experience more negative emotions (Watson & Pennebaker, 1989) and in middle childhood is reliably measured using the Temperament in Middle Childhood Questionnaire (Simonds & Rothbart, 2004). In their three studies of 7–​12-year-old children from the community, Woodruff-Borden and colleagues found that those children who reported higher levels of worry on the Penn State Worry Questionnaire for Children (PSWQ-C; Pestl...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Chapter 1 What is worry?
• Chapter 2 Children’s worry and development
• Chapter 3 Children’s worry and the family
• Chapter 4 When children’s worry becomes a problem
• Chapter 5 Children’s worry and psychological disorders
• Chapter 6 A new developmental understanding of worry
• Bibliography
• Index