Anxiety disorders are the most common mental health disorders in children and young people.
Anxiety is a normal and common part of childhood. In most cases, feelings of anxiety are temporary, and may be triggered by a specific stressful event. For example, a young child may experience separation anxiety when starting school. In some cases, anxiety in children can become persistent and intense, interfering with their daily routines, activities, relationships, and overall wellbeing.
When anxiety causes ongoing distress or impairment, it may indicate the presence of an anxiety disorder.
Signs of anxiety can include:
- Finding it hard to concentrate
- Problems sleeping or waking during the night
- Changes in appetite or not eating habits
- Becoming more angry or irritable than usual
- Worrying a lot or having persistent negative thoughts
- Feeling tense and fidgety, or using the toilet more often than usual
- Needing reassurance more often than usual
- always crying
- Being clingy or finding it difficult to separate from parents or carers
- Complaining of tummy aches, headaches, or feeling unwell
- Becoming withdrawn and losing interest in activities they usually enjoy
Common types of anxiety include
- Specific fears or phobias: a strong fear of a particular object or situation or activity like dogs, injections, or flying.
- Feeling worried or anxious most of the time for no obvious reason
- Separation anxiety: feeling very worried or upset about being away from a parent or caregiver.
- Social anxiety: feeling very nervous or worried in social situations like meeting friends, taking part in activities with others or speaking in class.
- School-based anxiety: feeling anxious about going to school because of worries about –friendships, bullying or schoolwork
- Generalised anxiety: Worrying a lot about everyday things often asking repeated ‘what if…?’ questions and needing lots of reassurance from others that things will be okay.
- Post traumatic reactions: feeling anxious, frightened, or distressed after experiencing or witnessing a stressful or frightening event.
- Obsessive Compulsive Disorder: experiencing unwanted worries or thoughts and feeling the need to repeat certain behaviours or routines to reduce anxiety.
Tier 2 CAMHS and Referral Guidance – Tier 2 Teams – Child and Adolescent Mental Health Services
The CAMHS Tier 2 service is made up of mental health professionals called Primary Mental Health Workers (PMHWs). One team covers East, Mid and West Lothian and a second team covers Edinburgh North and South.
CAMHS Tier 2 support children and young people’s mental health needs by offering an assessment through conversation with the young person and their parent/carer, followed by individualised signposting to the most appropriate services or resources.
GPs can discuss potential referrals with a Tier 2 PMHW, who can advise whether Tier 2 support is appropriate or whether an assessment referral may require assessment by Tier 3 CAMHS is required.
G.K & C.M – 6-10-26
Who can refer
GPs, school nurses, health visitors, teachers, social workers
Who to refer to Tier 3 CAMHS
Children and young people with persistent or severe symptoms of anxiety that significantly affect their daily functioning, should be referred to CAMHS.
Specialist CAMHS involvement should be considered when:
- Anxiety is having a significant impact on the child’s development or everyday functioning or there has been a sudden deterioration.
- The level of anxiety appears disproportionate to the child’s or family circumstances.
- Anxiety has a significant impact on family life or the parent / carer / child relationship.
Please describe this impact clearly in the referral.
Who not to refer
School attendance difficulties
CAMHS will not accept referrals where school truancy is the only concern. Where anxiety is affecting school attendance, referrers should consult with education colleagues in the first instance.
Schools and local authority education departments have their own protocols and a range of resources like inclusion support workers, educational psychologists and behavioural support services which will need to be explored prior to making a CAMHS referral.
Physical Symptoms
If a child is experiencing severe physical symptoms, an initial referral to a paediatrician is recommended to rule out any underlying physical health concern.
How to refer
Please:
- Discuss referrals with Tier 2 PMHW, if it is not clear whether an assessment by Tier 2 or Tier 3 CAMHS is required
- Otherwise refer via SCI Gateway to CAMHS.
Please see locality based mental health information under the Resources and Links tab.
Locality based mental health information/resources:
- Wellbeing – The City of Edinburgh Council (Edinburgh)
- Eastspace | Find support (East Lothian)
- West Space | Resources (West Lothian)
- Home – MYPAS HOME
MYPAS (Midlothian young people’s advice service includes counselling and family counselling services)
0131 454 0757
Helpful resources for parents and carers
Royal College of Psychiatrists have a range of resources written by mental health professionals and young people:
- Overarching Mental Health Information
- Anxiety for Children and Young People
- Coping with Stress for Children and Young People
Recommended reading for parents would be Helping Your Child with Fears and Worries: A Self-Help Guide for Parent (2019) by Cathy Cresswell and Lucy Willets.
Self-care for parents and carers is important while supporting a child or young person in understanding and managing their mental health. Information can be found here:
- Anna Freud Centre – Self-care for all parents and carers information.
- Parent Club Family Support Directory
Helpful websites for young people:
NHS Inform offer general information and signposting at a national level:
Young minds offer information on different mental health presentations, accessing support and what it may look like, and how to support a friend if they are struggling.
Self-help workbook of relaxation exercises for young people to practice:
NHS Scotland’s guide to understanding and managing trauma for young people.
NHS Inform’s information about phobias.
