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I t’s nothing new for pharmacy staff to see an anxious child enter the store flanked by apprehensive parents seeking to find some advice about alleviating a condition and facilitating wellbeing, especially during pandemic times. What they may not often know is the link between anxiety and dyslexia. It’s here that pharmacists and their assistants occupy a prime position to point out that anxiety might be affecting their children in ways parents hadn’t even thought of, and which can be addressed. One known way is in their learning, with many studies demonstrating an association between learning disabilities and internalising problems such as anxiety and depression. However, the understanding of this association for people with specific types of learning disability – such as poor reading – is poorly understood, according to Professor Genevieve McArthur, Head of the Centre for Atypical Neurodevelopment at Macquarie University’s Department of Cognitive Science, who co-authored a paper, ‘The association between poor reading and internalising problems’. The study presents the first systematic review and meta-analysis of studies that have examined associations between poor reading and internalising problems – including anxiety and depression – in children, adolescents and adults. The search identified 34 studies comprising 16,275 participants, of which 2,491 were poor readers. The study shows statistically significant differences between poor readers and typical readers on general measures of internalising problems as well as specific measures of anxiety and depression. These outcomes suggest that poor readers are at moderate risk of experiencing internalising problems compared with typical readers, which appear to stem from a greater risk of anxiety than depression. Bringing it to pharmacy level Professor McArthur says this information is especially pertinent to pharmacies where they deal with anxious children. She advises pharmacists to recommend cognitive behavioural therapy, which has many programs, as the most established and effective way to treat children with anxiety. As to reading problems, Professor McArthur says pharmacists would do well to refer the child to field reading experts where they can receive evidence-based, individualised reading intervention. This ideally should be provided by schools, but often that’s not the case. Mark Webster, owner of Stay Well Pharmacy in Christchurch, New Zealand, agrees, saying anxious children will manifest poor reading, but other conditions as well, from bedwetting and insomnia, to hyperactivity and rage. Anxiety will usually be the most obvious symptom, Mr Webster emphasises. He says pharmacy assistants can best help parents reduce anxiety in children by getting a good description from their parents of what is going on in their children’s lives, including their sleep patterns, their downtime in terms of how they relax and when they’re most anxious, and any other details however insignificant they may appear. “This enables a good understanding of where the anxiety is coming from and how it’s playing out,” Mr Webster said. Lee Holmes, nutritionist, author and founder of Supercharged Food (superchargedfood.com), says it’s important that caregivers and educators provide a safe environment for children to learn and read so that anxious feelings are not exacerbated, especially in group settings. “Guardians and healthcare workers have to have a good understanding about what is happening in the child and how anxiety can be reduced, so that the deactivation of stress responses can take place,” she said. “Use of visual aids/apps or tools would be good in these instances. Exercise is also a helpful tool to lower anxiety levels, as well as a healthy diet, which goes without saying. “This is vital for a properly developed nervous system. A deficiency in omega-3 fatty acids can lead to learning and behavioural changes, so including foods such as salmon, walnuts and flaxseeds in a child’s diet is helpful.” Ms Holmes points out that sources of vitamins, minerals and chemicals ideal for balancing out mood are vitamin B-rich foods such as eggs, fish, meat and chicken; “natural, feel good” dopamine- rich foods such as almonds, avocados and pumpkin seeds; folic acid as part of the “vitamin B umbrella” and fish oils. “Dopamine is a chemical in the brain that plays a part in pleasure/reward pathways, with a diet rich in dopamine increasing mood and decreasing ups and downs,” she said. “Folic acid is also a brilliant mood booster, with ‘superhero’ veggies such as rich leafy greens, broccoli and kale easy to sneak into kids’ foods. “Fish oils are essential for brain and nervous system boosting, increasing those serotonin levels in the brain and good for alleviating some of the feelings of anxiety.” Ms Holmes says oats in cereals provide a long-lasting energy source necessary for a long day at school. “Oats really help children who find it hard to concentrate when trying to read, and eggs are also great for concentration as they contain many omega-3s, as well as being loaded in essential proteins,” she said. “In fact, it’s shown that fat and protein together are great for settling the brain to allow for attentiveness.” Ms Holmes also highlights the value of oranges, providing natural glucose to boost energy and aid concentration, and walnuts, which are rich in omega fatty acids, improving brainpower and attention. An added advantage, she says, is that they’re easy “lunch box fillers”. “Similar to eggs, avocados contain fats and protein for lasting energy, so slice some on to a piece of homemade toast and you have an excellent snack for a kid, not to mention blueberries which are a snack of their own, bursting with antioxidants,” she said. “These little berries are the ultimate brain- boosting snack.” LITTLE LEGENDS 59 RETAIL PHARMACY ASSISTANTS • AUG 2020