Childhood Anxiety – March 2015

Q: My 6 year old is now suddenly afraid of a lot of things – getting on the bus, staying with a sitter, getting hurt, etc. I spend hours every day trying to convince her she has nothing to worry about but it doesn’t help. I’m getting very frustrated but also worried for her because I see her life getting more limited as she avoids the things she’s worried about, and my life is starting to feel more limited as I have to compensate (I drive her to school now every morning). What can I do to help her?
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A:It is so hard to see our child suffer, and when we can’t fix it it’s easy to get caught in the frustration/guilt loop. The good news is there are a lot of things we can do to help our child learn to manage anxiety, and if needed we can call on professionals. It’s important to remember that anxiety itself isn’t “bad.” We all feel anxious sometimes – no species would survive without a healthy dose of it. Not only does it play a critical role in keeping us alive but studies show that a small amount of anxiety can boost our performance. We deal with anxiety by controlling and avoiding, and it can work well or backfire. Anxiety in childhood is considered a problem when rational anxiety becomes irrational fear or chronic worry and interferes with at least one area of life to the point that it triggers inappropriate behaviors or they can’t participate in age-appropriate activities. The onset of clinical anxiety is usually around six years old and symptoms can escalate around age ten. Somatic complaints are common: stomachaches, GI distress, headaches, muscular pain, even injuries. Don’t be quick to assume your child is faking – it’s normal for anxiety to be experienced as physical symptoms. Some of this is the fight or flight system doing its job in ways that aren’t very helpful when there’s not actually a reason to fight or flee.

Children can struggle with different types of anxiety, and often more than one (separation anxiety, obsessive-compulsive disorder, phobias, social anxiety, generalized anxiety disorder). Their anxiety is often misread as depression, ADHD, or a learning disorder because the effects of stress hormones (adrenaline and cortisol) can present in a variety of ways: oppositional, irritable, moody, tearful, distractible, confused, disorganized, fidgety, isolating. After ruling out any medical reasons for anxiety, consider having your child meet with a specialist to help them learn to manage it. There are many options available to help children with severe anxiety: art therapy, play therapy, cognitive behavioral therapy, neurofeedback, and medication are some. Those professionals will work out a treatment plan for your child and instruct you on how to participate in it at home.

In general, you want to help your anxious child learn to identify anxiety, express it effectively, and manage it in a healthy way. Often parents take the child’s lead and try to remove all stressors from the child’s life so they don’t feel anxious but actually the goal is to create an environment where they can feel anxiety and triumph over it. You don’t want to knowingly expose the child to more anxiety than they have internal skills to manage but you also don’t want to teach them that avoidance is the best way to manage anxiety. Here are some things you could try:

  • Start by talking to them about it. Many parents want to ignore their child’s anxiety in hopes of extinguishing it. That could work for mild, typical anxiety but if it’s a real problem the child might feel invalidated and escalate their behaviors to be heard. Sometimes good old-fashioned empathy can help a lot. But know that it’s common for children to be unable to verbalize anxiety, or indicate something other than the true culprit. It’s hard for many of us to know why we feel anxious, but children especially have trouble acknowledging that. When exploring their anxiety with them try to avoid using the word “why.” It can sound like an accusation (even to adults) and children are particularly prone to wanting to please and are likely to interpret “why” as they’ve done something wrong. Try “how come” and questions that start with “what,” “when,” “where,” “are” and “is.” (One thing to keep in mind is that physical or sexual abuse can result in children being anxious about things that remind them of the offense, like the offender, place of offense, time of day of the offense, etc., but emotionally shut down about it and be unable to verbalize anything about it.)
  • Get objective collateral information about your child’s functioning from teachers, babysitters, and other adults who see your child when you’re not there. This will help you figure out triggers and patterns and allow everyone who spends the most time with your child to work as a team. Here are some tips to help minimize separation anxiety at school.
  • Teach them to self-soothe physiologically with diaphragmatic breathing, progressive muscle relaxation, and relaxing visualization techniques. These methods can be modified for any age. Fun visualization can help decrease physical manifestations of anxiety – imagine a “good” shark biting off chunks of that knot in your stomach and with each bite the knot gets smaller, imagine throwing that worry thought onto a cloud passing by and it carries it away, etc.
  • Try some compassionate reality-testing. Have them write down or draw what they’ve been worried about and later see if it happened. Doing this over time will show that either their worst fear doesn’t tend to come true or their fears sometimes come true and they are still okay. Then talk with them about how they would handle it if their fear came true. When we get wrapped up in anxiety we often stop at the “that would be so bad! I don’t know what I would do/I wouldn’t be okay” part. Usually when we think about it we know how we would handle it and just knowing that can help quell fear because it’s reassuring to have a plan. Plus, over time this can translate into a belief that one can handle difficult things in the moment.
  • Teach your child how to fantasize in a realistic or positive way. They are already very good at negative fantasizing and have trained their brain to do that without any effort. Train them to drift off to sleep with a positive fantasy about the next day, or have a realistic fantasy as they approach the event that worries them.
  • Coach your child in positive self-talk. Just as we teach our children how to talk to others we can teach them to talk to themselves in a supportive, loving way. “I can handle it” and “I will be okay” are hugely powerful beliefs to instill.
  • Don’t underestimate the power of prevention! Many children (and adults for that matter) do well with knowing what to expect in the day. For your child this might look like a brief discussion (or pictures) in the morning or the night before. Also, try to prevent them getting overly tired or hungry (teach them how to know these signs) since those conditions make them particularly vulnerable to stress.

Remember that you are a powerful role model for your child so if they see you anxious it will fuel their anxiety, and if they see you using these techniques they’re likely to try them. Learning to deal with anxiety is a process. Keep doing your best with empathy and compassion and trying new things, and remember that your child is also doing their best. Childhood anxiety often passes in the natural course of learning about the world and how to cope so don’t assume this will always be a problem for your child.