Aaron

“Mom!” yells Aaron. “I can’t find my glove or my jersey. Where are they?” He starts to yell and throw things. His two siblings are eating their cereal, chatting excitedly. It’s Monday morning, and Julie is trying to get her three children off to school. “I don’t know, you’ll have to look,” says Julie. Aaron, a 13-year-old boy, starts to really yell. “I never know you where you and dad put my things. C’mon mom, the least you can do is help me look.” She can feel her oldest child starting to panic. Julie sighs, and starts to prepare herself for the meltdown that she is sure is soon to come.

Toby

Toby is a second grade boy. At home, he is the loudest kid in the house. He is constantly talking, laughing and running around. He loves to play in the dirt, swing on the swing-set, and ride his bike. He follows the family Golden Retriever around everywhere, and reads him books. Maria is completely confused by him. Every morning, Toby reports a stomachache. The minute he gets in the car, he is transformed. His eyes appear to gloss over, and all expression seems to leave his face. He stops talking. When she asks him questions, he simply shrugs. Soon, he will leave the comfortable car, and transition to the school environment. He has 28 children in his class, and 500 children in his school.

At school, he is described by his teacher as “withdrawn” and “quiet.” His teacher says he rarely uses his voice, and only talks to her in one-word phrases. He has one friend, but he rarely talks to him at school. At home, however, they laugh and chat constantly. The week before he was supposed to give a short oral book report, he cried every night. His teacher says that she would like to help, but says that with that many students in his class, there is little she can do. After all, he’s not a behavior problem. None of the students or other school personnel complain about his behavior. In fact, most of the school staff barely seem to notice him.

What Parents Should Know About Anxiety in Children

Alaina

“I’m not going!” Alaina says.

“You have to go,” her mother, Lynnette replies. “It’s the last basketball tournament, and your team is counting on you!”

“No way am I going, there are clouds in the sky, and it’s starting to rain.”

“I already checked Weather Center and there are no storms in the forecast.”

“You don’t know that. They can come up as a surprise. And there’s no basement at the gym.”Alaina starts to cry and shake. “There is no way you can make me go,” Alaina yells.

Three kids. Three very different presentations. But all three kids have something in common. Anxiety.

Anxiety is a complicated. It is more than just worry. It is more than just stress. It can take over someone’s life. Sometimes it is small, like a mouse in the corner. Sometimes it’s loud and strong, like a lion in the center of a small room.

Anxiety can be tricky. It can cause someone to doubt her instincts. It can cause someone to believe that there is danger where it is harmless. It can cause people to feel threatened and vulnerable when they are protected and safe. It can cause people to see enemies rather than friends. It can cause people to see failure instead of success.

If you are a parent of a child of anxiety, you feel helpless at times, like nothing is ever going to work. You may also feel frustrated and confused, particularly if you have tried medication or therapy before, and your child is still struggling. Some parents come to see us in our practice to work with their child, and they are already so exhausted, it is hard to move forward. It can be hard to parent your child well, particularly when you are so confused and tired. It can be to see your child struggle or suffer. We want you to know that you are not alone.

“I feel like anxiety is a big hot air balloon that blocks the sun from the rest of my life.” child, age 8, about her anxiety

What is Anxiety?

If you are reading this, you or your child (or both of you) probably has some anxiety. You may be surprised to know that everyone has some stress, anxiety, or fear. It is part of the human condition. Our biology wires us to recognize and perceive danger. These are survival instincts, and actually quite miraculous. Anxiety allows us to stop, rather than walk out into traffic. It allows us an opportunity to question whether we should make decisions involving safety or taking risks. Anxiety can help us consider the feelings of others when we make decisions.

At times, though, anxiety can become the force that makes decisions for people. Anxiety can tell us to think too often, or worry too much. Anxiety can us that something dangerous can happen to us when the risk is slight. Very commonly, anxiety tells us to avoid, or not do things, that are harmless. As a result, we may worry so much that we can’t stop, or we may stop doing things that are important in our lives. We may struggle with our relationships, or our ability to cope with difficult situations. When these things start to happen, anxiety is said to “interfere with our daily functioning,”

There are many different kinds of anxiety disorders. The Diagnostic and Statistical Manual – Fifth Edition, classify them into different types. These are described by how many symptoms we have, and how hard they make our lives. There is a great deal of overlap between different types of anxiety. Many people have symptoms of multiple types of anxiety.

When a person’s anxiety is difficult enough to have multiple symptoms and make their lives harder in multiple ways, they are often diagnosed with a type of an Anxiety Disorder. The main purpose of a diagnosis should not be to label someone as different from other people or to make them feel bad. The purpose of a diagnosis should be to help you communicate better with your healthcare team, and to help guide your treatment with effective care.

Anxiety Disorders are common, and are among the most common reasons that people seek therapy, or take their children to therapy. Research tells us that one in three people will be diagnosed with anxiety at some point in his or her life. That is a lot of kids with a lot of anxiety! Just think about what that means. Think about your child’s class at school. Count to yourself, “1 – 2- anxiety, 1 -2- anxiety.” It adds up quickly. We also know that many people who have anxiety and either do not seek help or are misdiagnosed. So, the actual occurrence of anxiety may be even higher.

Anxiety is often described as uncomfortable and terrifying. However, as you can see from the three children described earlier, every child’s anxiety is different. Some people feel like they can’t breathe, and their heart beat is rapid. Other people describe nervous tension throughout their body. One can even seem frozen, as if they cannot move or think. It is quite common for people have stomachaches, headaches, and fatigue. Many people have constant worry about themselves, the world, or their future. Sometimes, these worries can be focused on one particular thing or another, such as dogs, heights, blood, needles, contamination, or negative evaluation from others. No one likes to feel anxious.

Anxiety is not acutely dangerous. Unlike a high fever or gaping wound, it won’t cause immediate death or severe injury. However, if you or your child has ever experienced a panic attack, you know it may FEEL like you are in mortal danger. However, people with ongoing anxiety DO have long term effects. For example, they may have impaired immune responses, headaches, stomachaches, depression, weight control issues, fatigue, sleep problems, or substance abuse. It’s certainly not healthy for us to have long-term stress or anxiety.

Unlike adults, children express anxiety symptoms differently. Children have difficulty contemplating their own thoughts and emotions well. The frontal lobes of our brains are largely in control of these “meta-cognitive” functions. Recently research has also found that frontal lobes in children and adolescents have not completed development often until the early 20’s. As a result, many children have difficulty understanding why they are worrying so much, as well as identifying how they experience anxiety and fear. Which means that even when parents ask things like, “Why are you worrying?” or “What is going on with you?” they often cannot answer accurately.

Many times, children are brought to treatment for anxiety because of other symptoms, such as school refusal, social withdrawal, and tantrums.

How is anxiety misunderstood?

Defiance

ADHD

Brattiness

Shyness

Uncaring

Disinterest

What are some warning signs of anxiety in children?

Over-reactivity to small things

Anger or aggression at home, but good behavior at school

Worries

Social withdrawal

Nightmares or sleep difficulties

Bed-wetting

Refusal to go to places or activities

Nail-biting or nervous habits

Inattention or a blank stare

Difficulties with transition

Tearfulness

How is this information helpful?

If you recognize some of those symptoms in your child, it is time to seek help from a therapist or psychologist skilled in cognitive behavioral therapy. There is strong research to support the effectiveness for cognitive behavioral treatment for children. This type of treatment teaches children the relationship between their anxiety (or other feelings), their bodies, their thoughts, and their behaviors. It is often skills-based, and teaches different strategies that children (and their parents) can use to reduce the discomfort and interference from anxiety. If you have some of the same symptoms as your child, it is time for you to seek your own treatment as well. Research finds that when parents are anxious, children are also often anxious. For your child to do better, oftentimes you need to address your own concerns. (For additional information please refer to my earlier blog post on the contagion of anxiety). Pay attention to your child’s symptoms. If you notice that your child is more inattentive, tired, or defiant, it may be important to consider anxiety as a possible cause or contribution, particularly if you or your spouse also has these symptoms. Be patient. Even with treatment, it can take some time for your child’s anxiety to decrease, particularly if your family has been through some changes or stressors. However, ask your therapist for things to work on at home, and then work on them at home. The more you practice tools to help your child, the sooner the anxiety will get better. Don’t give up. Stay hopeful. Treatment success is not instantaneous, but it is possible and will happen. It will get better. There is always time for things to feel easier or run more smoothly. Don’t settle for the discomfort of anxiety or think that it is the best you or your child deserves. Hope (and good treatment) change everything.

*The three stories mentioned in the beginning of this article are fictional. Any resemblance to real-life is unintentional.

Thank you to the following sources for the images: Death to the Stock Photo, Google Images

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