By Jan Cheek, MSW, LCSW
Children can suffer from several types of anxiety during the developmental years. Specific phobias are when children have excessive, extreme, or irrational fears of specific things such as bugs or thunderstorms. Separation anxiety is when a child is excessively worried and upset by being separated from a parent or primary caregiver. Social anxiety is when a child is extremely self-conscious and fearing being judged or being made fun of. Generalized anxiety is when a child worries about a variety of many different things – often referred to as the “What if….?” Syndrome. Obsessive-compulsive anxiety occurs when children’s minds are filled with intrusive and unwelcome thoughts and they develop compulsive behaviors (rituals) to try to alleviate or minimize the anxiety. Selective mutism occurs when a child who has the ability to speak and has vocabulary to use words for communication has extreme difficulty speaking out loud in some settings.
Anxiety is actually a normal response to stress and uncertainty. Typical anxiety is uncomfortable and distressing, but like most things that are uncomfortable, we figure out ways to problem solve and manage it, accept it, tolerate it. It is important for parents and children to know that anxiety itself is not dangerous and is something that can be managed and coped with.
As parents, it is normal to want to prevent suffering in our children and to try to protect them from pain and distress. However, when parents try to eliminate anxiety or triggers of stress and angst, they do not allow children to learn to manage, accept and tolerate anxiety. There will always be life-stressors at every age. The goal is not to eliminate stress or anxiety, but to discover ways to handle the discomfort and minimize impairment.
It seems like it would be helpful for parents to simply avoid the things that create anxiety for their children. However, avoiding things only helps in the short term and actually perpetuates the angst and duress in the long run. Children do not learn their own coping mechanisms when triggers are avoided, but expect to not be exposed because of the protection of their parents. Parents assisting their children in avoiding fears unwittingly actually contribute to cycles of fear and anxiety becoming repetitive.
It is important for a parent to acknowledge and respect the feelings of a child experiencing fear and angst, but it is critical to understand that validating someone’s feelings does not necessarily mean that as a parent, you agree with the feelings. For instance, if a child is terrified of going to school because they do not want to be away from home if there is a thunderstorm, it is important to recognize the actual fear, but not to amplify or fuel the fear. It would be important as a parent to send a message that it is okay to be scared, but you believe that the child is okay and will be able to get through the situation even despite being scared.
Promising things that are unrealistic is not helpful, such as saying it won’t ever storm outside. Instead it is more helpful for a parent to encourage their anxious child and express confidence that he will be okay and will be able to endure and manage the fear. It is important for parents to be clear about expectations, such as attending school, while expressing belief that the child will be able to handle the distress as they face fears. Over time, the intensity of the anxiety and fears decreases and the child builds confidence that they are indeed okay and can handle doing things even while experiencing some anxiety.
When a parent encourages a child to endure their anxiety it leads to improved tolerance and acceptance of the triggers and improved confidence for the child. Parents should let children know it is very hard work to deal with distress and discomfort, but that the intensity of the struggle decreases the more he exposes himself to the anxiety and engages in regular life events.
Just like for adults, typically with children the worst part of being afraid of something is the anticipation of how bad it might be. The period of time before we do something is often the time of greatest worry and upset and the actual doing or participating is far less troubling than predicted. Often the event itself is quite enjoyable and the worry thoughts were completely distorted. Parents can remind children how much worse the worrying has been versus the experiencing the actual event. Parents can sometimes minimize the amount of time a child has to anticipate something fearful, such as letting a child anxious about staying with a babysitter know an hour before versus a couple days.
Sometimes it is important for a parent to hep a child answer their own “what if…?” questions. If possible, it is best for the child to come up with their own answers and the parent to interject answers only if a child is unable to generate a reasonable answer to their worry question. If a child is worrying about “what if I get sick at school…?”, reasonable answers to the worry question might be: “I will tell my teacher and the teacher will call my mommy.” “I will go to the school nurse and she will help me and call my mommy.” “I will use a cool wet paper towel on my forehead to feel better.” “My mommy or daddy will check on me once they know.” A parent should prompt positive responses from the child, but only provide a suggested response if the child was unable to offer any reasonable ideas.
It is critical for parents to model healthy ways for handling anxiety and distress. Children need to know that stress and angst occur for all people and it is normal, but that it can be managed calmly and effectively. Children can use deep breathing, chill out time, coloring, journaling, play, music and singing, exercise and movement, positive self-talk and affirmations, fidget toys, etc. to help with coping and managing the symptoms of anxiety. Managing anxiety is possible, but it takes courage, support, and encouragement.
Some anxiety is indeed very normal, but when any type of anxiety remains intrusive and causes individual and/or family impairments in daily functioning, the symptoms might be related to an Anxiety Disorder. It may be necessary to seek professional evaluation and treatment to understand the nature of the Disorder and to reduce the impairments and improve quality of life. The professionals at Behavioral Healthcare Associates, LLC (BHA) have extensive training and experience with managing anxiety. BHA has several therapists and a Board-Certified Child-Adolescent and General Psychiatrist to meet treatment needs. BHA is providing both telehealth and in office appointments currently during the pandemic situation. For additional information contact our office at 919-292-146 and/or review our website http://www.behavioralhealthcareassociates.org