When it's more than worrying
What to do if you are concerned about your child’s anxiety
All kids worry.
Normal childhood anxieties like starting a new activity outside of the home, the first day of school, or having to make new friends are part of life for every child.
But for some kids, anxiety cuts into their ability to function and to participate in new experiences. For some, it keeps them home from school or any outside activity.
Daniel Villiers, founder and director of admissions of the Mountain Valley Treatment Center in Haverhill, was one of those children. His anxiety, he says, made high school a daily challenge and influenced his decision to drop out. By the following year, his anxiety increased to where he was “housebound.” He did not get help until he was 18 and when he was a kid, treatment was not as readily available, Villiers said.
Mountain Valley is a residential treatment center for adolescents struggling with severe anxiety and related disorders. Villiers works mainly with 13- to 19-year-old children, who suffer from anxiety.
According to Worrywisekids.org, “all children experience some anxiety in the form of worry, apprehension, dread, fear or distress. Occasional nervousness and fleeting anxieties occur when a child is first faced with an unfamiliar or especially stressful situation.”
Anxiety is a helpful tool in some situations. It can help protect us, or alert us, but according to the site, parents need to be concerned when children begin to experience “too much worry or suffering immensely over what may appear to be insignificant situations, when worry and avoidance become a child's automatic response in many situations, when they feel constantly keyed up, or when coaxing or reassurance are ineffective in moving them through.”
Villiers looks at the frequency, intensity and impact anxiety is having in determining the level of treatment required. If anxiety is occurring more days than not or interferes with a child’s ability to go to school, professional help is encouraged, he said.
Avoidance is also a big part of anxiety. Rather than face the event causing anxiety, many kids suffering from the disorder will stay home, and avoid social, school or sporting events.
“There are estimated to be 3 million kids hiding out in basements and in bedrooms because they have become dependent on avoidance,” Villiers said. He calls them “children in hiding” trapped in a cycle of anxiety, fear, and avoidance.
Villiers started his treatment center to help them. Anxiety is more common than eating disorders and drug addiction in children, he said. It can be treated in most cases without prescription drugs and he suggests parents or children reach out to school counselors or social workers as a first step to finding help. From there, they can also find someone who treats anxiety in children in or near their community.
Lynn Lyons, a licensed clinical social worker and psychotherapist in Concord, has written two books on Anxiety and children: Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children, and Playing with Anxiety: Casey’s Guide for Teens and Kids.
A sign anxiety has become a problem in the home is when the family starts spending a lot of time dealing with the anxiety,” Lyons said.
When families start making special arrangements or avoiding certain events, or even go far out of their way to accommodate a family routine, parents should worry.
“Accommodation,” Lyons says, “that is not good. That makes the anxiety stronger.”
Parents who work to provide certainty for their child with anxiety are actually strengthening the disorder, according to Lyons.
She also sees some schools trying to accommodate children with anxiety, meaning to help the child. It can feel right for caretakers and parents to try to solve the problem, but what needs to be done instead is to teach children they can handle uncertain things.
For example, Lyons says, a child with anxiety may fear going to the cafeteria, where it is loud and there are many people. In response to that, parents and school officials may make other arrangements, like allow the student to eat in an office or their classroom. That type of response is accommodating the anxiety.
“If adults accommodate …the child is ill equipped to handle what life throws at them.” Lyons said. “They don’t tolerate uncertainty and they are lousy problem solvers.”
What parents can do instead, Lyons said, is teach them anxiety is normal and what they can expect when anxiety occurs. Then they need to learn skills to respond to the anxiety.
“The tools we have to give them are based on problem- solving and tolerating uncertainty,” Lyons said.
One of the tools to use against anxiety is to “talk back to it,” Lyons said. Parents might say to their children “It’s true we don’t know what’s going to happen tomorrow. When you get to school there are things expected and unexpected….When your worry shows up you need to say I can handle it.”
They can also learn techniques to calm their bodies down when anxiety hits. Children with anxiety need to be given tools, then have to be put in uncertain situations and be allowed to work through it, according to Lyons.
Lyons conducts many free workshops for parents on anxious children and says anxiety is the number one reason parents bring kids to a mental health professional.
Parents bring their anxious children to her to help with school refusal and sleep issues, among other symptoms, “anxious kids can be really powerful,” she added and 1 in 5 kids meet the criteria for having anxiety.
Some children with anxiety are just quieter when outside the home and avoid taking risks. Many anxious children are also very rigid or they have a lot of questions and need constant reassurance.
Parents usually seek treatment when children enter school, Lyons said. She also treats children for anxiety as young as 4. An untreated anxiety disorder in a child can lead to depression in adolescence and young adulthood. When untreated, anxiety does not get better over time, and often worsens, she said.
Dawn Huebner author of What to Do When You Worry Too Much:A Kid's Guide to Overcoming Anxiety, maintains a psychology practice in Exeter and treats children with anxiety ages 12 and younger.
Huebner says parents need to look for “worry that gets in the way.”
Anxiety could be preventing a child from separating from parents, starting new activities, going to bed alone, or navigating the house alone, among other activities.
“Are they asking reassurance-based questions…needing to do things in a certain way?” “Routines are really healthy for kids, Huebner says, but if kids are adamant about detailed routines there is a problem.”
In her experience most parents intuitively know when anxiety has become a problem and will seek help, but there are still others who hope their child will grow out of it.
“It’s really, really hard to see your child struggling with anxiety,” Huebner said.
There is a balance parents need to achieve to help with child anxiety, Huebner said. “It does not work to tell a child just to do it,” she says about an activity a child is anxious about, “kids just fall apart.”
Parents can help the child build skills through therapy or self-help books.
She compares some of the treatment used for anxious kids to jumping into a cold swimming pool and getting used to the temperature of the water until it no longer feels frigid. Desensitization is a tool a child can use to overcome anxiety. It involves getting used to something.
“You stay in an uncomfortable situation until you are comfortable with it…stay with it until your fear goes down,” she said.
She gives an example of a child afraid to go upstairs in their home alone. Initially a parent could stand at the bottom of the stairs and have the child run up and down the stairs alone a few times. The next time they might run up and touch each door knob as the parent waits at the bottom of the stairs.
“Each time he goes a little further,” Huebner said.
One thing all the experts seem to agree on is how treatable childhood anxiety is.
Cognitive behavioral therapy has been shown to effectively treat anxiety and is different than talking therapy or play therapy, Huebner said. Parents should seek out a professional that specializes in anxiety.
Once a child learns the tools to use against their anxiety it is “hugely empowering to kids,” Huebner said. “They get over the fear.”
Andrea Bushee is a freelance writer and a mom of 2 children in Pembroke.
Once a month Dawn Huebner writes an article on Facebook on self-help for parents and kids. View it at https://www.facebook.com/pages/Dawn-Huebner-PhD-Self-Help-for-Parents-and-Kids/339298769474607
Dawn Huebner’s website: dawnhuebnerphd.com/index.aspx
To download Lynn Lyons' free e book:
Playing With Anxiety: Casey's Guide for Teens and Kids, the kids' companion book to Anxious Kids, Anxious Parents, go to playingwithanxiety.com.
Lynn Lyons’ website: lynnlyonsnh.com
A link to Mountain Valley Treatment Center: http://mountainvalleytreatment.org/why-mvtc/
Worry Wise Kids: http://worrywisekids.org