Lucy Daniels Center clinicians are frequently asked to help parents with their children's anxieties. We would like to focus in this article on children of school age. Many times, such children worry about situations needlessly, and approach new situations with trepidation. They often have endless questions, seeming to seek reassurance about something or other that is worrying them. We start by telling parents that although their child seems to have excessive anxieties, all parents need to help their children with the usual anxieties of childhood. Children need to be helped to face their anxieties so that they can develop "mental muscles" to surmount the inevitable anxieties of adolescence and adulthood.
The manageable zone: Children can develop these mental muscles when the "weight" they are asked to carry is challenging, but within their capacities. Therefore, the parental task is to help their child to maintain his or her anxiety in a manageable zone. For example, allowing the child access to the parental bed is a reasonable comfort to offer some infants and toddlers who seem to get very disturbed at night. However, as their own capacities grow, continued open access will be too indulging and deprive children of the necessary opportunity to thereby struggle and grow in strength.
Achieving the manageable zone: There is no firm rule about achieving this manageable zone: different children are anxious about different things, and grow beyond these anxieties at different rates. Individualizing parenting tactics is necessary. What is a helpful struggle to one child may be overwhelmingly painful to another. Parental empathy and instincts are more important than "rules". For example, although most two year-olds should be able to sleep through the night uneventfully, some two year-olds have trouble staying in their bed. The parents of these children might adjust to this, for example by laying down with their child at night as he or she went to sleep, lengthening the bed-time ritual, or coming more quickly and staying longer when their child wakes up during the night.
Preparation helps: Preparing a child for an upcoming anxiety-laden situation is an important way to help a child develop mental muscles. For example, chronically anxious children are often particularly worried about change. Appropriate individualized preparation could be a parent telling a three year-old in the morning that he or she will be going to the doctor that afternoon, or telling a two-year old that a baby-sitter is coming one half-hour before her arrival. Although such preparation will often cause fretting or distress, parents will be providing their child with an opportunity to experience, tolerate, and master his anxiety with their help. It may be messy and unpleasant in the short-run, but children cannot grow without staring the "monster" of anxiety directly in the face and learning that they can overcome it! Parents can also help by fielding questions and assisting children to find coping strategies so that they feel that they are active participants rather than being passively "done to." In addition to preparation, absolute honesty and straightforwardness on the part of parents is important to solidify the parent-child relationship.
Children don't understand why they are worried: Children are usually unable to explain the reasons for their anxiety. The reasons that they do give may seem superficial or inadequate. Generally, children simply don't know the full reasons, although occasionally children keep a secret because of fear, shame, or guilt. It may be best for parents to tell their child that they understand that he or she may not know the reasons for the fear. Parents might try offering their best guess, being explicit that it is a guess, and without pressing the point. Parents can also helpfully reassure their children about the unrealistic or exaggerated aspects of their fears. It is best to avoid repeated reassurance, however, because this can contribute to an over-dependency upon others to supply the very same comforting information that children could learn to supply for themselves.
How children try to manage: Children manage excess anxiety in different ways. Some children temporarily reduce their anxieties by avoiding the scary situation and turning to outside sources of help. They may demand to sleep with parents, need to have a transitional object with them, be unable to leave their parent's side, or repeatedly ask anxious questions. Although it may seem as if such a child is manipulating his parents because he does not appear frightened, he may actually be seeking extra help or attention because he or she is anticipating the possibility of becoming anxious.
Other children manage their anxiety by becoming spaced out and distractible, or impulsive, defiant, or aggressive. These behaviors that these children use to manage their anxiety may include running away, calling names, immediately repeating misbehavior, denying misbehavior or blaming others, laughing, becoming wild, and insisting that they do not care about the consequence or know that the behavior was inappropriate. These behaviors are called externalizing behaviors. They enable the child to reduce the painful feelings of anxiety. Children are generally not seeking negative attention through externalizing behaviors, but rather are willing to endure the negative attention if it is the price for their being able to externalize.
Managing externalizing behavior: We recommend a balanced approach to managing externalizing behavior. Parents should expect that their children accept responsibility for misbehavior. Therefore, we encourage parents to discipline their children, including setting appropriate limits, being consistent, using consequences that are meaningful but not excessive, and avoiding shaming and physical punishment. Parents should also tell their children that they know that they are as bothered and confused by their misbehavior as the parents are. This collaborative approach helps parents avoid turning the misbehavior into a parent-child battle; rather, they are offering themselves as a partner to children in their efforts to control misbehavior.
Although we hope that our recommendations will be useful to parents to some extent, parents may also wish to seek professional help for their child, especially if the anxiety has been present for some time and seems to be interfering with their child's ability to conduct his or her life or to feel good about himself or herself. Although medications can relieve some symptoms of anxiety in some children, we believe that treating anxiety in children solely with medication most often just treats the symptom but not the problem. For this reason, we recommend a careful evaluation that considered various options including parent counseling, family counseling, individual psychotherapy for the child, and medication if truly necessary. With an individualized plan in the hands of an experienced clinician, a child can be helped to overcome childhood symptoms of anxiety.
To download a PDF of this article, click here.