Understanding Your Child’s Anxiety
If you look up “anxiety” in the DSM (Diagnostic and Statistical Manual of Mental Health Disorders) you will find there are six types of anxiety:
• Generalized Anxiety Disorder (GAD)
• Social Phobia
• Panic Disorder
• Specific Phobia
• Post-Traumatic Stress Disorder (PTSD)
• Obsessive-Compulsive Disorder (OCD)
Each type has a number of symptoms and a time frame for which the anxiety has been present, which is often six months. The six-month time frame protects people from being diagnosed with anxiety disorders when, in fact, they are just experiencing a bump in the road. Many kids will experience a brief period of anxiety that lasts only a few weeks or months, while others will experience ongoing anxiety throughout their childhood. If your child has experienced intense anxiety for even a week, you may be concerned about your child having an anxiety disorder. But whether your child does have a diagnosable anxiety disorder or not, for the purpose of this book, I feel it’s important to help kids with their fears. No matter how long it’s been, the fear is real, and as a parent, it’s important to understand your child’s fears and what you can do to help.
Generalized Anxiety Disorder (GAD): Excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.
Social Anxiety Disorder: Overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.
Panic Disorder: Feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain, palpitations (irregular heartbeats), and a feeling of choking.
Specific Phobias: Intense fear of objects or situations, such as snakes, heights, or flying. The level of fear is usually inappropriate to the situation and may cause the person to avoid common, everyday situations.
Post-Traumatic Stress Disorder (PTSD): Can develop following a traumatic and/or terrifying event, such as the unexpected death of a loved one or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event and tend to be emotionally numb.
Obsessive-Compulsive Disorder (OCD): Constant thoughts or fears that cause people to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.
When I sit down with parents, I help them understand their child’s fears on a larger scale. Instead of simply diagnosing their child with one type of anxiety according to the DSM, I help parents understand what kinds of things are triggering their child and how to help them manage their fears. To help them understand their child’s fears better, I simplify and break anxiety down into two main categories: Object-Oriented and Relational. This helps parents get a better sense of their child’s triggers and helps them prepare him for fearful situations in a simple way.
Object-Oriented Anxiety in Kids
Kids with Object-Oriented Anxiety have debilitating fears of storms, getting kidnapped, going to the doctor, getting shots, getting hurt, and of someone breaking into their home. They are constantly checking with their outside environment: looking at the sky for clouds, listening for intruders, and identifying strangers in the grocery store parking lot.
Kids with Object-Oriented Anxiety are also drawn to watching the news. They pay attention to the weather report, acts of terrorism, wars around the globe, and the house that was broken into right down the street. They want to know how tornadoes happen and if a tsunami will hit the same beach they’ll be visiting for summer vacation. They do online research about diseases, natural disasters, and how to get rid of head lice—just in case they have it.
The ultimate goal for a child with Object-Oriented Anxiety is to be free from harm. Until the storm passes, the doctor’s appointment ends, the sun comes up without anyone breaking in, the child with Object-Oriented Anxiety will feel unsafe. The problem with this is that life doesn’t give kids the chance to be free from harm. There is always the threat of weather or dangerous people or a fire suddenly breaking out. Without some intervention, children with Object-Oriented Anxiety will be keyed up and fearful most of the time.
Helping Kids with Object-Oriented Anxiety
As a therapist, I teach kids their own tools to use during anxious moments. I will go into the tools more in detail in Part Two, but for example, I teach kids with Object-Oriented Anxiety how to do Square Breathing (Tool #1) in the midst of fear. I teach them how to focus their attention on positive thoughts by Changing the Channel (Tool #3).
Because kids with Object-Oriented Anxiety aren’t usually worried about how they are perceived, I also help them to refrain from acting in inappropriate ways in public—to manage their emotions instead. Kids with Object-Oriented Anxiety have no qualms about making a scene in the grocery store. They don’t care about making a scene at school either, and will cling to their parents, scream, yell, and curl up into a ball in the hallway. Whatever they feel, they will do. As a parent of a child with Object-Oriented Anxiety, you will be more worried about how your child behaves than he is. He doesn’t see what the big deal is if he holds on to your leg while you drag him to his classroom, or if he rips the curtain off the van window while you take him to a soccer game he doesn’t want to go to.
That’s why it’s important to teach kids with Object-Oriented Anxiety that social norms need to be followed. Just because social norms aren’t a big deal to them doesn’t mean they should be ignored. In the long run, if kids act out in public, their reputation will be affected. Other kids don’t easily forget those who’ve been dragged out of the classroom, who cling to their parents, or who throw a fit in the pick-up line.
For kids who experience high levels of Object-Oriented Anxiety, managing these fears can be difficult. If they are afraid of storms, they may rock back and forth and cover their eyes until the storm ends. If they are deathly afraid of tornadoes, they may have a stomachache when they hear the sirens or feel panic in their bodies.
Once the storm ends or the sirens turn off, these anxious kids will often go through a period of readjusting back into the emotional state they were in before the anxiety-producing event. This can happen rather quickly, or it can take up to several hours. Recalibrating is important, and it allows anxious kids to feel safe again.
Relational Anxiety in Kids
Kids with Relational Anxiety worry about people. They overfocus on friendships, how much attention little brother is getting, and what other people think of them. If they think someone doesn’t like them, they are hyperaware of it, often confusing a look that meant nothing to mean someone despises them. Kids with Relational Anxiety also take in enormous amounts of information about other people. They notice what other people are wearing, how they are acting, and what signals they’re giving off. They pay attention to who’s friends with whom, what is “normal” and “not normal,” and are careful to stay within the limits. They worry about whom they’re going to sit with at the birthday party, what someone will think of their new haircut, and how much their teacher likes them. Kids with Relational Anxiety are always aware of how they are seen by others.
When everyone likes them, they have plenty of friends, and little brother is at summer camp, things are perfect for a child with Relational Anxiety. But it’s a delicate balancing act that can be thrown off very easily. The day is going great until someone makes a snide comment or until they aren’t invited to the birthday party, and then everything crashes.
Until balance is regained, the life of a Relationally Anxious child can be tough. They will worry about the party, the friend, or the event until the issue has passed or until things are resolved with that person. Equilibrium will then be regained until the next event involving people triggers another surge of anxiety.
Helping Kids with Relational Anxiety
Kids with Relational Anxiety are the opposite of kids with Object-Oriented Anxiety. They care too much about what other people think. They try to hide their weaknesses and are devastated if anyone outside of the family knows about their behavior. They have just as many tantrums as kids with Object-Oriented Anxiety, but they don’t want anyone outside of their family to know about them. They’ll throw a fit in the car on the way to school, but when they step out of the car, they’ll act calm and collected. They’ll pretend a hurtful remark made by a friend was no big deal until they get home and burst into tears.
Because kids with Relational Anxiety work so hard at keeping appearances, they are often doubly hard to deal with at home. They stuff all of their emotions inside, only to come home and explode. Home is where their anxiety comes out, because home is where their safe people are. The definition of a safe person is someone who will accept them no matter what. A safe parent is a valuable resource to a child with Relational Anxiety. After he’s spent all day fearing rejection, he can come home to an environment where he knows he’ll be accepted.
The overall goal for a child with Relational Anxiety is to learn how to integrate the two sides of himself: the person at home with the person at school. Because there’s such a stark difference between the two, kids with Relational Anxiety can become confused about who they really are. They see themselves as leaders at school but troublemakers at home. They see themselves as capable at school but incapable at home. This only makes things more difficult at home, because they begin searching for reasons for why things are going so poorly there. They may blame their annoying brother or the broccoli on their dinner plate instead of realizing neither is really the problem. They are simply letting all of their emotions out, looking for something to blame for how bad they feel. A great way to improve the home environment for kids with Relational Anxiety is to implement a reward system, such as The Marble System (Tool #6). This helps them become successful at home and more able to integrate the two parts of themselves.
Anxiety Triggers
Anxiety triggers are what cause your child’s anxiety to flare up. Knowing what triggers your child’s anxiety gives you 80 percent of the information you need to help your child. The other 20 percent is knowing which tools to use to help your child get through their anxious periods, and we’ll get to that in Part Two.
We all get triggered by certain things, whether it is work or money or our irritating friend who won’t stop calling during a crisis. When I work with kids, I call these triggers Feelings Buttons, but as adults we have them too. It’s just that we’re more aware (or at least should be) of which situations trigger our anxiety and why.
If your son’s anxiety is triggered by social situations, it’s important to keep that in mind before dropping him off at the birthday party. You may also want to implement a tool, such as Giving Your Child a Role (Tool #7) to help your child navigate the social situation. If your daughter’s anxiety is triggered by storms, it might be a good idea to check the weather before driving to the beach for vacation. It’s not that you should avoid taking your child to the birthday party or the beach, it’s just that you should be tuned in to your child’s triggers enough to be prepared for a strong reaction if things don’t go perfectly.
In handling these strong reactions, try to stay as relaxed as possible. On the way to the birthday party, refrain from asking, “Are you okay?” or saying, “You’re going to be fine.” Instead, make sure you are calm and in a neutral emotional state. If your child wants to talk about his fears, that’s fine; just don’t be the one to bring them up. Instead, talk about something not related to the event. Changing the Channel (Tool #3) is a great way to change the conversation to a fun activity that’s coming up or a vacation he’s looking forward to.
If your child becomes angry and starts lashing out, try to emotionally disengage. That doesn’t mean you disengage from your child completely, but it does mean you refrain from escalating to your child’s level of frustration. While every parent has limits and can only take so much, try to stay neutral as long as possible. Listen to what your child is saying, and acknowledge his feelings. Instead of trying to change the way he thinks about the event, say, “I know you’re scared. I wish I could make it better for you.”
If you try to make it better by saying, “You’re going to have a great time,” you’ll get resistance, because your child is not in a rational place. Trying to rationalize with an irrational person never works. Plus, children want to bring you down to their emotional state. If they’re angry, they want you to be angry too, but going there with them only causes more problems. Instead, stay empathetic and neutral while allowing your child to release his anxiety.
Also, keep in mind that when anxious kids are triggered, they may bring up issues from the past. Emotions are a lot like spaghetti—they cling together—so when kids get upset about one thing, they tend to get upset about everything. On the way to an anxiety-producing event, they might bring up a disagreement with a sibling. They will talk about how awful the event went the last time you made them go and how you always make them do things they don’t want to do. Be careful to not engage in these types of discussions with your child. Be sure to listen and acknowledge their feelings, but don’t try to put out fires. Saying, “You chose to go to that event, not me,” will only make things worse.
Default Worries
Default Worries are the worries kids go back to over and over again. Just when you think your child is finally over his fear of storms, he’ll see a grey cloud and go into a panic. After you think he’s gotten over his fear of death, he’ll tug on your shoulder at 3:00 a.m., saying he’s afraid you’re going to die. While this is exhausting for you as a parent, there are good reasons why kids use Default Worries. Here are the two main reasons:
1. Kids have no idea why they’re feeling anxious.
There are times when anxious kids have no idea why they’re worried. It’s 2:00 in the morning, their heart is racing, and their stomach is upset. Nothing appears to be going wrong, yet they can’t sleep, and they can’t slow their mind down. During these times, anxious kids will use Default Worries as a way to make sense of how they’re feeling. This is a basic survival instinct—to understand why you feel the way you do—so kids will draw on a worry they’ve had before and view it as the current reason for the way they feel.
A parent’s first reaction to this is: Oh no! It’s back! Not to fear. The worry will probably go away and come back again periodically. What is important is that your child is afraid right now. Don’t panic, and don’t try to rack your brain for something that will remove the fear forever. Just be there with him and ride it out.
2. They are trying to burn off excess mental energy.
Anxious kids have lots of mental energy. Their minds are always running, and when they don’t have anything to focus on, they will choose a Default Worry to burn off the excess energy. It’s just like when you play with your iPhone in the waiting room of a doctor’s appointment. You have nothing better to do, so you scan through your phone, looking for a way to kill time. That’s much like what anxious kids are doing. They have extra energy, and they need somewhere to put it. If your child has too much time on his hands, try using Structuring the Unstructured (Tool #8). It’s a great way to keep kids from gravitating to Default Worries as a way to release their mental energy.
| Common Default Worries | ||
| Death | Doctor’s Appointments | The End / Beginning of School |
| Getting Sick | Global Warming | Storms |
| Growing Up | Achievement Tests | Natural Disasters |
The worries listed above are what keep the majority of anxious kids trapped in their minds. Growing up, getting sick, and dying are three inevitable parts of life and can keep an anxious kid’s mind occupied for years. There are no specific solutions for these worries, so kids spin the scenarios through their minds in search of possible solutions. They’ll think about what it would be like if you died, if they died, or if their dog died. Because they’re smart, they realize that any of those scenarios are possible.
If your child worries about death, don’t try to make him feel better by assuring him he won’t die or you won’t die. Instead, acknowledge his feelings by saying, “I’m sorry you’re so worried about this. I wish I could make it better for you.” When you approach his fear this way, you are connecting and supporting him without making promises about something you have no control over.
Doctor’s appointments, achievement tests, and the beginning and ending of school are yearly events many anxious kids dread. There is no escaping them either, so anxious kids can pull them out and worry about them at any given time. Storms, natural disasters, and global warming are also fears anxious kids can draw on. They are all over the news, and there’s no sure way of knowing if or when they will happen. If you live in a part of the country where there are lots of storms, anxious kids will worry about that. If you have earthquakes, forest fires, or torrential rains, anxious kids will choose to worry about what is covered most on the local news or talked about by peers and classmates. It takes just one kid to say “My mom almost got caught in that tornado last week” to make an anxious kid worry about tornadoes for months.
Baits
While anxiety triggers are what cause your child’s anxiety to flare up, baits are what your child uses to empty his emotional tank. Baits and triggers are different. Baits are not what trigger your child’s anxiety, but instead, what he uses to release his emotions. For example, if your child is worried about going to the dentist, he might bait you into an argument about putting on his pajamas. Putting on his pajamas isn’t one of his triggers, but because he is worried about going to the dentist, he will bait you into an argument so he can release some of his anxiety.
After a long day, when kids are tired and they haven’t gotten their needs met, they will often bait parents into arguments to let out some of their emotions. Suddenly, the bathwater is too cold, the food is too salty, the toothbrush too hard. It’s important to see the outburst for what it is—an emptying of the emotional tank—and for what it is not—something you necessarily need to respond to. You can adjust the bath temperature all night long…they’re still not going to like it.
When you are feeling baited, step back and ask yourself three questions:
1. Is my child hungry?
2. Is my child tired?
3. Is my child sick?
If your answer is “yes” to any of these three questions, then your child is not in Rational Mind.
Rational Mind is when your child is able to think through a decision. He has the ability to say, “If I refuse to take a bath, I’m going to get in trouble,” and decide it’s not worth it. If your child is not in Rational Mind, he either won’t go through the decision-making process or simply won’t care. He’ll continue to fight about the bath until his emotional tank is drained or until he finds another outlet that will do the draining for him.
If your answer is “no” to the above three questions, then you are likely dealing with an emotional issue, or for the purposes of this book, an anxiety issue. Children with anxiety will bait parents to release their emotions, and this often leads to a meltdown. When children melt down, they actually leave the situation feeling better, whereas adults leave the situation feeling worse.
After a meltdown, children feel better because they are no longer spinning with emotion. Their bodies relax, their minds rest, and they feel equilibrium again. Once they feel better, they might apologize or be confused by their actions. “I don’t know why I did that,” is what many anxious kids say after a meltdown, and the truth is, they don’t. They’re completely unaware of why they handled the situation like they did. They had no idea their emotional tank was full and needed draining. All they felt was a surge of emotion.
If this is typical for your child, please refer to the Think Sheet in the back of the book. Think Sheets help children process behavior instead of allowing them to simply apologize and move on. After a child has calmed down, either have the child fill out the sheet on his own or go over it orally with him so you can wrap up the event and both move on.
Anxiety and Sensitivity
Many anxious kids are also highly sensitive. If you haven’t read The Highly Sensitive Child by Elaine Aron, I would recommend it. Years ago, we called Highly Sensitive Kids “dramatic,” but now we’re learning that sensitivity is not a choice; it’s just the way some kids are made. When I talk to parents about their child’s anxiety, some will also report their child’s sensitivity to clothing, noises, changes in schedule, and touch. “Is this anxiety?” they often ask. The answer is that there are very few situations when it is just anxiety. It’s often anxiety and Attention Deficit Hyperactivity Disorder (ADHD); anxiety and Attention Deficit Disorder (ADD); anxiety and sensory issues; or in this case, anxiety and sensitivity.
When talking about sensitivity, Judith Orloff, a psychiatrist and author of Emotional Freedom, said: “It’s like feeling something with fifty fingers as opposed to ten. You have more receptors to perceive things.” A Harvard psychologist, Jerome Kagan, found that about 10 to 20 percent of infants begin life with a tightly tuned nervous system that makes them easily aroused, jumpy, and distressed in response to novel stimuli. Such highly reactive infants, as he termed them, run the risk of growing into “inhibited” children, who tend to withdraw from experience as a defense and are at high risk for anxiety.
Brain-imaging studies show that the reactivity of highly sensitive people reflects a distinctive biological feature: a hyperresponsive amygdala. The amygdala is the brain center that assesses threats and governs the fear response. The amygdala is what keeps anxious kids on the constant lookout for danger. Kagan believes Highly Sensitive People are unusually susceptible to both emotional and tangible irritants—for example, mean-spirited comments, as well as pollen or dander in the air.
If your child is highly sensitive, he will respond to things very differently than other kids. He may also process anxiety very differently. Each child has a different experience with anxiety, and as a parent, it’s important to understand how your child processes anxiety. Knowing how he processes his fears and worries will help you know how best to parent him.