Sunday 4 December 2016

Dear David: 'One of my twins is anxious and I want to be sure I am helping her'

Published 12/01/2016 | 02:30

Illustration: Maisie McNeice.
Illustration: Maisie McNeice.

The parenting expert on how to help your child manage anxiety and how to support a daughter with bulimia.

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Question: We have twins - a boy and girl aged seven. Our daughter has always had issues dealing with new situations, becoming very anxious and introverted. Normally she gets over this anxiety, recovers and gets on with things and has a great time. We want to help her manage her anxiety and not have this into adulthood. Our strategy has been to encourage her to try new things, exposing her to these situations in a positive way. Is this the right way to build her confidence that she's a strong little girl and that things turn out for the best?

David replies: It sounds to me like you are absolutely on the right track with your daughter. There are many children who are, by dint of their temperament, 'slow to warm up'.

Parents' experiences with such children are that they are often very slow to leave their parent's side at an event. In some ways, they may appear clingy, but actually, all they are doing is allowing themselves to become familiar with the new surroundings, while taking advantage of the security that their parent offers.

That is not to say that such children are insecure. In terms of their attachment, their relative security or insecurity is more evident in how they allow themselves to be comforted after a separation from their parent.

But the concept of being 'slow to warm up' is well accepted and many children will show signs of being this.

Indeed, even the fact you describe your daughter as "introverted" also fits with this personality type.

The key bit, however, is that if such children are given time, encouragement and support, they will, as you describe, "get over" the anxiety and get on with enjoying themselves.

Sometimes, we can be impatient with our children and we can be tempted to rush them through the process of familiarising themselves with the new environment or the new people. When that happens, and we try to push them away from us too soon, we are typically met with huge resistance.

Our children can become very upset, or even angry, with us. They tend to dig their heels in and become more determined not to leave us, protesting louder and more insistently that they can't or won't settle in the new circumstances.

This kind of interaction is worth avoiding, since it usually only serves to further entrench our child and ourselves in our respective viewpoints.

We come away feeling our child is 'putting it on', exaggerating their distress for dramatic effect (which they may indeed have been). We may also feel their anxiety is irrational and unnecessary and so we can end up cross with them. They can come away feeling like we don't understand or care about them and they can't depend on us to mind them properly (since we push them away too soon).

This may increase their sense of insecurity and their likelihood of clinging to us in the future.

So, a more effective way to respond to a child who is initially clingy, or 'slow to warm up', is to be warm, understanding, and patient. Give them time to be acclimatised to the new surroundings and to become more accustomed to the people or social rules that might apply.

Acknowledge that they may feel nervous, for now, about exploring or befriending other children, but remind them you have confidence in their ability to do these things when they are ready.

Just like you describe, it helps to remain positive and optimistic that socialising and exploring are well within your child's grasp and that it is fine for them to remain a little bit hesitant at first.

It can also help to remind them of their previous successes at separating from you, knowing the fun they had or the things they achieved when they launched from your side.

But, at the same time, do move things at your child's pace. Some children can't wait to get out and explore far and wide from their parents, others like to take things much more slowly and steadily.

If you continue with the approach that you are taking, I think that, in time, you will find your daughter will take more risks and try more new things.

Our family has had to split up due to my husband's work and my daughter now has bulimia. Please help

Question: Myself, my husband and my son moved to another country four months ago for my husband's job. My 15-year-old daughter has stayed in Ireland, living with a very close family friend, to finish her Junior Cert. But she told a teacher recently that she thought she had bulimia. We took her to CAMHS who confirmed the diagnosis and she is now on a waiting list for therapy. Is it because we've moved away? Do we need to go back? Do we insist she comes to live with us now? Please help as we are so confused and feel so guilty.

David replies: This sounds like such a difficult situation for you and your daughter. No wonder you are so confused about what is the best thing to do now. Your own upset is probably small in comparison with the distress and upset that your daughter feels.

Your original decision to relocate, while your daughter stayed behind, must have been hard and must have involved a lot of soul-searching.

I can only presume that your daughter was centrally involved in the decision to stay in Ireland. If so, then you have a good basis for approaching this new decision.

Now you are faced with another hard choice, so be sure to include your daughter in whatever next steps you take.

It is interesting that your daughter first chose to tell a teacher about her fears that she may have had bulimia. She didn't approach the "close family friend" that she is staying with and also found it hard to tell you directly.

There is nothing unusual about teenagers choosing to tell people who are slightly removed from them about important things. In many ways it can be protective for teens to tell someone else, other than us, since they don't have to witness our immediate reaction.

It may also be that, in the family upheaval caused by the relocation, your daughter just doesn't have the same easy access to you, or her dad or brother, to feel relaxed about talking about such important issues.

It will help for you to talk with your daughter about when the bulimia started, to see if you can track back to any significant events or experiences that coincided with its start. Until you can talk with her about it, you will be guessing about questions like: "Is it because we moved away?"

Most typically, bulimia begins with a focus on diet, body weight, or body shape. It is very easy to get locked into a cycle of binging and purging to try to avoid weight gain. Her bulimia may be primarily about body image.

But, if her bulimia coincided with the discussions about the relocation, the actual relocation and all of you moving away from her, or stresses about the Junior Cert, then any such factors may have been significant in why the bulimia started.

Knowing why it started may give you a clue as to what needs to happen next. For instance, if the relocation and separation from all of you is a very significant factor for your daughter, then addressing that separation may be critically important.

How you resolve that separation is still going to be a dilemma. Presumably there is something attractive about the country in which your husband has found work that drew you to decide to all move there. Are the facilities and services good? Could she easily access mental health services there, for example?

I do think it will be hard for your daughter to be receiving treatment here, while you are still living abroad. Much as even weekly therapy might be beneficial, the support of your family is also, usually, a very significant factor in recovery.

I do think your daughter will benefit from having her family with her while she tries to deal with her eating disorder. Dealing with the eating disorder is also far more important than her Junior Cert. Indeed, education easily comes second to your child getting well.

So, in your decision-making with your daughter, focus on trying to determine what will be most supportive for her. Hopefully you got to spend some extended time together over Christmas and even being together may have clarified what best to do next.

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