Friday 24 February 2017

Parenting an anxious child

We will all experience worry or anxiety at some stage in our lives. But recognising when a child is worried, or has a more severe anxiety problem, is key to overcoming it, says child psychologist David Coleman

David Coleman

David Coleman

Typical anxieties for children are usually transitory
Typical anxieties for children are usually transitory

Worry and anxiety are very normal parts of life for everyone at some point. Researchers estimate that about 40pc of children and teenagers have anxieties at any one moment, from separation anxiety in toddlers, through to fears of things like imaginary monsters, the dark, or heights, or spiders or anxiety about fitting in, or worries about being “normal” in adolescence.

With children, these typical anxieties tend to be transitory. Usually children will outgrow them as they gain greater experience or confidence. A successful outcome, that contradicts an anticipated bad outcome, for example, will often lead to a lowering of anxiety the next time.

Beyond “normal” anxieties, children and teenagers can experience more significant, or long-lasting anxieties that can fall into a more formal characterisation of an anxiety disorder. Estimates vary that between 6pc and 20pc of children and teenagers suffer from anxiety disorders.

Below are the different kids of anxiety disorders that might affect children and teenagers.

These are the kinds of clinical diagnoses that someone like me may use to describe a particular form of anxiety, or a particular source of anxiety.

Kinds of problematic anxiety

• Separation Anxiety Disorder

• Phobias

• Social phobia

• Generalised Anxiety Disorder

• Panic

• Obsessive Compulsive Disorder

• Post trauma reactions

Irrespective of the kind of problematic anxiety that a child or teenager may have, the treatment of it often follows a very similar path, often looking at strategies for helping a child to regulate the physical experience of the anxiety, while challenging their beliefs and thinking styles that might be keeping them stuck in patterns of worry and negativity.

Knowing when your child’s anxiety might have reached this kind of severe level can help. In the box over, I have included some of the signs you might like to look out for. If you are worried that your child may have severe anxiety, or an anxiety disorder, then do go and get a professional opinion and some professional help.

Signs that anxiety may be beyond what is “normal”

• Regular unexplained physical complaints (headaches, tummy upset, often dramatic)

• Frequently disturbed sleep having had a good enough sleep habit (requiring extra help to get asleep, repeated visits to parent’s room, regular nightmares)

• Change in eating

• Avoidance of their usual social activities (e.g. school, friends, parties, extra-curricular activities)

• Excessive need for reassurance (new situations, bedtime, school, storms, “is it bad?”)

• Inattention and poor school performance

• Explosive outbursts

• Not necessarily pervasive (some areas of function remain intact)

There can be a strong heritability or familial trend in anxiety. For example, during infancy and childhood children mirror their parents’ responses when interpreting internal states of

pain, arousal, and anxiety. So if parents seem afraid or are distressed in certain circumstances, their children may feel similar levels of anxiety, even if they

don’t quite know what event is provoking that anxiety.

In evolutionary terms, fear and anxiety have had a vital role in keeping humans safe. The release of adrenalin, when our fear system is activated, is what prepares the body to run away from that danger, or fight against it. That was critical when we were hunter-gatherers who may suddenly face dangerous animals on the trails.

Adrenalin is what raises our heart rate when we get scared. It also may lead to muscular tension as our muscles prepare to react. Adrenalin affects the digestive system, shutting it down, often leading to the butterflies-in-the-tummy feeling, or stronger nausea or urgency to wee or poo.

Nowadays, we are less often faced with physical danger in the way we were when we were Stone Age beings. However, the bodily response to perceived threat is exactly the same as it was then.

So, in coping with anxiety, we have to give children and teenagers some skills to deal with the adrenalin that is released. Sometimes, breathing techniques can help, or muscular relaxation techniques or meditation-type techniques like visualisations of calm or safe environments.

But, with small children, we can’t really expect them to be able to regulate the intensity of their anxiety by doing a deep-breathing exercise or meditation. They will rely on us to physically soothe them. That is why our natural reaction is often to hug them, rock them or stroke them while talking in calm soothing tones.

When we are trying to help children to deal with anxiety, it is critical that we acknowledge both the nature and extent of their fear. Even if their worry or fear seems irrational or unnecessary to you, it is still helpful if you can validate their experience of it.

For example, if they are afraid of the dark, it is okay to say things like “yes it can be scary not to be able to see things.” Or, “you seem very frightened that danger might be lurking in the dark”. This validates their experience, even though we ourselves might think there is no need to be frightened in the dark as the house is safe.

Sometimes, just the tone of our voice, or our physical proximity is enough to help our child to regulate and reduce the amount of adrenalin that might be circulating in their systems. Other times we may have to remind them (if they are older) to breathe deeply to help calm down.

Once we have empathised with the level of anxiety, validating their experience, then we can offer reassurance or give a more rational explanation of the situation. In most cases, this is enough to help the worry to dissipate.

So, with the earlier example of being afraid of the dark, you might add in “thankfully our house has no monsters or bad things hiding in the dark”. Or, “even though it is dark, nothing bad will happen”.

It is okay for children to get worried or scared. Successfully dealing with those fears, by calming themselves down, or being helped to calm down by us, and thinking more rationally about the situation, can give them greater confidence about their ability to cope in the future.

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