Dear David Coleman: My nine-year-old son is very anxious and picks his skin
Q My nine-year-old son is very anxious. He picks at his arms every time he is worried. I have tried loads of things with him like mindfulness, or talking through his worries. I got him a band for his wrist so he can pull at it if he's worried but nothing works. I am so worried about him. I know I need to do something but I don't know where to start to help. I feel like I am letting him down, as I can't seem to help him with his anxiety. I would love your advice as I am at a dead end and really worried about what the future holds for him.
David replies: Anxiety in children seems to me to be on the rise. Sometimes I think it is a reflection of how we parents are more anxious. We perceive the world to be a more dangerous place than it was when we were children and we worry about them.
Children often look to us, attuned to our feelings, to learn about how they should respond to the world. When children are in a situation that leads them to feel nervous, they can look to see how we are reacting to the same circumstances. If we seem relaxed and confident it can encourage them to set aside their anxiety and be more confident too. If we seem equally nervous, or scared, then it will exacerbate their anxiety.
In this context, I am minded of your descriptions of your own worry about his worry. It will be very hard for him to feel like he can regulate or overcome his worries if he perceives that you are panicking about the fact that you don't feel like you can help him. Even if you don't fully believe it, it will help him if you can project an air of confidence in his ability to deal with his anxiety.
A really positive way to interact with a nervous or anxious child is to invite them to look deep into your eyes and ask them "Do I seem scared?" Hopefully you won't feel scared and so they can respond with "No, you don't". Then you can let them know that even if it feels scary to them, you have confidence in them and you will stick with them and work things out together with them. The core message you are trying to give is "you will be OK and we can get through this together".
Although you say you have tried everything, and nothing seems to be working, I think you should be proud of the efforts you have made to support him, and the strategies you have given him. He is still quite young to adopt a traditional Cognitive Behavioural Therapy (CBT) approach, but in the longer term, I think that will be the most effective way for him to learn to deal with his worries. He needs to learn skills to relax himself, physically, while also knowing how to use things like positive self-talk to be able to reassure himself enough to be able to challenge his fears, such that he doesn't rely on avoidance, or skin-picking, as his only anxiety reduction strategies.
The fact that he is picking at skin may add to your sense of powerlessness to help him. The skin-picking may be very serious, and if it has been happening for a long time, then it may be resistant to change. If that is the case, then do ask your GP for a referral to meet a psychologist for some advice, both about the anxiety and the skin-picking. It is likely that the two are linked, but they may not be.
Sometimes skin-picking, like hair-pulling, becomes a habit in its own right.
You may consider going privately for that help, but do check out your local primary care psychology service, since many of them have specific programmes for children with anxiety, and it may be, for example, that your local service is running the Pesky gNATs programme, which could be ideal for your son. Your GP can make that referral too.
Health & Living