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Anxiety and Kids

Understanding anxiety is the key to helping kids cope

Alice Wagner’s 7-year-old daughter, Olivia, started showing signs of anxiety in kindergarten.

“It would take us hours to get her to go to sleep at night,” Alice says. “She would ask so many questions about what was going to happen the next day, even if we were just going about our regular routine. If we were doing something new, we’d have to discuss each detail and imagine every possible scenario.”

Editor’s note: All parents’ names in the story were changed to protect their privacy and that of their children.

In school, Olivia’s anxiety was demonstrated as she moved very slowly and deliberately from one task to the next, wanting to get everything perfect before she moved on. When Olivia was feeling particularly anxious, she would wring her hands over and over until her skin was raw. Always deliberate with her words, she developed a slight stutter. As spring conferences came around, Alice, her husband Scott, and Olivia’s teacher decided that her anxiety was more than just a phase and it was time for them to address it professionally.

Olivia met with a behavioral pediatrician, who referred her to a child psychologist for counseling. Olivia was also evaluated by her school district’s psychologist and speech therapist to determine what services the district could offer to support Olivia’s progress in school. After the evaluations were complete, a team meeting was held with Olivia’s parents, teachers and the school psychologist and speech therapist, who developed a plan of action. Olivia began working with the school’s speech therapist and met weekly with a math intervention specialist to help her meet the kindergarten math goals. Olivia enjoyed the one-on-one attention and looked forward to her weekly meetings with her special teachers.

A year and a half later, Olivia still has anxious days, says her mother, but now, thanks to the work of her counselor, Olivia has a literal bag of tricks and strategies to cope with anxiety that hangs on her bedroom door. In it are papers with tactics she learned in her therapy sessions, picture books, hand lotion and art supplies, all of which Olivia can use to calm herself during her anxious times.

“This school year has been so much better, now that Olivia has a vocabulary to talk about how she feels and strategies to help her cope with her feelings,” Alice says.

More than butterflies

Feeling anxious happens occasionally to everyone. Those feelings of butterflies in our stomachs or having a dry mouth when we speak in public are natural physical responses to a momentary stressful situation. It is normal for children to feel anxious as changes or milestones approach. Even strong, specific fears, such as a fear of the dark, fall into the realm of normal childhood development and, for many children, these fears and anxieties generally disappear as the child grows or life returns to normal.

But when children are anxious or fearful to the point that it affects their everyday life, prevents them from participating in favorite activities or causes health concerns, then it’s not just simple butterflies; it’s a problem that should be addressed, say mental health experts.

Anxiety is a recognized mental health condition and is the most common psychiatric disorder affecting children, according to the Child Mind Institute. In fact, the National Alliance on Mental Illness estimates that 1 in 5 teens and young adults are living with a diagnosed health condition, and of those, half develop the condition by age 14. It has been estimated that up to two thirds of high school absences may have a mental health reason as their underlying cause.

Symptoms of anxiety

Anxiety in children is often very difficult to recognize, and often looks like everything but anxiety. As a teacher, I’ve seen anxiety look like ADHD, defiance, depression and even allergies or heart problems. When one of my former students began experiencing difficulty breathing, chest pains, and dizziness, he was hospitalized with a suspected heart condition, but the ultimate diagnosis was that he was having extreme anxiety attacks.

“Symptoms of anxiety come in multiple forms and various degrees of severity,” says local therapist Maude Statler, who works with adolescents and teens. “They may range anywhere from consistent reevaluation of past events, to unrealistic worries about present-day activities, to excessive questions about what could happen in the future. These are the obvious symptoms, though. If children are not necessarily speaking these thoughts out loud, but are mysteriously prone to headaches and stomach aches, irritability, and fatigue, they may be experiencing anxiety. Other symptoms to watch out for include difficulty concentrating, relaxing, and/or sleeping.”

Boys and girls may sometimes display anxiety differently, Statler says. “Boys and girls will display similar symptoms of generalized anxiety if these feelings are considered acceptable in their environment. For example, boys may be quicker to express anger and frustration when coping with anxiety, while girls may be more apt to express physical pain,” she explains.

In my experience as a classroom teacher, I’ve found that boys who are anxious will often give up before they even try, while girls will often still want to please and may go overboard trying to get things “just right,” making themselves sick in the process. The unfortunate result is that we punish the boys’ anxiety, often labeling it ADD, and reward the girls’ anxiety by encouraging them and praising their hard work.

That was certainly the case for Marnie Swanstrom and her son Abel. Abel had begun having behavioral issues in preschool; by the time he was in second grade he was having meltdowns that could last for hours. Every day, when she would drop him off at school, he would run out of the building after her, screaming and crying. His struggles in class included issues with focusing and paying attention, and he suffered socially as well.
“We had one evaluation that said he was acutely ADHD, but that really didn’t address his outbursts and meltdowns. So we took him to a neuropsychologist, who, after several hours of evaluation, told us she couldn’t even test him for ADHD because his anxiety was so off the charts,” says Marnie. “She said it was like peeling an onion — we had to address the anxiety before we could even look at other underlying issues.”

For Marnie, the cause of Abel’s anxiety mystified her. “I thought, ‘What does he have to be so scared of?’ We thought we had done everything to make him feel loved, safe and secure. But, we learned, whatever was going on in his little brain was a mental health issue that required a lot more than just love and security to help him conquer.”

Finding the right words

Thanks to the stigma and misunderstanding of mental health issues, these topics are rarely discussed with children and they often don’t have the words to describe what or how they are feeling. This is especially true for children suffering from anxiety. At the same time, what we say to them can do more harm than good.

For children, anxiety is a physical reaction that they cannot “shut off.” Telling a child “Don’t worry” or “Trust me” doesn’t help and may even fuel more anxiety because your child is trying to please you by not being anxious any longer. What can be helpful to a child is saying, “What you are feeling is called anxiety. I understand what it’s like to feel anxious. It’s a very uncomfortable feeling.”

“Just being able to tell Abel that what he was feeling had a name, and that other people had it, too, we were able to break through his feelings that he was just a ‘bad’ kid.” says Marnie. “He is very bright so we went even further and talked about brain development and brain chemistry so he knew this wasn’t something he ‘caused.’

“Knowing what it was also gave us tools to help him. We worked with a therapist, we read books, watched videos and talked to other parents who had gone through it. It helped us make the decision to give him medication as well as learn methods to help calm him and quiet his brain. It broke my heart to see him so anxious, but I felt better helping him learn to handle it.”

Treating anxiety

Anxiety is treatable and manageable with assistance from the right people. Bringing your child’s teachers and health professionals on board can help determine the right combination of coping strategies to help make your child’s anxiety less overwhelming and daily life less stressful. Sometimes that involves medication and sometimes it doesn’t. But the most important first step is to seek help.

Start with your family doctor or pediatrician for a consultation. Your doctor can do an initial evaluation and steer you toward appropriate next steps. It is crucial to have your child evaluated for any mental health problems you suspect, because the sooner treatment is sought, the more treatable it is and the risks for other problems, like poor school performance and social isolation, decrease.

In addition, many resources are available for families who are trying to help a child struggling with anxiety. The Child Mind Institute (childmind.org) offers the following advice:

  • When your child is feeling calm, let him or her know that anxiety has a physical purpose, explaining that it is the body’s way of letting us know when things are OK and when things are not OK, and sometimes our brains forget to turn off the anxiety (fight, flight, or freeze). It is possible to retrain our brains to think different thoughts when we get anxious.
  • Prepare your child in advance for changes or situations that may cause anxiety. If you are going somewhere new or stressful, talk through the situation with your child in advance and focus on the details that are most important to your child. Will people be there that your child likes? Will there be loud noises? Can your child take a favorite book or toy? What food will be there? What time will you be home? Make a plan for what your child can do if he or she gets overwhelmed; scout out a quiet space ahead of time where he or she can go for a bit, or plan to take some time outside together if things get too hectic.
  • Be your child’s advocate. You are the best parent for your child, and while you can’t protect your child from all anxiety-producing situations, you can provide a buffer for him or her in social situations, particularly with friends or family members who, though well-intentioned, do not understand your child’s needs. Don’t insist your child hug and kiss everyone, and allow your child to take quiet time-outs if family events become too loud or overwhelming.
  • If your child is experiencing symptoms of anxiety, make an appointment to meet with your child’s teacher to discuss what the teacher is seeing at school. This isn’t a conversation for email. Talk in person so that both of you can get the fullest picture of your child’s health and make a plan to help him or her. It is likely that your child’s teacher has experience with children’s anxiety and may have ideas that will help both at school and at home. If you determine that your child’s anxiety is getting in the way of his or her education, ask your child’s teacher to help you work with the school system to put a formal plan (a 504 or IEP—Individualized Education Plan) in place that can provide accommodations for your child to help cope with the anxiety. This plan will follow your child through the rest of his or her K–12 education and will be updated each year with new teachers.

But above all, says Statler, be available and willing to address your child’s anxiety.

“The best way a parent can help is by being open to the possibility of anxiety. Talk to them about it; identify any anxious thoughts and then challenge them together,” says Statler. “If their thoughts are found to be unhelpful or inaccurate, help them generate alternative thoughts to replace them.“

Changing our way of thinking is not an easy task, but it “becomes easier when parent and child tackle it together, says Statler. “And, of course, do so with the utmost level of empathy; just because we are challenging their thoughts does not mean we are invalidating the feelings associated with them.”

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Anxiety Busters

Here are a few techniques that can help your child to become calmer and lessen their anxiety:

Deep Breathing

Deep breathing can help greatly, but sometimes kids don’t understand what you mean when you say “Breathe deeply.” Try saying it this way: “Breathe through your mouth like you’re filling up a balloon in your tummy” and “Breathe out like you’re blowing out birthday candles very slowly.”

Blowing bubbles also encourages deep breathing and provides a pleasant visual sensation as well.

In addition, there are apps available for all ages that help with relaxation and guided breathing.

Physical Activity

Find an activity that will tire your child’s “big muscle” groups, which will release endorphins and help calm anxiety. Have your child try climbing stairs 10 times in a row, doing wall sits or wheelbarrow walks, and pushing his/her hands against your hands.

Choose some songs you love or put one song on to repeat — and dance!

Distracting Activities

Playing with clay and Play-Doh. This can help relieve stress by allowing hands and fingers to do heavy muscle work.

Coloring Even adults have recently realized the calming power of coloring.

Interacting with animals. One of my students’ favorite coping mechanisms is to sit and watch a few minutes of kitten or puppy videos.

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