My experience as a clinician in private practice supports the statistics that indicate that anxiety has reached epidemic proportions in many countries, as 85% of my caseload consists of clients with anxiety. Furthermore, my past experience as a child and family clinician in a community health care setting, supports the statisitcs that 25% of the sample is made up of children over the age of 8 years.
The four main sources of stress in children are cited to be family, school, media and the world. A major increase in childhood anxiety was noted post 9-11, the media coverage having a significant impact. Sadly, since that time, mass shootings have been occurring with increasing regularity, with school settings often being the target. School, once regarded as a safe place away from home, can no longer guarantee that sense of security. Bullying, particularly cyber-bullying are also sources of intense stress.
The number 1 stressor for children is the loss of a parent, followed closely by divorce and separation. Not all children faced with the same stressors will develop anxiety. Some have a biological sensitivity to stress, with anxiety running in families, while others possess personality traits, which increase their susceptibility to developing anxiety. These personality traits include:- a sense of responsibility, perfectionism, liking to please and a preference for structure. These children tend to be cooperative, motivated and thoughtful. However, these positive attributes can be accompanied by a proclivity for excessive worry, a heightened sensitivity to criticism and ultimately a tendency to being easily exploited.
Anxiety can manifest itself in many different ways. During the course of development some anxiety is normal and throughout the lifespan a low level of anxiety can have a positive role eg motivation to do well in exams, or to keep a person safe in dangerous situations.
COMMOM FEARS IN CHILDREN & ADOLESCENTS
|0 – 6 months||Loss of support, loud noises|
|7 – 12 months||Strangers, sudden movements or large/looming objects|
|1 – 2 years||Separation, toilet, strangers|
|2 – 3 years||Separation, dark, animals, loud noises, large objects, changes in house|
|3 – 4 years||Separation, masks, dark, animals, noises at night|
|5 – 6 years||Separation, animals, ‘bad people’, bodily harm|
|6 – 7 years||Separaion, thunder & lightening, supernatural beings, dark, sleeping or staying alone, bodily injury.|
|7 – 8 years||Supernatural beings, dark, fears based on television viewing, staying alone, bodily injury|
|9 – 12 years||Tests, school performance, physical appearance, thunder & lightening, bodily injury , death|
|14 – 15 years||Family & home issues, political concerns, preparation for future, personal appearance, social relations, school.|
Changes in mood, behaviors and somatic symptoms can be indicative of stress or anxiety in children. Examples include:-
- Mood – Negative attitudes, irritability and depression
- Behaviors – Aggression, withdrawal, avoidance eg school related.
- Somatic – Sleep disturbance, headaches, tummy aches, restlessness, teeth grinding and muscle tension.
A child’s anxiety can have a profound impact on the whole family system, often leaving parents distraught and concerned, and siblings irritated. Family therapy is typically the intervention of choice and through my trainings and my own work with children and families, I have learned that second to having a trusting relationship with the therapist, is the need for the parents and therapist to get to know and understand the child’s personal experience of anxiety.
While a child’s anxiety needs to be taken seriously, this does not mean that therapy needs to be serious. A sense of playful curiosity can serve both the worried child and the parents well. (I do not include trauma and OCD here).
Narrative therapists’ approach to treating anxiety is to use externalizing conversations during which anxiety is increasingly seen as separate from the child. The client is not defined by the symptoms and is referred to as a child with anxiety rather than an anxious child. During externalizing conversations, the child is asked about when anxiety shows up, when does anxiety want to be in charge, what are anxiety’s goals for the child. For example, anxiety might want to keep the child all to himself, preventing the child from interacting with other children. Seeing anxiety as separate and even mischievous, gives the child an opportunity to exert control over anxiety and not let it get the better of him/her. One of the many techniques a talented NH therapist Lynne Lyons has developed, is to ‘talk back’ to anxiety and she has fun modeling ways to talk back to anxiety to disempower it. “Seriously anxiety, you’re here again telling me there are monsters under my bed. There have NEVER been monsters under my bed, so why should I believe you tonight?!” The more laughter in the room as family members begin to relax, the better!
Children love to learn about their minds, brains and personal experiences. Anxiety begins with a thought, just a thought, an ‘Uh-oh’ or ‘Oh-no’ thought as Lynn Lyons likes to explain. This worry thought forms in the creative right brain and is heard by the amygdala, an ancient alarm system. This then jumps into action and alerts the whole body that there is danger lurking. The body then makes the heart beat faster, and all the things that kids feel when they are scared! The body and the brain begin to work together in their mission to keep the child safe from danger, like a monster that might be lurking under the bed. BUT, there is no danger, just an Uh-oh thought!! Understanding this, the child can engage their logical left brain to talk back to anxiety and regain calm. Providing psycho-education in this way, serves to provide another layer of getting to know anxiety.
Another early intervention in family therapy is to help the parents understand their role in helping their child overcome anxiety. The parents who present as frustrated and dismissive of their child’s anxiety, first need to validate their child’s feelings and gain an understanding of their experience. Those parents who have their own level of anxiety about their child’s symptoms, need to parent in a way that initially may seem counter-intuitive. The bottom line is that they need to become comfortable with uncertainty and resist the urge to provide comfort to their anxious child and instead provide them with empowering options. For example, anxious parents generally respond to ‘what if’ questions with answers that reassure the child of certainty.
Child – “What if the bus driver forgets to drop me off at my stop after school?”
Parent – “Of course he wont forget, pumpkin!”
A more empowering response for the child would be –
“I’m pretty sure he wont forget to stop for you, but if he does, let’s make a list together or all the things that you could do if he does. I know you could handle that!”
Lynn Lyons summarizes these interventions as the 4 Bs for younger children:-
- Brain – Worry or Uh-oh thoughts setting off the alarm system.
- Body – Understanding the physiological manifestations of anxiety.
- Brain – Worry or Uh-oh thoughts setting off the alarm system.
- Bravery – Doing things even though you are worried – eg getting on the school bus.
- Bridge – Worried children often forget that they have handled a tough situation in the past and need to be reminded of their triumphs.
and the 3 Es for older children12 – 13 years
- Expect worry to show up
- Externalize it
When looking for the right therapist for you and your child, he / she should be involved in the process. The relationship between therapist and child is going to be central to success. Some things to look out for:-
- Does the therapist display a genuine interest in your child?
- Does she take the problem seriously?
- Is she willing to learn about the child’s personal experience with anxiety?
- Is she able to engage in a playful and fun way?
- Is she able to articulate coping strategies?
- Is she able to provide active learning experiences?
These are desirable qualities but most of all a child needs to feel that the therapist is not fake, and if she is ‘cool’ that is an added bonus!
My own experience of working with children, they feel empowered in the process of getting to know and understand their anxiety. As the experts in their own experience, they can play with being creative and inventive in discovering ways, along with their parents, to combat their fears. Parents are encouraged to model being flexible rather than rigid and to steer away from requiring perfection. When the family is on board and involved in a spirit of curiosity and support, great things can happen.
Covey, S. The 7 Habits of Happy Kids. NY: Simon and Schuster, 2008
Foxman P. The Worried Child: Recognizing Anxiety in Children and Helping Them Heal. Alameda, CA: Hunter House 2004.
Foxman P. Dancing with Fear: Controlling Stress and Creating a Life Beyond Panic and Anxiety. Alameda, CA: Hunter House 2007.
LynnLyonsNH.com – Video – ‘Decreasing Anxiety: How to Talk to Your Anxious Kid’.