Do you think your child suffers from anxiety?
The most common anxiety disorders and children’s phobias include:
- generalized anxiety (chronic worrying for at least 6 months with interferes with sleep or the ability to concentrate, muscle tension)
- separation anxiety (child worries about harm coming to a caregiver or self at separation from caregiver, often tries to avoid separation or endures it with a lot of distress),
- specific phobia (to animals such as dogs, or injections/blood, or vomiting, or situations like flying)
- social phobia (worry about being perceived negatively by others, or embarrassing oneself, usually they avoid performing or participating in class or group activities).
Obsessive-compulsive disorder, which is now its own category in the DSM-V, often presents as anxiety. Children with OCD have an obsession (recurring thought, image, or urge) and/or compulsion (ritual, repetitive behavior) that takes 1-hour or more a day. To be an actual disorder, the symptoms of anxiety must cause an interference or impairment in the child’s life.
What Can Parents Do?
Cognitive-behavioral therapy is the most empirically supported approach to treating anxiety. Using Anxiety-Free Kids, parents are guided to work directly with their children to address the 3 components of anxiety:
When you address all three, and particularly when you help the child face their fears, the anxiety can be overcome. Parents need to teach children the skills and techniques to address these 3 components of anxiety. Skills and techniques include:
- teach calm breathing, relaxation, progressive muscle relaxation, and other strategies to address the physiological expression of anxiety
- how to conquer worries through positive self- talk (e.g., “I must face my fears to overcome them,” “What would someone without anxiety think and do in this situation?”)
- worry loop recordings (where the child records his worries and listens to them repeatedly until he finds them boring)
- detached mindfulness (learning how to become an observer of, rather than a participant in, the anxious thoughts)
- challenge thinking errors
Construct a Ladder
Finally, parents can work together with the child to construct a “ladder” which is a list of the child’s anxiety-provoking situations, ordered from easiest to hardest. Then they learn how to gradually face their fears, one by one. With the practice of exposing themselves to the anxious situations, they will learn to habituate, or become used to it (it’s the avoidance behavior that maintains the anxiety).
An important component is for the parents to stop accommodating the anxiety. Warm and loving parents often make accommodations, such as supporting the child’s avoidance (for example, answering the child’s many questions in advance of a plan to help it be more predictable, letting them sleep in their bed when it’s in service of the fear of sleeping alone, calling the birthday party parents to ask if they can keep the dog in another room, etc.). These accommodations actually strength the anxiety, making it worse.
Once they complete their ladder, the child will have mastered their anxiety and no longer engage in anxious behaviors or avoidance. As a result, their self-confidence will strengthen and the family will no longer be organized or controlled by the anxiety.
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Bonnie Zucker, Psy.D., is a licensed psychologist and author of Anxiety-Free Kids: An Interactive Guide for Parents and Children (2nd ed.).
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