Monday, February 20, 2017

Dealing with Childhood Anxiety

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Dealing with Childhood Anxiety  

        Childhood is often seen as a carefree time in life.  Even so, anxiety can be found in children of all ages.  There are times when children feel overwhelmed with fear about the future in daily situations.  There may be worry around getting hurt, death, news, and peer relationships. One in five children has severe anxiety which can benefit from treatment from a mental health therapist.  The child’s anxiety may rub off on adults causing them to be more anxious adding to the intensity of the feeling in the child.  Adults may feel drained trying to deal with the child’s stress which may lead to impatient responses from the adult.  These reactions are normal, but not helpful.  To change we need to think about our interactions. To help children manage and cope, parents can help children deal with anxiety by encouraging them to be brave, spending quality time with the child during a noncompetitive interaction, teaching children about the physical symptoms of anxiety, providing an environment for healthy sleep habits, and by helping them to understand their thinking and feelings around anxiety.  Parents help children work through anxiety by acting as a compassionate and motivating coach.
        One proven way to reduce anxiety in children is for adults to spend five minutes of quality time with a child each day.  Studies have shown that giving a child 100% of your attention for as little as five minutes a day can make a difference in how the child manages anxiety.  When children are given full attention enjoy the child’s company by participating in an activity which is not demanding or competitive.  This may involve drawing, creating a story, cooking together with the child as the “head chef”, taking a hike, or playing with blocks.   He focus should be on the child and their interests without any judgment.  During these focused times avoid competitive activities, asking lots of questions, criticizing, or giving instructions.  Following the child’s lead in an activity can be comforting for a child. This direct attention creates a caring and relaxed environment.  Have your interactions fit the acronym PRIDE to create a supportive and non competitive environment for the five minutes.
Praise appropriate behavior.
Reflect on child’s comments
Imitate the child’s actions to show interest.
Describe what the child is doing.
Express enthusiasm about the time spent together.
The number one indication of success depends on how much the parents mirror the child in an age appropriate way.  Kids talk more without direct eye contact, so an activity which involves side by side work is generally a good time for meaningful conversations.  Talks during car rides can be a great time for conversations and connecting with your child. Establishing a strong relationship will help parents coach children as they deal with fear and anxiety.
         Creating a sense of security prior to risk taking is another way parents can help children to be successful in overcoming anxiety.  Instead of escaping from a stressful situation, children need to learn to tolerate some stress.  Tolerating a fear helps them get through the situation rather than avoid it.  Be a supportive coach by encouraging your child to complete the activity.   Learning to cope with life’s challenges helps to develop strong adults.  Use compassion and gentle nudging as your child works through anxiety creating situations.  
Physical symptoms, behaviors, and thoughts around anxiety are very real.  By helping your child recognize physical symptoms of anxiety, children learn that these sensations are a natural response to perceived threats.  Explain to your child that when they feel anxious they may notice symptoms such as increased heart rate, clammy hands, tight and knotted stomach, and/or shaky legs.  Wait it out; the physical response will acclimate and recede.  Elevated emotions in this state are hard to sustain. Awareness of the physical symptoms helps us to better understand the signs and helps individuals overcome fear around the physical signs.
It is beneficial to practice slow belly breathing as this is one of the most effective ways to calm the body when experiencing symptoms of stress.  Place one hand on belly and slowly breathe; the belly should move out like a balloon when you breathe in and deflate like a balloon as you breathe out.  It’s important to practice relaxing breaths when the body is calm in order for it to be more effective when you feel stressed.
Keep in mind that anxiety is a sign getting ready for a challenge.  Some level of anxiety is a useful tool.  If you are either too relaxed or too stressed it will be more difficult to do a task well.  Think of a baseball player at bat.  If you are too relaxed the arm will be limp when the ball reaches the bat.  If you are tense, the hit will be rigid.  It is best to be focused and aware, but not too relaxed or too tense.   The same is true for taking a test or any other activity which requires focused attention.  A moderate level of anxiety helps us to focus on important information.  The goal is to avoid becoming overwhelmed by anxiety.
Sleep has an impact on levels of anxiety.  Elementary children should get 10 to 11 hours of sleep.  Lack of sleep intensifies anxiety, which can create a cycle interrupting healthy sleep habits.  Anxious kids struggle to sleep.  Sleep is a necessity; eventually the body will sort it out.  Remind your child that the body will take care of itself.  They don’t need to worry about it.  When children struggle to fall asleep tell them to lay quietly with their eyes closed.  Eventually they will get some sleep.  It is common for people to take 45 minutes to fall asleep.  
When children rest quietly, encourage them to think of fun and interesting things.  Talking about not getting enough sleep when you go to bed will keep you from sleeping.  It is more helpful to have other lighter things to think about.  Create a list of things to think about such as fun thoughts during rest time.  Another step to creating healthy sleep habits involves following a routine.  Plan to have quiet time before bed, talk about fun events being planned, or invent a story or talk about favorite characters as part of the bedtime ritual.  Establish routines by both going to bed and getting up at the same time each day.  If a child wants to talk about their worries before bed, have them write it down and put it in a worry box to be discussed at another time.  Problems seem bigger when we are tired; this is not the time for stressful topics.  Consistent bedtime routines will help develop healthy sleeping habits in addition to reducing daily stress.
To understand the strong feelings and thoughts surrounding anxiety, it is important to remember that anxiety comes from a primitive response to anxiety provoking sensations. The anxiety response alerts the brain that danger is near.  To protect itself the section of the brain called the amygdala signals the body to freeze, flee, fight.   This response is important in emergencies.  However, sometimes we have false alarms and think there is danger when there is no life threatening danger.  It helps children to name what is happening with the brain.  The only trouble is there is no danger; it’s more of a discomfort.
Here are some examples of how the freeze, flee or fight response might look in children when they experience fear or anxiety.  It’s also easy for kids to make connections to these behaviors and animals.  When children stare at empty pages or read without remembering it is similar to a rabbit freezing and hiding in place.  Surfing the net, napping or work avoidance is like someone fleeing from the anxiety causing situation.  This can be related to a deer running from danger.  Fighting with parents or arguing over school work is like a wolf fighting to protect and push away the danger.  These are all examples of how primitive thinking occurs during stress induced situations as the brain responds to the anxiety.  These behaviors tend to be both automatic and self-defeating.
Avoiding stressful situations can increase anxiety.  Kids watch for cues from adults and peers as to know how they should behave in social situations.  If a parent is relaxed, it is easier for child to relax.  If we help the child escape a situation we send a message that it is too dangerous for them, encouraging an escape response.  Saying, “just get over it,” is not helpful or kind.  During these moments children need understanding and compassion.  Instead coach the child using small steps to move forward.  Orient the child towards bravery rather than getting rid of a response.  Bravery means doing something even though we are scared.   Children can become more self-assured by internalizing the message, “I can be brave.”  
Celebrate courageous acts by making small medals.  It could be a medal for bravery for saying hi to three people even though it was scary.  This recognition will help a child realize that they are capable of doing brave things.  Ask children to think about their goals.  What do they want?  What matters to them?  How can they move towards something even though they are scared?  Plan and make new situations predictable to give a sense of control.  Script a conversation or what to say.  Plan steps of what to do in social event, including look to see what others are doing.  If a child is fearful of people in costumes build tolerance by finding pictures of other people in costumes, take a photo of the child in costume, or watch a parade of people in costumes slowly building a level of comfort.  With each step or activity stay near your child in the situation until it no longer seems scary.  If a child resist these steps parents should gradually and lovingly cut down on how they help out.  Let them know you will gradually spread out the frequency of a response to a call for support.
Children need to develop competency to manage some situations.  To deal with social anxiety students should learn ways to connect and interact with peers through specific conversation starters or role playing practice.  If the child experiences test anxiety it is time to learn additional and effective study skills. Sometimes adults taking a step back from the situation encourages kids to figure it out.  When adults say, “I’ll take care of it,” the message sent tells kids they can’t handle it.  This takes away the opportunity to develop coping skills. Allowing children to develop their own solutions, shows you trust them to solve life’s problems.  
Thoughts also provoke anxiety.  “When you can imagine it, it can happen’” is the thought process for some anxious children.  Kids become scared of their own thoughts.  The more you think about it, the more you think about it.  If you are told not to think about it most people will think about that exact thought.  Remind your child that thoughts are not dangerous.  Have them try this activity.  Imagine your thumbs turning green.  Now open your eyes.  Ask them if their fingers turned green?  It’s not likely.  Children are in charge of their imaginations.  Ask the kids if it is likely to happen?  Now try making up fun things to imagine or silly things instead.  You could ask what’s in closet when they bring up fears.  
Teach the children to identify the difference between a thought and reality.  Have the child say the phrase, “I have the thought that…” in front of a scary idea or worry.  For example, "I have the thought that I’ll be embarrassed at the party."  Be aware of the thought and let it float by (don’t hang onto it).  Telling the child nothing bad will happen can make the thought stronger.  It might lead to thoughts around “what if this happens.”  Instead encourage your child to recognize the voice of anxiety in head.  The “anxious voice” is trying to boss you around.  To help kids consider trying the following ideas.  
Ask kids to evaluate the situation by using questions about how bad it would be if it happened on a scale of 1 to 10.  Consider how likely (not how easily imagined) it is to happen or how often in past year or 5 years has it happened.  Then consider if you should or even if you could do something about it.  Sometimes if it’s not bad or likely or if you can’t or shouldn’t do anything about it, let the thought go.  Dwelling on the thought makes us feel worse.  
With the use of positive self-talk individuals can be encouraged to cope with the situation.  “I handled hard things before I can handle this.”  Children shouldn’t need to fret about adult problems.  Look at what supports you have in place to help you if you need it.  Kids may want guarantees, but life is unpredictable.  We all need to be able to tolerate uncertainty.  
The way out of anxiety is through it.  Discourage avoiding anxiety provoking situations.  When under stress it is common to experience a response to freeze, flee or fight.  By avoiding the activities, feelings of stress are perpetuated.  To overcome the anxiety, have the adults model calm relaxed behaviors in the situation.  Children will feel calm, if and when the adult is calm.  
Think about bravery.  Gently support the child, while gradually cutting back on how much the adult accommodates the child with stress.  Work on improving skills to increase coping skills, ask relevant questions, and have the child develop solutions to the problem.  By focusing on bravery children can alter their thinking about the situation instead of avoiding thoughts.  
Name the anxiety.  When a child feels anxious, identify the anxiety and how to work with it.  Have the child ask himself questions such as, “How bad would it be if ….?”  “What is the chance of it happening?” or,”Could or should I do something about the situation?”  Then make a plan if action needs to take place to make the situation better or find ways to let the thought go.
    Have children use their internal voice to coach themselves through brave moments.  Coping with anxiety teaches kids to manage unpredictable situations.  Life is full of unpredictable events.  Learning to manage anxiety helps children learn to manage life.  

Kennedy-Moore, E. (2014).  Raising Emotionally and Socially Healthy Kids. Lecture presented at The Great Courses in Virginia, Chantilly.

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