Helping the Anxious Child

Dr. Emilie M. Storch, PhD

Helping the anxious child is often a challenge because anxious children have struggles that are internal. In other words, they are often not acting out and are not problems to others, so are difficult to identify. With anxiety, certain fears are very common at various developmental stages. For example, it is not uncommon for young children to worry about the weather, monsters, the dark, their parents dying or fire. With adolescents, social anxiety is a common concern. If an age-appropriate fear tends to be excessive and causes difficulty in normal everyday life, help should be sought for the child. Similarly, if the child has specific fears that are not appropriate for their particular developmental level, treatment might be needed. For example, if a 13-year-old experiences separation anxiety, or a ten-year-old expresses excessive worry about the family finances, these would be fears that are inappropriate for their particular developmental level. This might be an indicator of an anxiety disorder.

At a young age, some children are termed “behaviorally inhibited” or shy, fearful, quiet and introverted. This is considered to be a precursor of anxiety. Often, this is biologically based and might involve the amygdala and hypothalamic circuits. Clearly, there is a biological basis to many anxiety issues. Children whose parents are anxious have a much higher probability of being anxious. This is both biochemically and environmentally influenced. Often, anxious parents are overprotective and may interfere unknowingly with separation and self-confidence.

Stressful life events often mark the beginnings of childhood anxiety disorders. An anxiety proneness or vulnerability may interact with certain life events (stress, negative family interactions or child-rearing practices) to bring the problem to the surface. This is especially true for separation anxiety disorder and school phobia, which may begin or worsen following a loss or move.

The following are considered to be causes of anxiety:

	A genetic predisposition
	An over-protective environment
	The modeling of an anxious parent
	Life stressors such as a move, death, divorce, rejection, early trauma

There are many educational effects of anxiety. Excessive worry can disrupt a child’s general intellectual functioning. Anxiety reduces the child’s working memory available for various tasks. Lowered motivation is a result of high anxiety, as energy is consumed by dealing with the worry. So, less working memory and lower motivation lead to poorer academic performance. Distractibility is also a problem with excessive worriers and their hypervigilance taxes their attention. Children with speech and/or language disorders may show many signs of anxiety such as shyness and withdrawal, sleep problems, thumb sucking, fears and motor restlessness. Obsessive-compulsive children tend to check and recheck their work and this often interferes with scores on timed tests. Their difficulty with decision making and need for constant reassurance is also a problem for their academic performance. Overall, anxious children do not cope as well as other children. They often evidence an increased heart rate, changes in breathing, muscular tension, sweating and shaky legs. Thoughts of danger and worry are foremost in their minds and they then to react behaviorally by trying to escape, pacing, hitting, throwing temper tantrums and biting their nails.

When children understand the biological changes that accompany anxiety, they tend to have more control over them. Children can learn that specific thoughts are connected with specific feelings and learn to change or divert their thoughts. The thoughts that tend to control them are twofold:

1. They overestimate how likely it is that bad things will happen.

2. They assume that the outcome of these feared events will be unbearable.

As children learn to change their thoughts from more extreme to less extreme ones, their anxiety is improved. Adults can help with this by assisting children to be “good detectives” and looking for evidence to support or discredit their fears. Then, as children reevaluate their fears in light of the realistic evidence, they can look for a calmer thought that might be more reality-based. Clearly, Scripture is helpful here: have them focus upon God helping them, receiving God’s peace in their worry or casting their care upon the Lord. Another method that adults can use with anxious children is helping them to fight their fears from small to great by ranking the fear and setting up rewards as the child increasingly overcomes more difficult challenges. Making this a game with prizes, colorful charts and encouraging cheers is always more motivating to younger children. Both of these strategies can be aided by teaching anxious children relaxation by tensing and relaxing various muscle groups. Imagining peaceful scenes will help them divert their minds. Deep breathing, in the form of pretending to blow out birthday candles, will help them to regulate their shortness of breath. Coaching children on what to do in difficult situations and rewarding them for their small attempts will increase their motivation to try and will encourage them by the knowledge that they are not working on this alone. It also aids in preventing the child from avoiding the fearful situations.

The “Comfort Box” is one additional strategy to help children divert their obsessive or fearful thoughts. Help the child to obtain a shoebox and cover it with paper that they can colorfully decorate with markers and stickers. In this box, assist them in collecting things that bring them peace or contentment. These will include index cards with various comforting Scriptures as well as soothing CDs or tapes, pictures of their family members, a book of jokes, cards to divert their attention, special toys that bring them comfort, etc. When the child goes to the comfort box instead of to the adult to attempt to soothe him or herself, they can be rewarded for something they have actively done to combat their anxiety. Again, charts are very helpful to log their progress. Anxiety is so internally debilitating that external acknowledgements of successful “tries” are very helpful. Since anxious children look to adults to be directive and take over for them, the comfort box puts the responsibility on the child to do something actively to deal with their anxiety. Their successful attempts will increase their self-confidence that they can face the fears without an adult always being there.

Finally, some children are significantly helped through psychiatric medications that ease their anxiety to the point that the behavioral strategies can be more effective. Consultation with a child psychiatrist can be very helpful to determine the severity of the anxious condition and medication alternatives in each individual case.