In many ways, Tucker is like lots of 7-year-old boys. He plays baseball and soccer, knows the name of every Star Wars character, and is obsessed with Minecraft. But after his mother tucks him in at night, scary thoughts pop into his brain and he can't let them go. "He worries so much about everything, like that someone might be outside his window or the house will catch on fire, that he often stays up all night in fear," says his mom, Joanna, of Darien, Connecticut, who didn't want to use their real names to protect her son's privacy. "I tell him that we're safe, and although he knows it's true, he just can't settle down his mind."
Even during the day, anything that deviates from the norm for Tucker can lead to an unraveling. "We were a few minutes late dropping him off for soccer practice, and when we arrived he was so worried that everyone was looking at him that he couldn't relax and join the group," Joanna recalls.
All kids get stressed sometimes. They'll have butterflies leading up to the first day of school or worry about being left out if their BFF plays with someone else at recess. Most kids will complain, maybe cry a little, and then move on. But for the estimated one in five kids in the United States who suffer from anxiety disorders (including separation anxiety, social anxiety, and obsessive-compulsive disorder), it's a major challenge to manage their worries. They ricochet through the child's head, getting more intense over time instead of naturally fading away. "No matter how much you answer an anxious child's questions or tell her things are fine, she can't absorb your reassurances," explains Tamar Chansky, Ph.D., author of Freeing Your Child From Anxiety.
In severe cases, kids with anxiety may stop eating, sleeping, or going to school. At the very least, their instability can set them apart from their peers, often at an age when fitting in is crucial. "Maya is so scared she'll do something wrong, like knocking over a toy and making a big noise, that she avoids playing with others," says a mom we'll call Lee of her 5-year-old daughter, who has social and separation anxiety plus OCD symptoms brought on by an obsessive fear of vomiting. "Therapy has helped her express her fears, and we've been inviting kids over so she can practice socializing on her own turf, but it's a constant struggle."
A child's anxiety can have a ripple effect on the entire family. "We pick our vacations based on which location we hope will have the least noise, and my husband and I are both exhausted at the end of every day," says Lee, who lives in Los Angeles. Since not all therapy is covered by insurance, dealing with an anxious kid can also add a financial burden to an already stressed family. It can be difficult for a marriage too: If the child tends to confide in only one parent, the other may be skeptical, wondering, "How can a kid be anxious when nothing bad has ever happened to her?" That's a question parents across the country, including me, ask themselves every day.
Making Sense of Fears
My daughter has suffered from anxiety since she was in preschool. Although she talked seemingly nonstop at home, at school she'd become so frozen with fear that she didn't say a single word during the first half of kindergarten. She constantly asked us about earthquakes and floods, though neither was likely to happen where we live. She has the same DNA as her older sister and was raised in the same home, so why was one of my kids confident and calm while the other was wracked with worries?
"It's just the luck of the genetic draw," explains psychologist Steven Kurtz, Ph.D., president of Kurtz Psychology Consulting, in New York City, who specializes in childhood anxiety. "There's a sort of smoke detector in your head that's supposed to go off when the brain perceives danger, and it triggers the fight-or-flight response," says Dr. Kurtz. "In anxious kids, their smoke detector is set to a much more sensitive level, and they also have a much more dramatic reaction." In fact, research has shown that differences in stress response can be detected in babies as young as 6 weeks old, proving that nature is at least as important as nurture when it comes to anxiety.
There's a family connection too: Kids with an anxious parent are up to seven times more likely to have an anxiety disorder compared with kids whose parents are not anxious. (Neither my husband nor I have a history of anxiety; both of Tucker's parents have anxiety in their family.) The link is both biological and behavioral, explains Golda Ginsburg, Ph.D., professor of psychiatry at the University of Connecticut in Farmington. "There is an inherited risk, but when parents are overprotective or model their own fears, they increase their child's risk of anxiety."
Difficult situations, like the death of a relative, moving, or even the ongoing daily stress of having an unemployed parent or tough financial times can also push manageable anxiety into a full-blown disorder. "A major event can sometimes make a child feel like everything in life is changing and nothing is predictable," explains Dr. Chansky.
If your child's worries are keeping him from going to school, playing with friends, or taking part in other activities that he'd normally enjoy, or if he complains of headaches or stomachaches that don't have any medical origin, then he probably has a condition that requires treatment, says Dr. Kurtz. Another cause for concern: questions and fears that seem out of proportion to the situation and continue for six months or get much worse over time. For example, it's perfectly normal for a child to ask "Can that happen to us?" after seeing a news report about a house fire; it's not normal to obsess about that fire several months later.
The Bright Side
Fortunately, anxiety is one of the most treatable psychological disorders in kids. With talk therapy and medication, research has found that nearly 80 percent of children can control their anxiety and live a happy life. However, anxious kids often go undiagnosed. "Many parents think that their child will grow out of his issues or that it's normal for a child to be nervous," says Wendy Silverman, Ph.D., director of the Program for Anxiety Disorders at Yale University School of Medicine.
Though some kids with anxiety act out or refuse to attend school, most -- like my daughter -- are quiet and well-behaved, so they can get lost in the shuffle. When I first told friends that I was worried about her silence in school, they'd say, "She's just shy." And given how often parents are accused of helicopter parenting, I didn't want to overreact.
But I'm glad I didn't listen to the doubters and instead followed my gut. "It's unlikely that a child will outgrow an anxiety disorder," says Rinad Beidas, Ph.D., assistant professor of psychology at the Perelman School of Medicine at the University of Pennsylvania. "When it's left untreated, she'll have a higher risk of substance abuse later."
If you're worried about your child's anxiety, it's better to seek services early than to wait it out. Ask your pediatrician or school guidance counselor for a referral to a child psychologist or a clinic, and schedule an evaluation. It's important to treat this meeting with the same matter-of-fact attitude as you would when taking your child to the doctor for a sore throat, says Dr. Kurtz. Explain the visit to your child using the same words he uses to tell you about his problems: "We're going to talk to someone who can teach you how not to worry at bedtime," for example.
For many kids, especially those in the early stages of an anxiety disorder, cognitive behavioral therapy alone can make them start to feel better within a few weeks or months. While it won't eliminate anxiety from their life, children learn to recognize what they're feeling and manage those reactions. A child who has an obsessive fear of germs may, for example, be taught to notice when his heart beats faster at the sight of someone coughing and to take deep breaths to calm down. He'll also learn coping techniques, such as telling himself, "Millions of people touch things every day and don't get sick." Finally, he'll be exposed little by little to his fear, going with the therapist to a public bathroom and touching the sink, then the toilet handle.
Trying Drug Therapy
Medication is often recommended when a child isn't making progress with talk therapy alone or is so severely impaired that she's not eating or sleeping. This makes many parents uncomfortable, but doctors urge them to look at the big picture. "If a child's symptoms have overwhelmed her capacity to cope and her parents' ability to help her, then it's appropriate to consider every option available," says Anthony Charuvastra, M.D., assistant professor of child and adolescent psychiatry at New York University Medical Center. In fact, certain medications can often be an essential part of a child's treatment, he adds.
For children with severe anxiety, two types of medication have been found to be especially effective. The most common are antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft; these increase levels of serotonin, which is a naturally occurring chemical in the brain that is known to regulate moods. The second group are antianxiety drugs called benzodiazepines; they are used less frequently because they can cause hyperactivity in young kids and can become less effective over time, says Dr. Charuvastra. Common side effects for all the meds include mild headaches, nausea, irritability, or sedation. Most go away within a few weeks, or the prescription or dosage can be adjusted, he says. Talk to your doctor if you find that your child's behavior or personality seems drastically (and negatively) different after starting medication.
Helping at Home
If your child seems anxious but it's not yet interfering with his everyday life, there are plenty of ways you can help him manage his worries without professional help. First, ask yourself how much you've accommodated his fears. All parents instinctively want to protect and comfort their kids; if your child screams hysterically whenever a dog walks by, you'd naturally try to keep him away from dogs. "Doing that may make things easier in the short run, but it reinforces his fear," says Dr. Ginsburg. "Instead, he needs to confront the fear and work on his skills to manage it." You can help your child take small steps, like watching dogs from a distance and then petting a puppy on a leash. With each victory, celebrate your child's bravery. For some children, a small reward, like ten extra minutes on the Xbox, might help them face their fear.
At bedtime, develop a soothing ritual. Rather than allowing TV or other screens, have your child read a calming book or do relaxation exercises (go to childanxiety.net for an app with breathing exercises and progressive relaxation). Try a helpful exercise called The Four Doors. "Before he goes to bed, have your child imagine four doors," explains Dr. Chansky. Behind each one is something fun, like a party, a family vacation, a favorite celebrity, or even a candy factory. He can choose which of the four doors to "enter" and think about what's inside, which helps him feel more in charge of his own bedtime routine.
Also consider how your own anxiety might be affecting your child. Screaming at the sight of a bug in your room, for example, will teach him to be afraid of bugs too. So if you've been waiting for a good reason to seek help for your own anxious behavior, this may be it.
Whether your child gets help for his anxiety through therapy, medication, or by using strategies at home, the change in his behavior can be remarkable. My daughter had several sessions of behavioral therapy during the summer before first grade, in which she learned to feel more comfortable speaking to other people. Since then, we've mostly worked with her at home. Changes were slow but steady. She's now 11, and although she still feels nervous raising her hand in class, she's made progress that I never would've imagined possible when she was younger.
To my surprise, she's found that her anxiety melts away when she acts and sings, and she has performed in front of hundreds of people, both in school and professionally. With patience, work, and loving support from their parents, kids can find a way to finally feel secure and make the bad thoughts go away.
A Dictionary of Disorders
Most anxious children have a combination of the following conditions.
- Generalized anxiety disorder: An excessive worry about things that are out of a child's control and a tendency to always imagine the worst-case scenario or worry about adult issues, like money.
- Social anxiety: A child's fear of meeting or talking to people, along with a worry that she'll be teased or humiliated and that everyone is judging her every move.
- Selective mutism: A condition where a child who talks easily with family and friends gets so anxious in front of teachers, other authority figures, and even peers that he freezes up and can't speak at all.
- Separation anxiety: A constant, debilitating fear of being separated from one's parents or that harm will come to them, at a level that is inappropriate for a child's age.
- Obsessive-compulsive disorder: A need for ritual or compulsive behavior, like washing or counting, to relieve anxiety about a fear or intrusive thoughts about upsetting topics.
- Phobia: An illogical, all-consuming fear (such as fear of dogs, vomit, elevators, or bugs)
Originally published in the May 2015 issue of Parents magazine.
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