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Worried Sick: Dealing with Anxiety in Children

The summer before he started kindergarten, my son, Aidan, couldn't sleep. We'd put him to bed with a story and a kiss, but he'd pop out of his room so often that we dubbed him "Jack" for jack-in-the-box.

"What's wrong?" we'd ask.

"Do I really have to go to school?"

"Of course," we said. "Everyone goes. It'll be fun!"

By August, his sleeplessness hadn't improved, and he was getting increasingly irritable. "Maybe he's not ready for kindergarten," I worried.

"He'll be fine," my husband, Dan, insisted.

I drove Aidan to the bus stop on the first day of school. When I stepped out of the car, I heard an ominous click behind me: He had locked me out of the car with my keys still in the ignition.

Luckily, another parent who was waiting happened to be a police officer, and he had tools to get the door open. I nearly had to crowbar Aidan onto the bus. When I apologized to the crowd of parents, the cop shook his head.

"I was the same way when I was a kid," he said. "He's just anxious."

The guy clearly knew what he was talking about. Aidan was also afraid of the dark, birthday parties, monsters, playdates, and thunder. My husband and I took opposite stands: I often let Aidan bow out of activities, but Dan declared that he had to "man up," quit defying us, and face his fears. Neither of us had it right. It took us two more years to see that Aidan wasn't wimpy or defiant. He was an anxious child who needed help handling his worries.

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It's typical for children to feel nervous sometimes, especially at certain stages of development. Separation anxiety causes many older babies and toddlers to sob when they're left at day care, for instance, but that's actually a good sign that they're attached to their parents. Between ages 2 and 7, kids often develop sudden but temporary fears of the dark, strangers, dogs, bees, or other specific things. Your child's blossoming imagination, along with his increased exposure to books and the media, may even lead him to invent things to be afraid of, like talking trees. Older kids who watch the news on TV may worry about fires, car accidents, or war. "Luckily, most kids are able to manage their fears by the time they're 7 or 8," says Andrew R. Eisen, Ph.D., director of the Child Anxiety Disorders Clinic at Fairleigh Dickinson University, in Hackensack, New Jersey.

However, studies have shown that up to 15 percent of children suffer from anxiety that's severe enough to impact their daily lives. They experience physical "fight or flight" symptoms: a pounding heart, dry mouth, and sick stomach. "A kid who suffers from anxiety may feel like he is going crazy, or even dying, because he doesn't know how to calm himself down," says Michael Southam-Gerow, Ph.D., associate professor of psychology and pediatrics at Virginia Commonwealth University, in Richmond. While a child can certainly become anxious in response to a traumatic event or specific stressors in his environment, experts believe that vulnerability to anxiety is usually inherited.

Unfortunately, many parents and teachers perceive symptoms of anxiety -- like refusing to go to school or use a public restroom -- as defiance. Anxiety may also be mistaken for (or even mask) other developmental disorders, such as ADHD, depression, or learning disabilities, so it's important to identify anxiety early and help your child learn to manage it. "Otherwise, he'll continue to avoid challenging situations and is likely to grow up to be an anxious or depressed adult," says Kathleen Trainor, Psy.D., a child psychologist at Massachusetts General Hospital for Children, in Boston.

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If you feel that anxiety is affecting her life to the point where she isn't making new friends, trying new activities, or developing like her peers, and she has difficulty sleeping, it makes sense to consult a mental-health professional. However, you can also try some of these techniques at home.

Help him distinguish between real and imagined fears. Point out, for instance, that if he's in the middle of the street and a car is coming, then he's right to worry (and get out of the street). "But you could explain that refusing to go to sleep because he's positive there's a giant monster hiding under his bed is a silly worry," says Dr. Trainor. Although you should respect his emotions, try to help him understand where his fear is coming from and what he's really afraid might happen. Then use concrete evidence to explain why his worry is groundless. Patti Steindl, of Memphis, did this when her daughter, Sarah, literally became afraid of her own shadow at age 2 and would run away whenever she saw it. She taught Sarah about shadows by having her touch them and showed her that she was the boss of her own shadow because it could only move when she did.

Believe that your child is capable. If you step in too quickly or let her avoid things that scare her, you're sending the message that she can't do what other kids do. "Instead, explain that feeling anxious is good because it means she's challenging herself and growing up," says Dr. Eisen. Of course, this means you'll also have to push your own level of discomfort as you watch her struggle a bit.

Take it one step at a time. Forcing a child into an anxiety-provoking situation, however, can backfire. Most experts believe in a gradual approach. If you want your child to be able to go on a playdate by himself, for example, stay for the whole playdate the first time, and then reduce the amount of time you linger at each subsequent playdate until he'll go solo. Steindl used this technique when Sarah was 5 and refused to go upstairs in their house alone. "At first, we had to walk up with her," she says. "Then we started going only partway up, then halfway, and then just a few steps." After several weeks, Sarah could go upstairs all by herself.

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Reward bravery. Once you've helped your child recognize what anxiety feels like and what triggers it, set goals and use incentives to help her reach them. "If she cries when you say it's bedtime, start with that simple goal -- no crying -- and give her little prizes for it," suggests Dr. Trainor. Five minutes without crying might earn a sticker, for instance, but half an hour could get her a new puzzle or a movie outing with you.

Recruit help. Lessening your child's anxiety away from home is easier if you have allies. Carla Panciera's daughter, Beatrice, stopped talking in class when she started kindergarten. "She was a chatterbox at home, but she wouldn't say a word in front of the teacher," says Panciera, of Rowley, Massachusetts. Panciera and the teachers came up with a plan to make class less stressful for her daughter. In first grade, Beatrice still wouldn't read out loud, but she was able to read into her teacher's ear. By second grade, she was participating more fully.

Encourage taking control. "It's important for your child to learn how to break his anxiety down into manageable pieces," says Dr. Eisen. When I got Aidan to talk about his fears, I realized two things: The bus was simply too loud for him, and he was still having trouble separating. So I started driving him to school. During the first week of kindergarten, I walked him into his classroom and stayed until he got settled. Within a month he could go in alone. That year, this was enough of a feat for both of us. Before first grade, Aidan and I walked around the bus lot and met some of the drivers. When he told me he was afraid of getting on the wrong bus or getting sick while he was riding, we discussed how he could tell buses apart by the numbers on them, and what the driver would do if he got sick. Once school started, he was ready to ride the bus.

Now that he's older, Aidan is still an anxious child -- he hates loud noises, and the first day of camp always gives him a stomachache -- but he can recognize his anxiety and talk through it now. Most important, we both remember all of the new things he's done that were scary at first but, to his surprise, turned out to be fun.

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Experts typically use cognitive behavioral therapy (CBT), which involves gradually exposing a child to anxiety-provoking situations and teaching him to breathe deeply and verbalize his fears. However, a recent study found that kids had improved most when they had CBT and took the medication sertaline (Zoloft). Other meds that may be helpful: Prozac, Paxil, and Luvox. Below are the most common anxiety disorders.

Obsessive-Compulsive Disorder Having ideas that are intrusive and senseless, or repetitive behaviors like hand-washing or counting

Phobias Fear and avoidance of specific objects and situations, such as dogs, clowns, or bees

Separation Anxiety Significant worry when leaving or being away from parents, fear of being/sleeping alone, school-related difficulties

Chronic Anxiety Persistent worrying in the presence or absence of stressful events

Social Anxiety Fear of being embarrassed in front of others, which can lead young children to avoid speaking, eating in public places, or using public bathrooms

Originally published in the March 2010 issue of Parents magazine.

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