How To Help The Anxious Child

By Jan Howard

Some anxiety in children is expected and normal at specific times in their development. However, when there are symptoms of severe anxiety that interfere with normal functions, parents should be concerned and consider seeking professional help.

“Helping the Anxious Child Cope” was the subject of a workshop by Anna D’Aiuto, MFT, a marriage and family therapist, sponsored by the Family Counseling Center on May 22 at the C.H. Booth Library.

Refusal to go to school, intense fearfulness, racing or pounding heartbeat, dizziness or light-headedness, shortness of breath, trembling or shaking, fear of dying or of losing control or going crazy, over clinging, or extreme worries are some of the symptoms that may indicate severe anxiety.

To define severe anxiety and to recognize unusual behavior, it is important to know the child, according to Ms D’Aiuto. “There will be something that stands out, that doesn’t seem right,” she told attendees.

“We all get anxious,” she noted, but if there is ongoing, persistent, irrational fears or phobias or if children are always anticipating the worst, there is reason to suspect severe anxiety.

“Nine times out of ten there is nothing wrong with the kid,” she said. “He or she is just acting out as a result of something else.”

Parents need to look at what might be contributing to the child’s anxiety if he/she demonstrates fear or worry beyond what is reasonable for the child’s age, she said.

“Separation anxiety is the fear of separation from a primary caregiver,” Ms D’Aiuto said. “When the child refuses to go to school or has tantrums, you need to figure out what is contributing to it in the child.”

A new baby could create anxiety, bringing about fears of rejection, abandonment, or losing a parent. Beginning nursery school or going to kindergarten may be cause for anxiety. If the anxiety begins to impact on the child’s ability to attend school or take part in social functions and other components of daily living, the anxiety needs to be addressed.

Nursery schools often have a parent stay on a child’s first day. The schools may show children pictures of what they will be doing before the parent returns. “This increases their tolerance,” Ms D’Aiuto said. “Kids need structure and routine.”

Anxious children should be reassured to help build their self-esteem and encouraged in social activities with peers, she said. If a child continues to be anxious and fearful, the home, school, and social environments need to be looked at to see what is different that might be causing the anxiety.

“Kids know when they are made to feel different. Tell them you love and support them,” Ms D’Aiuto said. “Let them know you’ll take care of it. Let kids be kids.

“Abandonment issues are big with kids,” she said. “If you see those things, use strategy, and slowly increase your time away.”

After a child is over 4 years old, it is normal to start interacting with other children, she said. If the child is older, question why he/she is not separating from the parent.

A child can also learn the behavior of an anxious person in the home, she noted. Anxiety can also be triggered by change, such as with the death of a pet, Dad being away, or an illness in the family.

“Find out what they’re feeling anxious about,” Ms D’Aiuto said. If it stands out for a long period of time and strategies to address it have not worked, seek counseling as to why the fear is so severe and goes beyond typical behavior.

If the child has several caregivers, consistency is the key, she noted.

To teach children how to calm themselves, coping strategies, such as breathing exercises and guided imagery, may be used, she said. Guided imagery by a professional therapist consists of guiding a person into stopping a fearful thought and replacing it with something pleasant. “It has to be done a certain way,” she said. Humor or help from a friend may also be used to distract a child from being too anxious.

“Don’t push too hard. Take it slow or they will shut down,” Ms D’Aiuto said. “Normalize their feelings by letting them know it’s normal to have these feelings, that they are not the only one going through what they are going through.

“Do it at their level. You can’t talk to a five-year-old like they were 15,” she said.

Anxiety is worrying about all sorts of things, Ms D’Aiuto said. The child may always have to be aware of what’s coming up in the future. “They have the fear of almost everything, the fear of the unknown, of doing new things.” The question “What if…” is constant, she added.

It is necessary to find a resolution or more positive outcome to their anxiety, she said. “Things are not going to go by plan, they have to learn how to cope. They need to know that sometimes you have to pay a price, but that’s normal in life.”

She encouraged parents and educators to educate themselves on what anxiety is, look at causes, and what contributes to it. Recognize social phobias, such as fear of interacting. Be concerned if the child seems to be a loner, rather than shy. “When it gets to be a phobia, it’s severe,” she said. “You need to know what is causing it and increase the child’s tolerance.”

Question why a child may be always doing things alone, she said. “Be cautious in diagnosing this. It could be just a phase.”

Creating a buddy system usually works, she said. Doing chores with other children, such as at nursery or preschool, is confidence building. “Parents need to start getting the child involved socially. They need interaction. Through play, they learn how to interact with other kids.” Parents might want to consider play therapy with a therapist, she noted.

Medication may be an important part of treatment for children and adolescents, but Ms D’Aiuto urged caution. “Know if it’s necessary, if it will help bring the condition to where you can work on issues,” she said. “Ask the questions. Some have bad side effects or can be life threatening. They can also be helpful. Just be careful of meds.”

For questions to ask regarding psychiatric medications, see the American Academy of Child & Adolescent Psychiatry (AACAP) Web site at  www.aacap.org/web/aacap/publications/factsfam/medquest.htm.

Behavioral definitions of separation anxiety, anxiety, social phobia/shyness, and specific phobias are as follows:

Separation Anxiety

•_Excessive emotional distress and repeated complaints when anticipating separation from home or major attachment figures.

• Persistent, unrealistic worry about possible harm occurring to major attachment figures or excessive fear they will leave and not return.

• Persistent, unrealistic fears that a future calamity will separate the child from a major attachment figure.

• Repeated complaints and heightened distress after separation from home or the attachment figure has occurred.

• Persistent fear or avoidance of being alone.

•_Frequent reluctance or refusal to go to sleep without a major attachment figure being near.

• Recurrent nightmares centering around separation.

• Frequent headaches or nausea when separation from home or the attachment figure is anticipated.

• Excessive need for reassurance about safety and protection from possible harm or danger.

• Low self-esteem and lack of self-confidence that contributes to the fear of being alone or participating in social activities.

• Excessive shrinking from unfamiliar or new situations.

Anxiety

• Excessive anxiety, worry, or fear that markedly exceeds the level of the child’s development.

• High level of restlessness, tiredness, shakiness, or muscle tension.

• Rapid heartbeat, shortness of breath, dizziness, dry mouth, nausea, or diarrhea.

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• A specific fear that has become generalized to cover a wide area and has reached the point where it significantly interferes with the child’s and family’s daily life.

• Excessive anxiety or worry due to parent’s threat of abandonment, overuse of guilt, denial of autonomy and status, friction between parents, or interference with physical activity.

Social Phobia/Shyness

• Hiding, limited or no eye contact, refusal or reticence to respond verbally to others, and isolation in most social situations.

• Excessive shrinking or avoidance of eye contact with unfamiliar people for an extended period of time, such as six months or longer.

• Social isolation and/or excessive involvement in isolated activities, such as reading, playing video games, or listening to music in his/her room.

• Extremely limited or no close friendships outside immediate family members.

• Hypersensitivity to criticism, disapproval, or perceived signs of rejection from others.

• Excessive need for reassurance of being liked by others before demonstrating willingness to get involved with them.

• Marked reluctance to engage in new activities or take personal risks because of potential embarrassment or humiliation.

• Negative self-image as evidenced by frequent self-disparaging remarks, unfavorable comparisons to others, and a perception of self as being socially unattractive.

• Lack of assertiveness because of fear of being met with criticism, disapproval, or rejection.

• Heightened physiological distress in social settings (increased heart rate, profuse sweating, dry mouth, muscular tension, and trembling).

Specific Phobia

• Persistent and unreasonable fear of a specific object or situation because an encounter with the phobia provokes an immediate anxiety response.

• Avoidance or endurance of the phobia with intense anxiety resulting in interference of normal routines or marked distress.

• Sleep disturbed by dreams of the phobia.

• Mention of the phobia produces a dramatic fear reaction.

• Parents have catered to child’s fear and thereby reinforced it.

The Family Counseling Center, a nonprofit mental health agency, is located at 121 Mount Pleasant Road in Newtown. For information, call 426-8103.