When Our Children Worry and Struggle with Anxiety
Anxiety disorders are the single most common mental health condition in children and adolescents. It is also the most treatable, and so, though distressing, it’s a condition that contains much hope.
For children and adolescents in wilderness or residential treatment, anxiety is often hidden underneath anger, resistance of different kinds, and withdrawal or a depressive presentation. In addition, many of our teens in treatment have siblings whose own anxiety rises to the surface because of the changes in family dynamics.
Traditionally the most effective treatments have been medication-based, and some type of Cognitive Behavioral Therapy (CBT). Both of those modalities have upsides but also limitations. Medications, while often beneficial are not always trusted by parents who have safety concerns. CBT requires a child who is open to change and willing to engage with a properly trained therapist.
The most impactful approach to helping children and teens with significant anxiety is to change our adult/parent/caregiver reactions to their struggle. Studies are emerging that show the right kind of Parent Training produces as much change as when medication and CBT are combined. And it’s so empowering and wonderful to give children the message that while their struggle is real, their own parents have the capacity to help them cope and make things better.
Though effective treatment can be rooted in parents changing their behaviors, it doesn’t mean that parents are the cause of their child’s struggle. This is an important distinction because many parents find it quite easy to blame themselves.
The challenge is that by its very nature, a child’s struggle with anxiety becomes a relational and family-system problem. Parents are wired to protect and help their children regulate. When mammal babies are threatened, they don’t look to fight off the danger. Instead they look to and signal the parent or caregiver for protection and regulation. This is a critical bio-neurological loop of attunement between parents and their children. So it’s easy to understand that struggling kids and teens can be helped by parents learning to reframe that instinct to protect, into one of support and strength.
In the case of anxiety disorder--as opposed to real and imminent danger--when parents accommodate a repetitive and anxious behavior, they are sending the signal that the danger is real. This increases the child’s sense of insecurity and diminishes opportunities to develop resilience and grit.
This threat response disorder highjacks the system, including the parents'. We’re wired to protect and soothe and help regulate. But since our systems are hooked to the child’s dis-regulation, ours becomes disrupted as well. And we seek to soothe ourselves instead of healing the child.
Often, even when parents try to help, they minimize a child’s struggle. Statements intended to help such as “toughen up,” “don’t worry,” or “it’s not so bad,” are sending messages that their anxious feelings aren’t real. On the other end of a spectrum is what we call over-accommodating our children’s anxieties. Every time we answer a repetitive question or accommodate a fear, such as of going to school (because of a worry that they’ll be kicked out) or daily putting tape on a door handle because they’re worried about getting sick, we are sending the message that we know they can’t handle the problem and that the danger is real, and not imagined.
There are ways to be accepting and acknowledging of the realness of their feelings and discomfort AND to simultaneously give statements of confidence and belief that they can manage their distress and in time, reduce it.
Try this one out: “I understand how worried you are. I know it really sucks (stinks, is really hard and uncomfortable). I realize that if I answer your question about school again you might feel a little better right now. But I also think that we can help you maybe a little or a lot more and for a longer time. So I hear your worries, but I think you’ll be OK and together we can learn some ways to cope with it.”
As Dr. Eli Lebowitz of Yale teaches us, this starts to give the child acceptance and confidence.
Sanford Shapiro, M.Ed is an Executive Consultant and Learning Specialist at Evoke. For additional articles and comments on Learning and Mental Health visit his site at www.LDResources.org. *At Evoke we are continuously learning, training our staff, and offering new insights as we integrate Cognitive Science and Mental Health though a Universal Design Approach (UDL).