HOW TO HELP YOUR OVERANXIOUS CHILD Trey Ishee, Psy.D. Southeast Psych (704) 552-0116 www.southeastpsych.com

WHAT IS ANXIETY? All of us experience anxiety at some time Normal developmental pattern that is exhibited differently as children grow older Anxiety can arise from real or imagined circumstances One common definition is apprehension or excessive fear about real or imagined circumstances Triggers can be external and/or internal I wanted to start by giving you a little background on what anxiety is and some general information on anxiety disorders in order to help you understand what your child may be feeling. You may be frustrated or annoyed at their behavior, and you may not understand why they worry about certain things. You cannot help them feel better unless you understand them. Feeling anxious is normal-all children experience anxiety. It is our natural alarm system. It can range from very low levels to such high levels that it affects our social, personal, or academic performance. Feeling anxious or fearful can be a normal reaction to a real danger. Temporary fears are necessary for a child to recognize a challenging situation and gain a sense of accomplishment and mastery. It is our fight or flight system In children, any experience involving a fear reaction or threat to security can develop into an anxiety disorder Threats: seeing violence (movies, at home), divorce, violence in home, theft of personal property, becoming sick and vomiting, serious or painful injury, illness in a parent, abuse, being bullied, natural disasters, terrorism

SIGNS OF ANXIETY Cognitive Behavioral Physical Concentration difficulties Catastrophizing events Worrying Perfectionism Memory problems Overreactions Hyper vigilant Lack of confidence Shyness Withdrawal Frequent questions Frequent need for reassurance Need for sameness Excessive talking Restlessness Habit behaviors (biting nails, twirling hair) Impulsiveness Trembling/shaking Increased heart rate Shortness of breath Dizziness Flushing of skin Stomachaches or nausea Muscle tension Sleep problems Constant thoughts and intense fears about the safety of parents and caretakers, refusing to go to school, extreme worries about sleeping away from home, being overly clingy, trouble sleeping or nightmares Constant worries about being “on time” to events or doing things perfectly. They may appear inflexible or excessively worried about conforming to rules Sleep: difficulty falling asleep, difficulty sleeping alone, waking up several times in the middle of the night, frequent nightmares, waking feeling unrested

3 TIMES THAT CHILDREN WORRY Anticipation Experiencing the Feared Event Rumination Worry Wheel or running loop

HOW IS ANXIETY MAINTAINED? Self-talk or “automatic thoughts” Avoidant behavior Inappropriate response to a fearful child Once a fear or anxiety reaction has been created, the reaction tendency can be maintained a number of ways. The most common are: What a person believes can cause an emotional reaction. Examples: I can’t handle new situations. I am going to fail. All dogs want to bite me. A child steps on a dog’s tail & he bites the child. The child is then afraid of all dogs and avoids them. The child avoids talking about their fear and facing their fear. Also with school-Children reinforce and give power to their fears when they act to avoid or escape unrealistic fears, and the anxiety grows. Also, children will start to avoid situations where there is a only a small chance they will end up feeling bad. Eventually, they end up making choices based on feared situations and not realities. School avoidance may serve different functions in different children. For some, it may be the avoidance of specific fears or phobias triggered in the school setting (i.e. fear of school bathrooms due to contamination, fear of test-taking). For others, it may serve to help them avoid or escape negative social situations (being bullied by peers or having a very critical teacher). Can also gain attention for somatic complaints or temporarily reduce separation anxiety. The child’s parents ridicule him for feeling afraid instead of rewarding the child’s effort and courage, or they overly nurture the scared child, reinforcing the worry.

HOW DO YOU HELP YOUR CHILD? Maintain a consistent (but flexible) routine for homework, chores, and activities Help children express their feelings Don’t deny your child’s worries, ask “why”, or reassure them excessively Answer questions honestly Maintain realistic, attainable goals and expectations for your child and yourself Accept mistakes as a normal part of growing up Distinguish between perfection and excellence Distinguish between “wants” and “shoulds” Be consistent in how you handle problems and administer discipline. Part of anxiety is the unknown and the “what if”, so if the child knows what to expect, he will be less likely to feel anxious. Express feelings: feelings thermometer, draw, paint, teach them the language 3) Sometimes difficult to pinpoint the initial anxiety reaction, especially since anxious children are usually more aware of their reactions and emotions than of their cause. Remember that anxiety is not willful misbehavior, but reflects an inability to control it. Being overly critical, disparaging, impatient, or cynical will only make it worse. Being critical may increase the pressure to be perfect. Do not treat emotions, questions, and statement about feeling anxious as silly or unimportant. They are real to your child. Take all discussions seriously and avoid giving too much advice; instead, be there to help and offer assistance as needed. You may find that reasoning about the problem does not work. Sometimes children can realize that their anxiety may not make sense, but are unable to do anything about it without help. Also, do not engage in lengthy conversations about the worries-that is a burden to the child and reinforces the worry. Instead, the focus should always be on helping your child be free of worries and fears. Also, answer questions honestly-do not pretend everything is alright, but remind them that there are a lot of people in the world protecting them. Answer simply, with the best available facts, and do not dwell on details. 4) Do not communicate that perfection is expected or acceptable 5) No one is expected to do everything equally well. There is nothing wrong with praising success, as long as it does not create unrealistic expectations and result in unreasonable standards. Strive to nurture and encourage your child even when you are disciplining him. Make sure he knows that although you want and expect him to do better next time, you love him no matter what. Be flexible in your parenting style. If you feel “let down” by your child’s behavior, it may be due to unrealistic expectations. Parents who think in “shoulds” may find it helpful to do more reading or talk to other parents or child-developmental specialists, As your child changes, you will gradually have to change your parenting style. What works for your child now may not work well in a year or two. Perfectionism in raising children is impossible. Give yourself permission to take time out for your own stress management. Help kids learn to break down tasks into manageable units, focus on taking one step at a time, to keep the big picture in mind, and to view “mistakes” as learning opportunities, Change the focus from having the “best” project in the class to learning from the process. Excellence: doing one’s best within the constraints of time and available resources Emphasize the concept of choice in behavior-replace “I should” with “I could choose”

HOW DO YOU HELP YOUR CHILD? Focus on the attention the child receives- praise their effort and their courage Remind your child of previous successes Be a good role model for your child (and talk out loud) Develop a reinforcement system if needed (with graded steps towards a goal) Encourage independent activities and self- reliance Compromise Schedule activities in moderation Role-Model: talk aloud on how you handle mistakes, how you handle feelings of being worried. Also, model good health habits (regular exercise, proper diet and nutrition ,and good sleep habits) Use rewards for successful interactions, bolder steps, staying by themselves, going to school, etc. Since school anxiety is usually about separating from the parent, once the child gets to school, they usually calm down and are OK. Activities: should be chosen with your child’s age, temperament, interests, and abilities in mid. If too demanding, the experience will be frustrating. If not engaging, your child may be bored. PK may not need additional activities since they get so much stimulation at home and school. For elementary age, schedule no more than 3; with more than one child, choose 1 or 2 for each child. Adolescents: don’t spread themselves too thin, maybe choose 2 or 3

HOW DO YOU HELP YOUR CHILD? Help your child visualize-”Paint the Picture” Plan for transitions Teach your child strategies to help them handle anxiety: Develop scripts of what to do or say in feared situations and teach calming self-talk (change their “automatic thoughts”) Teach your child how to relax Help them problem-solve Help them plan instead of worry (i.e. practice for a specific event to build confidence) Organize their materials and time to reduce stress Provide alternate activities to distract your child from worries Allow “worry time”, have a “worry doll” or a “worry box” Use “coping cards” Transitions: visit the school ahead of time, have playdates with new classmates, role-play different scenarios with puppets or dolls at home, talk with your child about routines, etc. For school anxiety, find ways to attend school even for a short period of time, establish check-in’s when the child arrives in school, allow extra time for moving to another activity or location Flexibility and a supportive environment are essential for children with anxiety to be successful, especially at school. Identify patterns of difficulty and develop remedies to reduce a child’s challenges at these times. Scripts: can be for harmless worries or tragic worries. Harmless (so what if my Mom is late to pick me up, it’s not the end of the world) and Tragic “the chances of it happening are extremely low, so I don’t have to worry about it” Relax: deep breathing, count to 10, visualize a soothing place. It helps them develop mastery over symptoms and improve a sense of control over their own body. Do yoga or listen to music Encourage your child to help develop ideas and interventions

HELP AT SCHOOL Prepare for transitions (substitutes, fire drills, field trips) Class participation Assignment modifications Extended time for tests “Cool down” pass or safe place Preferential seating Participation: talk to the teacher to let them know comfort level with questions, signal before you call on them, modify requests to write on the board or speak in front of the class, have them share only when they are confident that they will be successful Modifications: word banks to help with “memory freezes”, set a reasonable amount of time for HW so the OCD child isn’t spending too much on it, Also, plan for unstructured times: recess, lunch, etc. Have “lunch bunches” or draw straws so the socially shy child isn’t left out Seating: away from disruptive kids

HELPFUL RESOURCES What To Do When You Worry Too Much (A Kid’s Guide to Overcoming Anxiety) (Huebner, D. 2006) The Worried Child: Recognizing Anxiety in Children and Helping Them Heal (Foxman, P. 2004) Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Children (Dacey, J.S. & Fiore, B. 2001) Keys to Parenting Your Anxious Child (Manassis, K. 1996) Freeing Your Child From Anxiety: Powerful, Practical Solutions to Overcome Your Child's Fears, Worries, and Phobias (Chansky, T. 2004) Wemberly Worried (Henkes 2000) When My Worries Get Too Big! A Relaxation Book for Children Who Live with Anxiety (Buron, K. 2006) www.aada.org (Anxiety Disorders Associate of America) www.childanxiety.net (The Child Anxiety Network) www.childhoodanxietynetwork.org www.schoolbehavior.com www.nasponline.org www.worrywisekids.org