"I can't go to school. One of the kids was sick yesterday and I might throw up."
"You're going out to dinner? Where are you going? When will you be home? Who is babysitting? I don't think I can do it. You can't go!"
"I can't go to the sleepover."
"I can't leave for school yet. My hair doesn't look perfect."
"I can't play soccer!"
Do you hear the common word in each of these sentences? Can't. Whether it's about school, sports, academics, or social life, anxiety is often debilitating for kids. It moves past the normal childhood and adolescent fears and becomes crippling, to the point where they are unable (please read that carefully—unable, not unwilling) to participate in any given activity that other kids enjoy.
Anxiety is the most predominant mental-health problem among children and adolescents today. It is also the most treatable. As a counselor with 20 years of experience working with children and teens, I undoubtedly agree. In the last three years, I have seen a dramatic increase in the number of children of all ages who walk through my doors struggling with anxiety.
So what does anxiety look like? It looks different in every child. It may look like a toddler-age girl who rages at home, simply because she is overwhelmed and fearful and isn't yet able to express her emotions. It may look like a school-age boy who worries constantly when you're away. It could look like a fourth-grade girl who cries every morning before school. Teenagers may wash their hands constantly, obsess over college and all grades leading up to that decision, feel that nothing they do measures up. Anxiety, from an emotional standpoint, can look like withdrawal, sadness, depression, obsessive fears, or even anger in a child or teenager.
So how is an anxiety problem different from typical childhood fears? All children worry and are fearful from time to time. Certain fears are typical for different ages. For example, young children's vivid imaginations make them fearful of monsters and scary things that go bump in the night. That same imagination can make them fearful of dress-up characters, the dark, and even what could happen when they're separated from you. For school-age children, fears become much more reality-based. They become afraid of fires, burglaries, illnesses, and even school-related and social fears. Because teens are as focused as they are on their social lives, much of their fear stems from these issues: they're worried about succeeding and failing and how they see themselves fitting in with the world around them. All these fears are normal for children and teens, and with help from you in talking through them, they will pass out of these stages and into normal adulthood without the fears shifting into problem anxiety.
Anxiety, as we stated before, is debilitating. One of the primary differences between fear and anxiety is that fear accompanies a triggering event, while anxiety is a more generalized state. Anxious children often live in a constant, low-level state of worry. They can't seem to shake it. And it often bleeds over into every aspect of their lives. As a parent, you will often be the first to notice that something looks and feels wrong.
Here are a few signs to watch for, which could indicate that your child or teen might be struggling with anxiety:
- The worry doesn't go away after the situation resolves itself.
- The worry affects other areas of their lives, such as grades, concentration, and enjoyment of typically pleasurable activities.
- Events that would normally cause a little worry are devastating.
- Reassurance doesn't help calm them down.
- They live in a constant state of tension.
- They ask constant "What if …" questions.
- They have frequent headaches or stomachaches when participating in certain activities.
- They engage in overly pleasing behavior.
- They are highly perfectionistic and overly critical of themselves.
- They'll participate only in activities in which they can succeed or win.
- They have trouble sleeping or frequent nightmares.
- They experience significant distress over normal activities such as fixing hair and getting ready for school.
- They are unable to leave home for "fun" events such as parties or going to a friend's house.
- They fixate on a certain idea, such as cheating or winning.
So what can you do as a parent if you've identified that your child is showing signs of anxiety? How can you provide support and not give in to the fear? How do you encourage your child to work through it? When do you seek professional help?
Anxiety experts break down the roots of anxiety into three different categories: environmental, learning/modeling, and genetic. The way you respond as a parent has a great deal to do with the roots of your particular child's anxiety.
Although anxiety often doesn't have a specific trigger, it can have an environmental base. For example, this past August, I saw five school-age girls who were struggling with fairly considerable levels of anxiety. It was related to the classroom setting, athletics, relationships, and as one girl so aptly called it, "playground politics." By November, all these girls were already doing much better and seeing me less frequently. What would you guess was the environmental root of their anxiety? Going back to school. All their worry ramped up in August and then, as they were given time to adjust to their new classrooms, teachers, and social lives at school, they started doing better. Other environmental factors include family stressors such as divorce or loss, moving, illness that causes them to miss school for a significant period of time, or any other significant event that causes stress in either their lives or the lives of families at large.
Anxiety can also be involved with learning and modeling. This is, quite honestly and very respectfully, what they are learning and seeing you model. Often, children who come into my office with high levels of anxiety have highly anxious parents. Your children could be repeating some of your behavior. Also, it is often the case that you, in your own anxiety, have a tendency to hover. Children of all ages need to take age-appropriate risks. As you allow them to wander away from you, in their toddler and teenage ways, they experience your belief in their capabilities.
In terms of the genetic component, do you have a family history of anxiety? Have you or your spouse struggled with anxiety at some point in your lives? If your child is adopted, how much do you know about your child's birth parents? If your child is set up from a genetic standpoint to struggle with anxiety, it could be a chemical issue. As a counselor, my suggestion would be to try therapy first. Give a trained, well-respected therapist several months to see if he or she can help your child process the anxiety and learn coping skills to combat it. But with a family history of anxiety problems, your child or teenager may need medicine to help alleviate it. Choose your child's counselor well, based on reputation, knowledge, and their own faith, and then trust that they will guide you in the right time and direction to best help your child.
As a parent, there are things you can try first at home. One suggestion would be to read the book Freeing Your Child from Anxiety by Tamar Chansky. It will help you understand the nature of your child's feelings and give you practical tools to help your child work through them.
In the meantime, here are a few more suggestions:
• Be aware, but don't change your expectations. Your child may need more time than your other children to get ready for school or to move toward spending the night away. Role-play fearful situations. Take fearful events a step at a time and celebrate even the small victories.
• Find something your child feels some degree of success in and provide plenty of opportunities to experience that confidence. Try different activities he or she might enjoy: sports, arts, academics, volunteering. Find something your child feels some degree of success in, that can give confidence through the more anxious times.
• Allow your child to learn things independently. Don't always do the work for him or her. Your child can learn, although it may take a little longer. If you always rush in to rescue, your son or daughter won't believe in his or her own capabilities.
• Help your child learn to talk about it. He or she needs to verbalize fears and the emotions accompanying them. In my office, I often have kids of all ages come up with a 1-10 fear scale. They identify what a 1 would be, all the way up to a 10. This provides them with a continuum to place their fear on, and can help give the specific fear perspective. Make sure your child knows it's okay to be afraid and you won't be angry over those feelings.
• If the anxiety causes misbehavior, your child still needs consequences. Give an opportunity to talk about feelings after a time out.
• Adolescents sometimes need a little nudge to talk. Take your teenager out, away from home to a quiet environment. Coffee shops and restaurants can be great conversation locations. Tell your young person you've noticed something different lately, then let him or her talk. Anxiety often causes kids to have what we call "looping" or repetitive thoughts in an area that they believe is the "worst" thing to think about. That's why they get stuck on that particular thought. So your teenager may be struggling with sexual or even violent thoughts. Provide assurance that you won't be angry and will love him or her through wrestling over any issue.
• Together, brainstorm things your child can do to help ease worrying. I help kids come up with lists of activities that calm them, such as taking a walk, playing with the dog, reading a book…whatever helps ease their anxiousness. Your child can post a similar list in the bedroom or bathroom as a reminder.
• If your child seems to be struggling with how to talk about anxiety or even understand what is going on, or if these techniques don't seem to help, it may be important for him or her to talk to someone outside your home. Because you are the parent, it might be that their love for you bleeds over into a fear of hurting or disappointing you that makes it hard for them to talk. A counselor can often be a sounding place for children and teens to help them discover and find ways to overcome their anxious thoughts and feelings.
As a parent, you will worry about your child. It starts with the first positive pregnancy test and will be part of your parenting journey forever. It does not, however, have to cripple you. And their anxiety does not have to debilitate them. They can work through whatever struggle they're facing. Anxiety is treatable. And more than that, we serve a God who "has not gives us a spirit of fear and timidity, but of power, love, and self-discipline" (2 Timothy 1:7). You can offer that power and love and self-discipline to them, through Christ, and they can live in the freedom of trusting in God's love and redemption.
Sissy Goff, MEd, LPC-MHSP, is the counseling director for children and adolescents at Daystar Counseling Ministries. The author of seven books and a video curriculum, she is a frequent radio guest and contributor to magazines. Her latest book is Intentional Parenting: Autopilot is for Planes (Thomas Nelson). Sissy has a master's degree from Vanderbilt University and is a sought-after speaker for parenting and teacher training events. She has been at Daystar since 1993. For more information, see www.raisingboysandgirls.com.