by Theresa Shank, Ph.D.
A mother in the neighborhood pulled me aside the other day and shared a concern that her daughter has been reluctant to leave the house since the tragic event at the Columbia Mall last month. While we cannot protect our children by predicting these random and senseless acts, we can help our children by predicting who among them will struggle in the aftermath. Inevitably, anxious children suffer the most after a tragic and unpredictable event.
I am a child psychologist with expertise on recognizing and treating anxiety disorders in children, adolescents, and adults. Socially, people ask me question like – “My child is now sleeping in my bed every night – how much longer should I let that go on?” or “I can understand being afraid to go the mall, but my child is afraid to go to swim practice and gymnastics. How can we get past this?” and “My son has always been a worrier, but now he is worrying about me going to work. I am waiting for it to go back to normal, but am not sure what to do to help him.” When I spoke on this topic informally with a small group in my community, they asked that I broadly share some ideas about what ‘normal’ anxiety looks like and what ‘problem’ anxiety looks like in children.
When is Anxiety Normal?
Normal anxiety is easy to describe, it is the typical worry and fear that a typical youngster musters when dealing with typical stress. Normal anxiety fits the situation, it is brief in duration, and it has no lingering wake. For example, a child may be anxious a day or two before a big test like the SATs. Everybody experiences normal anxiety, so it is intuitive for an adult to understand when a child is anxious. Often, parents dismiss problem anxiety as normal anxiety. The difference is a matter of degree; problem anxiety is unexpected for the situation, unexpectedly severe, unexpectedly long-lasting, and associated with impairment. Impairment is disruption in the ‘inner world’ – the home, social performance, and/or school performance – caused by the problem anxiety and its aftermath. While it is normal for a child to worry about the SATs before and to some degree after the test – “What if I did poorly? I will never get into the college of my dreams,” for those who suffer with anxiety, the implications of the SAT performance may last for days, splinter into other worries, or become a preoccupation.
Is My Child Anxious?
Temperamentally anxious children are more anxious and more often anxious than other children. Do you describe or has a caregiver or teacher described your child as too sensitive and or having a tendency to over-react? Temperamentally anxious children appear true to their natures; they are too sensitive and tend to over-reactive in numerous situations during different phases of development. In fact, temperamentally anxious children often seem even more anxious for a short time during important transitions, like heading off to pre-K or moving to a new home or to a new school. Temperamentally anxious children suffer more slings and arrows than children who only experience normal anxiety.
When is Anxiety a Problem?
The worst kind of anxiety is associated with an anxiety disorder. Anxiety disorders have names that describe an anxious theme, the themes follow a trend based on age of onset, and a stressful trigger event can set off the appearance of the disorder. The anxious themes join with outsized anxiety, physical symptoms, and avoidance behavior to create disorders. Younger kids may manifest separation anxiety disorder, a fear of being alone and craving for proximity to an attachment figure). Slightly older children may manifest selective mutism, a fear of speaking in front of untrusted peers and adults. Specific phobias (or focused fears of animals, natural environments, needles, blood, etc.) appear a bit later. Next comes social anxiety disorder (a fear of embarassment), and then generalized anxiety disorder (a fear for safety). Children with anxiety disorders may have significant physical anxiety, including irritability, insomnia, headaches, aches and pains, rapid breathing, heavy sighing, racing heart rate, sweating, etc. These symptoms could even evolve into a panic attack.
What Should I Look For?
How can an appropriately worried parent tell if their anxious child has the signs and symptoms of problem anxiety? It starts with education and awareness, and the suspicion that your child may be vulnerable to a powerful anxiety trigger such as a community tragedy. Try to gauge the size of your child’s anxiety, compare it to yourself, your other children, children at school. Look for the most telling signs, for example, prominent physical anxiety and panic attacks never occur in normal anxiety. Prominent avoidance is a coping mechanism for problem anxiety, whether subtleties like turning down playdates when there is nothing better to do or isolating indoors and in their room, compared to warning signs such as school refusal (which will be addressed in a separate blog.)
How Can I Support an Anxious Child?
First, check your own anxiety level. Then trust your parental instincts to listen to your child, reassure them, and pat them on the head if that helps. Have the confidence to ask for additional support for your child if your efforts are not enough to get them back in the game. You can start with an expert psychologist or psychiatrist, or you can start with the pediatrician or school personnel. Be prepared to juggle different opinions from different professionals who may have their own way of looking at the emotional world of children. In my practice, I use cognitive behavioral therapy as a powerful weapon against anxiety, and sometimes medication is carefully brought in as backup. ‘Problem’ anxiety can be managed and mitigated; it does not have to be a life sentence.
Theresa P. Shank, Ph.D. lives in Howard County with her two children. Her expertise is in treating anxiety disorders and attention deficit disorders in children, adolescents and adults. In addition to treating those conditions, she performs testing to evaluate learning disorders and other developmental disabilities to help. She can be reached at Dr.Shank@cpeclinic.com.