Sunday, April 29, 2012

Childhood Anxiety

I attended a talk last week about managing anxiety in children, presented by Michael Sweeney, Ph.D, who is director of the Metropolitan Center for Cognitive Behavior Therapy. While my kids are pretty happy-go-lucky, they both have experienced periods of stress that made me want to see how I might help them manage things when, for example, they are hit by an especially heavy homework load.

Dr. Sweeney started off by explaining that anxiety is an genetic trait. But just as people who inherit a predisposition for heart disease can manage their health via lifestyle choices, those born anxious can learn to control their emotions and actions.

Some level of anxiety in our lives can be a good thing. Fear of being late motivates us to get moving, fear of being destitute makes us show up to work every day, and so forth. But sometimes anxiety can become debilitating. Some people worry so much that they literally cannot get out of bed and function normally.

In turns out that anxiety has its roots in selective attention. Folks who become, say, anxious about attending parties, seem only to notice the negative cues (the person looking over their shoulder to see who else is there) rather than the positive ones (the friendly soul who laughs at their jokes). So if they attend a party, they dread going ("I won't know anyone so it won't be fun"), which alters their perception of what the gathering is really like once they are there ("no one is talking to me"), and then affects their behavior both during and after the party (they stand like wallflowers at the party instead of enjoying the chatter and the food, and then believe it to be a miserable party).

Anxiety can be caused by a fear of independence, social fears, or fears related to performance. The root of the anxiety is related to how it can be resolved. For example, very young children who are still mastering basic independence skills show their anxiety by hanging on to their mother's skirt. The proximity of their mother helps relieve the anxiety. For some children, a transitional object or lovey, can help ease their anxiety, too.

Distraction is another tool for relieving anxiety. Babies can be distracted by jangling keys; toddlers by a treat; and older folks by focusing intently on something else (e.g. playing racquetball in the elevator, reading or watching a movie while on an airplane).

Cheer leading ("you can do it!")--either by a parent to a child or the child him/herself can also work.

The most sophisticated way to control anxiety is via mood management. We all know that if you smile and tell yourself that you are happy, you can actually make yourself happier. This is true for relieving anxiety also, realizing that the goal isn't eliminating anxiety (that is almost impossible), but rather to reduce it to a level that makes desired behaviors possible (e.g. flying).

Kids can ask themselves "how much does it matter?" For example, SAT scores aren't the only criteria used in college applications. Further, attending a prestigious college does not guarantee the perfect life: plenty of people who attended Ivy League schools are neither successful nor happy; and plenty of people who didn't are.

Kids can practice mindfulness, thinking especially about delaying judgement. They can recognize that emotions are temporary--they've likely experienced them before--and so they don't need to hold on to fear, or disappointment, or anger.

Kids can control their mood and prevent anxiety with good planning and preparation. For example, a child who is nervous about a sleepover can be reminded about the five best things at Johnny's house.  If independence is the issue, talk about the set-up. If it is social anxiety, review what he knows about each child attending the sleepover so he'll know what to say to them.

Doing is the cure. Afraid of public speaking? Give speeches. This isn't to say it is easy. Managing your mood is a lifelong process, like maintaining your health or your appearance. Remember the goal is just to lessen the anxiety, rather than to eliminate it. 

The doctor gave the example of a child who was afraid of elevators (a debilitating fear if you live in New York City, as this boy did). The doctor rode the elevator with the child for hours, playing various games (including racquetball, as mentioned above), until fear was no longer the central emotion associated with being in an elevator.

Parents should acknowledge their child's anxiety. You don't want to deny your child's reality. But remind the child that he's already taken 10 history tests and received all As, so chances are that he'll get a A on tomorrow's test, too.

School can be hard. Adults can follow their passions and avoid subjects they don't like (hire an accountant if you don't like math; hire an interpreter if you can't learn Spanish), but kids are expected to achieve some level of proficiency across all subjects. The good news is that young minds can learn and adapt quickly, so children who are given tools to deal with their anxiety can make the adjustments they need now and will be equipped to deal with this common feeling for the rest of their lives.

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