I spoke to an expert on how to deal with a child struggling with anxiety.
I first started seeing signs of anxiety in my daughter about a year and a half ago. In many ways, her behavior seemed typical of a 10-year-old on the cusp of puberty, yet there was something that didn't sit right with me.


As someone who has lived with anxiety for years, I recognized the similarity of her symptoms to mine and wanted to address them right away. On the other hand, I wondered if I was projecting my own energy onto her. I sought out professional, objective opinions and assessments. When she was given a diagnosis of anxiety, it was the beginning of concerted learning for both of us. I wanted her to feel supported but also self-sufficient in coping.

As part of my own crusade to break down the stigma associated with mental illness, we talk openly about her struggles with anxiety and her various therapies, to each other and others. In these dialogues, I have been surprised to hear many other parents tell me that their child, too, has an anxiety disorder.

Deborah Epstein is a registered psychotherapist and school counselor who has worked with children and teens for 20 years. I asked her for her thoughts and expertise on anxiety in children and what we, as parents, can do to support them.

Q. What does anxiety look like in a child, tween, and teenager?

A. In younger children, anxiety can look like disregulated behavior, or a tantrum. They can go from 0 to 100 in seconds, both in terms of emotions and acting out. At any age, oppositional behavior or avoidance with parents and teachers ("he refuses to…") can also be a sign of anxiety. Kids might ask a lot of questions that begin with "what if". ("What if they don't have the cup I use? What if I can't find my ..." )

At school, anxiety can look like Attention Deficit Hyperactivity Disorder (ADHD). They might not be doing their work, they can't focus, maybe they're late to class.

Kids might have difficulty separating from their parents for things like play dates or birthday parties. They might try to avoid school and things they used to enjoy, like extra curricular activities or do them on the condition that their parent stays with them. Physical signs of anxiety can include things like headaches, stomachaches, trouble sleeping, and crying.

Teens who have anxiety will often avoid the situations that make them anxious, whether it's school, or social situations like parties. This helps in the moment because they don't have to deal with it (which decreases the level anxiety in the moment) but, it makes it that much more difficult the next time they are faced with the situation.

You might also notice behavior that isn't really age appropriate, like a 14-year-old who is afraid of the dark or is clingy with their mother.

Q. How can you tell the difference between a normal developmental stage (that might include tantrums, etc.) and anxiety?

A. If you start to notice that your child isn't just showing one of these symptoms but there are a number of them stacking up - oppositional behavior, physical signs, avoiding things - then you should consider that it might be anxiety and address it. In itself, anxiety is a good thing. Biologically speaking, we come with it built in. It is our body's way of telling us when something isn't right or that there is "danger".

However, when it starts to impact and interfere with daily living, that's when it is a problem that needs to be addressed.

Q. What are the most common stressors and triggers in the lives of children, tweens, and teens?

A. Some typical stressors include school, social life, and changes in their home life. Sometimes it's a psychological trauma, maybe something significant and negative has happened to them recently.

Things change when they enter the tween and teen years. Social media adds a big element of stress. They're now thinking about what they look like, what and how often to post. Fitting in often becomes paramount. It's almost tunnel vision for them in the way it affects the choices they make.

If their social status is threatened in any way - a friend develops a new friendship, a new kid in class - it can be a stressor. They might be also facing too many extra-curricular activities or a job - a busier schedule - and a heavy school workload.

Related: Extra-Curricular Activities for Kids: Yea or Nay?

Many kids haven't been taught or given the opportunity to develop coping skills because they have rarely been allowed to fail or experience feelings of discomfort. Therefore, they don't have the tools they need to deal with their feelings of anxiousness.

Q. What is a parent's role in helping their child who has anxiety?

A. Parents and guardians play a critical role. It is vitally important for parents to participate in their children's learning how to cope with their anxiety. For young kids, I often work with parents on their own and teach them some strategies to share with their child. This way the young child is well supported by his parents when he is experiencing anxiety.

A parent's role and influence in their child's life is enormous. Their perspective on their child's anxiety is also invaluable. There might be genetic factors at play (family history), or biological function, personality and temperament. A parent might say their child was 'like this from day one,' or that their child was always very relaxed and happy until recently.

Parents can also shed light on a child's environment and life experiences, and there is a lot to be learned about a child's learned behavior from how their parents treat them and the messages they are giving them.

Are parents allowing their child freedom to fail and learn coping skills, or are they themselves anxious and 'protecting' their child from discomfort and negative feelings? Are they letting their child learn natural consequences, like forgetting their textbook at home, or are they 'saving' them and driving it to school? If parents can learn to manage their own discomfort around their child's anxiety, it goes a long way.

Related: Why You Should Let Your Child Fail

Q. What tips can you offer parents of children with anxiety?

A. First, it's important to know that there is no 'cure' for anxiety. We need to learn how to manage it. It's not something we can erase, which is what parents are trying to do when they don't let a child fail, or try to solve problems for them. There is no quick fix. Instead, a parent's goal should be help their child develop solid coping skills so they are able to handle life's stresses on their own. Instead of trying to rescue them, a parent should be their guide as they learn how to rescue themselves. Here are a few tips for parents:
  • Listen: When your child tells you they are upset, look at them and really listen to what they have to say.
  • Validate: You can validate their feelings without necessarily agreeing with them. You don't need to agree with them. You can say 'I totally hear you. I understand how angry that must have made you, even if you don't agree with, for example, their behavior when they were angry.
  • Discuss: Wait until feelings of anxiety and stress are no longer peaking. Discuss things with them when they're calm.
  • Don't try to fix things for them. Encourage them to work through different approaches and come up with a solution themselves.
  • Give them tools: Encourage things like mindfulness, deep breathing, and how to manage less pleasant emotions. Ask them: 'what does that look like for you? What is a good way for you to work through your negative feelings?' Maybe it's reading, music, a karate class. Talk with them about their feelings and give them the words to identify the different things they feel. Give them a toolbox of emotion language. Let them see your feelings, too. If you never cry in front of your kids, you're teaching them it's not okay to cry, and they won't share those feelings with you.
See below for some useful resources.

The Expert

deborah-epstein


Deborah Epstein is a Registered Psychotherapist and school counselor. She has been working with children and adolescents in the Canadian school system for more than 20 years.

Deborah's clinical work focuses on issues such as anxiety, depression, parent/child conflict, family conflict, bullying issues, and assisting children through parental separation and family breakdown. She also works with children who have difficulty with self-regulation or anger management and those having difficulty with social integration.

She is passionate about helping kids learn how to build resiliency, as well as solid coping and communication skills so that they are well-equipped to handle life's challenges. She works with children to develop social skills and effective problem solving in order to enhance self-esteem and confidence.

Resources:

AnxietyBC: Website with a wealth of information and resources. The self-help section has useful tools for children, youth, and parents.

Drop the Worry Ball by Alex Russell: a parenting book for raising independent children

Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children

(by Lynn Lyons) *has an accompanying book for tweens, young teens called 'Playing with Anxiety: Casey's Guide for Teens and Kids'

Children's books

Moody Cow Meditates (by Kerry Lee Maclean)

Angry Octopus: An Anger Management Story introducing active progressive muscular relaxation and deep breathing (by Lori Lite)

Peaceful Piggy Mediation (by Kerry Lee Maclean)

Sitting Still Like a Frog: Mindfulness Exercises for Kids (and Their Parents) (by Eline Snel)

Mindful Monkey, Happy Panda (by Lauren Alderfer)