Impact of anxiety disorders in children every eighth child, making it a condition that many families face. But despite how common they are, anxiety disorders in children are little discussed, leaving many parents feeling unprepared and even helpless when it comes to raising an anxious child.
“Children with anxiety disorders can often be obsessive, have difficulty doing things on their own, and may have angry outbursts,” says Tianna Snyder, psychologist, child psychologist at National Children’s Hospital. “It can affect the whole family.” Parents face the difficult task of setting limits for their child while acknowledging their emotions, Snyder said.
But psychologists say they regularly help children with anxiety disorders, and part of that treatment is teaching families how to respond to symptoms of the condition. While none of them are saying that raising a child with an anxiety disorder is easy, they have discovered tools that can make life with an anxious child a little smoother. Here’s what they recommend all parents of children with anxiety disorders remember.
Anxiety may look like behavioral problems
Tantrums are common in all children of a certain age, but they can also occur in children with anxiety disorders. “Anxiety can manifest itself as yelling or swearing at something,” says Thea Gallagher, Ph.D., clinical assistant professor at NYU Langone Health and co-facilitator of the program. Mind in sight podcast. “Sometimes it can be difficult to know whether a child’s behavior is normal or whether it is caused by something larger or deeper.”
These tantrums “can be very difficult for a child with anxiety to control, but it is still important to set limits and have boundaries,” Snyder says. This means you don’t want to attribute the tantrum to your child’s anxiety and assume there’s nothing you can do about it. Once your child has calmed down, Snyder recommends reminding him that you have rules and expectations and that there are consequences for not following them. “You actually still need to provide discipline and consequences,” she says.
It is important to acknowledge your child’s feelings
Validating your child’s emotions is an important step when he’s upset, says Isabela Milaniak, Ph.D.licensed psychologist at the Anxious Behavior Clinic of the Department of Child and Adolescent Psychiatry and Behavioral Sciences in Children’s Hospital of Philadelphia. She recommends practicing what she calls “developmental empathy,” where you don’t ignore concerns that may seem serious for your child’s age. “A child’s worries may seem silly to an adult, but they are proportional to their world,” she says. “Avoid comments like, ‘It’s no big deal’ or ‘You don’t have to worry about it.’ Instead, Milaniak says, it’s important to let your child know that you understand that they’re upset.
She recommends saying something like, “I know the morning before school is hard for you. I see that you are scared and prefer to stay at home. I understand: sometimes I want to stay home and not go to work because I’m nervous too.”
Gallagher emphasizes that “feelings are always real,” even if you don’t understand why your child is experiencing them at a particular moment. “We can always acknowledge how terrible anxiety can be,” she says. Gallagher recommends talking to your child about how to “suppress anxiety,” emphasizing that they can control their emotions and not let anxiety take control.
Staying calm is essential
Ammon says it’s important to try to stay cool with your child. “Sometimes it can be difficult to stay calm when your child is upset, screaming or crying,” she admits. Gallagher agrees, but stresses the importance of staying calm. “If you can, stay as calm as possible,” she says.
Gallagher notes that mood can be contagious. “If you’re in a crisis situation and someone else starts to worry, your fight-or-flight response will be directed toward that, too,” she says. If you find it difficult to stay calm when your child is elevated, she recommends talking to their therapist to learn about tools you can use or consider therapy for yourself. “The best thing you can do with your child when he’s nervous is to be as calm as possible, go over his options and talk about the choices he can make,” she says.
Sometimes you have to let them ride the wave of anxiety.
Stopping anxiety can be difficult, especially when a child is really agitated, Snyder says. “If your child is at the peak of anxiety—10 out of 10—sometimes we need to ride that wave,” she says. “You probably won’t be able to make effective change if it’s already at such a high level.”
“This could mean simply being close to your child, holding them, or giving them time alone until they calm down,” Gallagher says. “If a child is having a tantrum or a panic attack, we want to get them to a safe place where they can express those feelings,” Snyder says. This is a good time to help them practice skills learned in therapy, such as taking five deep breaths together, counting down by threes, or any other techniques shared by their therapist. “It can distract them for a moment, relax their body and calm their mind,” Snyder says.
Don’t completely avoid things that make your child anxious.
If something is bothering your child, it’s understandable to want to do everything you can to help them avoid it. But experts say it may even make things worse. “The primary mechanism that increases anxiety symptoms over time is avoidance, where the child avoids experiencing anxiety, embarrassment, uncertainty, distress, or other negative feelings,” says Milaniak. “By the time an anxiety disorder develops, the child has repeated patterns of avoidant behavior, such as not raising his or her hand in class, not going to school, and not talking.”
But constantly avoiding a situation can make anxiety worse, says Hillary AmmonPsyD, clinical psychologist in Center for Women’s Anxiety and Emotional Health. “You may have an instinct to protect them and allow them to avoid anything that makes them feel afraid or anxious,” she says. “Unfortunately, this decision to help them escape sometimes exacerbates these fears for the child.”
Instead, Milaniak recommends that parents “compassionately teach courage skills” in anxious children. This means confirming expectations by saying something like, “I know this is hard for you, and going to school is one of your responsibilities, just as going to work is mine. What can we do to make it easier to go to school today?” Milaniak says it’s important to remain firm even if your child experiences a flare-up. “Stay calm and repeat a strong mantra to show that your child’s emotions don’t frighten you,” she says. This may include saying something like, “You are having a strong reaction because you are scared. I’m not afraid of your big feelings. We will get through this together. Emotions don’t last forever and this will end soon.”
If your child is throwing things, hitting others, or running out of the car, it’s important to have consequences for their behavior, Milaniak says. “Emotions are always valid, but we must be responsible for what we do with them,” she emphasizes.
Emphasize the good
There’s a lot to improve when you have an anxious child, but doctors say it’s important to praise your child when she’s doing well. “Highlight it when things are going well, rather than just focusing on what went wrong,” Gallagher says.
Snyder agrees. “You still want to act like a normal parent and let them know you’re proud of them,” she says. Open-ended questions can also be helpful, such as asking your child to share the best and worst parts of their day while you’re having dinner together or riding in the car. “It opens the door to communication and feelings if something goes wrong,” she says.
Overall, Snyder recommends reminding yourself that you’re doing your best. “Often parents of children with anxiety feel really stressed, frustrated and don’t know what to do next,” she says. “But it’s important to remind yourself that you are a good parent and caregiver, even if things don’t seem to be going well at the moment.”
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