How to Help Kids Manage Their Anxiety

When people are anxious or afraid, they act in ways that are unpredictable. Kids, more than anyone, tend to act out their fears. Here's one way of looking at it: you can tell what's going on in a movie by how the actors play their roles. Kids act out feelings in the same way- but they act them out through behavior, because they can't hold their emotions in. Some kids act out with hostility or aggression, because they can't handle the often severe agitation that anxiety triggers. Some kids become more depressed and others exhibit more attention-getting behavior. Parents often learn to read their child's behavior, looking for clues of what the problem might be so they can give them a solution.

Let me be clear: children will have to be taught the skills to identify, articulate and manage personal and social situations which make them anxious or afraid. If your child demonstrates behaviors that you think are triggered by anxiety, you must try to teach him the skills he needs to manage it in a healthy way instead of acting it out behaviorally, hiding out, or submerging emotionally.

So how do you help your child overcome anxiety? There are seven key things I believe parents should try to do to help their children:

7 Ways to Help Your Child Manage Their Anxiety

• Role play with younger kids: Look at pictures or magazines together and make up stories. Try asking questions like, "Look at this child. She's smiling. What do you think she's smiling about? Do you think she's going to have an ice cream cone? Or do you think she knows her mommy's proud of her? If you could ask her a question, what would you say to her?" Then switch to another photo and say, "Now look at this child. He's frowning. Do you think maybe he's afraid of something? Or maybe he didn't do his homework. What would you tell him to help her solve the problem of not doing it?" And then reason it through with them. Kids are not abstract thinkers, so you have to make things real concrete for them. One of the ways to make it real is by using pictures. You can teach kids how to talk to themselves in a positive way through this method as well. For instance, you can show your son or daughter a picture of another child who looks very confused or frightened, and say, "What do you think that child is saying to herself?" Often, your child won't be able to respond to this type of question because it's too abstract; kids are more black and white. So if they can't think of anything, you can say something like, "To me, he looks afraid because he doesn't know what's going on." Or, "I think she's sad because they forgot her birthday." Ask your child which of those two emotions the girl might be feeling. If your child says, "I don't know," say, "Take a guess. I think she's either feeling happy or frightened. Which one do you think she might be feeling? You're a great guesser. Take a guess." And after they try, you can say, "That's great. If I was her, and I was feeling sad or afraid, I would say things to myself like, 'I can handle this, I just have to take it easy and I'll figure it out. I'll talk to mom or dad about it.'" Understand that rehearsal and repetition are the major contributors to the effectiveness of this strategy. Kids need to rehearse things all the time. Often when you see kids talking to themselves (or with younger kids, to an imaginary friend), they're rehearsing or rehashing a previous experience. Repetition and rehearsal are really helpful tools for kids who are learning to become independent. And remember, independence is the best remedy for not acting out anxiety and fear. People who think and act independently also feel like they can make good choices about whether or not to take flight, sit tight, or get ready for a fight.
• Train children and adolescents in positive self-talk: Parents have to learn how to teach their kids how to talk to themselves positively. Parents often put a lot of effort into teaching kids how to talk to other people, while putting very little thought into teaching their children how to talk to themselves. It just never occurs to them to do so. But just as kids have to learn how to speak to others, they learn to talk to themselves in either a positive or a negative way. Often kids will overhear adults saying something out of context, like, "They said he's doing poorly in math," and what the child says to himself is, "I'm doing poorly, they're angry at me, there's something wrong with me." When a kid is involved in negative self-talk, these sentences are repeated over and over in their heads. On the other hand, when kids develop the skill of positive self-talk-sometimes independently, sometimes taught by their parents through role play and pictures-they learn to talk to themselves more positively. They are able to say, "It's OK. It'll be all right, I can handle it." They can say this because they've learned how to say "It's OK and I'm OK" when they're feeling insecure or uncertain about themselves. "I can handle it," is probably one of the most powerful thoughts a human being can have, but few people realize it. And "I can handle it" is the key to positive thinking and positive self-talk.
• Teach kids how to come up with phrases to articulate their anxiety. As they mature, train kids what to say to identify and articulate what makes them nervous. Ask them, "Do you ever get jumpy or afraid?" Use real or made-up social situations to share some of your thoughts and feelings. Say, "You know, I think our neighbor Mr. Smith doesn't like me because he thinks I'm stupid. But I'm really smart, and I know it. So when I see him, I say to myself, 'I'm really smart. Maybe Mr. Smith can't see it, but I'm really smart.'" And then say, 'If I have to, I say, 'I'm really smart' over and over again until the 'stupid' feeling goes away. And then you ask your child, "Does anyone think badly of you?" Your child may say "No, that's never happened." You might continue, "If anything ever happens like that to you, what could you say to yourself? You could say, "I'm a good kid, I'm OK." And repeat it over and over to yourself.'" You can also ask them, "Are there people you think don't like you or don't want to be your friend?" When you talk to kids about these situations, don't use logic to probe their answer or analyze the situation. Be much more concrete. Logic will often confuse kids and make them feel like they're stupid. Instead, during casual conversations, comment about other adults that don't like you. It's OK to say, "Mrs. Smith doesn't like me because she thinks we have a better house. And when I see her, I just tell myself, 'I can't change what she thinks.'" Then I say, "Hi, Mrs. Smith, how are you doing?" I can't change what she thinks, and I usually say that to myself as I'm walking away." This is one way of helping your child see what pushes their anxiety buttons, and also teaches them a way of releasing it by saying, "I can't change the way someone else thinks."
• Process it with them. Start asking "What" "When" "Where" "Are" and "Is" questions. "Is there anything wrong with the school bus? What is it?" Don't ask them, "Why don't you want to ride on the school bus?" Say, "Are there other kids bothering you? Are you sure? Is there something they're saying or doing? Because if there is, we can help make that better. Kids don't have the right to bother other kids." You can also say, "If you don't have to ride the bus, what's going to be different, what's going to help you?" Work through it with your child. Reassurance is key. Remember to say, "If there's something going on, let me know, we can face anything together." The next time that you see they're upset, try saying, "Are you OK? How can I help? Can I help you with this problem?" Don't ask them why. Often when kids are asked why, they automatically sense they've done something wrong. Remember, they're rarely asked why when they've done something good. Kids are not asked, "Why did you clean your room?" In most cases, kids don't know how they feel, and I'm not sure it would help them if they did. In my experience, knowledge of how someone feels rarely changes behavior.
• Get as Much Information as Possible. Talk to your child's teachers about what they see regarding your child's level of anxiety. Ask questions like, "Have you noticed if my son has any problems with other kids? Does he appear to be nervous? He seems very worried about grades and if the other kids like him. Do you see any of that getting in his way at school? What do you see?" All kids have anxious thoughts, but some kids learn to manage them better than others at an earlier age. Get some objective feedback. Watch your child play with other kids. How does he or she handle things? Look for his or her ability to interact freely and deal with other kids with various behaviors. Is your child able to resolve problems with other kids successfully, and is he or she able to act independently as well as within the group?
• Reward kids when they learn to do things that are hard for them. Remember, self esteem comes from doing things that are hard for you. Self-respect comes from doing things that you can respect. Reward your child and be sure to label what they did right in order to earn that reward. Don't assume kids can associate the reward with the task, even if the task occurred a couple minutes ago. Also, it's important not to always reward with things. Time spent with you reading a book or playing games or going to the playground can be tremendously rewarding.
• Honor Your Child's Choices When They're Not Ready or Capable. Maintain a realistic view of your child to continually determine whether what is being asked of him or her is in their developmental range and possible for them to do at all. Often, if kids don't want to get involved in something, such as team sports, the parents should talk about it with them and process it with them, but ultimately respect their child's decision. Parents must learn to come up with compromises or give their child a choice of at least two things. A compromise is saying, "Well, let's try it for a month." Or "let's try it three times, and then you can decide." Or you can say, "You can do A, or you can do B, but you must do one of them." Kids should not be forced to do the things that they don't have the internal skills to manage. Think of it this way: It's not good parenting to throw kids into the water before they can swim, even though many people swear by that. He may very well swim to the side and save himself. But remember this, he hasn't learned to swim by that, he's learned not to trust you and that you can't hear him. Parents do it because they're impatient, annoyed, or embarrassed by their kids. In the same way, don't force them to do things they're not ready to do.

Will My Child Ever Be Able to Manage his Anxiety Effectively?

In my experience, all children can learn to manage anxiety, if their parents possess or can learn to develop the skills necessary to teach them. Remember, it's very difficult for children to mature emotionally in areas where their parents are still immature. There are several ways that kids can learn how to deal with it independently. The first is that they grow up and become more mature, and frankly, immune to many of the things that used to hurt them. When rubbed enough, what once was a blister becomes a callous.

That being said, when kids experience moderate to severe anxiety, it does take training to help them learn how to manage it. Some kids only need these tools during a transition period, such as when they move to a new school or are in the midst of grieving a lost relative. Many of them will be able to learn ways of coping with it and move on with their lives. But in some kids, anxiety can become very powerful and sometimes blossom into something incomprehensible and crippling. Remember, many adults who are identified as having anxiety or panic disorders began the thinking and behavior that led to that early in childhood.

We are lucky that in this day and age there are many tools parents can learn how to use and give to their kids that can help their anxiety; these tools need to be applied thoroughly and consistently. That's why it's very important to begin getting help very early with your child if their anxiety appears to be getting more severe. It will enable them to learn to apply the tools and techniques they'll need to manage this level of anxiety into their adolescence and adult life, if necessary.

Remember, anxiety becomes a problem when it causes problems. Many, many kids say they don't want to go to school or ride the school bus, and it doesn't trigger inappropriate behavior. And they may tell you what's going on, or they may not. Either is normal and natural. Certainly, all kids will feel anxious, and this feeling may be something so intense that it interferes with your child's functioning. It may happen periodically as they grow, when they're going through a developmental change or a new experience or situation, like going to a new school, moving to a new town, or dealing with the birth of a sibling. Although these kids may need some help during the specific episodes, they generally can learn how to manage the situation. On the other hand, if the level of anxiety is so strong that it interferes with your child's abilities to function in a social or classroom situation at an age-appropriate level for an extended period of time, then I think you have to take it very seriously indeed.

Be sure to have your pediatrician rule out any medical issues that might cause anxiety to make sure it's not a problem with physical origins.

Anxiety is a very real, normal and natural part of child and adolescent experience and development. The best way for you to deal with this anxiety is not through probing for emotions or logic, but by learning concrete solutions to the problem of managing anxiety so it doesn't interfere with your child's functioning. Parents can acquire this knowledge through their own family situations, their life experiences, their education, or specific parenting training. In any case, it's critical for parents to understand the roots of anxiety and learn how they can help their children manage it.

For three decades, behavioral therapist James Lehman, MSW, has worked with troubled teens and children with behavior problems. He has developed a practical, real-life approach to managing children and adolescents that teaches them how to solve social problems without hiding behind a facade of defiant, disrespectful, or obnoxious behavior. He has taught his approach to parents, teachers, state agencies and treatment centers in private practice and now through The Total Transformation® Program.

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Step-Ladder Approach to Help Anxiety in Children

The step-ladder approach for the treatment of anxiety is medically known as graded or hierarchical exposure. It's one of the 'behavioural' components of cognitive-behavioural therapy (CBT) and it's useful to know about when encouraging your child to address their fears.

This treatment approach can be applied to many common childhood anxieties such as the fear of separation, fear of sleeping alone or fear of social situations. It can be used to help anxiety in children (and adults) of all ages.

To make a start, imagine a simple step-ladder with several rungs. Decide on the final goal (this task becomes the top of the ladder), then determine what an easy starting point might be (this becomes your first step). Next, work out what tasks might serve as intermediate steps with each situation a little bit more challenging than the last as you get closer to the top of the ladder.

When planning your child's step-ladder, it's important that the leap between steps isn't too daunting. If the jump from one step to the next seems too great, consider how you might break it up into a few smaller steps by creating variations based on what it is your child does, how long for, where they try it or who they're with.

This step-by-step approach allows your child to practise coping with their anxiety in manageable doses. In this way, your child also experiences successes along the way which builds up their confidence and sense of mastery.

Here are a few hints to improve your chances of success:

1. Let your child decide what tasks they add to their ladder. If you do need to help with this, make a few suggestions from which your child can choose. As much as possible, your child needs to feel like they're an active, motivated participant in this process as this makes it more likely that they'll stick with it.

2. Teach your child some strategies for managing their anxiety before you start. An example might be slow relaxed breathing, or a simple message to think about, for example, "I'm safe and this worried feeling will go away" or "I'm okay and my Dad will be back soon". It's a good idea to plan and practise these strategies with your child before starting so that they know what to do as soon as they start to feel worried.

3. Encourage your child to try to stay in the situation until their anxiety has passed. Anxious feelings don't last forever. In fact, our bodies can only maintain high levels of anxiety for a matter of minutes (rather than hours) but if your child always leaves the situation while they're still feeling anxious, they may never learn this.

4. Wait until your child has mastered one step on their ladder before moving onto the next. This might take one attempt or it might take twenty before a step is no longer considered anxiety provoking. It's always best to work at your child's pace.

5. Reward success. This doesn't need to be something expensive or chocolate-coated... Praise, letting your child know how proud you are, suggesting they call a grandparent/close adult to share news of their success or spending some special time together are all great ways to reward your child.

6. Be a good role-model. Children learn so much from us. If they watch us panic each time a dog approaches, they'll soon be doing the same. Consider what you say and how you behave when you become anxious. Sometimes we need to be as brave as we'd like our children to be!

Dr Kaylene Henderson
MBBS FRANZCP Cert C&A Psych

Dr Kaylene Henderson is a Child & Adolescent Psychiatrist and Founder of Little Children Big Dreams which provides online help for children who are afraid of the dark or scared of monsters - http://www.littlechildrenbigdreams.com/

Little Children Big Dreams offers personalized printable stories and parent guides to help children beat their fears of monsters or fears of the dark and sleep better at night. Parents visiting the Little Children Big Dreams website will also find Dr Kaylene Henderson's blog providing free access to Child Psychiatry tips and information - http://www.littlechildrenbigdreams.com/.

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