Kids and Anxiety: Looks Can Be Deceiving
Childhood fears and anxieties are common. Most parents consider them easy to spot. After all, kids are often an open book when it comes to what they're afraid of, or at least the fact that they are afraid of something. (That something can be difficult to track down. It could be something rational. It could be something irrational. It could be something you didn't even know your child had been exposed to, or something that your child only had a small piece of information about. Hearing that Uncle Lyle is struggling to get his dandruff under control can reduce a small child to tears...if they don't know what dandruff is. It also makes a great story to bring up at the dinner table when they're teenagers.)
But sometimes, there's something more. We all know what the word anxiety means. It means fears. Feeling anxious. Nervous. Scared. We associate Anxiety Disorders with panic attacks. We also tend to dismiss anxiety in kids, unless there's a good reason to focus on it. Kids are labeled shy. If they are extra shy, we start to worry that they might need medical help.
But Anxiety Disorders don't only manifest as shyness. And not all kids with anxiety disorders seem shy all of the time. They can be quite outgoing some of the time. Which makes it even harder to accurately differentiate between anxiety and Anxiety Disorder.
Symptoms of Anxiety in Children
- Quiet, shy demeanor
- Some kids avoid participating in specific activities, especially group situations
- Reluctance to separate from parent or caregiver
- Frequent stomach aches and headaches
- Excess fatigue
- Trouble sleeping
- Irritability that is outside the realm of normal
- Extra sensitive to criticism
- Praise seeking
- Avoiding or refusing to participate in school or afterschool functions
- Attention Seeking, overly outgoing
- Temper tantrums
What Does Anxiety Look Like in Children?
As I mentioned before, some kids with an Anxiety Disorder look like the painfully shy children we've all seen in movies and read about in books. They don't want to talk to strangers, or teachers, or even adults that they might know. They don't want to run out and play on the playground. They don't want to get on stage with their preschool class.
Shy kids are easy to spot, and easy to begin to help. They need a quiet approach. They need gentle support. They need techniques to help deal with their fears. Being shy, and being anxious because you're shy, are not necessarily the same as having an Anxiety Disorder.
Kids who have an Anxiety Disorder have a chemical imbalance in their brains. It doesn't really matter what causes this imbalance. What matters is that their brains will start to misfire. When that happens, the area that misfires sends out panic signals. "Something's wrong!" Adrenaline gets released. They breathe hard. Their head hurts, or their stomach aches. They don't know what's wrong, or why. But they know they need to 'get safe'.
The feelings are irrational. But like good parents, good caregivers, we ask them what's wrong. Maybe they even ask themselves, well before the adults get involved. What are they scared of? Being rational human beings, they (or we) look for rational causes for these irrational fears. We act as if being shy is the problem. When the real, actual, physical problem is that their brain is getting signals that something is wrong.
While kids with anxiety disorders often have a lot of fears, many of them constant, they don't always talk about those fears. Caregivers may be unaware that the child is worrying, since the child who doesn't want to talk simply appears introverted. Some kids can even juggle fears while acting relatively 'normal' in the rest of their life.
Kids with anxiety disorders sometimes have problems keeping their temper. They'll cry and scream, and sometimes lash out with their hands and feet. This behavior can not be tolerated, but it must be understood if we really want to help the child. A child with an Anxiety Disorder has excessive, irrational fears about ordinary things. For example, they may not want to put their toys back in the bedroom. The parent typically suggests a few logical fears the child may be experiencing, which escalates the child's anxiety level (They don't know why they're scared but, yeah, now that you mention it...there might be a monster in the closet. Now they REALLY don't want to go into that bedroom!)
The child feels that their feelings are rational. If the bedroom is dangerous, they should avoid it at all costs. When mom or dad or the babysitter insists that they enter a dangerous zone, and then take a threatening tone of voice when the child refuses to cooperate or voice their specific concerns the child doesn't simply feel afraid of punishment. To the child, they are being asked to choose between certain danger (the activity at hand) and punishment which may also translate in their brain as rejection. It's an impossible choice, and they know it. Asked to choose between two (in their minds) certain dangers, they lash out and throw a 'temper tantrum'.
As cliched is it may be, the best way to deal with a meltdown is avoiding it in the first place. When your child starts to escalate, step back and give them an opportunity to use other tools to deal with their overwhelming emotions. Even when it seems to you that it's ridiculous to sob their way through a simple activity like running upstairs to drop a few toys in the toy bin. If they do resort to temper tantrums, keep in mind that the child may have felt in physical danger at the time. (The fact that your house is perfectly safe and there are no monsters in the closet or toybin is irrelevant to the very real danger your child was sensing) While tantrums are not tolerable and need to have consequences, remember that getting angry will be counterproductive. Count to ten. Implement immediate consequences. And then when your child is calm and rational, discuss, again, the difference between appropriate and inappropriate ways to express themselves.
In some kids, the main manifestation of their anxiety is vague physical complaints. They have frequent headaches and stomach issues. They're often tired, and want to leave events early. They miss a lot of school.
Parents and doctors alike are frustrated by anxiety related physical problems. The symptoms children experience are absolutely real and may be disabling at times. However, there is no physical component for doctors to address specifically. The only treatment they can offer is symptomatic relief, and a referral to the mental health department.
If your child suffers from frequent physical illness without fever, it's vital to get them thoroughly checked out. Although anxiety is an easy diagnosis to make, real physical ailments can cause the same issues. Anyone with frequent stomach complaints should be screened for celiac disease and food intolerance. It doesn't help a child any if you treat a physical condition as if it's a mental health related one, even if the child has both.
Once you've ruled out a treatable cause, you face the tricky challenge of balancing a full life with validating your child's fears and reassuring them that they are safe and that their complaints, while valid and real, are not serious and the best way to treat them is not to go to bed until you feel better. The child with anxiety considers their physical complaints real, valid and potentially serious. Some are even smart enough to jump to secret worries that they may have some fatal condition. How would you feel if you were dying, and the people you loved most shrugged and said "I'm sorry, hon, try not to think about it"? Your child isn't dying of anxiety. But they may feel as if they literally might end up in a hospital or fatally ill. They need guidance working through that, reassurance that the symptoms (each and every concerning one) are not serious and maybe even simple explanations to help them deal with discomfort they need to ignore.
To deal with anxiety, your child doesn't need you to simply reassure them. They don't need to just learn that the world around them is safe. They need to learn tools to help them identify and deal with the anxiety they feel. Different kids will respond better to different tools. Once you know that your child's fears are outside the realm of normal, it's important to work closely with a professional who is experienced with kids and anxiety. Your child can learn to live a productive, happy life. But they will need extra tools to function normally within society.