- Mental Health
Childhood Anxiety: Myths Unmasked
Any dictionary can tell you that anxiety is a feeling of worry, nervousness, unease, or a strong desire to take action. These feelings are something we can all relate to. We've all been anxious at some point in our lives, some more than others. But no dictionary, no words can begin to describe what is experienced by someone with clinical forms of Anxiety Disorder (With a capital A).
When people experience 'normal' anxiety, their thinking brain stays in control. They are aware of their worry, or of a general unsettled feeling that pressures them to act. They are generally aware of a trigger; some specific event that makes them logically nervous. They also are able to find ways to deal with their anxiety regardless of how deep it is. Normal anxiety can range from 'butterflies in the tummy' to physically throwing up; but it's short lived and relatively manageable.
Anxiety Disorders cross the line into an unmanageable state of being. People who experience anxiety to a point where they avoid certain situations entirely are dealing with Anxiety beyond the realm of normal. They may or may not be able to identify specific triggers, they only know that they 'can't' enter certain situations. They may have random anxiety attacks they fear are caused by physical anomalies, such as the stomach flu or heart issues. To make matters worse, people with Anxiety Disorders are more likely to suffer from a range of random, seemingly unrelated physical symptoms like stomach aches and headaches. It is important to note that these physical ailments may be related to the Anxiety, but are very real and potentially debilitating to the one suffering from them. While a person suffering from typical anxiety can often overcome the related symptoms with positive self-talk, a person with true Anxiety can not employ mind over matter to the same extent or with the same level of success.
As an adult, we can recognize when Anxiety has taken control. Often, we are able to seek help. But children haven't yet grasped the concept of autonomy. Often, they are still in a narcissistic phase of life (they don't have the developmental tools to recognize that their experiences might be different from someone else's.) A child with Anxiety Disorders may present in different ways than an adult because to the child, the world has become a dangerous place. Some adults suspect abuse or bullying, others get frustrated that their child is suddenly uncooperative. Some children suffer in silence because they don't have the vocabulary or the experience to explain to the adults around them what they are feeling.
Once the issue has been identified by a medical professional, there are still a myriad of misconceptions surrounding true Anxiety Disorders.
Myth #1 Get Over It or Pray it Away
Since anxiety and anxious feelings are something we can all relate to, it's easy for people to give out advice on what works for them. A normal person who is experiencing normal levels of anxiety might take a few deep breaths and push themselves to deal with the situation at hand. Although it's difficult to understand, the person with an Anxiety Disorder literally can't 'get over it'. Some of the symptoms of anxiety become completely debilitating. The physical symptoms of stomach aches, nausea, stomach upset, headache and dizziness or heart palpitations are very real. They may be triggered by illogical causes, but they still affect a person's ability to function.
People with Anxiety Disorder may feel the same or similar symptoms as someone who is anxious, but experience those symptoms at an intensity that isn't normal. Then their anxiousness about what those symptoms might mean increases their anxiety load, making the situation feel impossible.
Along with "Get over it," a lot of people addressing someone with Anxiety bring religion into the discussion. Since it's a hot topic, and I don't want to turn this into a Believer vs Atheist debate, I'll leave it at this. Even devout believers suffer from Anxiety. While religious belief and prayer might be a tool used to help manage symptoms of Anxiety, prayer is as effective against Anxiety as it is against any other valid medical condition. It is not a treatment unto itself. If it doesn't work, it isn't the patient's fault. They just need a little earthly support in addition to divine intervention.
Myth #2 It's All in Your Head
Anxiety Disorder is classified as a mental health condition, and as such it is often considered a head issue. Once upon a time, all anxiety related symptoms were considered psychosomatic, and were treated as if the sufferer had control over them and could easily recover if they wanted to. We now know that people with Anxiety Disorders often have different chemical workings inside their brains. Severe anxiety symptoms can be brought under control through a balance of cognitive behavioral therapy (rewriting the negative messages kids with anxiety tell themselves) and medication that targets the seratonin levels in the brain.
Even once the problem is identified and treatment has started, there is no quick fix. Anxiety Disorders can be a lifelong struggle for some individuals. It takes time to find the right treatments, and time for therapy to kick in. Anxiety Disorders require patience, the person suffering isn't looking for sympathy or making it up. They're confused, scared and suffering.
Myth #3 Face Your Fears!
A child who is deathly afraid of their closet might be reassured with a bottle of monster spray, a bright light and a parent's leg to hide behind as they open the door and see nothing there. An adult who is afraid of heights might be able to overcome this fear by inching themselves closer to a balcony railing, or simply signing themselves up for skydiving lessons and forcing themselves to make the jump (and survive)
The approach works for some. But in the case of Anxiety Disorder, friends and family are continually frustrated when the patient never seems reassured. Sure, this time they made it through a day at the office. Tomorrow, though, tomorrow something bad might happen. They might get to know a new classroom (or office) inside and out, put a few comfort objects in their desk, prepare themselves as fully as they possibly can and still have a full blown panic attack in the morning.
This is not the Anxiety sufferer's fault. It's the definition of the condition, unreasonable feelings of anxiety, overwhelming fears that directly inhibit the ability to function. While the Anxiety sufferer absolutely needs to find ways to deal with their symptoms and to deal with what scares them, the sink or swim method won't help. Locking a kid in a car because they are terrified of riding in one is only going to make them more anxious overall, because while you see them emerge safe and sound, they feel like their life was in danger and they had no control over the situation at all. A child with Anxiety, needs to feel in control of their actions. Maybe they don't have any choice but to get in that car, but they need to be the ones to step in and buckle their seat belts.
Kids with anxiety disorders have a 'real', treatable condition. While all kids need to learn tools to deal with the stresses of everyday life, children dealing with anxiety disorder have more trouble finding those tools on their own and find that 'normal' days can be stressful. They need to be taught coping mechanisms while continuing to experience a relatively normal day on a regular basis.
Myth #4: They'll Grow Out of It
When kids are young, it's easy to blame anxiety on maturity levels. They aren't ready to leave their parents, they aren't ready for school, they'll face the big slide when they're ready for it. While maturity can play a big part in what a child is ready to face, Anxiety Disorders are a debilitating fear of ordinary things. A child with an Anxiety Disorder isn't growing out of their fears or is displaying them in ways that are not age appropriate. While there are parents who expect too much from their children, kids with Anxiety know what is expected of them and will do their best to hide their symptoms in public, making the disorder difficult for outsiders to understand.
Some kids can appear to function just fine during school hours, only to fall apart and sob as soon as they greet their parents. The obvious reaction from onlookers is either that there is something the kid wants to avoid at home or that the parents coddle them too much. The child is actually working extra hard to hold themselves together during the day and when they reach their parents they feel 'safe' enough to let their guard down. The crying is a symptom that the child is otherwise overwhelmed, not the problem that needs to be addressed directly.
Other children will try so hard not to let their anxiety show that they suffer from frequent, unexplained bouts of stomach aches, headaches and vague physical symptoms that keep them from participating normally. They recognize what is expected of them as they mature, and instead of learning to deal with the stressors of every day life, as the rest of us do, Anxious kids become more adept at hiding their growing fears.
Myth #5 Abuse, Trauma, Bad Parenting
When something goes wrong, as a society we always want to find a way to place blame somewhere. Unfortunately, there isn't always a scapegoat handy. In the case of anxiety and other mental health issues, it's easy to blame the parents. Maybe they were too strict (or not strict enough). Maybe something traumatic happened. Maybe they didn't breastfeed long enough. Potty trained too soon. Or maybe they tried to let the child cry it out too long. Perhaps they should have let them cry it out. Or weaned them earlier. We might even look to the dark side, whispering that the parents have secret issues with alcohol, drug abuse, or other addictions that are causing their child's problems.
I won't lie. Kids who are abused may have a higher tendency to develop anxiety disorders at some point in their lifetime. Kids who go through a traumatic event are more likely to develop an anxiety disorder (Post Traumatic Stress Disorder) than kids who live a sheltered life. But sheltered kids are as at risk for an Anxiety Disorder as anyone else. Their anxiety just seems to make less sense than one that has specific, identifiable triggers.
No one knows exactly what causes some people to develop Anxiety Disorder. But we do know that people with Anxiety disorders respond well to medications that directly impact seratonin levels in the brain, indicating that it is caused by a chemical imbalance, not a physical life event (such as parenting).
The Loneliest Child
Children with anxiety disorders are often very lonely. They don't understand the feelings they experience, and lock down inside. Sometimes they push people away because they don't want to try and figure out who is being sincerely nice and who is being mean. They also can't deal with explaining what they need; and find it very frustrating to have people offering the 'wrong' kind of support. Anxiety can turn into depression if it is left untreated or unrecognized for too long.
Kids with anxiety need to have lots of positive social interaction without being overwhelmed, and they need parents to provide plenty of healthy down time for them as well. The trick, for parents and caregivers, is to find the perfect balance between social engagements, quiet time, and 'normal' overstimulating situations to help children learn to eventually balance their own lives.
Myth #6 Kids Just Need Reassurance
With typical anxiety, you reassure kids (and grown ups, too). You give them as much information as you can to prepare them for events. You paint things in a positive light. You downplay the negatives.
Kids who have clinical Anxiety may take all that information and twist it into a terrifying monster. The more you focus on reassuring away their fears, the more they focus on the fact that there is a tangential something to fear.
What's a parent, teacher or caregiver to do? Instead of sitting down and explaining the myriad of reasons a kid shouldn't be afraid, keep your discussions short and sweet. Yes, that barking dog was scary. But dogs bark to talk. How else will they communicate? Make a joke (I think it'd be scarier if he jumped up on two legs and said "Excuse me, what's your name? Can I smell your hand?") and then move on.
The child learns to associate a previous anxiety trigger with positive memories, and hopefully become less frightened each time they are exposed. While parents and caregivers may begin to tire of constantly battling the child's anxiety, it's important to remain calm and matter of fact. Allowing yourself to be pulled into the child's need for constant reassurance doesn't help them to manage their fear. So stick to simple statements, positive self talk and move on quickly. Otherwise, they learn to remember their fears, not your reassurance.
Myth #7 You Can Tell if a Person is Anxious Just by Looking
Most people think they can spot an anxious child a mile away. Tears, shivers, hiding behind their mother or father, clingy, shy...these are typical anxiety symptoms,right?
Maybe. But clinical anxiety is something else entirely. A child who experiences frequent bouts of anxiety isn't always anxious. She doesn't necessarily hide behind her parents all the time. She isn't fearful all the time, or if she is, she learns to hide it behind her attitude.
A child with anxiety might be bratty. They might appear defiant, explosive or spoiled. Anxiety can trigger massive temper tantrums that leave onlookers shaking their heads and mumbling about what their parents would have done.
What they don't see is that an anxiety related tantrum is rarely directly related to a positive outcome for the child and often is worsened if someone tries to 'give in' to nip it in the bud. By the time an anxious child melts down, it's too late.
Anxious children may become class clowns, seeking positive feedback from their peers but never fully secure in their own skin. They may be seen as problem children by teachers, as their discomfort drives them to entertain their peers with misbehavior in an effort to 'fit in'.
Alternatively, anxious children may appear cooperative, they don't want to break rules. They don't want to get 'in trouble'. They are quiet and withdrawn, or sweet and friendly, eager to please and happy (Or at least quick) to do what is asked of them.
Children with anxiety may even seem normal most of the time; with occasional bouts of panic that make no sense to caregivers. Attempts to get to the source of the anxiety make things worse, as the child rationalizes that the adults must be right. Their mysterious symptoms must be caused by something. What are they afraid of? School, monsters, and other vague childhood fears can come from little more than a parent trying to ascertain the cause of sudden withdrawn panic and refusal to cooperate.
What to do if Your Child has Anxiety
If your child's anxiety level seems to be higher than normal, or they don't seem to outgrow it the way you expect them to, it doesn't necessarily mean there is something 'wrong' with them. The first line of action should be to discuss the problem with your pediatrician. Most pediatrician's are well versed in the concerns of parents, and can help you identify whether your child really needs intervention or not.
You can also ask for a referral to a child psychologist. The therapist will be able to reassure you if your child is progressing normally, and to counsel you if they aren't. Treatment should always include therapy. Even if your child needs medication to help them function well with their peers, studies show that the best treatment for anxiety disorders includes both medication (to help keep anxiety down to a manageable level) and therapy (to help children learn coping mechanisms that didn't develop normally for whatever reason.)
Therapy does not mean that you or your child have failed in any way or are lacking in some intrinsic quality. It's an important way to help your child develop the tools they need to succeed in life. Some kids need a math tutor, others need some support in reading. Kids with Anxiety Disorders need help managing their worries.