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Is My Child’s Anxiety a Sign of Serious Trouble? | Robin Alter

Is My Child’s Anxiety a Sign of Serious Trouble?

A young girl, looking nervous

Photo: Martin Yaffe

The myth about childhoods is that it is carefree and innocent, that if protected from the responsibilities of adulthood, children will be worry free. Many parents cling to the belief that through good parenting they can shelter their children from the frightening aspects of growing up, and, if they do their job properly, their children will spend their days in joyful pursuits. We all know, however, even when parents are doing a good job raising their families, that children still have many more fears and anxieties than adults. Over the natural course of becoming adults, most of us lose our fear of the things that terrified us as children. While as kids, we may have been afraid of the dark, the basement or something under the bed, few of us are still frightened by those things now.

How can you, as a parent, determine when normal childhood fears turn into a more serious problem? How can you best understand your child’s fears? And not blame yourself, when, in spite of your best efforts, those fears persist? How can you help your child be less burdened by worries? To answer these questions, we must first understand the difference between plain old fear and anxiety

Fear and Anxiety: How are they different?

Fear

Fear is defined as an agitated feeling or unpleasant emotion caused by actual or threatening danger, pain or harm. Fear is a normal and sensible response to something or someone that could realistically cause harm and therefore, fear has a important and useful purpose. Can you even imagine not being afraid of someone who is pointing a gun in your direction? Of course not! What else, besides fear should you feel when riding in a car in which the driver is inebriated or driving recklessly? When someone skilfully avoids a real danger, that person is viewed by others as having used good judgement. If we didn’t experience fear, it would be almost impossible to avoid hazards and injury. Life would be one catastrophe after another!

Anxiety

The fear response is called anxiety when a person is having the same kinds of physical responses that people have when they are afraid , but these responses are to events or things that are not dangerous, or are much less harmful than the person imagines. A good example of this is, claustrophobia– when someone is afraid of closed spaces, not being able to breathe, or having the feeling of walls collapsing and crushing them. The person in distress will be able to tell you that she knows logically that she is not really in danger, but her body is reacting in the moment as if the walls really are about to close and she will actually suffocate. It’s not hard to find other examples– giving an oral presentation, driving on a busy highway or a routine visit to the dentist. These may be unpleasant experiences, but, if considered logically, not nearly as bad as when they are amplified by the person suffering from anxiety.

How is it Different for Children?

In reality, children tend to have many more fears and anxieties than adults. They share many of their parents’ fears but also have many fears of their own. Your child has had less experience than you with the world and therefore has not had the same opportunities to discover what is truly harmful and what is simply new and unfamiliar. Unlike your child, you have had time to improve your skills at separating the potentially dangerous from the exciting but relatively safe. And, for your child, many more of the encounters are first time experiences, while for adults; we have frequently seen or done something at least similar, before. From your perspective, a fearful response in your child may sometimes seem absurd, because your child is reacting to something you know to be innocuous, like a walk in the woods. But from your child’s perspective this is an entirely new experience, unfamiliar territory and, therefore, potentially perilous. Think back to when you were a kid and imagine venturing into a dark forest. How many of these fears were going through your mind? –

  • Snakes
  • Bugs
  • Bees
  • Spiders
  • Poison Ivy
  • Wolves
  • Bears
  • Wild Dogs
  • Lightning
  • Getting Lost
  • Bad Guys
  • Quick Sand
  • The Boogeyman

And those are just the ones that are possible, but highly improbable. There are also the completely imaginary and impossible events, such as –

  • Monsters
  • Tigers (in North America)
  • Dragons
  • Evil Witches
  • Aliens

Children tend to rely on adults to inform them about dangers. They need adults to tell them whether they should proceed (and if so, what preparation they might need in order to do so safely), or retreat and avoid the situation altogether. Psychologists call this reality testing. We teach our children to do this when we insist that they check with us before doing anything new or of which they are uncertain. Adults who rely on others in a healthy and constructive way also do this with one another. When an adult talks something over with a spouse or a friend before taking action or trying something new, he is reality testing.

Children often don’t know the difference between reality and fantasy and become very frightened by the things they imagine, or see on TV and in movies. What is seen on the screen or in the mind can seem very real to your child. “Seeing is believing!” Your child might be afraid of a monster under the bed or in the closet, or perhaps what is in the dark, scary basement. Many of us can recall feeling afraid of exactly these things. In this instance, your child feels certain that some harm is about to come to her, while you are equally certain this is not true. To date, there are no statistics anywhere of children being harmed by monsters. (A recent movie “Monsters, Inc.” made the point that children, at long last, were discovering that monsters have not caused anyone any harm and thus, children were no longer believing in monsters. This was not good for the monster business!)

Sometimes children are anxious about things that have only a limited possibility of causing harm, things that are mildly irritating or uncomfortable, such as a needle in a doctor’s office, a birthday party, or using a public washroom. Their response, however, may seem exaggerated and out of proportion to the potential harm. You might expect that relying on you would solve this dilemma, and sometimes it does. Many children will ask – “Is it O.K? Can I do it? Is it safe?” and once, having received the O.K., will carry on with confidence. Your child, however, may not be able to respond to your reassuring words, which can leave you feeling quite exasperated as a parent, and fearful about whether your child’s anxiety is normal.

Perhaps, like many parents you are feeling powerless to subdue your child’s anxiety, and that somehow this is your fault. You might be assuming that your child doesn’t trust you enough to accept your advice, and this might leave you feeling frustrated or even hurt or angry. Lack of trust may exist in some instances, but in my clinical experience, this is generally not the case. For the most part, in the many families I have worked with in my clinical practice, I typically see an adult eager to be helpful and a child most desirous of receiving assistance from the parent, both signs of a healthy parent/child relationship. The body language between the two often suggests a close bond.

The answer to why your verbal and physical reassurance is ineffective lies more in the strength of your child’s highly active creative imagination. Your child’s ability to imagine and visualize a fearful event in gruesome detail makes it impossible for her to feel the impact of your words. The vividness of her mental imagery can be so compelling that your reassurance falls on deaf ears. More about this later when we discuss the incredible power of the imagination.

What to Expect and What to Look for

First and foremost, when deciding whether the expression of anxiety is normal or not it is important to consider your child’s age. Some anxieties are considered problematic after a certain age but not before and some anxieties are not even possible until a certain degree of mental development has been achieved.

Children develop anxieties only when they are mentally capable of having them. Fear of strangers, or stranger anxiety is not usually displayed until an infant is at least 6 months old. Before 6 months of age most infants do not recognize the difference between adults. Jean Piaget, a Swiss psychologist, called the ability to perceive different objects as same or different– “object permanence.” An infant at 6 months of age can usually distinguish different people and objects and show a preference for one person or thing over another. Thus, the child prefers to be held by the mother rather than a family friend. Stranger anxiety cannot be demonstrated until this capacity of the brain has developed.

Here’s another example: Research has shown that very young infants around the same age of 6 months are not afraid of heights. They will crawl over a glass floor that clearly shows a drop below them of many feet. They are fearless because they don’t have the depth perception to see the drop. This is called the “visual cliff” phenomenon. When children get a bit older they begin to show the fear response because, at that point in their development, the cliff is seen and sensibly avoided. We can’t be afraid of what we don’t see! In this instance fear is a learned response, something acquired with age. Of course, later in development, some of these fears, the “irrational” ones, are overcome with maturity. In the case of cliffs, it is useful and adaptive to be fearful of a huge precipice so that hurting oneself can be avoided; therefore we retain this fear because having it protects us from falling.

Going through the stages of developing certain fears and then outgrowing them is generally a normal part of childhood. Some of the common anxieties reported by parents of very young children are stranger anxiety and separation anxiety . Let’s look at both of these important examples, the typical age of their appearance and why each is regarded as a problem only after a specific age. When these anxieties are expressed before certain ages, they are considered normal; many children respond to reassurance and then simply outgrow them.

Stranger Anxiety

As a child develops, many normal and predictable fears emerge. For instance, between the age of 6 months and 3 years, many children exhibit a fear of strangers . Since infants are extremely dependent on their caretakers, it is useful to be able to identify and cling to the person who is your lifeline. But sometimes stranger anxiety persists past the age of 3 or 4, and can spiral to include all social situations, such as birthday parties and athletic activities, etc. This can certainly take the fun out of anyone’s social life!

Why is it that many young children exhibit stranger anxiety, preferring to stay only with familiar adults, while children over the age of 3 do this less often? As thinking develops, children become more capable of reasoning, and thus may be able to better manage their fears. She has likely had some experience with strangers, remembers previous encounters with someone previously unknown to her, and now has the reasoning power to connect previous events with each other. When encountering a new person, perhaps a distant aunt or uncle, she can make use of her idea of family, and is much more likely to accept him or her. She is also likely to watch carefully how you, her parent, act towards this person and takes her cues from you. Your behavior is likely to be very different if the person at the door is a friend, a salesperson or a police officer. Your child has been watching your behavior for most of her life and storing it in memory. Like most children, she likely pays more attention to your body language and tone of voice than to your words. She notices how tightly you are clutching her hand; or whether you are urging her to be polite and say hello.

Depending on how you behave, as well as her own memory of similar people, your child will decide whether to accept or be wary of a new person. The key is that your child, at this later age and stage in her life, now has more cognitive capability to engage in this complex mental task of sizing up a new person. She can put all the pieces together, her own thoughts and experiences, as well as your cues, and arrive at a reasonable conclusion. She may not always be right; none of us are, but she will be behaving much differently than the reflexive and immediate reaction of the one year old in response to all strangers.

Some children, however, persist in this behavior of being fearful of strangers long past age 3 and if you are witnessing this in your child, she may need your help to change this behavior. She may even recognize that her reluctance to participate in the event is unfounded, or in her words, “makes no sense”, but may be incapable of overriding the intensity of the fear and participating in the event. Because she believes her fearful imaginings about the “dreaded” activity, she focuses on avoiding it at any cost.

Separation Anxiety

Many young children, in the preschool years, are afraid of being apart from a familiar person or leaving the home. Before the age of 4 separation anxiety is frequently observed in many children. This age group often resists change, preferring what is known over what is unfamiliar and strange. When forced into a new and unpredictable situation, such as going to school on the first day, or switching to a new school, a child will often cling to a familiar adult as a means to ensure his safety. While the first day of school might be experienced as the worst day of a child’s life, after a few days, a sense of familiarity often takes over and he grows sufficiently accustomed to the people and the surroundings; the anxiety subsides and he saunters willingly into the classroom. After 4 weeks or more, if your child is still refusing to leave your side, or insisting that you accompany him to the classroom and remain there, then it is time to take some action and remedy the separation anxiety. Many of the ideas and suggestions in this book should help you successfully assist your child overcome these anxieties

Mental Ability and Anxiety, What’s the Connection?

You might be surprised to learn that the emergence of separation anxiety and the ability to overcome it, as well as the onset of formal education are all linked. This not a coincidence and that all three are determined by the emergence of certain capacities of thinking which occur normally at this stage of development. In fact, the starting age for formal education is universal; children all over the world begin school at the same time– around the age of four or five. Our society and most societies around the world have come to the same conclusion – that at the age of 4 or 5, children are cognitively, emotionally and behaviorally ready to engage in the challenge of school. School begins for children when they are, on average, ready for it.

At around 4 or 5 years of age, children, on average, are capable of sustained periods of attention and of having reasonable control over their behavior and emotions. At this age a child is capable of engaging in productive and constructive learning, which includes meeting the expectations in a classroom where a teacher’s attention must be shared with many other children and a strict routine is enforced. Furthermore, the child is able to function independently, at least for short periods of time.

If formal schooling begins too early, let’s say at age 3, teachers spend too much time trying to keep calm and order, drying away tears caused by frequent conflict and disappointments. Witness a recent an ABC Eyewitness News report that the rate of suspensions in preschool and nursery schools has risen over 200% in the U.S. over the past few years! It is not difficult to understand why. For many two and three year olds, even though their cognitive development is proceeding normally, they are incapable of behaving in a manner that would be expected in a school environment on a consistent basis. Many children don’t have the self-discipline required to sit quietly in a circle, pay attention to an adult reading a story, or even engage in reciprocal play with another child, share or wait their turn. Allowances need to be made for them and they should not be punished because their cognitive development is not in sync with a school’s unrealistic expectations.

Just as the changes in thinking capacity make it possible for your child to recognize friend from foe and to manage the demands of a formal school program, anxieties are only possible when your child is able to envisage frightening ideas and possibilities. It may falsely appear that your child’s reasoning ability is deficient because his actions are so irrational. The truth is that the strength of his creative imagination can overpower his logic. As the imagination develops, so does the ability to visualize many kinds of images and sequences of events. This can lead to positive emotional reactions, such as joyful anticipation or excitement, but in some cases, the reaction is one of anxiety and fear. It all depends on which direction the imagination takes

Enter the Imagination

Beginning around the age of 3, your child’s mental and creative capacities are enjoying a monumental growth spurt. Your child is now able to better understand the connections between things, such as cause and effect, to reason and use memory skills. He is also developing an imagination – to conjure up all kinds of possibilities, real and fanciful. He is beginning to understand the concept of the future, or at least the immediate future, later today or tomorrow. Few children at this age are thinking about next year or even next month. In order to think about some time other than now, a person must be able to imagine what might be happening at that time. This could be something probable, highly improbable or impossible. For instance, all of us can imagine the sun coming up tomorrow or ourselves getting out of bed, both highly probable events. We can also imagine aliens landing in Times Square tomorrow, although this is much less probable. We will likely all have different images associated with such events, but most of us can imagine them.

Children differ with respect to the rate at which they develop the milestone skills, such as walking and talking and the same is true for the emergence of the imagination. While most children develop a sense of imagination and a creative inner mind around the age of three, I have known some children who have demonstrated this capacity even earlier. It’s not really important at what age it occurs, what is important is that anxiety and imagination arrive together.

From your vantage point, as a parent, it is usually obvious when the creative imagination begins to emerge. You begin to see signs. You might witness your child’s eagerness to flex her imagination in a number of different ways– drawing, making up stories or songs, creating imaginary worlds with dolls or action figures, etc. This is a joyful time for most parents, who are usually delighted and amused by their child’s creativity and imagination.

It’s at this point, however, that anxiety can rear it’s ugly head, because the imagination, especially in this early stage, isn’t rooted in reality. Your child can and will imagine all sorts of things, which could never possibly happen, like monsters or ghosts. She might also imagine things that are likely to actually happen but see them with much more intensity or magnitude than is realistic. The more vivid and developed your child’s imagination, the more anxious your child may become. Anxious children, as well, tend to think more about the future than more relaxed children because their minds are filled with more imaginative possibilities. While an active imagination can lead to many hours of exciting and joyful play, it can also lead to frightening visual images and debilitating anxious states.

For example, I treated a young girl, Emma, age 5, who was terrified of storms. She believed that the rain would cause her house to dislodge and float away. Now, it is possible for a house to be flooded by a torrential rain, but highly unlikely for it to float down the street. If your child is afraid of storms, like Emma, this image of your house, floating wildly like a boat, down a river that was once your street, may be exactly what’s occurring in your child’s mind. For a 5 year old, what a nightmare!

How Can I Tell What’s Normal?

One of the most common questions parents ask me is whether their child’s fear is normal or abnormal. When asking this question, it is usually in reaction to the tenacity and intensity of their child’s anxiety response. They may have had repeated experiences of their child hiding under the bed when it’s time to go to school or to a swimming lesson, talking in a rapid and non-stop manner days before a planned sleep over, trying to convince them to cancel the event or make other arrangements so they can avoid participating. These can be upsetting behaviors for a parent to observe and it’s hard to know what to do. You are right to ask this question.

Fear is normal and necessary

We all know that fear is part of our biological and neurological make-up. All people have it and, as mentioned before, it is not something that anyone wants to eradicate. If there were a magic pill that could eliminate the fear response, it would be a dangerous drug to put on the market. In the absence of fear, people would make many wrong choices and put themselves in harm’s way much too often. This is not a worthwhile goal!

Many of the fears expressed by children with anxiety issues are also expressed by adults and other children who might be described as better adjusted with respect to anxiety. Who isn’t afraid of a large barking dog? Who isn’t afraid of illness, or is loathe to vomit? Who isn’t afraid of standing up in front of a group of strangers and being submitted to criticism? Many of the things feared by children who have an anxiety problem, are potentially very harmful, even life-threatening. Dogs can attack, illness can be fatal. One might seriously question the soundness of character of a person who claimed not to have any fear of these things. Perhaps this person had taken that magic pill I referred to earlier. The fact that many of our child’s fears have a basis in reality can make the decision about “normalcy” even harder to make.

Brave people experience fear and anxiety too!

Many people who are viewed by the larger society as exceedingly brave, such as firefighters and police officers, who put themselves in harm’s way in the normal course of their day, often acknowledge that they experience fear, and not just in small doses. This fact is surprising to many people. It is a common misconception that people, seen by others as brave, do not experience fear. In fact, I have noticed that when children are asked to define words on a standard IQ test, the most common definition given for the word “brave” is “not afraid.” This is given full credit according to the official scoring criteria, but, is technically inaccurate. Brave people, by their own accounts, experience fear and often intensely, even while exhibiting courageous actions; they simply don’t allow the fear to control their behavior.

It was reported in Katherine Hepburn’s biography that she suffered from such debilitating performance anxiety that before every opening night performance on Broadway, she would vomit. She learned to anticipate this response, vomit and then proceed with the performance. Even this extreme reaction did not prevent her from performing. The show must go on! Ms. Hepburn and other brave people do whatever is called for in the situation, in spite of the fear. The firefighter enters the burning building; the police officer chases the man with the gun; the ordinary person on the street acts courageously to save someone from danger. All of these people feel fear in their bellies, their chests or their throats, and, yet act with courage, determination and bravery. Bravery is not the absence of fear, or as John Wayne once said, “Courage is being scared to death and saddling up anyway!”

The Price of Anxiety

While firefighters and police officers have learned to overcome their rational fear so they can go on about their work, we don’t all need to be heroes. But, for some, anxiety and unnecessary fear prevent them from leading a normal life. In my experience the characteristic determining whether someone has an anxiety problem or is functioning within the realm of normalcy, is the extent to which the anxiety interferes with one’s life. If your child is worrying so much that he takes hours to get to sleep, refuses to eat in restaurants or attend birthday parties, or does poorly on tests in spite of adequately understanding the material beforehand, then worry and anxiety are interfering with having a normal, enjoyable and productive life. When your efforts to calm your child are ineffective and the behavior persists over several months, then the anxiety needs to be reduced, in both intensity and frequency, so that normal life can proceed.

I often advise my clients when they are faced with the difficult decision of whether anxiety is a problem needing professional attention, or whether it’s something your child will outgrow or eventually overcome, to try to look as objectively as possible at how much of normal life is being sacrificed or put on hold because of anxiety. This is an extremely important assessment to make and one that will require you to make some important decisions. If your child expresses a lot of anxiety, gives long explanations about things of which they are afraid, but then, with your encouragement, marshals the courage to take action, your child is definitely NOT suffering from an anxiety disorder. Your child, if she is behaving in this way, is likely to be an imaginative, articulate and intelligent person, who is aware of all the things that might cause harm, but is still managing to participate in the activities of her choice.

Many children experience significant amounts of anxiety, but are able to manage their feelings and not let their apprehension stop them from pursuing their desired activity. One child I saw, Evan, was very nervous about going to overnight camp; he was having bad dreams and sleepless nights in the weeks leading up to departure day. The intensity of his feelings was so great that he woke his parents in the middle of the night, for several consecutive nights, to talk with them about his worries. When the time came, however, to leave for camp, he said good-bye, abruptly turned away and off he went. Once there, his parents received only good news reports from him and the camp personnel. In this example, the anxiety was intense, but the outcome positive. The anxiety did not prevent him from going to camp or from having fun once he arrived. In the words of the British novelist and journalist Arthur Koestler– “Courage is never to let your actions be influenced by your fears.”

If your child does not allow all the frightening possibilities to dictate his behaviour, then Bravo! Your child should receive applause and accolades for having courage and good judgement. The intensity of the anxiety reaction is not the defining factor, and neither is the length of time the anxiety persists. Your child might express worry and concern about an upcoming event for many weeks, or even months, but then move forward and deal effectively with the object of his fear. Some people, like Evan, anticipate a lot more problems with something that is likely to occur, but deal successfully with all their anxiety beforehand, leaving them relatively free of anxiety at the time of the event. This can be a very successful coping strategy, psychologists call preparatory anxiety . If, however, anxiety is interfering with normal activity, e.g. cancelling camp, losing the deposit, having to be leave camp prematurely because of anxiety issues, and these occurrences persist , then this presents a different and more problematic scenario.

To help decide if your child has an anxiety problem, try answering the following questions.

  1. Have most children outgrown the anxiety by your child’s current age? If you have limited experience with other children besides your own, speak to the pediatrician, teachers, camp directors, sports coaches and others who interact with many children, or other parents, etc.
  2. Does your child miss out on many potentially enriching and fun-filled events that they might enjoy because of anxiety?
  3. Do other members of your family miss out on many desired events because one of your children is too anxious to participate?
  4. Does anxiety prevent your child from participating in an academic, athletic or extra-curricular activity?
  5. Does anxiety cause your child to perform poorly in an activity?
  6. Does your child spend excessive amounts of time arguing with you and trying to convince you to change plans, so that he can avoid something that should be fun or worthwhile?
  7. Do you feel that anxiety is determining too many of your child’s decisions?

If the answer to many of these questions is yes, then this is a situation calling out for change.

Key Points to Remember

  • As much as parents would like to believe otherwise, childhood is not a worry-free and carefree time in life.
  • There’s a difference between fear and anxiety, although both are unpleasant emotions. Fear is a response to actual or threatened danger. Anxiety is in response to imagined threat or danger, or harm that is exaggerated and out of proportion with reality.
  • Children normally have many more fears and anxieties than adults. Many of these fears are outgrown as the person matures and has more experience with the world. Children often can’t determine the difference between reality and fantasy because their experience with reality is more limited than an adult’s.
  • Children overcome certain fears when their thinking has developed to the point that they understand reality better, such as fear of strangers and separation. Sometimes children acquire fears when their development enables them to appreciate real danger, such as sharp drops from cliffs.
  • Children with highly developed imaginations are more prone to anxiety reactions because they are able to imagine many more frightening possibilities and imagine them with much detail and intensity.
  • A certain amount of anxiety is normal, but when it dampens a person’s enthusiasm for regular activities of life and when too much of normal life is being avoided in order to silence the anxiety, then your child is in trouble and needs some help.