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The Worried Child shows that anxiety is preventable or can at least be minimized by raising children's self confidence, increasing social and self-control skills, and teaching them how to play, ...
The Worried Child shows that anxiety is preventable or can at least be minimized by raising children's self confidence, increasing social and self-control skills, and teaching them how to play, relax, and communicate their feelings and needs. Written for parents and teachers and anyone dealing with children, the guide covers the importance of adequate rest, sleep, and exercise and provides detailed lists, skill exercises, sample dialogues, and case studies. It also presents extensive information on the various types and symptoms of anxiety disorders. Advice for educators, health care professionals, childcare workers and psychotherapists is included along with a chapter and tutorial written specifically for children.
The Worried Child is a highly accessible self-help guide for anyone dealing with a child who is or may become anxious.
Anxiety is a normal part of life for everyone, especially children. Separation from parents in early childhood, taking an exam in school, giving a presentation in front of a class, and interviewing for college are all examples of normal anxiety. Anxiety can even be helpful by motivating children to cope with some of these challenges. However, persistent or intense anxiety is abnormal, and when it interferes with daily life it can become a disorder requiring professional help.
So how do we know when we're seeing "normal" anxiety in children, and how do we know when it's problematic?
This chapter introduces the key concepts necessary for understanding anxiety. In it, we will make a distinction between the normal anxiety experienced by most children and anxiety disorders (which are discussed in detail in Chapter 2). This introductory chapter also provides an overview of the biology of anxiety by describing the fight-or-flight reaction and how it relates to fear and anxiety. In addition, the "three ingredients" model of anxiety is introduced as a foundation for understanding how anxiety developsin children.
We will also take a preliminary look at the environmental stresses and threats that lead to anxiety in children, as well as the personality traits usually found in children who develop anxiety disorders. Those personality traits are the subject of Chapter 3.
The environmental causes of anxiety are addressed in Part II of the book, where the influences of family and society are explored. These include the impact of performance pressure, child abuse, terrorism and war, the media, schools, religion, sexuality, divorce, drugs and alcohol, parental anxiety, and health-related issues. Throughout Part II, you will find suggestions on how to minimize the effects of many of these sources of anxiety and thereby reduce anxiety in your child.
In spite of our best efforts as parents, there are many stresses and threats beyond our control that can lead to anxiety disorders in children. Therefore, two of the aims of this book are 1) to help you determine if your child could benefit from professional help and 2) to provide insight into psychotherapy, medication, and other approaches. In Part III, you will find information about available treatments for anxiety, including when and how to find a suitable professional to work with your child.
What Is Anxiety and Why Is It So Prevalent Today?
To begin our understanding of anxiety, let us clarify some related terms that will be used throughout the book. These key terms are often used interchangeably, but there are some important distinctions among them. Here is a quick preview:
FEAR - an instinctive reaction to a clear and present danger or threat
ANXIETY - a state of apprehension or worry about a danger or threat that might occur
FRIGHT - a state of fear when danger or threat catches us by surprise
STRESS - any situation (positive or negative) that requires adjustment or change
Fear is part of our survival instinct. When we are confronted with a dangerous or life-threatening situation, we automatically react with the fight-or-flight response. A survival center in the brain-the locus ceruleus-triggers this defensive reaction for the purpose of self-preservation. Chemical messengers (adrenaline, norepinephrine, adrenocorticotropic hormone, serotonin, and others) are released into the bloodstream to activate the entire system. For example, muscles tense to prepare for fight or flight, heart rate increases to supply extra oxygen to the body, vision and hearing become acute and focused, breathing intensifies to assist in oxygen supply, and posture assumes a self-protective mode. By this reaction, we become energized and we prepare to protect ourselves when threatened. All this takes place without our thinking about it, and once the fight-or-flight reaction begins it cannot readily be stopped.
The fear and survival reactions in children involve the same body-mind mechanisms as they do in adults. And when these reactions are chronic (due to frequent threats or stresses), they can lead to the next stage of symptoms, which includes difficulty concentrating, memory impairment, fatigue, physical complaints, anxiety and phobias, and difficulty relaxing. In children, these symptoms may manifest as low motivation, deterioration in school grades, or social problems.
Anxiety is related to fear. But while fear is an appropriate reaction to clear danger or actual threat, anxiety is the same reaction to a perception of danger or threat. In other words, anxiety is the fear reaction triggered by the possibility of danger or threat. In children, dangers and threats consist of anything that jeopardizes emotional security or physical dependency. They can include sexual or physical abuse, witnessing violence, divorce of parents, being bullied, losing a parent, injury or serious illness, and other stresses. The high rate of such stresses and threats facing today's children is the main reason why anxiety disorders have become so prevalent.
Anxiety tends to develop after a child experiences a frightening or traumatic situation. For example, a child who has a traumatic social experience (which can range from social embarrassment to blatant physical or sexual abuse) may initially have a fear reaction, but the lingering aftermath may include persistent worry, concern, and dread-in a word, anxiety.
The survival reaction takes no chances, occurs quickly, and gives little time for thought. Furthermore, for self-preservation the brain's survival center makes no distinction between possible and actual threat: Taking time to think or evaluate may be costly when faced with actual threat or danger. But the concept of "threat" today is often ambiguous or uncertain. Another reason why anxiety is so prevalent right now is that global stress and perceived threats are increasing, and they are magnified by vivid media coverage. As a result, we learn to see many situations as life-threatening. Indeed, many people recognize that their anxiety is irrational, but they are still unable to control it.
Anxiety can be explained to children by asking them to imagine being a small animal, such as a rabbit, living in nature where there is a clearly established system of predators and prey. When a vulnerable animal is threatened, it senses danger and hides until it is safe again. When it is safe, the rabbit relaxes and resumes normal activities.
Threats That Lead to Anxiety in Children
Let us consider some of the stresses and threats that lead to anxiety in children, keeping in mind that a perception of danger has the same effect as an actual danger or threat. Any situation that threatens children's basic security can lead to an anxiety disorder. Divorce, for example, often involves a reduction in a child's contact with one parent and generates anxiety about whether the parents will be there to provide care and protection. During divorce children often believe that if one parent can leave, then the other parent might also leave. For young children, security is based on the depth and consistency of emotional bonding with primary caregivers, typically the parents. Therefore, by minimizing loss of contact and maximizing involvement in a child's daily life, an anxiety reaction to divorce can be reduced.
Any childhood experience involving a fear reaction or threat to security can develop into an anxiety disorder. Such experiences can include the following:
Seeing a gun or weapon
Seeing violence on television or in movies
Divorce of parents
Violence in the home (often associated with alcoholism)
Theft of personal property
Becoming sick and vomiting
A serious or painful injury
Illness in a parent
Sexual or physical abuse
Being bullied in school
Natural disaster (hurricane, flood, fire)
Terrorism or war
What is common to most anxiety disorders is an intense emotional response to an experience, such as one of the events listed above, followed by worrying about a reoccurrence. However, it can sometimes be difficult to pinpoint the initial anxiety reaction, especially since anxious children are generally more aware of their reactions and emotions than of their cause. The causes of anxiety in children are discussed in more depth in Part II of this book.
The Role of Stress in Children's Anxiety
As a source of anxiety in children, stress can be any situation that involves unusual demands, strenuous effort, adjustments, or change, and it can be both positive and negative. One measure of stress is the Life Change Scale, which lists life events that are considered stressful, ranked by their severity and the likelihood of their producing bodily reactions. For adults, the highest stresses include death of a loved one, serious illness in the family, divorce, and marital separation. Less devastating but still stressful are increased responsibilities at work, financial problems, and family relocation. The lower end of the stress scale includes minor traffic violations, holiday stress, and planning a vacation. The impact of stress is considered cumulative. That is, a combination of several stresses during a period of approximately one year can cause a person to develop symptoms such as anxiety. By taking appropriate action, however, a person can reduce the impact of stress. Exercise, getting enough sleep, psychotherapy, reducing commitments and responsibilities, and other steps can offset the effects of stress.
The concepts used in the Life Change Scale can be applied to children. Table 1.1 lists many stresses that affect children, as well as a scoring system for estimating the likelihood of stress-related symptoms. Note that the stresses with highest impact include loss of a parent, divorce/separation, school stress, and family issues, all of which are addressed at various points in this book. Keep in mind that managing stress in children will lower the risks for physical or emotional problems. Suggestions for how to do this are included throughout the book.
Another source of stress is the recurring demands of daily life that we assume are normal and that fill our schedules with increasing speed and intensity. For adults, such demands include working for a living, raising children, maintaining a home, doing the laundry, shopping for food, cooking and kitchen cleanup, recreation, and even socializing. Recognizing these demands as sources of stress, biologist Hans Selye wrote a now classic book on stress, titled The Stress of Life. He asserted that stress is an inherent and inevitable part of life.
Furthermore, in modern life our efforts to manage stress can become another source of stress. Our recreational activities, exercise, and even vacations are often approached with the same time pressure as the rest of our daily lives.
Children today can be as rushed and stressed as their parents, and this is often because of their parents' stress. In an effort to provide opportunities and to jump-start their children's success in life, many parents are overloading kids with extracurricular activities such as sports, music, art, and various other social, religious, educational, and recreational activities. The net result is stress in children who have too little personal time for relaxation and stress recovery. Chances are high that if the parents are feeling stressed and overwhelmed, their children are also feeling the same way.
On the other hand, stress itself does not necessarily lead to anxiety. We can handle stress without negative impact if we recover regularly. If we do this, our stress-recovery pattern becomes balanced, our energy reserves are replenished, and we can deal effectively with more stress. Some steps people can take toward stress recovery include regular exercise, adequate sleep and rest, proper nutrition, effective time management, positive social activities, and meditation. We will discuss these and other steps in later chapters.
However, when our recovery practices fail to keep pace with the demands of stress, we gradually deplete our energy reserves and wear down our resistance. We then go out of balance and develop early warning signals of stress overload in the form of mild symptoms. Headaches, backaches, difficulty relaxing, muscle twitches, and low energy can all be early warning signals of stress overload. When these signals are ignored, they may intensify until we are forced to notice and respond. This often occurs as anxiety, such as panic attacks, nightmares, or phobias. Why some children develop an anxiety disorder instead of a different set of symptoms is determined by personality type and family circumstances, as we will discuss later.
Emotions and Anxiety
In the preceding sections we have taken a preliminary look at some of the traumatic or threatening events that can cause anxiety in children. Those events can be thought of as external triggers of anxiety-that is, circumstances occurring in a child's environment. But internal experiences, such as strong emotions, can also trigger anxiety. Actually, it would be more accurate to say that emotional arousal involves the same bodily reactions as the fight-or-flight response. Anger, for example, involves arousal in the form of muscle tension, increased heart rate, increased blood pressure, and intensification of breathing-effects associated with the fight-or-flight response. Excitement is another easily recognizable example. But other emotions, such as guilt, grief, and shame, can also involve bodily reactions similar to those triggered by the fight-or-flight response.
The distinction between external danger and strong internal emotions can be confusing, especially for the sensitive, anxiety-prone child, who tends to fear strong bodily reactions. As we will see in Chapter 5, many anxiety sufferers are raised in families where emotions are not discussed, or where they are expressed inappropriately, or even actively discouraged. In some families, strong feelings, such as anger, may be associated with out-of-control behavior. For these reasons, many people who develop anxiety disorders tend to be fearful of strong emotions. The onset of emotional states can therefore signal danger and trigger anxiety. To counteract this pattern, and to help children become more comfortable with emotions and how to express them, psychotherapy for anxious children usually includes education about emotions and communication skills.
Some of the techniques used to teach these skills are described in Chapter 11, which discusses psychotherapy for children with anxiety, as well as in Chapter 12, where these skills are outlined in language appropriate for young people. In addition, some of the cases described in Chapter 13 include details about the emotional and communication techniques that were used in the therapy.
Cognitive Patterns and Anxiety
Another internal source of anxiety that will be emphasized in this book are the patterns of thinking that I find characteristic of many child anxiety cases. Some of these cognitive patterns are found among the criteria for diagnosing anxiety disorders, and they are covered in detail in the next chapter. Worry, for example, is the hallmark feature of overanxious disorder, the children's version of generalized anxiety disorder. Anxiety-producing cognitive patterns also include perfectionism, "shoulds" or "musts," negative thinking, and all-or-nothing thinking. These thought patterns are described in more detail in Chapter 3, as part of the personality style of anxious children, and at that point some techniques for tempering them will be introduced. In Part III of the book, where we look at psychotherapy for anxious children and at some specific cases, a number of techniques for changing cognitive patterns will be described. Collectively, those techniques are known as cognitive-behavioral therapy.
Excerpted from The Worried Child by PAUL FOXMAN Copyright © 2004 by Paul Foxman, Ph.D.. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
|How This Book Can Help||4|
|My Experience with Anxiety||5|
|Part I||Anxiety in Children: When Is It Normal, When Is It a Disorder?||7|
|Chapter 1||What Is Anxiety?||8|
|What Is Anxiety and Why Is It So Prevalent Today?||9|
|Threats That Lead to Anxiety in Children||11|
|The Role of Stress in Children's Anxiety||12|
|Emotions and Anxiety||16|
|Cognitive Patterns and Anxiety||17|
|Three Ingredients in Anxiety||17|
|Chapter 2||Childhood Anxiety Disorders||21|
|Children's Normal Fears||21|
|Anxiety Disorders in Children||23|
|Mixed Anxiety Disorders||37|
|Other Disorders Associated with Anxiety||38|
|Anxiety Disorders at Different Ages||38|
|Chapter 3||Personality Traits in Anxious Children||41|
|The "Anxiety Personality Style"||41|
|Cognitive Patterns of the Anxious Child||43|
|Assets and Liabilities of the Anxiety Personality Style||44|
|Identifying Anxious Children in School and Day Care||44|
|What Parents Can Do||45|
|Part II||Sources of Anxiety in Children and How You Can Help to Counteract Them||53|
|Chapter 4||Before and Beyond Birth: Developmental Stages and the Roots of Anxiety||54|
|Brain Development and Anxiety||62|
|Early Child Development and Anxiety||65|
|What Parents Can Do||68|
|Chapter 5||The Family and Anxiety in Children||70|
|Families and Feelings||85|
|Other Family Patterns and Styles||87|
|Drug and Alcohol Abuse||90|
|Religion and Spirituality||91|
|Parents' Own Anxiety||99|
|Stress in Parents||103|
|Other Things Parents Can Do||107|
|Chapter 6||Society and Anxiety||110|
|Dangers in the Environment||111|
|Lack of Health Care for Children||114|
|Violations of Trust and Power||123|
|Children as Exploited Consumers||125|
|Drug and Alcohol Issues||127|
|Obesity and Related Health Problems||128|
|Chapter 7||Terrorism, War, and Child Anxiety||131|
|My Anxiety about War||131|
|Government Responses to Terrorism||136|
|What Parents Can Do||139|
|Chapter 8||Anxiety in School||144|
|Grading Our Schools||144|
|How Schools Create Stress and Anxiety in Children||145|
|Social Stress and Anxiety||152|
|Bullying, Teasing, and Violence in Schools||153|
|Theft in Schools||154|
|Academic Sources of Anxiety||155|
|Homework Stress and Anxiety||155|
|When Does College Begin?||156|
|What Parents Can Do||159|
|Chapter 9||The Media and Child Anxiety||162|
|Television and Movies||162|
|Inadequate Rating Systems||172|
|What Parents Can Do||173|
|Part III||Treating Anxiety in Children||177|
|Chapter 10||Biochemistry, Medication, and Nature's Remedies||178|
|Help Often Begins with the Family Doctor||178|
|Biochemical Approach to Treating Anxiety||180|
|Brief History of Drug Treatment for Anxiety||181|
|Pros and Cons of Medication for Children's Anxiety||181|
|Chapter 11||Psychotherapy for Anxious Children||192|
|When to Seek Therapy||192|
|How to Choose a Therapist for Your Anxious Child||193|
|How Therapists Evaluate Anxious Children||194|
|Types of Therapy for Anxious Children||195|
|Components of Therapy for Anxious Children||199|
|Health-Insurance and Managed-Care Issues||213|
|Chapter 12||A Chapter for Young People: What You Can Do to Help Treat Your Own Anxiety||216|
|What's Good about Anxiety?||216|
|What You Should Know about Anxiety||217|
|How to Relax and Why||220|
|How to Control Stress||222|
|Are You Having Fun Yet?||224|
|Are You "Too Sensitive"?||225|
|Are You a Perfectionist?||226|
|Do You Worry a Lot?||227|
|How to Stop Unwanted Thoughts or Behavior||228|
|How to Speak Up for Yourself||229|
|Are Your Parents Divorced?||230|
|Does School Make You Anxious or Stressed?||231|
|Bad Things That Can Happen and What You Can Do||233|
|How Do You Feel?||234|
|The Good and Bad News about Television, Movies, Video Games, and Music||235|
|Good Foods and Bad Foods for Anxiety||238|
|Should You Get Professional Help?||240|
|Medicine for Anxiety||241|
|Chapter 13||Case Examples||243|
|Group Therapy for Adolescent Social Anxiety||248|
|Panic Disorder and Separation Anxiety||252|
|Divorce, Separation Anxiety, and Emetophobia||256|
|Generalized Anxiety Disorder (GAD) and Anxiety Associated with a Medical Condition||257|
|Quick Cure for Generalized Anxiety Disorder||259|
|PTSD with Mixed Anxiety Disorder||260|
|Appendix||What Schools Can Do to Reduce Anxiety||264|
|Alternatives to Tests and Numerical Grades||264|
|Group Learning and Multi-Age Classes||266|
|Safety and Violence||269|
|Relationship Between School and Family||270|
|Use of Technology||273|
Posted February 23, 2008
How do I know if my child is worried or anxious? What causes a child to worry or become anxious? How can I talk to her about the problem? What resources are there for us? These and many other questions will be answered in the book The Worried Child by Paul Foxman PHD. Dr Foxman takes a gentle and common sense approach to helping the child and the family in this situation. He explains that there are many things that can cause stress and anxiety for a child, and discusses the impact it has on their daily lives and well being. He explains the difference between the normal every day stress and worry a child might feel and when it crosses the line to become a disorder that needs to be reckoned with. He presents information on how to recognize if your child is showing symptoms of anxiety. Issues from home life to school to the possible sexual abuse are addressed in these pages. disorders from Generalized Anxiety to OCD, Panic and Seperation anxiety explained. There is imformation on conflict resolution, which can be so important, not just for our children, but for ourselves. All types of therapy are discussed, from conventional 'talk therapy' to medications, and alternatives such as herbals, flower remedies and homeopathy. No matter what your personal philosophy of treatment might be, this book will help you along the way. The importance of good nutrition, and relaxation is emphasized. From the birth, to the child in college. Fears and stressors are discussed and possible solutions for allaying them are suggested. The important matter of bonding is addressed. Not just bonding with the child before and at birth, but staying connected with her throughout the years. This is a wonderful handbook for anyone with a child of any age. It gives calm and reassuring suggestions on how to handle those bumps in the road that we all face at some times or another. I highly recommend this to anyone who has or works with a child of any age.
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