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The Worried Child: Recognizing Anxiety in Children and Helping Them Heal


Anxiety in children diminishes their intellectual, emotional and social development, as well as physical health. Author Paul Foxman believes there are three interacting ingredients that contribute to anxiety in children -- biological sensitivity, personality, and stress overload.

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, ...

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The Worried Child: Recognizing Anxiety in Children and Helping Them Heal

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Anxiety in children diminishes their intellectual, emotional and social development, as well as physical health. Author Paul Foxman believes there are three interacting ingredients that contribute to anxiety in children -- biological sensitivity, personality, and stress overload.

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.

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Editorial Reviews

Publishers Weekly
Psychologist Foxman (Dancing with Fear) has penned a caring yet straightforward book about helping kids deal with feelings of angst. Noting that one in five children suffers from a mental health problem, Foxman says some experts call today's children the "shell-shocked" generation. Divorce, crime, violence, failing schools, the threat of terrorism and drug abuse are a few of the contemporary issues often magnified for kids by vivid media coverage, and they've contributed to the rise of stress and anxiety among children, says Foxman. The author, who suffered from anxiety as a child and as an adult, melds personal and professional experience as he differentiates between normal and abnormal worrying (the latter involves a degree and frequency that interferes with daily routines). According to Foxman, three factors coincide to create an anxious child: biological sensitivity, personality and stress. Children who are perfectionists, who are overly sensitive to criticism and have difficulty with assertiveness, among other traits, are prone to anxiety, though many of the worried child's personality traits, such as intelligence and a strong sense of responsibility, are positive. In addition to global issues such as war, terrorism and violence, Foxman delves into how personal crises (e.g., divorce, sexual abuse and school-related stress) can affect children, and suggests how parents can help and when they should seek therapy for their child. He rounds out this informative guide with a chapter for children that speaks directly to young readers. (Mar.) Copyright 2004 Reed Business Information.
Library Journal
Psychologist Foxman (director, Ctr. for Anxiety Disorders, Burlington, VT; Dancing with Fear) addresses a problem in which he specializes: anxiety in children. Parents will find an indispensable chapter on the components of childhood anxiety and the personality profile that suggests a predisposition toward it. Drawing on case studies, Foxman describes various types of childhood anxiety disorders in addition to chronicling danger signs which may indicate that a child needs professional help. Moreover, the author devotes a substantial portion of this book to sources of anxiety in children. Biology, family dynamics, sociocultural factors, school, and the media can generate anxiety, which can be counteracted by the biochemical and psychotherapeutic treatment approaches set forth in Part 3. Best of all, Foxman includes a helpful chapter written for anxious young people in language easily accessible to them. This superb book belongs on the shelves of public libraries alongside Katharina Manassis's Keys to Parenting Your Anxious Child and Elizabeth DuPont Spencer's The Anxiety Cure for Kids: A Guide for Parents.-Lynne F. Maxwell, Villanova Univ. Sch. of Law Lib., PA Copyright 2004 Reed Business Information.
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Product Details

  • ISBN-13: 9780897934206
  • Publisher: Turner Publishing Company
  • Publication date: 2/15/2004
  • Pages: 304
  • Sales rank: 151,450
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.90 (d)

Read an Excerpt

The Worried Child

Recognizing Anxiety in Children and Helping Them Heal

Hunter House Inc., Publishers

Copyright © 2004 Paul Foxman, Ph.D.
All right reserved.

ISBN: 978-0-89793-420-6

Chapter One

What Is Anxiety?

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.

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Table of Contents

Foreword x
Acknowledgments xii
Introduction 1
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
Secondary Depression 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
Bonding 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
Divorce 71
Child Abuse 81
Performance Pressure 83
Families and Feelings 85
Other Family Patterns and Styles 87
Sexuality 88
Drug and Alcohol Abuse 90
Religion and Spirituality 91
Discipline 95
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
Natural Disasters 112
Lack of Health Care for Children 114
Sexual Abuse 116
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
Terrorism 134
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
Learning Styles 146
Multiple Intelligences 147
Emotional Intelligence 149
Personality Integration 150
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
Music 168
Video Games 170
Inadequate Rating Systems 172
Internet Surfing 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
Alternative-Medicine Approaches 184
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
Treatment Progress 212
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
Social Anxiety 243
Generalized Anxiety 244
Obsessive-Compulsive Disorder 246
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
In Closing 263
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
Curriculum Considerations 272
Use of Technology 273
Honor Code 273
Resources 275
Bibliography 279
Index 283
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  • Anonymous

    Posted February 23, 2008

    A Helpful Handbook for Parents

    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.

    4 out of 4 people found this review helpful.

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