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

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

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

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

by Paul Foxman

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Overview

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.

Product Details

ISBN-13: 9780897935913
Publisher: Turner Publishing Company
Publication date: 01/01/2011
Sold by: Barnes & Noble
Format: eBook
Pages: 304
File size: 803 KB

About the Author

Paul Foxman, Ph.D. is a psychologist and Director of the Center for Anxiety Disorders in Vermont. In his clinical practice, Dr. Foxman specializes in anxiety disorders with children and adults, stress, and relationships. He supervises and provides professional training for psychotherapists, and he has served as a media consultant on stress and anxiety. A graduate of Yale University, Dr. Foxman earned his Ph.D. in clinical psychology at Vanderbilt University. His child psychology background includes training at the Kennedy Child Study Center. Paul Foxman lives in Burlington, Vermont.

Read an Excerpt

The Worried Child

Recognizing Anxiety in Children and Helping Them Heal
By PAUL FOXMAN

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.

(Continues...)



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.

Table of Contents

Forewordx
Acknowledgmentsxii
Introduction1
How This Book Can Help4
My Experience with Anxiety5
Part IAnxiety in Children: When Is It Normal, When Is It a Disorder?7
Chapter 1What Is Anxiety?8
What Is Anxiety and Why Is It So Prevalent Today?9
Threats That Lead to Anxiety in Children11
The Role of Stress in Children's Anxiety12
Emotions and Anxiety16
Cognitive Patterns and Anxiety17
Three Ingredients in Anxiety17
Chapter 2Childhood Anxiety Disorders21
Children's Normal Fears21
Anxiety Disorders in Children23
Mixed Anxiety Disorders37
Secondary Depression37
Other Disorders Associated with Anxiety38
Anxiety Disorders at Different Ages38
Chapter 3Personality Traits in Anxious Children41
The "Anxiety Personality Style"41
Cognitive Patterns of the Anxious Child43
Assets and Liabilities of the Anxiety Personality Style44
Identifying Anxious Children in School and Day Care44
What Parents Can Do45
Part IISources of Anxiety in Children and How You Can Help to Counteract Them53
Chapter 4Before and Beyond Birth: Developmental Stages and the Roots of Anxiety54
Bonding54
Brain Development and Anxiety62
Early Child Development and Anxiety65
What Parents Can Do68
Chapter 5The Family and Anxiety in Children70
Divorce71
Child Abuse81
Performance Pressure83
Families and Feelings85
Other Family Patterns and Styles87
Sexuality88
Drug and Alcohol Abuse90
Religion and Spirituality91
Discipline95
Parents' Own Anxiety99
Stress in Parents103
Other Things Parents Can Do107
Chapter 6Society and Anxiety110
Dangers in the Environment111
Natural Disasters112
Lack of Health Care for Children114
Sexual Abuse116
Violations of Trust and Power123
Children as Exploited Consumers125
Drug and Alcohol Issues127
Obesity and Related Health Problems128
Chapter 7Terrorism, War, and Child Anxiety131
My Anxiety about War131
Terrorism134
Government Responses to Terrorism136
What Parents Can Do139
Chapter 8Anxiety in School144
Grading Our Schools144
How Schools Create Stress and Anxiety in Children145
Learning Styles146
Multiple Intelligences147
Emotional Intelligence149
Personality Integration150
Social Stress and Anxiety152
Bullying, Teasing, and Violence in Schools153
Theft in Schools154
Academic Sources of Anxiety155
Homework Stress and Anxiety155
When Does College Begin?156
What Parents Can Do159
Chapter 9The Media and Child Anxiety162
Television and Movies162
Music168
Video Games170
Inadequate Rating Systems172
Internet Surfing172
What Parents Can Do173
Part IIITreating Anxiety in Children177
Chapter 10Biochemistry, Medication, and Nature's Remedies178
Help Often Begins with the Family Doctor178
Biochemical Approach to Treating Anxiety180
Brief History of Drug Treatment for Anxiety181
Pros and Cons of Medication for Children's Anxiety181
Alternative-Medicine Approaches184
Chapter 11Psychotherapy for Anxious Children192
When to Seek Therapy192
How to Choose a Therapist for Your Anxious Child193
How Therapists Evaluate Anxious Children194
Types of Therapy for Anxious Children195
Components of Therapy for Anxious Children199
Treatment Progress212
Health-Insurance and Managed-Care Issues213
Chapter 12A Chapter for Young People: What You Can Do to Help Treat Your Own Anxiety216
What's Good about Anxiety?216
What You Should Know about Anxiety217
How to Relax and Why220
How to Control Stress222
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 Behavior228
How to Speak Up for Yourself229
Are Your Parents Divorced?230
Does School Make You Anxious or Stressed?231
Bad Things That Can Happen and What You Can Do233
How Do You Feel?234
The Good and Bad News about Television, Movies, Video Games, and Music235
Good Foods and Bad Foods for Anxiety238
Should You Get Professional Help?240
Medicine for Anxiety241
Chapter 13Case Examples243
Social Anxiety243
Generalized Anxiety244
Obsessive-Compulsive Disorder246
Group Therapy for Adolescent Social Anxiety248
Panic Disorder and Separation Anxiety252
Divorce, Separation Anxiety, and Emetophobia256
Generalized Anxiety Disorder (GAD) and Anxiety Associated with a Medical Condition257
Quick Cure for Generalized Anxiety Disorder259
PTSD with Mixed Anxiety Disorder260
In Closing263
AppendixWhat Schools Can Do to Reduce Anxiety264
Alternatives to Tests and Numerical Grades264
Group Learning and Multi-Age Classes266
Safety and Violence269
Relationship Between School and Family270
Curriculum Considerations272
Use of Technology273
Honor Code273
Resources275
Bibliography279
Index283
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