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When our children are born, we do everything we can to make sure they have love, food, clothing, and shelter. But despite all this, one in five children today suffers from a diagnosed anxiety disorder, and countless others suffer from anxiety that interferes with critical social, academic, and physical development. Dr. Donna Pincus, nationally recognized childhood anxiety expert, is here to help. In Growing Up Brave, Dr. Pincus helps parents identify and understand anxiety in their children, outlines effective and convenient parenting techniques for reducing anxiety, and shows parents how to promote bravery for long-term confidence. From trouble sleeping and separation anxiety to social anxiety or panic attacks, Growing Up Brave provides an essential toolkit for instilling happiness and confidence for childhood and beyond.
|Publisher:||Little, Brown and Company|
|Product dimensions:||9.40(w) x 6.00(h) x 1.20(d)|
About the Author
Dr. Donna Pincus is the Director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University. She has appeared on The Today Show, Good Morning America, 20/20, and more. Her work has appeared in The Huffington Post, Psychology Today, Boston Globe Sunday Magazine, and more. She lives outside Boston, MA.
Read an Excerpt
Growing Up BraveExpert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety
By Donna B. Pincus
Little, Brown and CompanyCopyright © 2012 Donna B. Pincus
All right reserved.
UNDERSTANDING CHILDHOOD ANXIETY
The Brave Child
Learning to Cope with the Range of Human Emotions
We all want our children to enjoy a happy, carefree childhood. But that goal can be hard to achieve. From packed schedules and demanding jobs to family complications, economic pressures, illnesses, and on and on, parents today live under a barrage of stressors. So do our kids. Cable television and the Internet deliver a relentless stream of anxiety-provoking news and images into our homes, where impressionable children struggle to make sense of reports about wars, terrorism, violent crimes, environmental disasters.
Then there are the everyday, personal worries and tensions of childhood. Your son has a bossy peer whom he has to sit next to. Your daughter wasn’t invited to a birthday party. The first day of kindergarten is looming. A math test is coming up.
Anxiety is real. It’s not all bad; in fact, this completely normal human emotion is not only unavoidable, but it’s a necessary and useful part of life. Most children figure out how not to let their fears get the better of them. Others have a harder time. And for some, persistent, uncontrolled anxieties make them feel miserable, interfere with age-appropriate development, and cause their parents endless worry and frustration.
In Growing Up Brave, I want to share with you this good and hopeful message:
Children with extreme anxiety or anxiety disorders can get better.
We are learning more all the time about what helps a child get better.
Parents—not therapy, not prescription medications—can be the key ingredient in how successfully a child or adolescent begins to approach the world with greater joy and confidence.
In my years as a clinical psychologist working with hundreds of children and families, and in league with other professionals at the forefront of advances in treating anxiety disorders in young people, I have seen again and again the truly life-changing results when parents and children put into practice some relatively simple skills.
Growing Up Brave: What Does It Mean?
A common quick-to-come-to-mind notion is that bravery means not being afraid. “You’re afraid of the water? Just jump right in. Get over it. There’s nothing to be afraid of! Go ahead. Do it.”
Of course, there are things to be afraid of. Parents know that, children know that. And some things it’s right to be afraid of. But kids who are prone to anxiety fear too much, including situations and objects that will bring them no harm.
When I talk about a child growing up brave, I mean one who over time develops a solid sense of self-efficacy. The psychologist Albert Bandura, sometimes called the father of self-efficacy, writes: “People with high assurance in their capabilities approach difficult tasks as challenges to be mastered rather than as threats to be avoided.”
A brave child navigates tough situations, even if he worries that every other kid he knows seems to have no problem with them. He learns to cope with his emotions, no matter what they are or how uncomfortable they make him. He confronts what he’s most afraid of, and does not let what’s stressful in the world stop him from taking steps, moving forward, and participating in his life. He knows that some things are hard, but even when his brain is saying, You can’t do this, he develops the personal resources to deal with stress, with daily hassles, and with what frightens him. He learns to be accepting of himself; he feels good about his accomplishments.
That is what you hope to see in your child, the conviction that he can manage whatever comes his way. You play an active role in helping him get there. Part of any parent’s job is to encourage a child to feel there’s nowhere he can’t go—within the context, of course, of teaching what’s truly not safe or not appropriate. It’s not safe to go off with strangers, but it is safe to walk into the kindergarten classroom even though mom won’t be staying with you and you don’t know the other kids. You feel worried about going on a playdate, but being a little worried doesn’t have to stop you from doing it. You’re afraid of the dark and bedtime, but you can sleep and you’ll wake up in the morning feeling just fine.
That’s what anxious kids want to know. When I work with children, I sometimes ask them what it means to be brave. We talk about who they consider brave people, even among the characters they’ve met in books and movies. I ask, “What is it about that person that you admire?” Usually, the brave one is identified as being strong. Children tell me, “He can do anything, he’s strong, he has a lot of confidence.” They say they wish they were more that way themselves.
In gaining self-confidence, with parents’ help, children realize that their emotions and sensitivities don’t have to derail them from activities that may be a required part of growing up or may just be a lot of fun. And parents can help children learn to go through life without having one eye constantly on what’s around the corner or what’s ahead. Bravery speaks to the idea of being in the present moment. Anxiety, after all, is a future-oriented emotion. The anxious child is always anticipating, mentally putting himself in an expected situation that he is sure will make him feel just terrible. When you help your child become brave, he discovers that even if you’re not around, he has the ability to calm himself, to notice situations and avoid the ones that are not safe and approach the ones that are okay, even if it’s difficult.
All this is kind of a tall order, or at least a challenge, for us parents. We’re protective. It hurts to see your daughter sitting tearfully next to you at the birthday party while all the other little guests are playing musical chairs. It’s painful—and maddening or frightening—to watch your son obsessing over routine activities and engaging in compulsive behaviors that may make him seem strange and isolate him from his peers.
The first step in helping your child get control of his emotions is to deal with yours, by appreciating the role of anxiety in life.
Anxiety: A Normal Human Emotion
Anxiety or excessive fearfulness in a child is difficult for parents to confront. We have a hard time with it. We tend to yank our kids back from the situations or objects that are causing them fear, yet we don’t react that way with other emotions. If a child is sad, we feel comfortable telling him it’s all right, everybody feels sad sometimes, it’s okay to cry. If he’s angry, well, everybody gets mad sometimes, being angry doesn’t mean he’s bad or naughty, we just don’t hit people.
When a child says he’s afraid, our instinct is to wave it off: “There’s nothing to be afraid of, don’t worry, relax.” He talks about having a frightening dream: “It’s not real, come on, we’ll make some cocoa.” He says dogs are scary: “That’s all right, you don’t have to meet any dogs.”
Besides having a tendency to just shoo them away, parents often misinterpret signs of anxiety—the behaviors that worried kids use as coping mechanisms, such as avoidance, physical complaints, crying, tantrums, withdrawal, and clinging—as intrinsic characteristics, “just his personality.” Family members, teachers, too, will describe a child as “shy” or say he’s “always been a fussy kid” or is “going through a phase.”
But fear is normal. In fact, our society has somewhat of a fascination with this emotion. The feelings that are associated with anxiety can be exhilarating. Many children become really excited about Halloween, for example, about all the neat, spooky, ghosty, witchy creatures, and how much fun they are. Kids are intrigued by the anglerfish with the gigantic, scary teeth in the movie Finding Nemo. They’re thrilled by a roller-coaster ride. Many of us adults actively seek out the sensation of fear. We’ll go mountain climbing, skydiving.
So fear and anxiety are natural, part of being human. Sometimes they’re actually enjoyable. Sometimes they can be helpful. When I first work with a child, we often start off talking about “emotion identification” (and many children, even older ones, to their detriment, don’t possess a “feeling vocabulary”; they don’t understand the full range of human emotions). I ask the child to describe the different emotions she experiences. What do they feel like? With older kids, I might say, “Why would I not want to take away all your anxiety?”
We discuss the idea that if all her anxiety were eliminated, she wouldn’t be safe anymore. She wouldn’t know to stop and lurch back when a car came rushing at her. Being afraid of getting hit by a car is obviously what helps her move out of the way. That’s what we know as the “fight-or-flight response,” which prepares her body to confront the threat and deal with it or to leave the scene as quickly as possible. A little anxiety also enables people to perform better; she can run a bit faster in a competitive race, do a bit better on a test. It can put us on heightened alert in a good way.
The fact that we know certain fears are developmentally appropriate and are experienced across all cultures makes us understand that they are almost hard-wired, or part of the chemistry of the brain. It’s adaptive to become afraid of some things; it’s how we’re supposed to be.
When fears persist, are not age-appropriate, or interfere with daily functioning, however, and when they are undetected, untreated, or misunderstood, a child is at risk in several ways. One teenager’s story demonstrates that risk.
When Anxious Feelings Take Over
When 15-year-old Leah came to our clinic for treatment for panic disorder, the girl had just been released from a two-week inpatient program after her parents discovered she’d been skipping school to hang out in the park drinking and smoking pot. In the program, Leah had admitted that she used drugs and alcohol to “numb out” the stress she felt about school and social situations. She told her parents and therapist that simply walking into a classroom would make her heart start to race, and she’d feel so nauseated that she thought she might throw up. She was always afraid of having a panic attack.
Smoking a joint before the day began became a ritual that allowed her to get herself into the school building. At parties, she’d drink heavily in order to lessen her fear that no one would talk to her. She was associating with a group of kids who were making similarly bad choices because she was convinced no one wanted to be friends with her. Leah avoided many social situations out of terror that she’d panic and embarrass herself.
Her mom and dad were shocked to learn how Leah felt. They thought she was just “testing the waters,” playing at being an indifferent and rebellious teen. They never considered that their daughter was desperately trying to manage the high levels of anxiety that made her everyday life unbearably stressful.
But in my office that day, Leah told all three of us she couldn’t remember ever feeling any other way.
Anxiety and Social Development
Childhood social anxiety tends to become apparent when children first enter social situations. By age three, they are moving away from parallel play (alongside other children with minimal interaction) to social play with peers. They’re hard at work developing the skills that allow them to separate psychologically from the caregivers they depend on, growing in autonomy and self-esteem.
Observe in any preschool or playgroup on any day, and you will likely see kids gather in the dress-up areas, assigning roles and costumes: “You be the mom and I’ll be the dad and Rachel can be the kitty.” They fully inhabit imaginary worlds, learning to adapt to one another’s personalities and styles. There is often also a child or two who are reluctant to enter the fantasy play. They hang back, or seek out the teacher for special attention, or hide in a corner with a picture book.
Such behavior is not always cause for alarm. Some children do hesitate to engage in social play, and there are plenty of boys and girls who feel shy in new situations, or are overwhelmed by kids whose play-style differs from their own. The child who simply has a shy temperament, however, will usually eventually warm to social situations if given time and encouragement.
Leah’s mother remembered how her daughter would cling to her when she was a young child, insisting that mom stay during playdates. Although she was chatty and playful at home, Leah refused to go to friends’ houses. When she did have friends over to her home, she was sometimes reluctant to play with them unless her mother made an effort to engage both little girls by participating in make-believe games. “Leah loved to be the princess,” her mother recalled. “But only if I would join in and be the dragon, or the queen, or whatever extra character she needed.” On the rare occasions when mom was successful in initiating shared play between Leah and a friend, and was able to leave the room, it wouldn’t be long before the friend came looking for her with the complaint that “Leah won’t play unless you do.”
If her parents had brought Leah to see me when she was a preschooler, I would have asked them whether Leah found other situations difficult. I would also have asked about the family’s nighttime routine. It would not have surprised me to hear that the child insisted on mom or dad sitting with her or even climbing into bed with her until she was asleep. They might have noted that Leah worried excessively that something bad would happen to her or her parents if they weren’t all together. And it’s likely that during our interview, her mother would have mentioned difficulties with drop-off at school or daily requests to stay home from activities.
These are typical behaviors demonstrated by children with separation anxiety. In our work with adolescents who are diagnosed with panic disorder, we will sometimes hear the teen report having had problems with just these issues as a child.
Leah’s parents characterized their young daughter as “a little shy,” and they assumed she’d become more outgoing as she got older. They often allowed her to evade situations that distressed her, letting her stay home from birthday parties, for example. The truth was that Leah’s anxiety back then was already interfering with her ability to engage with others. Over time, she internalized her parents’ message that she was shy, and the more she avoided social encounters and separation situations, the less chance she had to experience success and develop confidence.
Socially anxious children find personal interactions nerve-wracking, whether it’s meeting new school classmates or trying to join a group on the playground. Paralyzed by a fear of saying or doing the wrong thing and worried about being disliked, they turn away from the peer interactions necessary to developing a healthy sense of social identity. Consequently, they often fall behind their age-mates in peer relationship skills.
It’s understandable that parents might question whether social deficits caused by childhood fears or worries should be of concern during the early years. The fact is, by the time a child begins elementary school, they can emerge as real liabilities.
Anxiety and Academics
If a child carries debilitating anxiety into the school years, she may also face challenges in the classroom.
Studies show that children learn best when they are alert and relaxed, but have trouble storing and retrieving information when excessively stressed. For optimal learning to take place, kids need to be focused and feel safe, and for some anxious kids those two conditions can be impossible to achieve in the classroom environment.
In elementary school, Leah said, she was always terrified that she’d be called on by the teacher, because this meant that the other kids would shift their attention to her. She was afraid to make a mistake, or ask for extra time to figure out an answer. As a result, her earliest classroom memories were of trying to be as unobtrusive as possible. Because all her mental energy was directed at staying invisible, she couldn’t concentrate well on anything that was taught.
Teachers recognized that Leah was a bright child from an educated, middle-class family that wanted her to succeed. Despite her anxiety, her work was fine. She was not disruptive, and because she rarely interacted with the other children she was never a source of social drama. Throughout her grade school years, teachers attributed Leah’s lack of participation to the fact that she was just quiet.
Next to parents, teachers are on the front lines for identifying troubles. But, quite understandably, they are inclined to focus on children who upset the classroom by being oppositional. They also watch for indications of learning disabilities—delays in communication skills; slow language development; difficulty in forming words, writing, or understanding others; or trouble with spelling, math, and grammar. Students who consistently lose materials, or who do the work but forget to hand it in, may also be on a teacher’s radar.
In a busy classroom, with perhaps a couple dozen children to monitor, a teacher might not connect certain behaviors, such as asking to leave the room (by making requests for frequent bathroom passes, for example) or refusing to read aloud, to anxiety. But in fact, the actions of an anxious child can mimic many characteristics associated with learning disorders. She may be so stressed about getting the right answer on a math problem that she attempts to avoid the question altogether, telling the teacher, “I can’t do this” or “I don’t know.” Fears about reading aloud can cause a confident reader to stumble over words or even freeze to the point of being unable to speak. A child who is afraid to go to school may be so distracted in the hours before it begins that she can’t organize the materials she needs for the day and consistently leaves homework or notebooks behind.
As parents, we all have expectations for our children’s social, academic, and athletic success. We don’t often stop to consider that simply by making them attend school, we are requiring them to encounter and cope with potentially stressful events. Many children rise to the challenge, channeling their occasional nerves over tests or sports into sharpened focus and heightened response. But for anxious kids, every day brings the anticipation of inferiority, which reinforces anxiety about performance, which reinforces a reluctance to approach situations. They can begin to engage in extreme avoidance, which can take a dangerous turn in the middle and high school years.
Leah remembered middle school as a horrible experience. She did not fit in with her peers. She still had anxiety over speaking in class, and her reticence was beginning to reflect in her grades. By the late-preteen and early teen years, kids who have not developed age-appropriate social skills are typically excluded from groups and activities. At the same time, teachers may be losing patience with those children whose anxieties interfere with learning, and previously “good students” can find themselves labeled “problem students,” especially if they avoid the classroom or are frequently tardy.
Because no one had yet identified Leah’s troubles as stemming from extreme anxiety, her parents’ insistence that she start to “figure out this stuff” on her own served to reinforce the pattern of inferiority-anxiety-avoidance that had been set in her early school years. They wanted her to “get her act together,” go to her classes, and cultivate a “nice group of friends.” Leah needed but couldn’t ask for their help; she felt her parents were withdrawing from her, while they were convinced that they should practice some “tough love” in order to promote autonomy in their late-blooming daughter. This is by no means an uncommon parent-teen dynamic, and it’s not always misguided. But some teens actually need more parental support to develop self-autonomy.
By the time she reached high school, Leah had begun using alcohol in social situations to help her to relax and “fit in” and was smoking pot to “numb out” before classes. She continued to be frightened by the rush of symptoms she felt—the racing heart, the nausea—and worried constantly about having a panic attack. Ultimately, her avoidance techniques led to the chain of events that ended with her visit to my office. She was not that different from a lot of adolescents who find their way to the clinic for treatment.
Reading the Signals
After her initial interview with me, Leah was admitted to the Teen Panic Disorder program. There, she made great progress, in a relatively short space of time, in managing the feelings that had driven her to self-medicate. She learned the coping skills I will present in this book, and by the end of treatment her life had opened up considerably. She was attending school regularly and no longer smoking pot. Hers was a happy ending.
But her story has much to tell us.
When undetected or untreated, excessive anxiety can interfere with development. The parents of young people like Leah are often baffled by what’s going on and why their son or daughter is failing to thrive socially and in school. It’s also not at all unusual for kids to arrive at my office after having been through a battery of psychological and physical testing in search of answers.
And if, finally, a label like “separation anxiety” or “panic disorder” has been attached to a set of behaviors, the parents blame themselves for misinterpreting the warning signals. One of the most common remarks I hear is, “We didn’t know she was so stressed. How did we miss all this? Was there anything we could have done to help her sooner?”
There is much that can be done sooner, and sooner is better than later. Our understandable tendency as parents, as demonstrated by Leah’s story, is to shoo away early evidence of anxiety, or deny that there’s anything to worry about, or assume it’s just a passing phase. Sometimes it is just a passing phase. But many youngsters suffer greatly over insignificant situations. Nipping excessive fears and worries in the bud—through warm, empathetic, and attentive support, and through teaching a child how to deal effectively with negative emotions when they arise—works miracles in preventing small problems from getting bigger. The techniques I explain in Growing Up Brave will show you how that’s accomplished.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a skills-focused approach for combating anxiety. The child and often his parents are taught strategies for examining maladaptive thoughts and changing avoidant behaviors. The techniques are very much hands-on. CBT is not talk therapy, in which the child comes for appointments with a therapist just to discuss his feelings or the events of the week. It is not play therapy, during which a therapist observes how the child is playing and interprets what it means. Many different therapies are available; they’re not all bad, but neither are they based on hard evidence of success.
The efficacy of CBT for child anxiety disorders is supported by research. Studies—“randomized controlled trials,” as they are called—have shown that the majority of children who receive CBT are diagnosis-free or much improved after treatment and tend to maintain their gains. That’s important data. It’s why this is considered the state-of-the-art intervention, the gold standard treatment for anxiety disorders.
My work includes the development of cognitive behavioral treatments for youth with anxiety disorders, and the dissemination of these procedures to therapists and others who work with troubled kids. But I also want to get the information out to parents, and part of that message is that not all children need therapy. (In chapters 2 and 11, I outline the behavioral signs and signals that suggest a child can benefit from professional therapy.) In fact, most kids who show symptoms of anxiety just need to learn a few CBT-based skills. Some of these skills are ones that parents can teach.
Research has demonstrated that, invariably, a child’s anxious response to a situation or object he fears can be deconstructed or broken down into separate parts. We call this the “cycle of anxiety,” the interrelated influences of thoughts, feelings, and behaviors. When your child is afraid or worried, what behaviors do you see? What thoughts are on your child’s mind, and what physical sensations does he experience? I will show you how to plug these observations into the cycle so that you can start to see why he’s having the problems he’s having.
Once you understand your child, you can begin to figure out how to help by breaking the cycle. That might mean encouraging him to replace his worrisome thoughts with ones that are more realistic, or to develop the more accurate perceptions that lead to a healthier way of coping. It might mean showing him how to gain control over his physiological reactions to stressful events by learning to “ride the wave” of anxiety until his body calms down. It means helping him take small steps, one at a time, to change behaviors from avoiding or resisting situations to entering them with new courage.
These strengths and competencies will enable him to approach difficult tasks as challenges to be mastered rather than as threats to be avoided. He will build up a kind of toolbox of life skills. I like to think about teaching skills as inserting protective factors, buffering a child from the predictable stresses of the world and from the possible vulnerabilities of his nature and circumstances.
Skills-based treatment requires some motivation on a child’s part (and on that of his parents), but what I have learned in years of working with children and teens is that every fearful child wants to feel better. Every child wants to learn to be stronger.
I gave this book the title Growing Up Brave (and not, perhaps, Helping Your Child with Anxiety) to emphasize the bigger picture of the lessons it describes. You are involved in your child’s developmental stages. You are fostering a lifetime of confidence.
What’s Normal, What’s Not
Decoding Childhood Emotions, Fears, and Anxieties
At a recent birthday party for my daughter’s friend, I was standing with a group of parents, watching the children dig into the carrot cupcakes with the abandon of 4-year-olds. Some crammed whole cupcakes into their mouths, others broke off tiny pieces and nibbled at them cautiously. One little girl glanced furtively at her mom as she carefully licked off the white icing.
“Aren’t you going to try the cupcake?” her mother prodded.
The little girl shook her head emphatically: no!
“Try a taste, honey. It’s good,” the mother urged.
“I don’t want to,” her daughter said.
Mom pointed to the other kids demolishing their cake in a flurry of crumbs and smeared frosting. “Why don’t you give it a try?”
Her daughter pushed away from the table so violently that her chair fell over. She began to cry and insist that she wanted to go home right away.
The mom turned to me in exasperation. “She will only eat things that are white,” she said. “Please tell me this is just a stage, not the beginning of a food phobia or eating disorder.”
A seemingly innocuous behavior on the part of a very young child had burgeoned in this mother’s thoughts into the seeds of a major problem. I hear these parental worries whenever I give a talk or run a workshop. I am invariably questioned by parents as to whether a child’s behaviors are age-appropriate quirks or signposts of deeper troubles. They ask:
“My 3-year-old only wants dino-shaped chicken nuggets and hot dogs. Is that normal?”
“My 7-year-old daughter is resistant to wearing anything that isn’t blue, and she can’t stand tags or buttons on her clothing. Should I be concerned?”
“My 10-year-old needs constant reassurance that we’ll be okay when her dad and I go out at night. If we deviate from our plan or we’re late, she becomes agitated. Is this normal?”
“My 8-year-old still wants to sleep with a night-light. Should I let her?”
“My 12-year-old Little Leaguer has more pregame routines than a major leaguer. Should I try to break some of his habits?”
“My teenager can’t sleep the night before an exam, and it’s hurting his grades. How can I get him to just relax?”
Is it normal? What can I do?
The bottom line is that we all—adults and children—are sometimes stressed and anxious. When it comes to common childhood fears and anxieties, it is helpful and encouraging to understand that they tend to follow a particular sequence and result in specific behaviors from infancy to adolescence. And many of these fears disappear by themselves over time.
It’s normal for a 3- or 4-year-old to be afraid of the dark. A 6-year-old who is unnerved by the loud sounds and flashing lightning of a severe storm is probably working through a predictable developmental stage. A teenager who gets sweaty palms when speaking in front of her class for the first time is experiencing a reasonable level of stress, one common to many adolescents.
On the other hand, an 8-year-old who can’t sleep without a night-light and a parent present is more likely suffering from underlying worries and finds nighttime stressful. A 10-year-old who thinks that every strong wind means a tornado is imminent and who refuses to venture out in the rain is exhibiting heightened fears. The teenager who feels she needs to drink alcohol to “loosen up” at a party may be trying to cope with overwhelming anxiety.
In this chapter, we will look at what’s normal and what’s not. In talking about “what’s not,” I outline and illustrate the six most prevalent anxiety disorders experienced by children and adolescents. I hope you will use this broad spectrum of behaviors to help you recognize when your child’s fears are par for the course and when some attentive interaction on your part is needed.
But first, where does anxiety come from?
Anxiety: What Causes It?
The mother of a child brought in for therapy said she’d been thinking about this whole matter of anxiety and whether it ran in her family. She decided it did. “Practically everyone on my side, and that includes me, is a nervous Nellie. One of my uncles—this is many years ago—I think suffered a nervous breakdown, though nobody talked about it. My mother worried about everything, to the point that we couldn’t leave the house without checking ten times that the stove was off, the back door was locked, et cetera, et cetera. My older sister practically wouldn’t let her two kids out of her sight until, when they got to be teenagers, they pretty much told her to back off and leave them alone.”
Were anxious tendencies inherited, she wanted to know? Was she responsible for the fact that her son was afraid to take part in normal kid activities, like going to parties and other events, seemed to worry a lot, and consequently just didn’t seem to be having much fun?
This mom raised a legitimate question, one I’ve heard many times. Research does show that the vulnerability to experience anxiety disorders may be heritable. A child’s temperament or personality—whether she’s inclined to be withdrawn or inhibited, for example—will be partly determined by genes. That’s not enough to produce a particular disorder, but the predisposition, the genetic loading, will likely make the child more sensitive than others to a certain degree of stress in the environment. Yet even if it’s “in the genes” on both sides of the family, it doesn’t necessarily mean the child will develop a disorder. (Dr. David Barlow, a leader in the field, writes extensively about the causes of anxiety in his book Anxiety and Its Disorders.)
Many influences come into play. Seeing disturbing images or stories on TV can make children fearful. Fear might develop after a child has gone through some form of trauma. We know that major life events can be difficult for some kids to navigate. Many studies talk about children of divorce, for example, and the main stressors that children experience around this event. Other situational issues—moving to a new city, a parent losing a job, changing a nanny—can have an impact. Some kids handle them just fine; they’re resilient. Others need extra support.
I reassured this “nervous” parent that although her child might have a genetic vulnerability, it is not likely that she simply “gave” an anxiety disorder to her son, despite the family history. More to the point, and even more reassuring, with small adjustments in how she probably interacted with her child, it was in her power to make an enormous difference in easing the youngster’s fearfulness and timidity. For example, she could model better or non-nervous behavior (more about this in chapter 3). Children do watch us. They pick up cues about what’s a worry and what’s not a worry from the way we behave.
In fact, the burgeoning field of cognitive neuroscience is coming up, practically on a monthly basis, with indications that experience can influence the expression of genes, or how certain genes are switched on or off. Psychologists are starting to connect some of this research with the kind of applied research that I do, such as understanding how certain cognitive-behavioral skills actually affect a child’s brain. Even if a youngster has been genetically loaded for anxiety, the right kind of parental interaction on a regular basis may be able to reinforce desirable pathways in the brain and discourage other, less desirable pathways.
Instead of worrying about what causes a child’s anxiety, we parents can better focus on what we can, normally, expect. The following guidelines describe common fears at the different stages of childhood.
Ages and Stages: The Normal Fears of Childhood
Ninety percent of all children, ages 2 to 14, tell us they have at least one fear; many report more than one. We say that in early childhood, kids’ fears can change pretty frequently. And most children, across cultures, go through a common trajectory of fears at predictable stages, a progression that largely follows cognitive development—the increasing ability to think about what’s real and what’s not, about what one can see and can’t see, about the past and present and future. The progression follows a general course from the more concrete to the more abstract.
Especially during the younger years, the fears that arise naturally are adaptive mechanisms; they’re meant to protect. At different stages, your child is afraid of something that, if not controlled, might affect his survival, or in other words, might cause him to be hurt. So your baby clings to you in alarm if a stranger tries to hold him. The toddler shrinks back when he sees a spider, not knowing whether or not this creature poses a danger.
What we understand about these fears is that just as they surface at particular times they also tend to dissipate with development. Your spider-spooked youngster six months later will let you know he’s over that.
While none of these age-specific anxieties is etched in stone—there’s a good deal of variability as to when or whether they will appear, depending on temperament, life circumstances, wide ranges in developmental milestones, and a variety of other factors—here’s the generally accepted schedule:
Infants and Toddlers
Drop a large pot in your kitchen, and your baby will likely shriek in fright. She doesn’t know if the racket means danger.
Large or unfamiliar objects
Because your young child has no basis on which to judge whether unfamiliar things are going to be dangerous, her brain tells her, Okay, just to be safe, let’s turn on the anxiety system in case this is a problem.
When I blew bubbles out of the toy wand toward my 1-year-old, who’d never seen bubbles before, she began screaming, as though I’d just loosed daggers into the room. Although she’s an easygoing, not overly sensitive child, she was clearly terribly scared. I sat her on my lap, so she was on the other side of the bubbles, let her touch the bottle, and showed her how to gently blow a bubble. Then I smiled as I popped the bubbles with my finger, one by one. Gradually, she quieted down.
Your 3- or 4-month-old doesn’t start crying when she sees someone she doesn’t know. When, a few months later, her sight becomes more developed and she gains the ability to differentiate familiar from unfamiliar faces, she may develop stranger anxiety.
This, again, is a protective mechanism. It’s not abnormal for your 7- or 8-month-old child to cry when the pediatrician wants to pick her up, though at your previous well-baby checkup she was fine with it. It doesn’t mean she is anxious; she understands she shouldn’t go with someone she doesn’t know. It’s adaptive, keeping her close to her caregiver.
Hold your youngster in your arms as you’re chatting with a neighbor, and your child will be content. Let the neighbor, being friendly, arms outstretched, say, “Come here, sweetie, let me give you a kiss,” and you will likely feel your child resist, her grip tightening. She turns her head away, or starts to whimper.
Usually anxiety over unfamiliar faces resolves around the end of the first year.
Preschoolers, Ages 3 to 5
Costumed characters, monsters, ghosts
As a child’s world expands, he begins trying out new situations and testing the world. Between ages 3 to 5 or 6, your child is figuring out what’s real and what isn’t. You may see him having trouble with the clown or the magician wearing a mask: Why is that person’s face like that? Why are his eyes not moving? If it’s a real person, why is it pretending to be not real? Things not functioning the way he knows real things do is upsetting.
Ghosts, monsters, anything supernatural, might be scary. Younger preschoolers, especially, have these fears. By ages 5 and 6, they’re getting a better handle on the whole matter of pretend creatures and imaginary dangers.
Fear of the dark and sleeping alone
Preschoolers might also struggle with fear of the dark, of the basement, of what’s under the bed or in the closet. Most kids naturally and gradually realize there’s nothing to frighten them, and with the proper parent encouragement, they can sleep alone. Others have more trouble, and this is when many sleep problems arise and when fear of the dark can expand into difficulties with the whole nighttime family routine.
Other specific fears
Many children at this age develop specific fears—about dogs, insects, water, blood, elevators. The fear may connect to a sense of being out of control because of limited knowledge: Which dogs do I need to be afraid of? Or do I need to be afraid of all of them? And it may connect to observing the reactions of others: Why does Mom jump when she sees a bug? Is this really scary or not?
Children grow a healthy attachment to their parents or primary caregivers, the critical developmental task that begins in infancy and continues through preschool and the early childhood years. Separation anxiety, or fearfulness at leaving a parent, can appear in infancy and usually dissipates gradually, but it can resurface at school entry. The youngster heads into preschool, mom or dad starts to head out the door, and crying and clinging ensue. It usually lessens over the next two or three years, and by the end of kindergarten most kids have mastered the idea of separating, knowing that a parent is coming back again.
Awareness of death and dying usually develops around this time; many children learn about it through their religion. In the context of separation anxiety, it’s not unusual for a child to express fears about a parent dying.
My older daughter has asked me, “Are you old? Does that mean you’re going to die before me? Is Grandma going to die before you? What happens when you die? Where do you go?” That’s normal. I try to answer her as simply and honestly as I can.
Though we tend to expect separation anxiety within this time frame, it isn’t necessarily a problem if it’s still lingering at age 4 or 5. It is even normal for kids this age to have trouble separating initially when starting a new activity. Usually with some practice or after a few tries, the separation gets easier.
Early School Age, Ages 6 to 10
Developing peer relationships is a major challenge. Children at this age have access to many sources of new information, through the Internet and elsewhere, and are trying to sort out images and ideas that have an impact on their social interactions, what other kids know or have and how they fit in. It’s terribly important to some children that they find a best friend. They can feel lonely and different without one, or if a friend moves away.
At this stage, children fear burglars, kidnapping, storms, lightning, illness, bodily injury. They have trouble distinguishing between a remote risk and an imminent danger and have concern over being and staying safe. They may worry about getting sick.
Death in the family
The possibility of a loved one dying becomes less of an abstraction. A child may repeatedly seek reassurance from a parent that mom or dad is feeling all right, taking care of his or her health, not going anywhere.
Many children start to worry more than they did before about doing well in school, getting good grades, and pleasing their parents and teachers. They may take even a temporary failure hard.
Middle School Age, Ages 10 to 13
By middle school, many children become concerned with social status. Your child starts comparing herself to her peers; she worries, will I be accepted, am I smart enough, am I pretty enough?
Making and keeping friends, avoiding enemies
The social cliques and informal groups of middle school can be a source of torment for a lot of kids. Many teens and young adults, in retrospect, describe middle school as the worst time of their life. Kids are afraid of getting bullied. Relational aggression—intentionally rejecting and isolating a classmate—can create misery.
Academic and athletic performance
Excerpted from Growing Up Brave by Donna B. Pincus Copyright © 2012 by Donna B. Pincus. Excerpted by permission.
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Table of Contents
Part I Understanding Childhood Anxiety
Chapter 1 The Brave Child
Learning to Cope with the Range of Human Emotions 11
Chapter 2 What's Normal, What's Not
Decoding Childhood Emotions, Fears, and Anxieties 27
Chapter 3 The Attentive Parent
How Parent-Child Interaction Styles Affect Anxiety 51
Part II Daily Routines that Ward Off Anxiety
Chapter 4 Five-Minutes-a-Day Time
A Simple Strategy to Set the Stage for Brave Behavior 73
Chapter 5 Managing Bedtime
The Benefits of a Consistent Sleep Pattern 101
Part III Strategies to Lessen Anxiety and Promote Bravery
Chapter 6 The Cycle of Anxiety
A Three-Component Model 121
Chapter 7 Examining Anxious Thoughts
One Step in Breaking the Cycle 127
Chapter 8 Accepting Physical Feelings
Learning about the Body 151
Chapter 9 Changing Avoidant Behaviors
The Power of Parental Reinforcement 171
Chapter 10 The Bravery Ladder
Step by Step to Success 181
Chapter 11 Halfway to Adulthood
Combating the Fears of Adolescence 217
Part IV Special Considerations
Chapter 12 Growing Up Brave Through the Years
Finding Professional Help, Using Medications, Maintaining Progress 245
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