In recent months I happened to work with a number of elementary-age children who had developed anxiety symptoms such as resistance to separation, excessive worrying, nightmares, restricted activity, and “meltdowns.” They were all very bright, creative children who engaged in a lot of fantasy play and were described by their parents as very sensitive. While excessive anxiety is not limited to this cohort of personality factors, I do believe that they represent a majority of the children who, in fact, get immobilized by their fears.
The good news is that those same characteristics can be used to help them change from feeling powerless and overwhelmed into children who feel capable of solving their problems. In other words, these children learn to be more resilient. When I ask parents in my workshops what qualities or strengths they most want for their children, I usually hear a list that includes happiness, health, kindness, sociability, and achievement. What I focus on, however, is resilience. This concept, expertly evolved in a series of books written by Drs. Robert Brooks and Sam Goldstein, refers to developing a sense of being able to solve the problems that life inevitably poses to all of us.
In the discussion that follows, I will describe some of the issues these children presented (details are changed to protect confidentiality) and the strategies used to empower these children to learn how to manage their fears.
Micah, an 11-year-old boy, who was described as very sensitive and caring, had developed a significant problem around separating from his parents. It had reached a point where it impacted their ability to go out without him as well as his ability to go on field trips or to stay over at a friend’s house. He had developed chronic complaints of stomachaches (nothing found by his physician). We refer to developing physical symptoms as somatization. It is very common in children (keeps school nurses very busy) but is also common in adults.
Typically one of the first stages in my work with these children is a psychoeducational piece. With Micah, I explained what happens in the body when we get anxious (nervous, worried). The brain sets off an alarm and the body, like a fire department, swings into action. This is about the “flight or fight” mechanism. The body produces adrenalin which in turn causes our heart to speed up, pumping more oxygen to give the body more energy. Our muscles tighten, ready to spring into action. Our pupils dilate, the better to spot problems. Now, this can be helpful if there is really a threat that we need to deal with. But what if there isn’t? I use one of the many ideas I’ve learned from a colleague, Dr. Susan Davidson, a behavioral psychologist, who specializes in the treatment of anxiety disorders. “Micah, does the smoke alarm ever go off in your house but there isn’t a fire?” He laughs. “Sure sometimes when mom’s cooking!” Please note the value of humor in helping children understand and deal with problems. (Actually it’s also very helpful with adults.) So we begin to use the concept of “false alarms.” Do we want those firemen racing to his house when there’s no fire to put out? Of course not.
Micah and I worked on the problem in a few ways. I taught him how to relax his body. Open your palms, hands pointed down (an inviting rather than rejecting position that is part of yoga), taking a deep breath, and then drop your belly! Kids usually laugh when I say this. But they catch on quick as I demonstrate it and can immediately feel their body relax. I explain how their body can’t be anxious and relaxed at same time. Micah started to feel he could control at least part of what was happening to him.
We also talked about how stress causes “aches” and he was able to list stomach, back, and head as common aches we all experience from stress but he had never thought of it in that way. Another helpful piece of information.
Then we began to make lists of past worries and checking off which had actually come to life. Sometimes there may be a couple. Often there are none. Either way, it is immediately clear that most of the worrying is for naught. Then we make a list of worries about what bad things might happen in the coming week. At our next appointment we review the list and rarely has any of the worries come true. I focus on the concept of the brain sending false alarms (not Micah having unnecessary worries – better to blame the brain) and that he can now begin to tell the brain when there really isn’t a fire. “Aw, it’s just mom burning dinner again!”
Given a way to understand what has been happening inside his body and a few strategies to better control what is going on, Micah quickly has a couple of positive experiences and quickly improves. I find that these bright children are able to take the ball and run to daylight almost immediately. They start to feel more confident, more resilient, and often are quickly telling me they don’t really need these appointments any more. Thank you very much, but I’d rather be playing with my friends!
Allison, an 8-year-old, brought another aspect of these issues into the office – temperament. She was described by her parents as “slow to warm up.” These children, and their close “cousins,” shy, have an exaggerated self-consciousness that makes them more prone to worry. Allison demonstrated a common aspect of worriers – “catastrophizing.” This refers to taking a small problem and turning it into a potential catastrophe. Often the child doesn’t see that she is doing this but Allison did. However, she said she couldn’t stop it and had no idea why she was doing it.
Again I use a psychoeducational piece. This time I make a fist, tucking the thumb under my curled fingers, and talk about the different parts of the brain. The thumb represents the place where emotional messages come from, the fingers are the front of the brain that manages things (executive function), and the wrist is the lower brain, oldest or reptilian portion, that carries the action messages down the spine (the forearm). The child can see that emotional messages beat managing messages to the parts of the body that will be responding. Thus, if we can learn to delay our reaction for just a second, the thinking part will have a chance to solve the problem, avoiding “bad reactions” including meltdowns. Being able to “see” this is helpful. Then we practice those relaxation strategies to gain the time needed for more effective responses. This can simply be taking a few deep breaths. I explain hyperventilation to children, the subtle, often undetected, taking of short, quick breaths that can make us feel anxious and light-headed. Just a couple of slow, deep breaths provides some relief and, again, buys time for a better response.
I use lists for catastrophizers just as I do for worriers. I try to provide some information that a child can relate to that puts the low probability of her fears into perspective, e.g., you are more likely to be hit by lightning than to be kidnapped. Transitions are especially hard for these self-conscious children. Common symptoms include difficulty trying something new and difficulty returning to school after a vacation, but especially after missing a couple of days of school due to illness. The latter usually responds well to my incredulous response, “Are you telling me that the best solution to missing a few days is to miss some more days?!” Then I’ll ask (these are usually good students) if they have ever not caught up after missing some school? “No.”
I also explain the inborn nature of their self-consciousness and how walking into a new group or their old class after being out makes them feel like everyone is looking at them. Doesn’t she look at the new child or the friend who has been out a few days? “Yes.” “How long do you keep looking?” “Not long.” “Okay. Remember that when you are the one walking in.” Also add the deep breath that helps to calm and the child is often able to begin to take control in a situation where she has previously felt a lack of control and not understanding what was happening. (You can see certain themes repeating themselves here – knowledge and strategies that work leading to a sense of empowerment.)
Some of these children are capable of using visual relaxation techniques. Picture yourself in a safe place doing something that is very relaxing. Floating in a swimming pool. Lying on ground and looking up at the clouds or stars. One child described sitting on the floor and drawing pictures. The point is that children can learn to use these relaxing images to manage anxiety or to clear their minds at night if they are having trouble falling asleep. Again, it is important that the child comes up with what works for her. It is all part of developing the sense of being able to solve her own problems.
Jonathon, 10 years old, presented me with a long list of daily worries. They appeared to become exacerbated following a medical procedure that left him worried about his health, even though everything was now fine. Jon had a tendency to worry even before this happened but it was manageable then. Not now. He was not only intensely preoccupied with his worries but also was having nightmares, a common symptom for this group of children. Since he loved to draw, I had him draw a picture of his body part that had required some repair. His image reflected a distorted sense of a still damaged organ. Input from his doctor allowed me to help him create a correct drawing and enabled him to quickly begin to “feel” healthy because he didn’t feel defective.
We addressed the avalanche of worries in a few ways. Little annoying worries were zapped with weed killer spray (we had identified these minor worries as weeds growing in his lawn and drew a picture of that image). A large number of medium strength worries were identified as “spam.” He, like so many young children today, was very computer literate and knew about spam and spam filters. So he “installed” his own mental spam filter and “delete spam” became a way to clear his mind! We used a scale of 0-10; zero being no worries and 10 being overwhelmed with worries. He started out at 8 and within weeks the number was steadily dropping until it actually got to one, to which I complained that now he was worrying less than I was! Could he please help me get to one?
We worked on the nightmares with my usual strategies. Nightmares are the child’s own thoughts. “They are your nightmares and you can control what happens in them.” We work on coming up with assistance from a superhero or adding superpowers. The former can be a real superhero or one created by the child, e.g., a pet dog or a favorite stuffed animal or a character from a favorite book. The latter can be a plastic ring or elastic wristband worn to bed (have extras in case the original gets lost). The child then learns to call upon the superhero or the superpowers in the dream and vanquish the threat. It requires children to recognize they are having a dream but it is amazing how most children can do this. Sometimes, when the problem is proving to be a bit more stubborn, we’ll use drawings of the dream and change the process in the drawings which the child is often able to carry into their nightmare after some practice.
All these children showed the rapid recovery I mentioned earlier. It’s a reminder how most children have a natural resilience that we just need to tap and unleash with strategies that give them helpful information and some techniques to allow the emergence of a sense of being able to solve their own problems. This not only helps resolve an immediate concern but it provides them with a foundation for managing the future challenges that life will inevitably present.