Like many active 10-year-olds, Ava* is involved in competitive cheerleading, enjoys playing the flute in her school’s band and loves spending time with her group of five close-knit friends. But daily life is a struggle for this fifth grader, who is haunted by debilitating worries about her personal safety, her health and being alone.
“She’s always had issues with being alone in the house,” her mom says. “If I’m doing laundry, she’s in the laundry room with me. She still sleeps in our bed at night. I make her go to bed in her bed every night, and I sit in her room until she falls asleep. But, by about 1 o’clock, she comes and gets in our bed.”
Ever since Ava broke her arm last year during a cheer practice, her anxiety has steadily worsened.
“She thinks she’s having heart attacks, and she’ll go to the school nurse saying she can’t breathe and her face is numb,” her mom says. “Before that, she’d never been to the school nurse in the six years she’s been in elementary school.”
Ava isn’t alone. Mental health experts say that anxiety is now the number one most common mental health challenge among children. The National Institute of Mental Health estimates that 31 percent of adolescents, ages 13 to 18, suffer from an anxiety disorder of some kind, with girls at a slightly higher risk.
Thanks to increased awareness and understanding of the disorder among healthcare practitioners, more children receive the treatment they need at an earlier age.
“I’m seeing kids who in the past would have just white-knuckled their way through life until it got to the point where they couldn’t do it anymore,” says Dr. Jane Sosland, a child and adolescent psychologist. “The stigma of mental health is slowly, slowly being chipped away and that’s a good thing.”
What is anxiety?
From your heart slamming against your rib cage before standing up to speak in front of an audience to sweaty palms during a job interview, we’ve all experienced anxiety.
Anxiety becomes a problem when it affects quality of life and interferes with the activities you normally enjoy.
Some symptoms of anxiety disorder include panic attacks, sleep problems, heart palpitations, chest pain, muscle tension, unexplained uneasiness, dizziness and cold, sweaty, numb or tingling hands or feet.
“Usually, anxiety can start in the very young years, but then it can rear its ugly head in the teenage years,” says Dr. Sosland. “It’s something probably to do with hormones and puberty and a time in kids’ lives when they are starting to feel more self-conscious.”
Left untreated, anxiety can cause kids to miss out on important social experiences and lead to poor performance in school, substance abuse, physical illnesses, depression, self-harm and suicide.
Causes of anxiety
Anxiety can be a product of genetic wiring or a result of a specific stressful or traumatic event. The condition can also be triggered by a combination of factors, ranging from marital and economic distress in the family to overwhelming school pressures, social media and intense news stories.
Some experts also worry that “helicopter parents” can exacerbate anxiety. This style of child rearing refers to parents who go to great lengths to protect their children from failure or struggles, resulting in emotionally fragile young adults who lack the confidence to independently solve their own problems.
Without a sense of resilience, trying to manage life’s inevitable ups and downs becomes exceptionally stressful.
“Resilience is built by working through adversity and difficult situations. It is difficult to pick yourself up and brush yourself off if you never fall down,” says Dr. Zafar Mahmood, a child and adolescent psychiatrist.
Parenting anxious kids
Although you should maintain the same expectations for your anxious child as you would another child, it’s okay to adjust those expectations during stressful moments. Plan ahead for transitions to ease anxiety and praise small accomplishments, like when your child tries something new.
“Anxious children are very difficult to parent sometimes. On the one hand, they’re usually very well-behaved, very much follow the rules, do well in school, but they also can be challenging for a parent because they really want a lot of reassurance,” says Dr. Sosland. “However, they can’t get it enough.”
Suppose your child repeatedly asks you: “Do you think I did OK in the concert?”
The more you reassure her with statements like “Yes, you did great! Everybody thought you were awesome!” the more you unintentionally reinforce your child’s belief that maybe she isn’t okay.
Instead of trying to make her feel better through reassurances, Dr. Sosland recommends acknowledging your child’s worries and then asking how she can best manage her thoughts.
Parent: “It sounds like you are pretty worried about your performance. What can you say to yourself to cope with your worry?”
Child: “That was hard for me, but I did my best. I’m proud of myself for hitting that note I’ve been practicing all week. I’ll be OK.”
By guiding your child to reframe how she thinks about a situation, you send the positive message that you believe she has the resolve to cope with her feelings, and she doesn’t need to rely on external evaluations to feel good about herself.
Since parenting a child with anxiety can be stressful, surround yourself with a strong support network for when you need a break or a compassionate shoulder to lean on.
Coping with anxiety
Help your children identify healthy coping mechanisms for when they are anxious.
“Having someone who they feel is actually listening to them is a huge piece of learning how to feel better,” says Dr. Sosland. (See sidebar for additional coping ideas.)
As parents, we often think we need to help our kids solve their problems. Dr. Sosland has another suggestion called the 80/20 rule.
“Eighty percent of the time kids just want their parent to listen. They don’t want you to fix the problem,” she says. “We are quick to come in and tell them what to do or tell them they shouldn’t feel the way they do. That doesn’t usually make them feel better. It just makes them feel like they’re not being heard.”
The other 20 percent of the time they do want your help. Usually, they will ask you directly for advice about how they can solve a problem.
Rising social anxiety
Our hyperconnected children can’t imagine life without technology. Studies are beginning to suggest that too much screen time could correlate to increasing rates of anxiety, depression and loneliness.
In her book, “iGen,” psychologist Dr. Jean Twenge studied trends among children born between 1995 and about 2012. Through her research, she discovered disturbing patterns indicating that as smartphones became more commonplace among teens, depression and unhappiness also began to rise.
“They are on the forefront of the worst mental health crisis in decades,” writes Twenge.
Kids today spend about an hour less per day with their friends than teens did in decades past, preferring online interactions. But the more time spent online, the less happy they feel.
“Eighth graders who spend 10 or more hours a week on social media sites are 56 percent more likely to be unhappy than those who spend less time,” writes Twenge. “There’s not a single exception: All screen activities are linked to less happiness and all non-screen activities are linked to more happiness.”
Why? Biologically, we are designed to spend time with friends face-to-face. When we socialize with friends, our brains release a host of neurochemicals and hormones that reward us with an overall sense of wellbeing, helping us to better manage stress and even buffer us from illness. The brain doesn’t respond in the same way to computer-mediated communication.
Over-reliance on screen interactions can interfere with a teen’s ability to develop crucial social skills that help them pick up on emotional cues, manage conflict or build confidence in social situations.
“Without developing interpersonal skills and discipline, kids may experience feelings of anxiety anytime they step out of the house and interact with others,” says Dr. Mahmood.
Social media can also give kids the impression that everyone else’s world is hunky-dory and that they’re alone in their struggles. And with unhindered 24-7 social media access and multiple messaging platforms, there’s no break from the rest of the world for quiet reflection or relaxing time alone.
“In days past, you could leave the bully on the bus. Now bullying follows kids into their bedroom when it is time to go to sleep,” says Dr. Mahmood.
Foster resilience to challenge anxiety
We’d all prefer to avoid situations that make us uncomfortable. The trouble is if we don’t participate in activities because we’re scared of failing or because they make us nervous, we can’t grow more self-confident and resilient.
According to the Anxiety and Depression Association of America (ADAA), when we avoid stressful situations, we reinforce anxiety and end up feeling more demoralized.
Knowing how far to push a child can be tricky and depends on the intensity of their anxiety.
“If you have an anxious child, what you don’t want to do is push her too far and too fast out of her comfort zone,” says Dr. Sosland. “On the flip side, you don’t want to be overly protective and never expose her to those things that make her anxious.”
Instead, she recommends taking baby steps to increase self-confidence. Also, tap into the activities that your child is already passionate about. Self-confidence in one area can increase self-confidence in other areas of a youngster’s life.
“If your child is really anxious in school, but loves to go horseback riding, then, let’s do that horseback riding because she feels really good about that. A child can learn lessons from that which she can transfer over into school,” says Dr. Sosland.
Seek experiences that gently push your child to try new things in a supportive, collaborative atmosphere. Acknowledge and praise those moments when she accomplishes something despite the initial uneasiness and discomfort it caused, whether that’s pushing through a mile at cross country, going to her first sleep-away camp with a friend or trying out for a part in the school play.
Day-to-day, look for opportunities where your child can advocate for herself. For example, instead of emailing your child’s teacher about a grade that your child felt was unfair, encourage her to talk to her teacher about it. If she’s struggling in a particular subject, suggest that she asks her teacher for extra help. If your child complains about a playground disagreement with a classmate, listen to the problem and if she wants advice, offer ideas for how she might manage the situation.
“Let them face adversity,” advises Dr. Mahmood. “Everyone will face disappointment and adversity in their lifetime. Those who succeed are those who have developed the skills and discovered the resources to deal with it.”
Anxiety is highly treatable. If your child continues to struggle, consult your family physician.