“I don’t want to do that. I don’t want to go there.”

Has your child uttered these phrases? Were tears involved? Did the whole episode seem to come out of nowhere?

The experience may have been related to anxiety. This isn’t surprising since anxiety rates in the United States continued to rise last year. According to American Psychiatric Association, 26.6% of young adults (ages 18–29) reported having anxiety symptoms in the past two weeks. And, in a recent study released by the World Health Organization, approximately one in seven children between the ages of 10 and 19 are affected by mental health conditions, with anxiety being the most prevalent.

It’s important to note that just because a person experiences anxiety, they do not necessarily have an anxiety disorder. However, being aware of what to look for and how to talk about anxiety with your child is key in helping them develop proper coping skills.

What Does Anxiety Look Like in Kids?

Anxiety can look like anger, fear, frustration, mood swings or sadness, especially in children. “The most common sign of anxiety in children is an out-of-the-blue reaction that doesn’t match the situation,” says Josh Spitalnick, PhD, ABPP, Licensed Psychologist. He is the CEO and Practice Owner of Anxiety Specialists of Atlanta in Dunwoody, one of the largest anxiety-only therapy practices in the country, where they see patients ages 3 and older.

“A child might refuse to go to a place they normally like. They may get argumentative. This is a sign they are withdrawing emotionally or verbally and should cause you, as a parent, to be suspicious,” Spitalnick says. “Avoidance is the one common symptom of all anxiety disorders.”

The consistent use of the word “not” or any form of it is something to take note of if you are concerned your child might be experiencing anxiety. “’Can’t, won’t, shouldn’t.’ Using these words a lot is a sign that your child doesn’t like what is coming up or is feeling anxiety or fear around whatever the topic is,” says Spitalnick.

Other signs can be more overt. “These may include physiological symptoms like stomach aches, headaches, nail biting, chewing (on hands or other objects), sweatiness, itching, jitteriness, having trouble sleeping and changes in appetite,” says Ashley S. Lingerfelt, MS, LPC, PMH-C who specializes in infant, early childhood and perinatal mental health as a Licensed Professional Counselor at Playtime Therapy of Georgia in Woodstock.

Children often articulate their anxiety in the best way they can. “With limited emotional vocabulary, they sometimes rely on vague statements to convey how they are feeling, such as, ‘My head feels funny’ or ‘My tummy feels yucky’ to describe their anxiety,” says Lingerfelt. “This varies depending on the age and language development of the child, but these types of statements are common across many ages.”

As children get older, using absolute language about the future can be a sign they are experiencing anxiety. “If your child approaches things with an all or nothing attitude it means that they can’t sit in the middle with the stress or uncertainty,” says Spitalnick. “This is a clear sign of anxiety, and it sets them up for being disappointed. Life isn’t 100%; it’s usually 80/20.”

Parents — The Problem or Solution?

In too many cases, parents are contributing to their child’s anxiety and don’t even realize it. “Parents can unintentionally contribute to their child’s anxiety by having developmentally inappropriate expectations,” says Lingerfelt. “For example, expecting their 3-year-old to consistently complete a household task or spacing out rewards for ‘good behavior’ in weekly intervals instead of daily.”

One of the most well-disguised things parents do that unknowingly contributes to anxiety in their children is known as family accommodation. “About 95% of parents do it,” says Spitalnick. “And, they do it out of love.”

What is family accommodation? “It’s when we step in at moments that we don’t need to,” says Spitalnick. A few examples are bringing lunch to your kid at school, ordering for your child at a restaurant when they are capable of doing it themselves, covering for your child when they forget to do their homework, or over-engaging with or babying your kids.

“When you see your child struggling, you want to step in and fix the problem, but this doesn’t let them learn to problem solve or be resilient,” says Spitalnick. Instead of jumping in and inserting yourself too soon, he recommends you sit back. “Acknowledge the struggle and help them understand how to work through it. Take time for your child to process the situation. Ask questions like: ‘Why did you get a bad grade?’ ‘What do you want to do?’ or ‘How can I help you?’.”

Your own behavior toward other adults and your child can also contribute to anxiety for your child. “Yelling, being unpredictable, not following through, and being disengaged from the parent-child relationship can all contribute to anxiety,” says Lingerfelt. “Children need predictability and consistency in order to thrive. Having a rhythm to the day and a close, connected relationship can greatly minimize anxiety.”

“Be kind and compassionate,” says Spitalnick. “Often parents are reacting to their own stress in the moment — embarrassment at their child’s behavior in public or not getting into the ‘right’ school.” Help your child be seen and heard by validating the experience and asking open-ended questions that give them the space to open up without feeling judgment.

When Is it Time to Seek Help?

Anxiety is a biological experience, so just because a child is worrying or having night terrors doesn’t mean you need to seek therapy or that your child has an anxiety disorder.

“Often parents will call and say, ‘My kid cries about everything,’” says Spitalnick. “This is a challenge when a child starts learning ‘When I have meltdowns, I get my way in avoiding a stressful situation.’” If your child develops a pattern of never going on a playdate, struggling to get out of the car to go to school, missing birthday parties or refusing to play a sport, it may be time to seek help. “Kids need these healthy, developmentally appropriate interactions and opportunities.”

If the child’s anxiety is happening several days of the week, is moderately intense, and the child is unable to recover from these anxious moments, even with the help of a caregiver (or if it takes them more than 20-30 minutes to recover), then they likely will benefit from clinical support. “At the end of the day, I encourage parents to seek support when they feel like their child’s quality of life is being impacted by their symptoms of anxiety,” says Lingerfelt. “We want our kids to feel happy and supported. Childhood is too short to be filled with stress and worry!”

A very important warning sign to seek treatment for your child is when the anxious kid’s behavior is affecting other kids or family members in the home. This includes the parents. “If caregivers disagree or can’t be consistent on how to parent kids with anxiety, parents should seek support,” says Spitalnick. “Good cop/bad cop doesn’t work in these cases, and parents need to learn skills for helping their child.”

In older children and if depression is a secondary concern, you should seek support. Pay attention to signs of self-harm, substance abuse, body issues or if they make statements like, “I feel like I don’t want to be here” or “I wish I was gone.”

“These statements are often very scary for parents to hear and should be addressed appropriately,” says Lingerfelt. “They are a sign that the child is feeling overwhelmed and doing their best to articulate their emotional state with the language they have.”

The treatment experience will vary based on the age of the child and the severity of their anxiety. “Typically, anxiety is treated with a combination of cognitive behavioral therapy (CBT) and a relational-based therapy, such as play therapy or a type of parent-child based therapy,” says Lingerfelt. “Therapy options with a parental component are ideal, as they provide parents with childhood anxiety management skills to support their child at home.”

As with other developmental challenges, early intervention with teaching coping skills in anxious moments is key to preventing disorders as teens and adults. “Research has proven that kids who can sit with discomfort and stress do not develop anxiety disorders as adults,” says Spitalnick.

Sometimes the most difficult, challenging moments of parenthood stem from an anxious child. If you can identify the signs and support your child with providing coping skills from a young age, you can set them up for success as they get older. Remember, everyone worries. “When you gain the insight to empathize with your child’s struggles on a deeper level, you can better help them,” says Lingerfelt. “Your child is lucky to have you!”

The 3-3-3 Technique

The 3-3-3 technique is a mindfulness tool that can help calm anxiety by bringing your focus back to the present moment. To do it, simply name three things you can see, hear and touch or move.

How to use the 3-3-3 technique

  • Look around and identify three things you can see. For example, a clock, a tree or a chair.
  • Close your eyes and listen to three sounds you can hear. For example, a bird, the air conditioner or a clock.
  • Move three parts of your body. For example, wiggle your fingers, rotate your shoulders or stretch your legs.

Benefits of the 3-3-3 technique

  • The 3-3-3 rule can help you manage stressful thoughts, feelings or memories.
  • It can help you calm anxiety symptoms like shortness of breath or rapid heartbeat.
  • It can help your child develop coping skills they can use at any age in any situation.

Resources

When seeking information about mental health, it is important to verify your sources. Some trusted sites are:

–Tali Benjamin

Expert Tips for Raising Resilient Kids

You are not alone.

Whether through a support group, social media or your local and state resources, there is strength in numbers. Finding other caregivers who have children with anxiety can help you build a sense of community, and recognize that you are not alone – and neither is your child.

It’s OK to not be OK.

It’s one of the hardest lessons for us to learn, and it’s something anxiety specialists truly believe. Sending the message to children that their meltdowns or terrifying moments signify that something is wrong keeps them stuck in the loop of false alarms. You have the opportunity to model acceptance by letting them know that it’s OK to not be OK.

Be aware of how your own stress impacts your parenting style and expectations.

While there will be amazing moments to witness, parenting a child with anxiety or OCD can be exhausting. If you find yourself feeling frustrated, take a break. Explain to your child you want to be helpful and do not think that you can do that without taking a break.

Learn the vocabulary of an anxiety specialist, starting with the BIG three: T’s, O’s, and C’s.

  • T’s are the Triggers. Triggers are the internal or external things that bother us; T’s elicit the initial fear response. Almost any thought, thing or experience can be a trigger.
  • O’s (which can also be F’s) represent Obsessions or Fears. These are the worries, images, feelings, beliefs, or physical sensations that are unwanted, unintentional, and make the person feel nervous, guilty, fearful, disgusted and more.
  • C’s (which can also be R’s or SB’s) are called Compulsions, Rituals, or Safety Behaviors. These are intentional actions and thoughts (the latter are called mental rituals) that are used to temporarily avoid distress. These actions are the fuel that’s maintaining anxiety or OCD. Knowing the difference between a T, O or C is foundational for a child (and the parent) to gain insight and have a better understanding of what is being addressed through treatment.

– Dr. Josh Spitalnick and Marti Munford, LPC, Anxiety Specialists of Atlanta

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