How to Help Your Child With Anxiety

Getting Serious About Your Child’s Anxiety: Beyond simple tips!

Guest Post by Victoria, a Child Psychologist, parent coach and mum.

The internet is overflowing with articles about how to help your anxious child. Mindfulness, noticing their feelings, worry books, gratitude journals, distractions etc. They are all very reasonable suggestions, but what’s missing is a system for all of this. Often when I meet parents of anxious kids, they tell me that they have ‘tried everything’ and reel off the numerous things that haven’t worked. But sometimes they describe feeling that it’s been like throwing spaghetti at a wall and hoping something sticks. Whereas I am always a great fan of thinking about mental health in a more systemised way so that we can get the right steps in the right place, and here are my thoughts on how to help your child with anxiety.

In case you’re wondering who I am and why I’m writing this: I’m Victoria, I still work as a child and adolescents psychiatry consultant, now almost exclusively with very unwell teens who are admitted to a psychiatric inpatient unit. Nearly every young person I look after has anxiety alongside other mental health difficulties. Alongside this, I also run Emerging Parent: a parent coaching and education site where I post weekly free videos and blog articles looking at different aspects of mental health and parenting. I’m also a Mum of a 7-year-old daughter, and I have used everything I learned during my extensive training and consultant career. The big thing I am working on at the moment is putting together my thoughts on what really matters in parenting when it comes to raising emotionally well-adjusted kids – the four essentials of balanced parenting.

When I think of addressing a child’s anxiety, I imagine it happening in these 5 steps:

Step 1: What’s your anxiety profile?

Okay – you have to be honest here. Are you constantly worrying? Are you looking for the next thing that is going to go wrong? Or are you quite chilled out and struggle to understand why people worry about anything? Or maybe it fluctuates, and usually, you’re okay, but you might get stressed about big things (totally normal, by the way).

There is absolutely no point in trying to help your child with anxiety if you (or any other adult significantly involved in their care) are perpetually anxious. There is no way of bypassing this. So, if you’re reading this and thinking ‘yes, I am a bit of a hypervigilant stress ball’ then start with yourself first. Whether it’s working on your own anxiety through self-help books or doing it with a therapist – give it the attention it deserves. I cannot tell you how many children I have come across in my career, being brought into specialist services with anxiety that we investigate. And as this investigation unfolds, we realise that the primary source of this is actually their parent. It is very common.  And it doesn’t matter what fantastic therapy we do with the child – if they go home to a very anxious parent, it makes it extremely hard for them to change their way of thinking. There is no way around this – you have to be able to manage your own anxiety.

So, you have to look at yourself, decide where you are, and if there is work to be done – do it. If you are anxious, but you have already addressed this, and you have excellent skills around managing your anxiety, or if you are someone who experiences less debilitating levels of anxiety and you usually know how to deal with it – then go to Step 2.

To see my previous post on advice on how to support your children’s mental health, click the image below.

Step 2: Are the basics taken care of?

This step is all about considering your child’s basic needs. Are they getting enough sleep (or are they on their phone all hours of the night?). Are they getting regular and relatively healthy meals? Are they physically and emotionally safe (or is there either domestic or verbal abuse going on at home)? Do they get the time and space to socialise with friends? Do they have free time to ‘play’ and explore things that matter to them, even if they don’t make their school grades any better? Do they have a chance to move their bodies in ways that make them feel good (sport, dance, skateboarding, walking whatever takes their fancy)?  Is their life fairly predictable (or is there a lot of turmoil with physical moves or an unpredictable absent parent)?

Again – there’s no point moving onto more complex stuff until these things are sorted. If a child is living in unpredictable circumstances where they have to fend for themselves, where there is a lot of emotional unpredictability or even aggression – they are going to struggle not to be anxious. If they’re not getting enough sleep because their siblings are keeping them awake, or because they are obsessed with social media or gaming – again additional stuff is unlikely to work because the foundations need to be taken care of.

Sometimes getting the basics right means putting in boundaries – e.g. having rules about electronics at night, or preventing a particularly perfectionist child from re-doing their homework ten times, or getting more serious about bedtime. These can be hard to implement, but if you are reading through this list and wondering about whether some of the basics are actually not okay and this is now causing anxiety – don’t be scared to do something. Your child needs to understand that setting healthy boundaries is vital for lessening anxiety and stress and key to helping your child with anxiety.

Step 3: is there a specific worry?

Regardless of whether your child is generally a ‘worrier’ or not (we consider that next), is there currently something very specific that is triggering a surge in anxiety. A significant change coming up, a difficult relationship at school, a competition or exams?

Dealing with specific short-term worries is different from dealing with long-standing anxiety, though, of course, the former can come layered on top of the latter. I would still say, regardless of your child’s overall temperament, help them deal with any short-term worries in more proactive ways. Short-term worries are often about finding solutions for something or getting prepared.

Help your child feel more in control of that worry by doing what they need to do to resolve the problem. They might need to get more information about something: for example, if they are worried what the new school will be like – they might want to have another visit or chat to someone about their experience. Or if it’s something they have been putting off and the deadline is looming – they might want to enlist your help to do it and tackle it head-on.

Think about how you deal with short-term worries and pass on the practical skills you have – you might decide to create a timetable to ensure that everything that needs doing gets done, or help them organise an appointment for a visit.

Anxiety around specific events or significant changes is pretty standard for almost all (save extremely laid back) people. So, normalising it, helping them see this kind of anxiety as a motivator that gets them resolving a problem and giving them some ideas about how to tackle it is the most helpful thing.

Step 4: is your child generally a ‘worrier’?

This is important. Because how you handle things will depend on where your child is at in their anxiety baseline.

If you feel they’re not generally a worrier – then in many ways it’s easier to work with the anxiety that does pop up now and then.

Your child is more likely to be able to tolerate anxiety when it does go up – which is precisely what we want them to do. If children learn to be in that state of anxiety and work through it, by either resolving the problem or working with their mind to lessen it – then they are more likely to continue being able to do that. So, for a child who is generally okay – I would just work my hardest to stop any avoidance of anxiety-provoking situations and help them tolerate the anxiety they do experience until they come out the other end.

A little example from my own life – my daughter is not a worrier, but when she’s a bit tired, and it’s a bit late at night, she can start getting worried about things. The other night it was a spider. She came down from her room after bed-time worrying that she may or may not have seen a spider, she can’t see it now but what if it is in her room. I listened to her and acknowledged that yes, that’s a bit unpleasant, but then ultimately said ‘well what do you want to do?’. Of course, she wanted me to go and turn her room upside down to check that there were no spiders there. But I politely declined. I said that if she wanted to, she could look for it (‘tackling problem head-on’ option) or since she wasn’t actually sure whether she had seen it, she could use a few distraction techniques while trying to fall asleep (we love going through letters of the alphabet and thinking of something that starts with each one in a specific category – like fruits or countries). She moaned, but opted for the distraction technique and returned to bed.

Like most people, even non-worriers will have times when they worry and the focus needs to be on:

• Helping your child have the language they need to describe what they feel.
• Teaching them a few techniques that will allow them to tolerate the worry or help them bring their thoughts back from worries (this could be a distraction, mindfulness, sensory, though challenges or a combination).
• Support them to use those as independently as possible.

If you’re looking at this and thinking – ‘yup, my child is definitely a worrier’ then go to step 5.

Step 5: what’s the cause of the constant worry?

Children who seem to feel worried all the time are not all the same. Taking some time to consider why your child experiences this is a crucial step. Partly because depending on what the cause is, you’ll approach what you do differently. It might also explain why some techniques that you find in ‘Top 10’ lists don’t work.

A few reasons why children might be perpetual worriers:

• Early childhood experiences – children with insecure attachment are more prone to being worried. There are all sorts of reasons why an insecure attachment pattern might have formed – the parent’s own attachment pattern is significant in this, as is their mental health during the early years. Often children with insecure attachments intrinsically worry about the people who matter to them not being there anymore. Relationships can cause a lot of stress as can unpredictability, changes, and also their close adults being unwell or absent. Children who are anxious because of this often benefit from a predictable schedule which involves regular and dependable times with adults who matter.
• Having an anxious parent – if you grow up with a parent who is always on the lookout for what can go wrong, you learn to do that too. It makes sense – because your brain thinks that the world must be a tremendously dangerous place if your adult is that worried all the time – so to survive you have to be sure you’re just as hypervigilant. This sets up a variety of negative thought biases in the brain, and for those young people the keys are: a) getting the parent to work through this and b) challenge the thought patterns that have developed through a CBT based workbook or therapy.
• Temperament – we know that some brains just are more sensitive to stressors. Nature is biased towards making us more anxious as it helps us survive. For those young people, it’s really important for them to understand how their thoughts work and accept that this is something they are more at risk of.
• Undiagnosed autistic spectrum disorder – anxiety is really common in children with ASD because the world is not designed with them in mind and feel unpredictable and often overloads them in a sensory way. The things that would make me wonder about ASD are: additional sensory difficulties (e.g. sensitivity to loud sounds, bright lights, food and clothes textures), difficulties with relationships with peers (but often better relationships with adults), decreased awareness of other people’s emotions, anxiety induced by unexpected changes, new settings (such as holidays) or unpredictable events. Significant anxiety appearing straight after starting secondary school also makes me wonder about ASD (as small structured primary school often mask it). Dealing with the anxiety associated with ASD is quite different from dealing with anxiety disorders. Whereas with anxiety on its own we are usually aiming for the child to be able to experience it and come out the other end, with ASD initially you work to avoid anxiety as challenging it straight away is often too intense. Using different sensory approaches can also be an important part of reducing anxiety in children or making difficult situations more bearable.
• Trauma – if a child has experienced some sort of significant trauma (witnessing or experiencing domestic abuse, assault, witnessing significant event) this can get their worry system into a hyper-vigilant mode. Often parents describe that when their child was small, they seemed to be okay, but a significant change happened at a certain age and they just seemed to get much more anxious.
• Sensory integration difficulties – you can get sensory overwhelm without having ASD. Some people are just much more sensitive to certain sensory input, and it can look very much like worry. Usually, you notice that your child seems a lot better in their home environment but will struggle with noisy, busy places, or having to eat out, for example. They may also have specific sensory preferences – e.g. certain toys they like to bring with them because they ‘feel nice’. Again, this kind of anxiety is all about understanding the sensory profile and working with it to prevent some of the anxiety or use pleasant sensory input (e.g. certain physical activity such as jumping on a trampoline or going on the swings) to lessen anxiety.

The key to supporting your child who is a perpetual worrier is:

1. Understanding what has contributed to this level of worry – this may be very obvious to you, or you might want to do some more reading around this or enlist the help of a professional such a psychologist or a psychiatrist to help you and your child understand what is happening.
2. Helping your child find approaches that will help:
   • Keep their baseline level of worry at a lower level. This will vary depending on what you feel has contributed to them developing anxiety. It may involve doing daily activities to bring the worry level down (e.g. start the day with a meditation and 15 minutes on the trampoline, have a specific time as dedicated ‘worry time’) or it may involve creating a timetable for a very structured and predictable day. There are also a number of books to help anxious kids.
   • Help them deal with more acute anxiety episodes such as distraction techniques (e.g. listen to music), grounding techniques (e.g. breathing exercises, mindfulness), sensory activities (e.g. squeeze or fidget toys, physical activities involving body movement).  
3. Helping them develop self-knowledge, by:
   •  Identifying what is ‘normal’ background anxiety for them
   • What keeps the background anxiety at bay
   • What their triggers are for more acute episodes
   • Helping them distinguish normal short-term anxiety in response to something that needs to be resolved or acted upon. 
4. Helping them accept that their level of anxiety is higher than many other people and that they will need to do things slightly different to ensure that they can function at their best – and that’s okay.
5. Not engaging in avoidance of anxiety-provoking situations – this is tough, and you’ll need to be clued up on how anxiety works and gets perpetuated. Helping your child have that knowledge is pretty important too as it will help them understand why staying with anxiety and challenging it is the way forward.

So, in summary, you can see, that yes, the tips do fit in there, but what really matters is getting a more global picture of what’s happening to your child and helping them develop their own working understanding of what anxiety means for them and empowering them to take charge of it. Once you have done that, you can start to help your child with anxiety and help them to manage their anxiety.

I Have Some Work To Do!

Thank you so much, Victoria for such an informative and actionable post with useful tips on how to help your child with anxiety. As the parent of an anxious child, and as a mother who has struggled with my own anxiety, the advice and simple and practical steps you recommend are definitely something I will be working on going forward. At the moment there are many children struggling with anxiety going back to school after the long lockdown period. These tips will enable so many parents.

Please do take a moment to go and see the amazing free resources on Emerging Parent from Victoria.

You can also follow Victoria on her on Facebook – her page is @emergingparent

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