Essential Guide to Understanding and Responding to Children's Anxiety

I'd like to welcome everybody to today's presentation on understanding anxiety through a child's eyes. I'm your host, Dr. Donnelly Snipes. Over the next hour, we're going to identify symptoms of anxiety in children, review some common misdiagnoses, explain how children's developmental stage impacts their fears, and propose interventions to help children deal with anxiety. So let's start out at with the basics. What is anxiety? Anxiety is another word for fear, which is the flee part of the fight or flight response. It's the flee part of the stress response. And yes, I know that fight orf flight or the stress response is fight, flight, fawn, freeze, and forget about it. But when people are anxious, that anxiety can manifest itself in any one of those five ways. So it's important to recognize. And as we talk about symptoms, we'll talk about that a little bit more. So what do people fear? And children have very similar fears to adults. They just may be more, maybe broader, because as adults, we've whittled them down and said, okay, well, this really, in a lot of contexts, this may not be stressful or may not be threatening. So we fear death as adults. We think about death with our biological clock and that existential anxiety. But we fear not getting our needs met if we are hungry, if. If we are feeling unsafe, if we are sick, and we may get very fearful. So think about if you've been, and I know some of you have been very, very sick in the past. And when you're very, very sick, sometimes fear will ramp up because you're like, oh, this is really scary. And I don't know if or when I'm going to feel better. We also have a fear that kind of goes along with death for our own safety and the safety of others. Now, for children, remember children that are. And when I use the word children Today, we're talking 18 and under. But a lot of children, especially, you know, 14, 15 and under, they can't survive on their own. They can't pay the rent, they can't rent an apartment, they can't get a job that earns enough money that they can put food on their table and keep their bellies full. So it's really important to recognize that children not only have anxiety about their own safety in the moment, if you will, but also about the safety of their caregivers, the people who make sure that they get their needs met or are supposed to make sure. We as a humans, fear rejection, isolation, and abandonment. And I put those kind of all together because when people Fear rejection. The reason they often fear it is because they're afraid they're going to be abandoned and isolated again. For the child, if they're abandoned and isolated, if you take a four year old and you drop them off in the middle of the woods, that's a bad thing. Even if you drop them off in the middle of New York City, that's a bad thing. They don't know how to find help and how to make it on their own. They need caregivers. It is natural for us to have some amount of anxiety about the unknown. And for children there's a lot of unknown. They don't have nearly as many experiences as we do. So as adults we go through certain experiences that may be anxiety provoking at first, but then we do them and we're like, okay, that wasn't so bad. So then we can check that off the anxiety list. Children haven't had that experience yet. So the newness of life can in and of itself promote a little bit of anxiety. And loss of control is another issue that plagues a lot of us. And some of us tend to be more structured and preferring control and routine, shall we say, than others. So when that structure or when that control is undermined, we feel like we are a fish out of water. And it's important to recognize that, that children want to have a certain amount of control now developmentally, when they're two, they can't tell you, nor would they be able to effectively tell you maybe what they need to eat and what nutrients they need. So it's up to caregivers to make sure we help them identify what is within their control and what is not. Many threats that we have adjusted to as adults are still extremely threatening for children. And I gave you a few examples. I mean, there are other things like snakes and dogs and roller coasters in the dark and all kinds of things that maybe you were afraid of when you were a kid, that you have learned that in many contexts is not threatening, is not dangerous dangerous. And, and I keep saying in many contexts I'm not going to say that the dark or snakes or anything is never ever threatening. There are times that that could be, but that's where we come back to that context. Looking at the context and going in this situation at this time, is this particular thing a threat? To me, the emotional or instinctual part of a child's brain is much stronger than their reasoning areas. And we've talk this in so many other classes that until about the age of 24, people's prefrontal cortex where they do a lot of their higher order reasoning and planning and problem solving, it's not fully developed. Their amygdala, their fear response and some of their instinctual based responses that is more developed. So they are often going off of emotion based reasoning. They don't have that fact based reasoning. And when children get upset, they often have a stronger, more disregulating response that they don't know how to stop. So when they start, when something happens, they may disregulate, they may have that tsunami of stress hormones and they're like, oh my gosh, this feels really awful. I want to make it stop. I don't want to feel this way, but I don't know how. And they often don't have the vocabulary to even say all that to us, which feels even more threatening and scary. They're just like ah. And it may come out behaviorally or physically. A lot of times we see more somatization in children. So let's talk about some symptoms of anxiety in children and remember that any one symptom can mean a whole host of other things. So we don't want to say if a child is being extremely sensitive or touchy that they are anxious. It could be that something else, maybe they're in pain. You know, it's not anxiety, they actually are having pain that is triggering their stress response. But if they suddenly become a lot more sensitive and easier to upset. And we want to think about when did this change? And one of the things that I tell people and parents as well as adults that I work with, when you start noticing a change in feelings, thinking, behavior, okay, notice it non judgmentally and then get curious and say what changed? When did this start happening? And can I identify anything that changed that may be causing this or contributing to this? They may be more irritable, they are just cranky. And we're going to talk, we're talking about children from infancy on. And infants and toddlers often don't have the words to actually tell you what's going on. So it comes out more behaviorally. And we need to recognize that behavior is communication. Behavior for a lot of children is their words because they don't have the actual words to put on it, which is where we come in. Being responsive, we can help them identify those. I've shared with you in other classes, but I'll share again for those of you have who haven't been in them. There was one day that my son had to come with me for work. We had to stop, we had to Stop by the office for some reason. And this was when I was working in residential. And we were walking down the hallway and. And he was about two and a half, maybe three at this point. And we're walking down the hallway and all of a sudden he clenches his fists and he says, mommy, I so angry. I said, all right, well, that's good identification. Over the years, you know, the few years that he'd been alive, when he had started exhibiting signs of irritability or anger, you know, I had said, seems like you're really angry right now. You want to talk about it? So then in this situation, he had started to learn those words, and he couldn't really tell me what he was angry about at that point. I remember we still had to figure out kind of what was going on. But children are not born being able to identify emotions or being able to tell you necessarily why. It's like, I feel really angry right now. I don't know why, but I feel angry. Okay, you know, let's. Let's work with that. When children are afraid of making even minor mistakes, and this can include test anxiety, this can include anything at home. We want to look and evaluate for anxiety in that child. Children, especially children who are highly sensitive, may have more anxiety because they are more perceptive, if you will, of disapproval or energies in their environment. And if you've been around children that are particularly sensitive, you know that sometimes you don't even have to say something to them. If you look at them in a certain way, they may bust out an alligator tears. And that strong emotionality indicates a sense potentially of anxiety. It could indicate a sense of regret or guilt if they've done something wrong and they're like, oh, I'm busted. So again, we don't want to assume that means anxiety, but we do want to get curious. Panic attacks, obviously are symptoms of anxiety. A lot of children, most children will have phobias or extreme fears about particular things, bees or dogs or natural disasters. And if those things appear, quote, unquote, in their environment and they don't have any control over that, then they may have underlying anxiety. So every time they go out to the park, they may start fearing that they're going to get stung by a bee or bit by a dog. So we do want to recognize if a child is articulating a fear. We're going to have to process that. Just telling them, oh, don't worry about it, or you're fine, or that's not going to bother you. A lot of times is not overly Comforting. They need to understand why they worry about things that are far in the future. Obviously this is for your older children. However, children that are worrying about things that are far in the future, we want to examine what is it that you're worried about and how is that going to impact you. If they're worried that they're not going to graduate college, but they, or get into the college they want, but they're only in sixth grade or seventh grade, you know, let's talk about what, why getting into the college of your choice is so important to you. What does that mean to you and in what ways does that define you? So we want to explore those things and look at where they're getting those messages from. If the child has frequent nightmares, that is a symptom of anxiety, could also be a symptom of what they're seeing in the media. However, sometimes what you see in the media can prompt anxiety. And I've shared with with y' all before Scooby Doo used to love Scooby Doo. But they had that, you know, electric monster that used to pop out of the filing cabinet in the introduction to Scooby Doo. And I was terrified of that. And I would have nightmares about that stupid electric monster on Scooby Doo. But that is anxiety. It's something popping out of somewhere and making you feel unsafe. In my little, you know, six seven year old brain, there was part of it that was saying, okay, that's not real, that's on cartoons. And then there was a part of it that was saying, okay, maybe the, the electric monster isn't actually real, but, but things can pop out and things can jump out at you and make you feel unsafe. So getting curious about that and saying, okay, what does this represent in real life to this child and how can we help them feel safer and more empowered? If the child gets distracted from playing by worries or incorporates worries into their play, sometimes the child may start acting out divorce or acting out war or whatever it is that is bothering them or the, the scary dog down the street that they're afraid is going to bite them. We want to pay attention to that. Or if the child is playing or starts trying to play and then quickly loses attention and gets distracted, maybe they're not interested in what they're doing or maybe they're distracted by something else. So if we notice especially things that they used to enjoy doing is, are not holding their attention anymore, let's get curious. If they have compulsive repetitive behaviors, children think very what behaviorists would call superstitiously they may believe that if they do this, this and this in this order, then it's going to keep them safe. And we can see the beginnings of the development of obsessive compulsive behavior in children with anxiety disorders. They figure if they do these things correctly, then they might be safe. We need to, as caregivers, work with them to look at exceptions when they haven't done those things and they still have been safe. We need to also help them evaluate whether those behaviors really are effective for them. Behavioral signs of anxiety starting to melt down or having tantrums. Well, when children are stressed out and they melt down, they have a tantrum. That's them saying, I am completely overwhelmed or I need some structure. I need to know that you're there to help pull me back together. Okay? Sometimes meltdowns and tantrums could also be an expression of pent up anxiety where they had to be quiet and still all day long in school and they get out and they're just like, I gotta let it go right now. And if you keep me from doing that, I am going to, you know, explode and maybe explode towards you. So it's not that they're trying to be inappropriate. They are, they have all this energy and they can't keep a lid on it anymore. If they ask what if? Constantly now, 2 year olds will often ask why. Sometimes they'll ask, what if? That could be curiosity. But if the questions indicate more anxiety, then we want to explore where the questions are coming from and help the child recognize that, you know, you have all these what ifs, but you are safe. And there's a book that I absolutely love. I used to read to my child all the time. I believe it's called I love you, stinky face. And it was this mom reading a story to her son and he said, you know, what if this happened, would you still love me? And she's like, of course I would. And she talks him through it, but it is a really heartwarming book. If they avoid participating in group activities or remain silent or preoccupied during group work or family time, you know, this can be at school or at family. If they don't want to engage with other people, we want to explore. Do they have some attachment anxiety that is causing them to not want to put themselves out there for fear of rejection or criticism? Do they have social anxiety? What's going on? Why? What is making them feel apprehensive? Sometimes it's just overwhelming. Maybe they do better in smaller groups, but groups of 15 is too much. If they refuse to go to school. That may be another issue with anxiety. What is it about school that is causing you anxiety? Causing. There's, there's a difference. There's not wanting to go because you'd rather stay at home and watch television or play on your Xbox or whatever it is. But then there is flat refusing to go to school and making up excuses for why you can't go to go to school, sometimes feigning illness. And then we want to say, all right, why are you, why is it worth so much energy to try to avoid going to school? What are you trying to avoid the younger years? Well, even in the older years it can be bullying. It can be a fear of lack of acceptance. It can be fear of being judged. It could be anxiety about not being able to pass a test. Let's talk about it. They avoid social situations with peers after school or on weekends. Same sort of thing that we're talking about. Becomes emotional or angry when separated from parents. If there is a secure attachment with the parents, but they don't feel capable on their own, if they don't feel safe and empowered as individuals and they feel like they have to have their caregiver there, then they may become emotional or angry. They may also have separation anxiety. They may fear that their caregivers are not going to come back. Now we know that separation anxiety is a very normal part of child development. So we want to separate the normal phase from ongoing separation anxiety or excessive separation anxiety where the child is completely inconsolable when separated from parents if they constantly seek approval. That's another thing that we want to look at. I, I'm going to talk in a little while about making sure that we love or dislike behaviors, not children. I love you for who you are and I love this drawing that you did. Or I, I love you for who you are and I don't like the fact that you drew on the wall, you know, so we have options here, but we want to help the child feel loved, feel safe, feel accepted, feel like they can come to us, tell us anything and they will be loved and supported. We're not going to reject them for a choice that they've made or a thought or a feeling that they had. Children with low self esteem and low self efficacy or a lack of a sense of confidence in their ability to get things done often have anxiety. If you don't feel confident in your abilities, then you're often not going to feel empowered. And if they're overly concerned about negative evaluations, there may Be a lot of anxiety because they don't feel good enough in their own skin. They rely on other people to tell them that they're okay. And when they don't constantly have that input, they start feeling anxious, they start feeling less than they start feeling feeling disconnected. Physical signs of anxiety include frequent complaints of headaches or stomach aches. A lot of these, when you look at the physical signs of anxiety, you're going to go, oh, that sounds like a stress response. And guess what? It is. So physical signs of anxiety may come out in children because they don't have the words to say, I'm anxious, I'm worried, I am angry, I am whatever. So frequent complaints of headaches or stomach aches. We know that there are tension headaches. We know that when we get distressed or upset, it can upset our GI tract. We know that when we are chronically upset, it actually alters the gut microbiome refusing to eat. It could be because of food sensitivities, or it could be because they're not hungry or, or. But if there are particular times that they refuse to eat or a sudden extended period of refusing to eat, then we want to explore why. What's going on. Stress upsets our tummy or can upset our tummy, which can make it uncomfortable to eat. They may become restless, fidgety, or hyperactive. Remember, anxiety is part of the stress response, which means your body is dumping energy to prepare you to fight or flee. And if they're not doing anything with that energy, they're just having it dumped. And they're sitting there revving their engine, but they're being told they have to sit still. That energy's got to come out somewhere. They may have difficulty concentrating. Well, when stresses your stress reaction, your HPA axis is kicked off. Guess what? You're focused on fight or flee and survive, not how do I do this math problem. They may start to shake or sweat in intimidating situations or start to get dizzy. That's that panic response. A frequent urge to urinate. When we get stressed, our body's not focused on rest and digest is focused on fight or fleet. So sometimes the urge to evacuate our our bowels as well as urinate can be symptomatic of stress. Constantly tense muscles, exaggerated startle response, difficulty falling or staying asleep, either because they don't feel safe where they're at or because they're afraid they're going to have nightmares, or when they have nightmares, they can't get back to sleep. So we want to explore what's causing this. If they Start falling asleep in school. That can be because they're not getting enough sleep at night or they're feeling stressed. And sometimes when people have anxiety, especially young children, one of the ways that they block out anxiety is by going to sleep. Another really interesting thing, and I'm getting off track a little bit with infants when they are over stimulated, when they start feeling anxious, they will often avert their gaze so they stop looking at whoever's looking at them and they start to yawn. What do we know about yawning? We know that yawning triggers that vagus nerve and triggers the relaxation response. So when they avert their gaze and they start to yawn, that may indicate that they are feeling anxious. Repetitive activities like tapping or leg shaking that kind of goes along being with being restless and fidgety. Nail biting, skin picking and hair pulling or what we call technically excoriation. And, and both, all of these things can be signs of anxiety. The nail biting, if you've been a stressed nail biter or you, you pick at your skin. A lot of children don't even recognize that they're doing that until somebody points it out to them. It's just, it's a self soothing behavior. And children who have rigid routines and I guess that's not really a physical sign of anxiety, but it's here and we're going to talk about it. Children who adhere to rigid routines that may help them feel like they've got some element of control that may help them feel like, like they're, they've got some element of empowerment and they can predict what's happening so there's less unknown and that can help them feel a little bit less anxious. It can also indicate other issues like autism spectrum disorder in which change is very difficult. But again we want to look and say is this something that's always been present for the child or is this something new that recently started? What's causing the anxiety? A lack of sleep can trigger anxiety. When we don't get enough sleep, our HPA axis goes into overdrive. We, our body may feel more vulnerable. Poor nutrition or hunger. Lack of the building blocks to make the neurotransmitters to help the child feel relaxed and calm, to make the GABA and the serotonin can contribute to anxiety. And low blood sugar can also contribute to anxiety. When your blood sugar gets really low, you can start getting kind of shaky. It's important to recognize that some children burn through blood glucose more quickly than others. And especially if they're engaged in highly cognitive activities. Gifted Children tend to burn through a lot more blood sugar when they're in school because they're thinking and their mind is going so fast and the brain uses so much blood glucose that, or so much glucose that their blood sugar actually often gets low before lunchtime. And then they start feeling shank, shaky and agitated and it may end up resulting in behavioral issues that then get corrected or criticized and then they feel even more anxious because they feel, you know, like they were rejected or, or, or unacceptable for some reason. Hormones. Now this is obviously for your older children, but sex hormones are changing rapidly in the older part of childhood, which can contribute to a lot of anxiety. Even if there is no outwardly precipitating factor. Thyroid hormones. When the thyroid is hyperactive, people can feel somewhat anxious, somewhat revved. And so it, if it suddenly starts happening, especially if the child is having a hard time maintaining their weight or suddenly starts eating a lot more, you run it by the dock. Or if they're neurod. Divergent people who have sensory gating issues, whether it is ADHD or autism spectrum or schizophrenia or bipolar disorder, there's a lot of evidence that shows that they have more difficulty identifying the important from the unimportant stimuli. It's called sensory gating. They have a hard time shutting the gate on the un unimportant stuff. So they may get overwhelmed very, very easily in environments which can cause anxiety affectively. The highly sensitive child also may have a lot of anxiety because they for whatever reason, either is how they're wired or because they grew up in an environment in which it was unsafe to not be hyper aware of what's going on. The highly sensitive child feels stress, feels anxiety from others, and may or may not accurately interpret what others are communicating, especially non verbally. So they may be in a room with somebody who's upset or angry or whatever about something that has nothing to do with them, but they're in that room with somebody who's upset or angry. Children personalize and they say, oh my gosh, you're upset, you're angry, this is not a safe situation. Or worse yet, you're upset or angry at me. Cognitively unhelpful thoughts and just lack of knowledge and experience can cause anxiety when they encounter things that they're not sure of. It can be stressful. Relational bullies, including siblings, can cause anxiety. External pressure from teachers or parents, especially if it's combined with what we call conditional positive regard. You are only lovable if you get A's in school. You are only lovable if if you do this or if you don't do these things. So that can be really stressful for children too because they're constantly going through this list of I'm lovable if, and I'm not lovable if. Parental enmeshment or disengagement can also cause anxiety because it causes insecure attachment. The child in the enmeshed family, the parent or caregiver constantly tells the child what to think, what to feel, what to do, what to wear, how to do it. They are enmeshed, they are sort of joined, if you will, with the child and controlling of the child so the child doesn't ever feel like their thoughts, feelings, wants or needs are valid. Because the enmeshed parent or caregiver is. Controlling things. In a disengaged environment, the caregivers aren't even aware what's going on. They are too overwhelmed with their own stuff. Whether it's work or relationships or social media or depression or addiction, the caregivers are not there to provide the support and the framework and the structure the child needs, which causes anxiety. Environmentally. A chaotic home environment that is characterized by one or more people having mental health issues or addiction or abuse or neglect, whether it's verbal or physical. All of these can contribute to an environment that feels very, very unsafe to the child. And they don't know how to deal with it, but they're stuck. And this, these types of environments often lead to the development of things like complex post traumatic stress and social learning can also cause anxiety. The media that tells people how they should look, what they should do, what they shouldn't do, and peers. So it's not just online, sometimes peers can cause anxiety in a child. Differential diagnosis anxiety disorders. You know, we, we do want to look and make sure that we're diagnosing it appropriately. And there is social anxiety disorder in which the anxiety is specifically around social issues and rejection. Obsessive compulsive disorder, which is another anxiety disorder, anxiety related disorder and then just generalized anxiety when the child is worried about a lot of different things and it's persistent. Depression can mask anxiety. When a child is depressed or anxious for too long, they may start to feel very hopeless and helpless and just out of gas, they're not sleeping well, they're not eating well, their gut microbiome is a disaster and they just start feeling done. And that is the forget about it section of the fight, flight, fawn, freeze and forget about it response and the stress response. Add Sometimes children who are anxious will be hyperactive, will have difficulty Concentrating will make careless mistakes. And all of the symptoms of add, for the most part, can often be also attributed to anxiety. So we want to look, is it anxiety or is it add? Because the treatment is very different, ADD meds are not going to be effective for a child with anxiety. Autism spectrum disorders can also look or have an element of anxiety to them. Now, you can have concurrent anxiety with autism, but sometimes autism spectrum disorders can get missed in their diagnosis because it's being diagnosed as anxiety. When the child is having difficulty with sounds or having difficulty making eye contact or something, sometimes it gets misdiagnosed as social anxiety, PTSD, and more specifically cptsd. Often in children is when the child experiences a very threatening situation in which they perceive there is no hope of escape. And when we see children that are in households where there's uncontrolled mental illness, where there's uncontrolled addiction, where there is insecure attachment, then they may start feeling very hopeless and helpless and scared and alone. And that can contribute to the development of cptsd. And sometimes it will come out as oppositional defiant disorder. So anxiety, like I said earlier, can be masked by depression. It can also be masked in some cases by anger. So the child may become oppositional and defiant because they're trying to control their world as best as they can, because they don't feel like the people around them are doing a good job. So what do we do about it? Create a secure attachment, consistent mindfulness of what's going on with the child. Now, I don't mean you've got to follow them around 24 7, but notice, you know, have your pulse on kind of what's going on with the child at any particular point in time. Respond. Help them identify, identify the emotion or the issue or both, and tolerate the distress. Children need to learn that they can feel distress. They can feel anger or anxiety, and it won't overwhelm them, it won't overcome them. They can tolerate the distress until they can get into their wise mind and start problem solving. Use attention as prevention. Children who are securely attached with whom they spend quality time other than when they're in distress, start feeling safer communicating with their caregivers about their thoughts, their wants, their needs, their feelings. So having that open dialogue really sets. It sets the foundation for a caregiver to be more supportive for the child. Validate their perception, use empathy to encourage communication. We don't want to say, oh, you know, you're scared. There's no such thing as monsters. Go back to sleep. That's not validating in their world at that point in time, they believe there's a monster in the closet. All right, so, you know, let's take a look. You know, why don't we go look in the closet and see if there's a monster there? You know, let me help you feel safe. What can we do together? How can I support you? Encourage them to express their feelings and their thoughts, even when they're not in distress. Explore ways to act in order to achieve their rich and meaningful life. You know, how do you want this to resolve? What can we do here? And then to take initiative. However, when we take initiative, that means getting out of our comfort zone, which means it's important to have safety through unconditional positive regard where the child can try to solve a problem, they can try to achieve a goal, and if they fail, they can still come back home and they're still loved just as much as if they had succeeded. You may hurt for them, but they're loved just as much. So they feel like there is a place where they can always go back to. So children are not little adults at the age of 0 to 2. They're just, you know, they don't have vocabulary at all. And then up through just starting to learn vocabulary, they are developing object permanence. Infants, if you are not in their sight, you, you've disappeared. They don't know that you're in the kitchen. They don't know that you're going to be right back. And they start developing as they get older, personal agency, they will may, they may throw their bottle off the high chair and go, oh, when you pick it up and you give it back to them, they're like, hey, I figured out how to communicate a need. And that that person responds. How cool is that? So they start feeling empowered and they start feeling safer. If they express something, caregiver will respond. It's important for infants for us to remember that when the child is overtired, startled, too hot or cold, has low blood sugar, etc. Their HPA axis, their stress response gets activated. When that happens in their primitive brain, they're going, is my caregiver going to make sure my needs are met? If we meet their needs, great things go well. If we don't, then they may start developing a fear schema. We want to be aware of infants. They can't tell us when they've got a belly ache. They can't tell us when it's time to go to bed and say, okay, I want to lay down for my nap now. We need to be responsive when we're aware and we notice things. According to Dr. Howard Chilton, before six months, you're just extinguishing. And this can be fear. You know, when they have a problem, you respond, they feel better, all is well, you've extinguished that fear or hope. They have a problem. They, they cry, they start, you know, getting fussy, whatever, you don't respond. They may lose hope. They may feel like, okay, I'm hungry. Caregivers not meeting my needs. Hello. And then they start losing hope. They start losing the ability to trust in you. Loss of caregivers is a serious danger for babies. They're designed to cry until their caregiver is restored. But beyond a certain point, even a hysterical baby will stop crying. This is because in an evolutionary sense, an unprotected crying baby is broadcasting to all the predators. Here I am. Instinct tells them that it's its parents have vanished and that the tiger that killed their caregivers is close. So they need to be quiet to survive. So from a survival standpoint, one of the reasons children eventually, quote, cry it out or become quiet is because on some level, they may realize that that effort is not going to be useful. They need to conserve their energy, and it may not be safe to continue to do that as caregivers. Even with infants, it can be helpful to start getting into the habit of modeling emotion or problem identification. The child starts crying, oh, you're upset. You know, are you hungry? Let's see, let's check. Are you cold? Let me check your little feet. As caregivers, we tend to talk to our children a lot, and that helps them develop those words to express themselves. We want to model effective distress tolerance. Children are very perceptive because it's in their best interest to be perceptive. If their caregiver is upset, then that means there's danger, and so they get upset. If their caregivers calm, they tend to be more calm. Children pick that up. Whether it's from pheromones or our energies or whatever, children pick that up. So if we model distress tolerance when the child starts crying or is really anxious or upset, if we can model self soothing, then the child may learn that even with little children, when you hold them through kangaroo care, they found that the child's breathing will slow down more in attuned to their caregivers or will connect more attuned to their caregivers. So if their caregivers hyperventilating, the child starts breathing faster. If the caregiver is breathing slower, the child will slow their breathing. Now, children naturally breathe faster than we do as adults, so they're not going to completely sync up at this age. But it's interesting to note and make sure the child feels safe through compassion and curiosity. Okay, let's figure out why are you crying, little baby? What is it that's wrong? Let's, let's get curious. Start teaching emotional vocabulary and needs identification. If the child gets startled by a dog and starts to cry, wow, the, the dog scares you. The dog is loud and loud. Sc loud sounds are scary. You know, you're articulating to them what's going on so they can start forming that memory pathway. Toddlers struggle with being able to correctly identify their emotions and find the right word to describe it. So you can use feeling face emoji charts or identify feelings in videos and ask how different characters feel, whether it's, I don't know, whatever, cartoons or shows that the kid likes to watch. Play games to help with fears. You can play hide and seek with older children to help them recognize that you're going to come back. And mommy and me classes or play dates can also help kids get exposure to other children. At the age of two to seven, they're still not little adults. They think egocentrically. What I think is going on is what everybody thinks is going on. Personalized. It's my fault or I did that. Concrete. What I see in front of me has to be what's going on. There are no other explanations. Dichotomous means all or nothing and mystical and that's, you know, imaginary or fairies and fantasy. During this stage, according to Eric Erickson, children are going through and developing a sense of initiative and industry. It's okay for me to try new things and here are the things that I'm good at. Things you may hear from a child at this age. Daddy yelled at me, then Daddy left, so daddy must hate me and it's all my fault. Or I told mommy I hated her, so now it's my fault that she's sick. Or we got into a car accident because God is mad at me for not saying my prayers. Or the neighbor's dog always charges the fence and wants to bite me. So all dogs are dangerous. We need to recognize they're going with what they believe, with the facts that they have. Let children know plans and create safety with structure and consistency. Let them know plans for the day and what's happening next. So a daily schedule chart can be helpful and they may even participate in making it to give them a sense of Personal agency. But this helps them not be kind of caught unawares. And for children who desire structure, give plenty of warning before transitioning. Either tell them in five minutes, four minutes, three minutes, we're doing this. Have a bell that you ring in school? Maybe having a chant like the clock on the wall says it's time to stop, time to stop, time to stop. The clock on the well wall says it's time to stop and go to lunch, go to bed, go outside. Whatever the transition is for, ensure children always know what's expected. It's very anxiety provoking for any of us if we're going into an environment and we don't know what's expected. So we need to make sure that they're aware of what we expect from them. Have a rules chart or coloring pages and review it ahead of time, whether this is before you go to grandma's or before you go to the doctor or a new school or whatever. And be patient because children will test the rules if they know that they're supposed to act this way when they go to maternal grandma's house. Then when they go to paternal grandma's house, if you haven't reiterated the rules, they may test them out and to go is it the same here? Same rules apply in these. Both these different situations teach mindful awareness of their physical sensations, urges and thoughts associated with emotions. Two to seven year olds can start to develop this vocabulary and the earlier we teach kids to be mindful, the better off they are because they are able to identify those early warning signs and start engaging distress tolerance skills like deep breathing or grounding techniques, positive self talk or getting support. Identify the feeling or issue and reassure them that you'll be with, you'll be there to help keep them safe. If it's a monster in the closet or they've got to do a solo at school or whatever it is that is causing them anxiety. Let them know that you're going to be there to keep them safe and you love them. You may not be able to be physically there, but following up with them can be helpful. Being there in spirit. If you can't be there physically, join them in the reality. Talk about the anxiety monkey that likes to play tricks on them and then you can help them deal with monkey mind. Remember, children are concrete. So if you have a monkey stuffed animal and you name him Reginald in this case you can say, you know, sometimes Reginald really isn't ready to sleep and you can use guided imagery with the monkey to help him quiet his mind. Or you can say sometimes Reginald doesn't know what's going to happen, so he makes you think about the worst possible things that could happen. When that, when that happens, what can you tell Reginald to help him feel safe? So this is empowering the child to start, start developing self soothing scripts. Address cognitive distortions to reassure children that they're safe and loved. So the all or none thinking, reminding them, I can be mad at your behavior and still love you. Address global attributions by looking at facts. If they say all dogs are bad, okay, well, let's look. Are there any exceptions to that? And try to discourage the use of extreme words like everyone or always with magnification. This is when they take something bad that happened and they blow it out of proportion. It's like, oh my gosh, keep a frequency chart about things that they're worried about. Going to school and having a bad day. How likely is it that every day you go to school it's going to be a bad day? And minimize exposure to the news, especially at this age or discussions about the news, because children have difficulty understanding what is has happened a long time ago or last week versus what's happening now and what's happening a hundred miles away versus in their backyard. Personalization, and this is developmentally appropriate. Children personalize things, so it's important. When you're having a bad day, identify your emotions generally and why you feel that way. They don't need to know all the nitty gritty. But you know, mommy is really angry right now because I had a bad day at work. It has nothing to do with you. I love you, but I need to take a timeout right now, you know, telling the child, yes, I'm acknowledging you're spot on with perceiving that I'm in a bad mood, but it's not about you or asking them if you're feeling upset or distressed. Have you ever felt this way, but it wasn't somebody else's fault, you know, you know, it had to do with something else or just saying something like sometimes bad things happen and it's nobody's fault. And you can give them, potentially give them an example. At the age of seven, it's important to recognize that they start talking a lot more like little adults, but they're not. The small size of their world and relative lack of experience makes everything seem much bigger. And they're constantly growing and changing. So some days they may feel more awkward, tired, and have difficulty feeling like they fit in. According to Erickson, about the age of 13, children start developing their Identity and trying to figure out who they are and what they stand for. Now, I would argue that I think they're starting to do that a little bit earlier now, but we want to be aware as they're trying to figure out what is it that I can do that makes me excited? Acceptable. What is it that I can do that helps me be my authentic self? And is my authentic self acceptable? Between 7 and 11, children are using what we call inductive reasoning. So they're using global attributions from making global attributions from specifics. I failed a test, so I'm a failure. I didn't make the team, so I'm a failure. Or I don't look like this person, so I'm unlovable. This is a new school. New things are scary, so this must be terrifying. We want to help them break it down and identify the specific and then check the facts. This thing at this point in time, what is scary about it, what's not? From the age of 11 on, they start advancing to more advanced reasoning. But they still have very little life experience and have often not questioned their prior faulty schema. So if they got chased by a dog one time and now they feel like all dogs are bad, they may never have stopped to question, is that actually accurate? Other schema they may not have questioned is what it takes to be loved. They may think, to be loved, I must fulfill all these criteria or what it takes to help them stay safe. Interventions. We want to respond with non judgmental acceptance and help them with non judgmental acceptance. They identify what's going on, how they're feeling, what they're thinking, the situation, and they're like, okay, is what it is. Engage in distress tolerance activities. Unhook from it. So I've got this problem or I've got this feeling or this issue. Here it is. Now let's move on to problem solving. What am I going to do with it? And that may involve exploring exactly what that is in context. If they think, if they're anxious, that they're not going to be successful, okay, well, what does success look like to you? You know, you don't know if you can be that until you know what it is. Validate how they're feeling, acknowledge how they're feeling, even if you disagree or you're like, oh honey, this will pass. It's not for them, not right now. Encourage forward steps. What can you do to improve the next moment? And make sure to provide safety when validating. Avoid phrases that minimize the child's feelings or sound patronizing like I know it seems like the end of the world, or when I was your age, I went through the same thing. Trust me, you'll get past it. Instead, say things like you'd say to maybe another adult, this is one of the most devastating things you've had to go through. And you know, yes, as an adult I can look at it and go, there are much worse things, but they haven't experienced that yet. Or I know this is really hard right now. You're not minimizing, you're acknowledging how hard it is for them in their reality with their experiences at this point in time. Model distress tolerance like grounding and deep breathing or going on a walk and let them know you will support them while they feel they're feeling or endure the problem. Encourage them to identify solutions, suggest as needed because we typically have more tools in our toolbox, and then provide scaffolding, which means be there to support them. Let them do as much as they can on their own, but then when they get stuck, you're there to give them a boost to help them the rest of the way, whether it's researching or skill building through role playing or just being there for moral support. General anxiety management skills Keep blood sugar stable. Encourage them to get enough sleep and practice positive self talk. Help them get in the habit of checking the facts against their feelings if they feel anxious, is there something to be anxious about in this context at this time? Find exceptions instead of all or nothing thinking. Use visualizations of success, seeing yourself do, having that recital and doing really well. Regularly practice deep breathing or grounding. Encourage mindfulness to nip anxiety in the bud. Encourage them to get support from people who care about them unconditionally. Encourage them to reach out. Not just wait for somebody to come to them, but to reach out and say hey, I'm anxious or hey, I've got a problem. Help them find mentors who've gone through the same thing. Maybe if they're getting ready to try it, they want to try out for a sports team and they're feeling a lot of anxiety. Finding a older child or even a coach who obviously has been through that before who can provide some guidance. Spend 20 minutes generally as a family focusing on the positives each day the other 23 hours and 40 minutes. Focus on whatever you for whatever you want and encourage them to remember that just because they have a thought that something is scary or they feel anxious doesn't mean it is necessarily scary. Children's cognitive, physical and experiential differences make their anxiety different than that of adults. Children's symptoms of anxiety also often manifest differently, with more irritability, defiance, and physical complaints. Anxiety disorders are frequently misdiagnosed as add, autism, odd, and ptsd. Children's fears often focus around Maslow's lower three biological needs, safety and love and belonging. Addressing anxiety means helping the child understand, in a developmentally appropriate way that they will have what they need, that they are safe, and they will always belong and be loved.