Extreme weather phobias are relatively common. Gradual exposure to the feared situation is the most effective way to conquer a phobia. It may also be helpful for you to explain to your child that many children’s brain’s get stuck on this kind of worry and that it is much like a hiccup in his mind that is remedied by following a few steps.

 
First, help your child come up with a nickname for his fear: “Worry bug” or “Mr. windy” are appropriate. Referring to a nickname when a child’s fear is triggered serves two functions that will help him conquer his fear: 1) it will help him maintain objectivity about the fact that his brain is hiccupping, and 2) it will help the parent avoid reinforcing the child’s fears by reassuring him, explaining to him why he shouldn’t be so afraid, etc. It is preferable to use the nickname when addressing his fears. If your child isn’t particularly verbal or doesn’t like the idea of naming his fear, it is not necessary.

 
Next, construct a hierarchy of situations involving wind beginning with situations that are wind-related, but which elicit low levels of fear. I use a “Fear Thermometer” from 1-10 (a picture of one is on the opening page of my website) to have children rate how scary a particular situation is to them. “10” is the scariest and “1” not scary at all. If your child is too young to understand this numerical system, make a chart of 3-5 faces depicting varying levels of distress and fear and use it to enlist your child in rating the situations you will ask him to rate to make your hierarchy. Now, you must get creative. With each idea you invent, ask your child; “how scary on your fear thermometer would that be?” Your child will show distress doing this, and may in fact want to avoid it, since even discussing it is a type of exposure. Don’t be deterred. Move slowly, take baby steps, but do not allow your child to avoid this. Rewards are very helpful to increase a child’s motivation to persevere. I use them in my practice regularly and encourage parents to set up a reward system. The reward needs to be delivered as close to the desired behavior as possible to be maximally effective and the reward needs to be sufficient to encourage your child. It is not bribery: REWARDS MOTIVATE!

 
Below is a sample hierarchy of a hierarchy that might be appropriate:

 
Look a drawing or painting of a windy day-3
Listen to my Mom/Dad make wind noises-2
Listen to Mom/Dad make wind noises while he makes a bush or tree shake like in the wind-4
Watch a video of a breezy day-4
Watch a video of a windy day-6
Listen to a weather report about wind conditions-4-8
Have Mom/Dad read a book to me about a windy day-5
Sit in the car at a windy spot and watch the windy day-6
Sit in the car on a windy day and open the window a crack-8
Stand/play outside on a lightly breezy day-7
Stand/play outside on a windy day-8
Stand/play outside on a very windy day-10
Watch a movie with a big wind storm-9
Watch a movie with a small tornado-10

 
For your child to habituate to the situations he fears, he must have massed exposures at each level of the hierarchy, starting with the situations with the lowest fear thermometer ratings. Massed means, as many as it takes such that he can eventually do that particular exposure with out any fear thermometer at all. Make a special working game of it on a daily basis and perhaps several times a day. The more exposures your child does, the easier it will become and the more rapidly he will conquer his fear. You might introduce it in a manner similar to this: “Now it’s time for us to do our Worry bug exposure game and for you to work toward bossing back Worry Bug and earning some great rewards.” Each time you play the Worry Bug game, the goal is for your child to do enough exposures (over and over and over again) for his fear thermometer to reduce while he is doing the exposures to 0 or at least half of what they were when he started that particular day.

 
In order for habituation to occur during exposures, your child must also agree to refrain from doing Safety Behaviors. You must also reduce and eventually eliminate your participation in Safety Behaviors. Safety Behaviors are behaviors done to reduce the level of exposure or quell your child’s distress in the face of the feared situation. Safety Behaviors that your child may have developed include: covering his ears or eyes when he thinks it’s windy, asking for weather reports from you, seeking reassurance that wind will not come up, avoiding going outside, clinging, etc. Rather than reassure him and explain

What if my teacher doesn’t like me?
What if I don’t feel well and you are not there to help me?
What if the other kids think I’m not as smart as they are?
What if I can’t do long division?
Can’t I just stay home?

Every fall, millions of American children begin a new school year with emotions ranging from excitement to dread to resignation. As parents, we anticipate that our children may have questions and concerns about going to school. Many of us, during our own childhoods, experienced that “butterflies-in-the-stomach” sensation as we strapped on our backpacks and shuffled to the bus stop. These mild to moderate feelings of anxiety are normal and to be expected.

Some children, however, experience more severe anxiety about returning to school. These children typically have fears about specific situations that make up a school day or fears about separation from parents. When these situations ended with the onset of summer, so did much of the anxiety. Moreover, during the school year, your child may have habituated to the situations that triggered his fears because he was exposed to them constantly, but since he has been away from these situations his fears may have re-emerged. “Back to School” can, indeed trigger or re-trigger a plethora of common fears.

Common types of anxiety triggered in the school experience include:
Social anxiety: fears about being judged negatively by others, often perceived as shyness in particular interactions including using restrooms.
Perfectionism: worries about making mistakes, getting less than an exceptional grade, missing an assignment, and imperfect performance.
Contamination fears: concerns about germs, chemicals, etc.
Somatic worries: fears of vomiting, fainting or feeling ill.
Separation anxiety: worries about harm coming to parents when the child is at school or on a sleepover and concerns about being away from a parent in a time of need, such as an illness or upset.

If your child exhibits signs of anxiety, the way you respond to his fears can either help him conquer them, or unintentionally feed them. Parents often respond to a child’s anxiety by participating in “Safety Behaviors” with the child. “Safety Behaviors” are actions taken to manage, limit or mitigate the exposure to the situation that triggers fear. They range from very subtle, such as going a special route to avoid a feared interaction to overt and extreme, as when a situation is completely avoided or endured with great distress. Engaging in “Safety Behaviors” can indeed reduce a child’s anxiety in the short run, but in the long run, doing so invariably reinforces your child’s fear for a number of reasons. First, in interferes with a child’s ability to learn that the exaggerated fear they perceive is indeed not accurate. Thus, any exposure the child does gain will be ineffective when safety behaviors are used. When a child does a safety behavior it sends a direct message to his brain that he should worry about the situation.

Examples of such potentially harmful responses that parents make include: helping the child avoid the situation, reassuring him excessively, engaging in repeated explanations regarding why your child really has nothing to fear and doing ritualistic behaviors with your child such as; “good bye” rituals that “need” to be done to comfort the child.

Many parents find this to be counter-intuitive and fear that they are not doing a good job helping their child to “feel safe” in the world if they do not engage in these behaviors. In fact, engaging in and enabling these behaviors teaches your child to feel more scared and in fact less safe. So how can we help our children combat their anxiety in a way that will empower them and set them on the path of healthy thinking?

Step One: Gather data. Parents should monitor the situations that provoke an anxious response in their child. Keep a log detailing the date, the situation, and the fear; specifically including the behaviors manifested by the child, how you responded and the degree of anxiety you perceive your child to be experiencing rated on a scale of 1-10 (“1” signifies little to no anxiety and “10” is the highest degree of anxiety you have observed in this situation. Encourage your child to specify what it is that he fears. Many children with anxiety will attempt to avoid even clearly thinking about what scares them and will respond with vague statements such as: “I just don’t like x.” This is a “Safety Behavior” for it is part of their strategy to mitigate their anxiety. Holding a benign, business-like attitude, be a detective with your child and encourage him to look for clues with you regarding the specifics of his fears. For instance, is the child afraid to go to school or afraid to leave home? If she does not want to go to school, what does she fear? Is she afraid the bathrooms will be dirty? Is she nervous about talking aloud in class? By maintaining a written log, parents gain a better understanding of what it is that is triggering the child’s fearful thoughts and any safety behaviors utilized.

Step Two: Objectify the worry. Some children name it “Mr. Worrywart” or the “Worry Bug.” Use this term when discussing the child’s anxiety. However, parents should avoid too much conversation about the fear itself because this too becomes a safety behavior; instead, if the child wants to talk about his fears, help him label it and call it “Worry Bug” or whatever nickname he has given to it. The focus should be on defining the situations that provoke anxiety and identifying safety behaviors that you and your child have developed in the attempt to quell your child’s fear.

Step Three: Identify and make a list of all “Safety Behaviors.” Go through the list with your child item by item, reminding him that although these actions seem to help in the short run that they just make his fears worse in the long-run and that the two of you are going to gradually reduce engaging in them. Introduce the concept of a “fear thermometer” (a scale of “1-10”, with 10 being the most scared she has ever been in a similar situation) that the child can use to gauge her level of anxiety. Using the fear thermometer as a guide, ask your child how hard on his fear thermometer it would be either for him or you to not do the particular behavior or mental action. Start eliminating the lowest fear thermometer “Safety Behaviors” first. Don’t forget to utilize rewards here to motivate your child to take on these challenges that will ultimately make him feel stronger.

Step Four: Gradually expose your child to the situation he fears. From the log developed in Step One, you have pinpointed the situations that trigger your child’s anxiety. Select a situation to begin exposures with. I recommend starting with a situation that occurs frequently (or that you can make occur frequently, even if you must manufacture it just to be able to practice it). Once the situation is selected, you and your child must break that situation down into a hierarchy of steps ranging from low fear thermometer ratings to high. For example, if she is concerned that you will be late picking her up from school, ask her how scary it might be if you were to arrive 30 seconds late, one minute late, 2 minutes late, 5 minutes late, and 15 minutes late. Together with your child create the situation hierarchy, and start with a situation lowest on her fear thermometer. Begin slowly and within the child’s comfort range (usually that translates to a fear thermometer situation of 3 or below). Perhaps, the first day, you both agree that you will arrive one minutes late, which your child thinks will be a 3 on her fear thermometer. When you do arrive one minute late, ask your child to measure her degree of anxiety on her fear thermometer and praise her and provide the agreed upon reward. Continue to arrive one minute late every day until the child experiences no concern at your tardiness (a “0” fear thermometer reading). At first, be prepared for slightly increased anxiety for a brief period. Over time, however, through this gradual and consistent exposure, the child confronts his own fear and actually teaches his brain that it need not over-react when in that situation.

You and your child must join together in this effort and your child must have some motivation to conquer her fears. Often, children do not present with a desire to do this, as they are comfortable to avoid and continue to do “Safety Behaviors” for as long as the parent does. To engender motivation, I recommend rewards, established ahead of time for each successful exposure and attempt to resist the urge to engage in a “Safety Behavior”. Additionally, you may wish to create a list of “hassles” that the fear and its associated behaviors causes the child. Common hassles include: feeling stressed out, things taking much longer than necessary, not feeling comfortable doing activities the child truly enjoys, missing out on various activities such as sleepovers, camping trips due to her fears, and family stress.

Remember that all of us experience worries, and that varying levels of anxiety exist on a continuum. The process outlined above provides real-life strategies that you, as parents, can employ to lead your child out of anxiety-based thinking and its behaviors. However, if you feel that your child’s fears are interfering with his ability to function on a daily basis, seek the guidance of a professional. A mental health expert, experienced in Cognitive Behavior Therapy, can provide you and your child the guidance and the tools you need to overcome even the most severe anxiety disorders.

Teachers are among the most constant and important figures in children’s lives. Teachers, as well as school counselors, special education providers, extended care staff and administrators interact with children for many hours of a child’s day. They are therefore quite frequently on the front lines of helping anxious children navigate their days and manage their fears.

Teachers, like parents often gravitate toward solutions that may result in short term relief, but ultimately feed a child’s fear. Allowing or encouraging a student to avoid engaging in an activity that he fears, or does not feel at ease in doing, may make his day easier; but will not help the child conquer his particular fears. When a child avoids a feared or uncomfortable situation, he essentially tells his brain that he has something to fear. Additionally, he misses the opportunity to benefit from learning that the situation does not result in the dire consequences he feared. Repeatedly talking and rationalizing with a child about why he should not be afraid or uncomfortable, similarly does not help him conquer his fears. Another counter-productive strategy that I have observed being utilized in the classroom is encouraging the anxious child to develop an exit strategy for uncomfortable or distressing situations. This tactic similarly sends the child the message that he should be afraid and that he cannot manage the situation. The child must gradually face the situation that triggers his fears to free himself from anxiety.

Here are some suggestions to guide you in your efforts to constructively manage anxious behaviors and support your charges. First and foremost, resist the urge to help the child avoid feared situations. Instead, encourage the child to participate in the trigger activity or situation. It may be helpful to break down exposure into manageable steps, beginning with easier aspects of the entire situation, and as the child masters each step, move to the next step that is more challenging. Rewards are typically very helpful in motivating the anxious child to face her fears.

For example, let’s say Johnny expresses reluctance to play outside during recess because he thinks he can’t play 4-square as well as his buddies and he fears that they will judge him negatively because of this. He complains to his teacher about this. She knows he’s generally a great kid (as are most kids with anxiety issues) and thinks she’s doing him a favor by allowing him to stay in the classroom during lunch recess to work on a “special” project that allows him to show his talents making beautiful artful posters for the upcoming book fair. This tactic will indeed put the child at temporary ease, but only serves to perpetuate and feed that child’s fear in the long run. A far healthier strategy would be to encourage the child to participate in 4-square and reward him for so doing. If committing to play feels too hard to try at the outset, encourage the child to be out on the playground to observe the game until he feels less distressed about that. Once he experiences diminished distress on the playground while observing, encourage him to take the plunge and play the game. The more he repeats each step, the more rapidly he will master his fear. If he makes only one brief attempt and gives up before he has habituated, he will simply be triggered and will not have as much opportunity to learn that his fears are not so likely to come to pass.

In sum, do not enable the anxious child to avoid the situations he fears, but rather, encourage him to engage in triggering activities. Make it a fun challenge and be generous with rewards. As Eleanor Roosevelt said: “Do one thing every day that scares you.”

Check out Shirley S. Wang’s article, Tantrum Tamer: New Ways Parents Can Stop Bad Behavior in 11/08/11 Wall Street Journal

View Article Here

Ms. Wang reports about findings at Yale University and King’s College, London indicating that the ways in which a parent responds to a child’s disruptive behavior can significantly reduce these behaviors. If you’ve been following my blog posts, this will come as no surprise to you and in fact you may already understand why these findings make sense. The studies at these parenting research clinics essentially use principles of behavioral therapy to help parents shape their child’s behaviors by both eliminating reinforcement of the bad behaviors, skill building (teaching these children alternative behaviors to do when their distress is triggered), and rewarding their child’s successes at managing distressing situations in appropriate, rather than disruptive ways. They call their parent-training model, the ABC’s. The A stands for antecedents; in other words, what was the situation that triggered the tantrum. The B stands for behaviors; what are the target behaviors that the parent wants to eliminate or reduce. The C represents the consequences of the behavior (the goal is to reward a child for not doing the bad behavior at all or for doing a behavior that is less disruptive). They guide parents through a structured training module, that they admit is difficult and requires a great deal of discipline and focus by parents.

I use behavioral shaping principles and techniques every day in my practice with children. When working with children a good portion of treatment involves teaching parents how to respond and more often, how not to respond to behavioral issues. Though I have not yet reviewed the specific studies referenced in the WSJ article, I can see by reading it that some of the children in their studies had anxiety disorders and/or were highly sensitive. They sited an example of a little girl with extreme separation anxiety; something I see in my office weekly. A significant part of what successfully treats separation anxiety is gradual exposure to being separated from Mom(or other significant other). This is what they were doing in the example case that the article used; coaching the mother to move her daughter from her lap, instructing mother not to reassure her daughter, but rather to be neutral and descriptive. Another part of what the psychologists did with the mother-daughter duo, and in fact the focus of the entire article is how the mother responds to her child’s signs of distress. Again, the scientists instructed mother to remain neutral, to not jump in and try to quell her daughter’s distress or rescue her from a situation that triggered fear.

Often kids with anxiety disorders or kids who just have low tolerances for distress react in extreme ways. Sometimes the purpose of the tantrum is to avoid a given situation (A in the studies sited for the WSJ article). Other times, sensitive and anxious children become irritable because managing their internal distress is so very energy and attention consuming. Some children engage in disruptive behaviors to get attention. Doing these behaviors, however, offers nothing positive to the child or parent, unless you consider avoidance of a situation that triggers fear or discomfort a positive, which in the short run it is for the child, but in the long run avoidance only reinforces a child’s fears and low tolerance for distress.

What I do in my practice with parents of children exhibiting behavioral problems is multi faceted. First, one must have an accurate conceptualization of the purpose of the behaviors. Is the child suffering from anxiety? Does he have a very low tolerance for distress? There are many kids who don’t present with clear anxiety symptoms, but who fall into this latter category. They are the ones who can’t stand itchy labels, seams on socks, feeling too hot or too cold, feeling hungry, etc. These are children who are often prescribed sensory integration training (which is a behavioral intervention involving skin brushing of essentially exposing them to the stimuli that distresses them until they habituate). Once I have accurately identified the problem, I must find an appropriate solution, which involves treating the source and managing the behavior problems that reinforce the source problem. If, for example, it is determined that the source of tantruming behavior is to seek attention, then we make sure the parent practices “safe ignoring” during a tantrum. We also might set up a behavioral plan that involves rewarding a kid for resisting the urge to tantrum for specific doable amounts of time. For example, through careful evaluation of the antecedents of a tantrum situation we might see that leaving for school is a vulnerable time for the child. We might set up a behavior management plan that rewards the child for not yelling, throwing things, making threats (the target “Stop Behaviors” must be clearly defined and readily observable to parent and child alike) for 5 minutes of that vulnerable time and reward her to successfully achieving that goal. If, on the other hand, the purpose of the tantrum is to avoid going somewhere that triggers specific anxieties, we treat the fears through gradual exposure to the feared stimuli, and work to eliminate avoidance and other safety behaviors. Since the tantrum in this example is a form of avoidance, we reward the child for controlling herself for chunks of time she can manage in situations that are no too distressing and gradually increase the time spans and broaden the situations.

These are basic, cognitive behavioral principles that most CBT clinicians who work with children utilize as a matter of course. I am so very pleased when I see that proven CBT techniques are brought to the attention of the lay public, as with this article. The article underscores how very important a parent’s role is in determining the course of the behavioral problems that children exhibit. When parents get educated about how they can positively impact their child, this is a powerful tool. This helps parents make educated decisions regarding how to manage behavioral issues and how to know what to ask for when they seek the help of a mental health professional.

Tolerating the distress that an anxious child experiences when his fears are triggered can be challenging. Some parents have particularly low levels of tolerance for the distress of their anxious child and jump in to remedy any distress by any means they can. We have discussed in the previous three blog entries the myriad of ways that parents unintentionally reinforce their child’s fears in their attempts to quell their child’s distress. Aiding and abetting avoidance of feared situations, arguing, reassuring and over-explaining/rationalizing are a few we discussed in detail. If you’ve read previous blog entries, you also know that engaging in these behaviors with your anxious child actually results in feeding his fears rather than helping him conquer them.

Let’s shift our focus from your child’s responses, to yours. Let’s talk about your own responses and fears regarding the distress that your child exhibits in the face of fearful situations. What scares you about Sally’s shaking and crying in the face of being urged to; for example, take medicine that she is afraid to swallow? What scares you about Johnny’s agitation and uncharacteristic serious stance about going to baseball practice in spite of his love of baseball? What distresses you about hearing your child crying to you about her fears that she might not do well on her spelling quiz? Think about it for a few minutes. Ask yourself; “What bothers me about witnessing my child’s distress?” I’d like to hear some actual responses to this question from parents reading this blog entry. Please take the time to send a comment so that I can include it in further discussion and so that parents of anxious children can see that they often share similar fears:

“I am a bad parent if I allow my child to suffer.”
“She will get so upset that it will damage her in some way.”
“It disrupts our routine and causes serious problems for me and other family members.”
“It is incredibly stressful and distressing to see my child so upset.”
“I want to be able to make my child feel better; it is my job to be able to help her.”
“It will just get worse and he will be worse off if I don’t do something.”
”It is embarrassing.”

As a parent myself, I often have the conditioned instinct to step in and do something when I hear a crying baby or distressed child. We are genetically programmed to protect and nurture our offspring. If we were not, we would not have survived in the wilds as humans had to to evolve and continue on this earth as a dominant species. That being said, if you are the parent of an anxious child, you’ve already come to the understanding that your child’s responses to anxiety trigger situations are repetitive and far more extreme than the situation warrants. Furthermore, you know that the situations that trigger the anxiety are far from life threatening or dangerous. The things about which your child worries are simply more extreme and more fixated upon than the average same-aged child would experience in a similar situation.

By learning to manage your own responses to your child’s fears, you can help your child learn to be less afraid. Consider the possibility that your own anxiety about your child’s fears may play a role in influencing your behaviors toward your child. In other words, your own distress about your child’s distress could be compelling you to engage in behaviors that reinforce your child’s fears. Once you identify the role of your own fears, you have the power to change your behaviors so that you are helping your child conquer his fears rather than feeding them.

Parents of Children with anxiety problems sometimes find themselves arguing with their child about his or her irrational fears. The child may insist that there is good reason to be afraid while the parent tries to convince the child that there is no sound basis for fear. Or, the child may throw a tantrum or fit or act extremely distressed in the face of a feared situation. The upset often serves as a mechanism for the child to in fact avoid the situation or even talking about the situation that scares him. The attention is drawn to the drama of the fight or fit. Parents respond to such fits with anguish, fear, attempts to quell their child’s fear by agreeing to do things that they know are not helpful. Feelings of anger, frustration, and helplessness are common for many parents in these situations. Some parents change their behaviors to avoid such responses from their children. When any of these behaviors occur, the child’s anxiety has won and will most certainly be reinforced. This interplay can go on repeatedly for days, months or even years, all the while the child’s symptoms do not improve, but rather shift and grow.

As a parent your job is to recognize these avoidance strategies. Do not scold your child for attempting to draw you into an argument about his fear, but rather, do not take the bait. You may instead: 1) ignore the invitation, 2) distract your child, 3) or play Columbo (act like you’re a little puzzled, don’t quite get the gist of what your child is requesting) and move on to some other topic. Consistency is crucial here, for your anxious child may marshal all of his intellectual resources to come up with ways to convince you otherwise. Endurance also helps, because if you can hold tight until your child’s invitations for argument reduce, you will see less of that distressing behavior and you will have done your part in reducing your child’s anxiety.

Dr. Harold Koplewitcz indeed does seem to be the kind of informed advocate that our children need. Mental illness is a fact of life and very frequently has nothing to do with bad parenting or traumatic experiences, but rather with genetic predispositions. Neither a child nor a parent can do anything about the genes that have passed on to a child; a distressing anxiety disorder, psychotic spectrum disorder or mood disorder. This is a fact of life, and competent mental health professionals know this. I wholeheartedly agree with Dr. Koplewitcz’s mission of removing the stigma from mental illness among children and teenagers and “make it something to be managed and overcome as it was with dyslexia and attention deficit disorder before it.”

Unfortunately, much of the lay public does not understand mental illness and it is challenging to know how, where and from whom to seek help for a child who is suffering. Indeed, as Dr. Koplewitcz notes, “People think of child psychiatry as playing with kids on the floor” and further suggests that “we need to educate them and change the way they think about childhood psychiatric illnesses, so the shame goes away and it improves access to care.” Amen to that! I treat children as young as 4 years of age for anxiety disorders and never do play therapy simply because it is not effective in treating anxiety disorders. Of course, for very young children much of the work is done with the parents in teaching them how not to reinforce fears and how to reward a child for doing the necessary exposures that are required to alleviate the child’s fears and anxieties.

For the 30-40 children I successfully treat each year for anxiety disorders, I do just what Dr. Koplewicz preaches: I teach the child and the parent, through the scientifically proven methods of Cognitive Behavioral Therapy, how to manage their fears and resulting anxiety so that the symptoms either go away or no longer cause distress or interfere with the child’s enjoyment of life. To me, an anxiety disorder, which 3% of all children suffer, is simply something to be managed, not something that has to inflict distress, disrupt a child’s life or be viewed as a stigma to be hidden.

View original article.

Aid and Abet your child’s attempts to avoid the situation that triggers his fears.

What does this mean? It means that you help your child avoid fearful situations and or that you actually encourage avoidance as a strategy to manage your child’s distress. There are countless ways that a parent can do this and countless ways that a clever child can influence a parent to do so. Why is it counter-productive to help your child avoid these situations? Because it reinforces their fears, of course! Avoidance is typically one of the first strategies that a child or adult will use when confronted with a situation that triggers a fear. Avoidance does, in the short run, alleviate an individual’s fears. In the long run, however, it feeds the person’s fears by teaching that person’s brain (often repeatedly) that the situation is indeed something to be afraid of.

Avoidance breeds more avoidance and can generalize to other situations, rendering a person increasingly fearful. This is what happens in Agoraphobia. Agoraphobia is a type of Panic Disorder, which means that a person has panic attacks and fears having more panic attacks. Panic attacks are often first triggered in a specific situation. The person then avoids that situation for fear that he will have another panic attack because he is in that situation. The situations that the person fears as potential triggers increases, until that person avoids exposure to all situations and becomes house-bound because he feels that it is the only “safe” place to avoid triggering a panic attack. Of course when we treat someone who has Agoraphobia or Panic Disorder, one of the first things we do is to help the person gradually reduce and eventually eliminate avoidance behaviors.
So, parents, if you have an anxious child, do your part by not allowing avoidance and by gradually reducing it if it has started!

Here are a few examples that I see frequently:

*Allow your child to simply not go to specific locations, such as parks, off leash areas of dog parks, movie theaters, grocery stores, etc.
*Physically lift up your child or rush to soothe your child when a situation arises that you know triggers anxiety in your child.
*Serve only foods that your child is comfortable with.
*Frequent only well know, often-visited restaurants.
*Make changes in your child’s schedule to accommodate his fears.
*Allow him to avoid sleepovers, etc. when he has reached an age where most of his friends are doing so.

Use your imagination! If you have an anxious child, you can no doubt add to this list.

Thank you for reading.

Bridget Flynn Walker, Ph.D

My previous blog entry focused on the “most important” advice I have for a parent of an anxious child: determine how you are unintentionally reinforcing your child’s fears, and stop doing that. I thought it might be useful to readers if I discussed, in detail, specific ways that parents reinforce their children’s fears. Just as there are “50 ways to leave your lover,” there are at least 50 ways to unintentionally feed your child’s fears. Each week for as long as it seems useful, I plan to discuss a particular way that I have seen a parent feed the fears of his/her child.

Ways a parent feeds a child’s fear: #1 Repeatedly reassure your child. A child with excessive anxiety typically turns to his parents for comfort and safety. Of course, providing safety and comfort are normal aspects of parenting that are generally healthy. When you have determined that your child has extreme, irrational, persistent fears, however, providing reassurance in response to these fears does more harm than good. Why? It reinforces the child’s fear: it sends the child’s brain the message that her particular fear, is indeed something to be worried about and that, without the parent’s reassurance, the child will not be o.k. Though, rationally, as a parent you may feel that you are simply trying to supply information to quell doubts and fears, your frustration is that the information never seems to really sink in and truly quell the fears your child is experiencing. Your anxious child asks the same questions repeatedly and begins to use you as a safety behavior that ultimately feeds his fear.

Here is a list of reassurance-seeking questions that anxious children may ask repeatedly:

* ”Mom, is this cupcake o.k. to eat?”
* “What will happen if…?”
* “Is it o.k. to touch that?”
* “Who do you think used this last?”
* “Is it bad for me if I smell a pesticide?”
* “What are you doing while I’m at school?”
* “What if your car breaks down?”
* “Is the soccer game near the off leash area for dogs?”
* “What are we doing after school?” related to need to review daily schedule repeatedly.
* “I said something mean to Sally at school today: can I tell you what I said so you can tell me it was o.k.?”

In addition to responding to these types of questions with logical explanations (often repeated many times), parents often try quell an anxious child’s fears by supplying such explanations before a child has even asked. This, too is reassurance seeking/providing that is counterproductive to helping a child overcome his fears.

Reassurance-seeking behaviors: Anxious children also seek reassurance through various behaviors. My previous blog discussed an example of a parent who provided reassurance to his daughter without even being asked to do so by his child. That situation involved a dog walking past the girl, who must have feared dogs, since, upon seeing the dog, the father raced to her side and began reassuring the girl that she would be fine, that Daddy was there to protect her. It is very common for anxious children to display extreme distress (crying, hyperventilating, screaming, leaping into parents’ arms). Parents often have a very difficult time tolerating their child’s distress and intervene when a child’s fears are triggered by providing lots of reassurance. Moreover, as exemplified by the above example, parents themselves become conditioned to intervene by providing reassurance because they want their child to avoid getting distressed in the first place.

My next blog entry will discuss another way that parents reinforce their children’s fears: allowing avoidance. Thanks for reading!

Learn how you may be unintentionally reinforcing your child’s fears and then gradually stop doing it. If you have read some of my previous blog entries or the content on my website, you will understand how easy it can be to reinforce a child’s fears in the long run in your attempts to quell their distress in the moment.

How do you respond to your child when her fears are triggered? Keep a log of your responses for a few days. Include in your log: the date, situation, what you observed your child to be fearful of, what you did or said, and how distressed (on a scale of 1-10) your child appeared to be. Use descriptive, objective terms in your log. Usually, specific situations trigger fear and anxiety in your child. Determine which situations are trigger situations and observe the patterns in your responses.

Examine your log. How did you typically respond when your child expressed his anxiety? Did you repeatedly answer your child’s pleas for explanations to quell his fears about particular situations? Did you rush to his side to comfort him the minute he entered the feared situation? Did you help him avoid the feared situation or alter the situation so it would be less scary? If you did anything similar to the behaviors I just noted, you are very likely reinforcing your child’s fears. In the short run you may quell his distress, but in the long run you are making your child’s fears bigger.

Some parents have very low tolerance for their child’s distress: they want to jump in and rescue them and make it all better rapidly. Some children, on the other hand, have a low tolerance for their own distress and are very reactive, causing disruptive scenes, etc. Quite often, both cases are true: the child is very reactive and the parent has trouble tolerating the child’s distress. This can make it challenging for a parent to know how best to respond when their child exhibits anxiety.

Once you have determined how you respond to your child’s fears and, most importantly, which responses reinforce his fears, you must work to gradually change how you respond.

Here is an example that might be useful in conveying this important issue. Last week, I was walking my dog (a large black standard poodle) on a wide road dedicated to cyclists and pedestrians. As I approached a father and his 2 young children I noticed that his daughter was sitting on the curb, happily adjusting her equipment and having a juice break. The minute the father saw my dog, before the little girl said or did a thing, he rushed to her side, stating, “It’s O.K., I’m here.” The father obviously anticipated that the girl would be scared, which she indeed may have. The problem with his behavior is that he is actively reinforcing his daughter’s fear: he is giving her brain the message that she can’t be O.K. around a dog without his protection.

What to do instead? Work on solving the problem and stop those behaviors! If your child is, for example, fearful of dogs, gradually expose her to dogs in a gradual manner. Start with dog situations that are not too scary and gradually move up the ladder to exposing her to situations that are more difficult. For example, some children are so frightened of dogs, that simply exposing them to pictures of dogs elicits distress. If that is the case with your child, do picture exposures until your child’s brain learns not to be afraid of the pictures, then graduate to sitting in the car and looking at dogs until your child is not afraid of that, then graduate to getting close to leashed dogs, etc. Be creative! Reward your child for her exposure efforts.

Parents, pay attention to your behaviors! It is far better for your child if you maintain a matter of fact, business-like attitude regarding your child’s fear and distress. Let your behaviors reflect how you believe your child should respond to the situation. Act like it’s O.K., don’t get sucked into his distress and certainly do not help your child avoid feared situations. This does not mean that you must be a cold automaton-like parent. If you make adjustments to your behaviors and stick with them, even when your child initially escalates his or her distress in response to your behavior changes (this is known as an extinction burst, in behavioral terms) you will gradually see your child become less fearful.