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Two day school students engaged in a session with a Gateways therapist

How to Help Kids Cope with Anxiety

by Kara Baskin, written for JewishBoston.com.

A little bit of anxiety is normal. Here’s what to do when it isn’t.

Dr. Donna Pincus is the director of research for the Child and Adolescent Fear and Anxiety Treatment Program at the Center for Anxiety and Related Disorders at Boston University. She’s also the author of “Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety.” She recently spoke at The Rashi School as part of the Gateways Community Mental Health and Wellness program, and she spoke to JewishBoston about strategies to help kids grapple with fear and anxiety, too.

If you’re a parent dealing with an on-edge kid, read on.

Be attuned to physical clues. Anxiety often manifests physically: Your child might complain of a stomachache, sleepiness, lack of appetite or shortness of breath. Often, these complaints send parents to their primary care physician. If your doctor can’t find a physical problem, remember that the issue might be mental instead.

Interference and avoidance are good reasons to see a professional. Is fear intruding on your child’s daily life? Are they avoiding school, social events, sports or group activities because they feel afraid? Or maybe your child is white-knuckling through school or a sleepover but needs a safety object to get through the event. If it’s affecting their enjoyment of normal activities, seek help.

Some anxiety is developmentally normal. That said, everyone gets anxious sometimes. “Anxiety problems run a predictable course in all parts of the world,” Pincus says, beginning at around age 3. Young children often fear the dark or strangers. Often, these fears are protective. As kids get older, fears become more abstract: monsters under the bed or social fears, such as being left out at lunch or getting stung by a bee at camp. “Usually, those fears don’t interfere with a child’s ability to actually go to camp, though,” she says. Don’t “over-pathologize” the anxiety, she warns, which sends a message to kids that uncomfortable feelings have to be avoided at all costs. Anxiety is a natural human emotion. But if the fear is dictating an avoidant behavior, interfering with their daily routine and causing distress, it’s time to get help.

Anxiety isn’t forever. “Just because you feel anxious at 3 doesn’t mean you’ll be anxious at 13,” Pincus says. “With appropriate intervention and modifying your parenting, you can shape your children’s environment and model how to deal with stress. This has a big impact on kids’ ability to handle fear.” On that note…

Anxiety runs in families. Tough but true. “There is a genetic component,” says Pincus. “However, you don’t inherit an anxiety disorder. Just because mom had separation anxiety, it doesn’t mean that your child will, too. Instead, you inherit a vulnerability, a combination of genes that leaves us vulnerable to negative emotions. We see it across generations.” If you have anxiety issues, make sure to get help so that you don’t instill fear in your children, who look to you as an example. “Remember, kids watch us and model us all the time,” Pincus says.

It’s also common for nervous parents to overprotect. Resist the urge. “It may be innate to want to protect your child at all costs,” she says. But ultimately your child will learn far more, and become more resilient, through natural disappointments.

Ask pointed questions. It’s tempting to work yourself up into a frenzy when your child exhibits anxiety symptoms, especially if you’re predisposed yourself. Take a deep breath and ask questions instead. She advises breaking the questions into thinking, feeling and actions. Ask your child, “When you worry, what are you thinking? What are you feeling? What do you do?”

Normalize the fear. Let’s say a child has separation anxiety and hates being dropped at school or play dates. Thanks to your proper questioning, you now know what they’re thinking and feeling. Maybe they’re afraid that you won’t come back because you could be late and in a car crash. In situations when a fear is irrational, Pincus advises parents to “ask kids to be detectives. Ask: ‘What would be another reason I’m late, besides a car crash?’” Remind them that just because a thought pops into their head, it doesn’t mean it’s true. “Walk them through scenarios: Maybe you were in traffic. Maybe you were picking up dinner,” she advises.

Build a bravery ladder. Adults might call this exposure therapy, but Pincus prefers the ladder term for kids. Separate scary situations into manageable, incremental steps to build a sense of accomplishment. Let’s say your child is terrified of separation. They have a birthday sleepover coming up, and instead of dreaming of manicures and cheesy movies, they’re terrified.

“This is where parents are essential,” Pincus says. “Provide and create opportunities for [positive] things to happen.” Start small, with 10 or so steps, spread out week by week. Leave them alone while you run to the store. Another step could be a sleepover at a familiar place, maybe with a grandparent. With each step, implement “labeled praise”: Tell your child specifically how proud you are of their achievement. Record the triumph with stickers or a chart. Implement rewards of your child’s choosing, if you like. They needn’t be tangible or super fancy; it could be as simple as a pizza night. Often, Pincus’s patients tell her that just being able to complete a small milestone is reward enough.

For more information, visit the Center for Anxiety and Related Disorders. “No one is turned away for financial reasons,” Pincus says. To search providers, visit ChildAnxiety.net.