From the Monsters Under the Bed to Preparing for College

Regardless of age, there is always plenty to worry about. To worry is a universal phenomenon. Adults have bills to pay and a whole gambit of expectations to meet. The coupling of worry and concern tends to provoke action. Under normal conditions, this action is simply referred to as problem-solving. In other words, on the useful side of life, worry generates an important call to action.

Do the worries of children follow the same trajectory? Yes, of course. The school-age child may find he’s worried about an up-coming exam or report. Ideally, the message becomes, “Get prepared!” and the child responds in kind. Child, adolescent and adult worries flow in and out of any given life. They differ in accordance with age or developmental stages, as well as the circumstances that surround the individual. They are transitory in nature. Anxiety is a higher grade of worry. It doesn’t have the same in/out flow. Anxiety has staying power. In children, it can be quite specific as when it is provoked by exams; before, during and afterwards. Or, it can be quite generalized as when concerns around being safe seem constant.

Anxieties are associated with the immediate or foreseeable future. They are related to obligations, demands, expectations of self or others or individualized fears that seem imminent or potentially dangerous. In almost all circumstances, the anxious individual, be it child or teen, has a perception of being unprepared to meet the life challenge, or even unable; as in the case of an upcoming audition or try-out. In this scenario, the child/teen is anxious weeks in advance. Anxiety has penetrated. Ultimately, the child/teen fails to appear for the audition or try-out.

Worries become anxiety when…
Anxiety becomes a boni fide disorder when it handicaps normal life functions. For example, when the child cannot bear to be separated from his mother and will not go to school. Or, when the teenager is so concerned about what “they” think of him that his constant awareness makes for constant discomfort leading to a refusal to partake.

Most commonly seen by a child or family therapist are the following types of anxieties, spelled out by the American Academy of Child & Adolescent Psychiatry (Facts for Families, 11/12).

Symptoms of separation anxiety include:
• Constant thoughts and intense fears about the safety of parents and caretakers
• Refusing to go to school
• Frequent stomachaches and other physical complaints
• Extreme worries about sleeping away from home
• Being overly clingy
• Panic or tantrums at times of separation from caregivers
• Trouble sleeping or nightmares

Symptoms of phobia include:
• Extreme fear about a specific thing or situation, i.e. insects or needles
• The fears cause significant distress and interfere with usual activities

Symptoms of social anxiety include:
• Fears of meeting or talking to people
• Avoidance of social situations
• Few friends outside the family

Other symptoms of anxious children include:
• Many worries about things before they happen
• Constant worries or concerns about family, school, friends, or activities
• Repetitive, unwanted thoughts (obsessions) or actions (compulsions)
• Fears of embarrassment or making mistakes
• Low self-esteem and lack of self-confidence

Also important to underscore is an anxiety associated with 17 and 18 year olds, particularly prevalent in senior year of high school. This anxiety is characterized by an avoidance of the future. Symptoms of avoidance of the future include:
• Procrastination of anything related to that which follows high school
• Avoidance of all questions regarding “what’s next?”
• Seemingly indifferent to passing senior year
• Lack of motivation to secure a driver’s license
• Loss of self in drugs, alcohol use, or video games

So what is a parent to do?
The first task is NOT to minimize the child’s fears by responding with a cursory, “It’s nothing; you’ll be OK; just don’t worry about it!” The much better response is to embrace the concerns and position oneself as an ally with your child. The parent becomes a collaborator in helping the child to shrink the anxiety. If the anxiety can be seen as an entity, albeit an unfriendly one, that interferes with the child’s satisfaction in life, the team of parent and child now has an opponent. The parent has joined an effort to beat back the anxiety. As the child feels joined, the parent is likely to become even more aware of the anxiety’s hold on her child, and just how deeply the child wishes that he were normal, as in free of the anxiety. If the anxiety persists beyond the parent and child’s creative attack, the alliance allows the parent to suggest to the child the enlistment of a professional member to the team, a child or family therapist.

The job description of a parent who has volunteered to become an anti-anxiety agent includes:
• To be a voice of optimism and constant encouragement
• To be patient with a gradual and incremental pursuit of change
• To be a collaborative and creative problem-solver
Here are transgressions the parent is advised to avoid:
• To become impatient, angry and derogatory
• To succumb to the child’s fears and conclude that “Maybe this is too much for you.”

Most anxieties of childhood and adolescence are not life sentences. They can be overcome. Many parents used to be terribly afraid of the dark and sought safety in their parent’s bed. Many parents are amazed to this day that they finally left home and navigated life quite well on their own. Anxieties are a part of growing up. When posed as a challenge, even better a joint challenge, they become a problem to be surpassed. They are among the adverse circumstances in our children’s pursuit of life. If handled wisely, they build competence and confidence, the ingredients of full participation.

Steven J. Stein is a marriage and family therapist, practicing in Rockville, MD. He works with school-age children and adults on a wide array of mental health concerns. He is grateful to the YMCA’s Youth & Family Services for the opportunity to present on this topic.