How To Help A Child With Anxiety : Life Kit When a child is scared of the dark or being left alone, it can be hard for adults to know the difference between an age-appropriate fear and full-blown anxiety. This episode is full of tools to help parents better understand and manage their child's "worry brain."
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How To Help A Child Struggling With Anxiety

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How To Help A Child Struggling With Anxiety

How To Help A Child Struggling With Anxiety

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ANYA KAMENETZ, HOST:

This is NPR's LIFE KIT. I'm Anya Kamenetz.

CORY TURNER, HOST:

And I'm Cory Turner. I want you to meet a little boy from Central Illinois. At 5, he loves to draw and wear capes and play with a wooden sword that his dad made. He has one big brother, two parents and three cats. But by 8 or 9, he also has this constant, pit-of-the-stomach feeling that something's about to go wrong. He doesn't know what it is or what to call it. All he knows is he's scared - of storms and high places. When he flies on an airplane, he can clearly feel it breaking in half and imagines what it would be like to get sucked out.

Most of the time, nobody else can see all of this worry. And he doesn't talk about it because it's either normal and nobody talks about it, or it's not normal, and that's super embarrassing.

In spite of all this, he gets married. He finds a job he loves. He becomes a dad. But the worries follow him, until he has a panic attack in front of his kids. So after 40 years, he finally describes this fear to someone else, a doctor, who very quickly gives a name to this shadow he's been living with all his life, anxiety.

And this is a hard story for me to share, Anya, because it's my story. This is me, and I'm sharing it because it's also a lot of other kids' stories - right now. And this episode is all about how we grown-ups can help them so they don't have to live quite so long in the shadows.

KAMENETZ: Thank you for sharing, Cory.

TURNER: Thanks for listening. That was hard. (Laughter).

KAMENETZ: I know. I know. But I really respect it because, you know, childhood anxiety is a growing issue right now. It's one of the most important mental health issues out there. Researchers have found that 1 in 5 kids will experience anxiety that rises to a clinical level before adolescence. Now, most of that, experts say, won't last.

TURNER: No. But some will without help. We know that anxiety in adulthood is also incredibly common, though somewhat more common in women than men.

KAMENETZ: That's right. So today we're going to go deep on how anxiety works, how parents can spot it...

TURNER: What they can do to help kids with anxiety and when to know it's time to get professional help.

(SOUNDBITE OF MUSIC)

TURNER: All right. So where are we going?

KAMENETZ: So we are going to Dr. Danny Pine's office on the NIH campus. It's in Building 15.

TURNER: I'm at the National Institutes of Health, north of Washington, D.C. And I'm here because in my research on childhood anxiety, nearly everyone I've spoken with has asked me the same question.

WILLIAM STIXRUD: Do you know Danny Pine?

TURNER: People I really respect told me they really respect a guy named Danny Pine.

KRYSTAL LEWIS: Oh, yeah. Danny Pine would be a great person to talk to about that.

TURNER: The NIH campus is chock full of big, unremarkable office buildings. But nestled in between them, looking like it has no earthly business there, is a cottage.

DANNY PINE: OK. Should I turn off my buzzer on my computer? 'Cause it'll ring each time I get an email.

TURNER: Yeah. I'm sure you get a lot of email.

KAMENETZ: Dr. Danny Pine is a child and adolescent psychiatrist at the National Institute of Mental Health, and he's one of the world's top anxiety researchers.

PINE: Well, so the main thing to know about anxiety is that it involves some level of perception about danger. So when somebody's anxious or afraid, they're concerned about harm.

TURNER: Harm that hasn't happened yet. And that's takeaway No. 1. Anxiety is, fundamentally, a fear of the future and all of its unpredictability.

KAMENETZ: We're all born with some anxiety because we need it. Dr. Pine says it's one of the reasons we humans have managed to survive as long as we have.

PINE: Young children are naturally afraid of strangers. That's an adaptive thing. They're afraid of separation. That's an adaptive thing. And we actually see the same thing in other animals, that there are forms of stranger wariness and forms of separation anxiety that, again, are adaptive.

TURNER: These fears have stuck because they've helped keep us safe.

KAMENETZ: But full-blown anxiety happens when these hardwired fears that all kids have - strangers, or storms...

TURNER: Or busy places, or being left alone. The list is long.

KAMENETZ: Yeah. Anxiety is when these everyday fears get amplified. It's like somebody turned up the volume.

(SOUNDBITE OF MUSIC)

KAMENETZ: And they last longer than they're supposed to.

PINE: If it's only going on for a few weeks, that's not necessarily something to get concerned about right away. It's really when it goes into the one to two-month range. That's where parents should really start thinking about it, worrying about it.

TURNER: We spoke with a colleague of Danny's, Dr. Krystal Lewis. She is also a clinical researcher at NIH who provides therapy to anxious children.

KAMENETZ: And she says another way for parents and caregivers, and even teachers, to gauge if it's time to ask for help is by looking at how much the anxiety is interfering with everyday life.

LEWIS: Where it's disrupting kind of family functioning or it's disrupting the child's performance, whether it be in school or sports. We just look at the level of interference for the symptoms. We look at, yes, the avoidance behaviors, but are there things that the child really wants to do or needs to be doing, and they can't do those things? And so if you feel you're hitting a wall in terms of trying to get the child to do those things, that might be another indicator that potentially, you know, we should get some help.

TURNER: Danny and Krystal both say your child's pediatrician is a great place to start.

KAMENETZ: We should also say, Cory, that our understanding of why anxiety affects some kids but not others has really changed. And, you know, parents reach out to us, and we heard this question, can I pass anxiety on to my kids? The answer is yes. It is somewhat genetic.

TURNER: But we also know that stressors in a child's environment are also really influential, triggers like poverty, bullying, violence in the neighborhood, racism.

KAMENETZ: Or factors even closer to home, like abuse or a parent's addiction. All of these can increase a child's risk of anxiety, and especially if they don't have a lot of counterbalance, a lot of supportive grown-ups, loving people in their lives, that can help buffer that stress.

(SOUNDBITE OF MUSIC)

KAMENETZ: OK. So we've talked about what anxiety is. But the trouble is, how do you spot it?

TURNER: Yeah. Because my parents were very loving and supportive, but I didn't tell them what was happening with me. And back then they had no idea what to look for.

KAMENETZ: So our next takeaway is learn to recognize the physical signs of anxiety.

TURNER: So here's Anna, a mother in Brampton, England, telling us about her 7-year-old son.

ANNA: He was having trouble at school. He was just coming home and saying his stomach hurt. He was very sick. He did tell me he was worried about school. And he told me, specifically, it was a teacher that he was worried about.

TURNER: We heard lots of stories like this from parents who first caught on to their child's anxious feelings because of a telltale tummy ache or headache, or even vomiting, when their kids had to do something they just didn't want to do.

ROSEMARIE TRUGLIO: As you're getting closer to the moment, you'll see that they'll have rapid heartbeat. They'll get clammy. You know, because their heart is racing.

KAMENETZ: This is friend-of-the-show Rosemarie Truglio from Sesame Workshop.

TRUGLIO: They'll become tearful. That's another sign. Why is your child sad and crying? Because in their heads, you've got to keep in mind, anxiety is about what's going to be happening in the future. So there's a lot of spinning in their head which they're not able to articulate.

KAMENETZ: And Dr. Pine says a child's anxiety becomes most visible near the point of panic.

PINE: You can see it in their face. There's a certain way the eyes might look. People tend to either freeze, be inhibited, not do things, when they're anxious. Or they can get quite upset. They can pace. They might run away.

KAMENETZ: So Rachel, a mom in Belgrade, Mont., says her 6-year-old son is avoiding something that for many children is their favorite part of the school day.

RACHEL: He doesn't like recess. He just started kindergarten. Mom, I love school. I don't like recess. So unstructured time seems to be the worst.

TURNER: And it's not just recess.

RACHEL: We have, like, a super-cool splash park in our little town. And he refuses. And he just says there's too many kids. And he cries. And I've tried, (laughter), to go early in the morning when there's no one there. I mean, I've lost count of how many times we've driven by just to see if I could get him out the car. And he won't.

And I'm not going to drag him. I'm not going to drag a crying kid out and stick him in the water. Like, that's not fun.

KAMENETZ: We heard this kind of thing from so many parents, Cory - I mean, my child is terrified to do something that I know is not going to hurt him, that I think that he might actually love. What do I do?

TURNER: I know this can be so exhausting. And I was that kid once. So we're going to go step by step now through some strategies that we hope will help all of you grown-ups out there and your children. We're going to start when they are the most panicked.

KAMENETZ: Yeah. So takeaway No. 3 is, before you do anything, says Rosemarie, try to help your child relax.

TRUGLIO: You're not going to be able to move forward until you get them to calm down. And I think that is just so important to know what you can do physically to reset their system so that you can then have a conversation.

TURNER: But again, don't try to have the conversation before they're calm.

TRUGLIO: Because if you can't calm them down, you can't even reach them. They're not listening to your words because they can't. Their body is taking over. So talking and shouting and saying you're going to do this is not very helpful.

TURNER: Or also just, like, presenting them with facts. That's not going to work. So you will be safe...

TRUGLIO: Not at the moment. Not at the moment of their heightened physical aspect of anxiety.

KAMENETZ: OK. So in that heightened moment, how do you break through?

TRUGLIO: It's so important to learn these belly-breathing techniques because that deep belly-breathing, cleansing breaths is a re-centering of your physical system.

TURNER: Anya, I feel like every episode we do, we end up circling back to that episode we did a while ago with Cookie Monster.

KAMENETZ: Oh, my God. How can I forget?

TURNER: The power of belly breathing.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

TURNER: Ready?

DAVID RUDMAN: (As Cookie Monster) Yeah. (Inhaling). Ahh. Hey.

TURNER: It's pretty good, huh?

RUDMAN: (As Cookie Monster) Yeah. Let me try it again. (Inhaling). Ahh.

KAMENETZ: OK. So let's say you managed to calm your child down. What's next?

TURNER: Takeaway No. 4, you need to validate your child's fear. So we heard from lots of parents who say they really struggle to know how to respond when their kids worry about really unlikely things.

KAMENETZ: Especially in those moments when the fear is getting in the way of, like, a busy daily routine or maybe even a fun family outing.

TURNER: Or your sleep.

KAMENETZ: Yeah.

TURNER: That's a big one, right? So here's Amber, a mother in Huntsville, Ala., talking about her 8-year-old daughter.

AMBER: Middle of the night. I'm asleep. She comes down. It's 2 a.m. And she wakes me up, and I said, what's wrong? And she said, I don't want to go away to college. I want to live at home for college. And it's 2 a.m. I don't even know if I had a coherent response, but it was probably, OK, fine. Go back to bed. That's when I really have to filter and not say that is ridiculous, this is not a big deal.

KAMENETZ: Yeah. Because she's 8 years old, and college is at least 10 years away.

TURNER: Yeah. I mean, the good news here, Rosemarie says, is that Amber's response was just right. Never dismiss a child's worries, no matter how irrational or unlikely they seem to you.

TRUGLIO: Validating your child's feelings and not saying, you know, buck up, you could do this. That's not helpful.

KAMENETZ: And Dr. Krystal Lewis even offered a script she gives to grown-ups who may be very stymied by a child's seemingly irrational fears.

LEWIS: I know that you're feeling uncomfortable right now. I know these are scary feelings. You want to personify the anxiety. And so you can almost say, you know, we know that this is our worry brain. And so using the language so the kids understand - OK, Mom knows, Dad knows, that I'm feeling uncomfortable right now, I'm feeling anxious.

TURNER: I have to admit, Anya, I actually used the worry-brain line on my kids the other day. I said, sorry, guys, that was my worry brain. (Laughter).

KAMENETZ: I love it. I love it.

TURNER: Yeah. And here's another don't from Rosemarie. If your child's afraid of something - say, like, a tornado or a car crash - believe it or not, don't just tell them that's never going to happen. Because you don't know that.

KAMENETZ: Yeah. Absolutely. And, you know, kids are getting information from all over the place. And things they can see are very real to them. So no matter how irrational or unlikely you think or you hope that the fear is, you need to validate it and make sure your child feels heard. Now, when we say validate, we don't mean agree with them that this is going to happen, but say, I hear you and I understand that your feelings are real.

TURNER: So now you've calmed your child down, and you've made clear you understand that they are afraid. And you respect that fear. What's next?

KAMENETZ: So we're going to circle back now to Rachel, the mom we heard from earlier. And this is the one whose son didn't want to go to recess. He was too scared for the splash park. And she has tried so hard to help him feel comfortable, and she wants to know, is it ever OK to just make your child do the thing that they're afraid of?

RACHEL: Is pushing him out of the nest to do new things really the best for him? Like, is that going to - am I going to - is that going to have, like, long term - is he going to have long-term baggage because he's constantly feeling like, you know, his feelings weren't valued, (laughter), because I'm just - nope, we're doing this, and now you're doing this?

KAMENETZ: And, Cory, I wonder - because you were that kid. I mean, how did your parents do this? Because you never let on what was going on for you, right?

TURNER: No. But see, this totally reminds me of a dark moment in Cory's childhood (laughter).

(SOUNDBITE OF MUSIC)

TURNER: It was my mom and my brother and I on vacation in Chattanooga, Tenn. And they wanted to go to the very top of Lookout Mountain. And I was terrified, and I refused - nope. Never going to happen. So we got lunch, and I somehow fell asleep in the back of the car. (Laughter).

KAMENETZ: Uh-oh.

TURNER: And when I woke up, we were above the clouds (laughter), driving up the side of this mountain. And I freaked out. The rest the way, I just had to hunker down in the back of the car until we got there. (Laughter).

KAMENETZ: Oh, my gosh. Oh, my gosh. What a moment. So this brings us to Dr. Pine and our takeaway No. 5.

PINE: I think our initial reaction when we see an anxious child is to help them and protect them and not to push them or encourage them to do the things that they're afraid of. One of the things that we've learned from watching kids over time and helping kids who are having problems with anxiety is that we've learned how important it is to face your fears.

TURNER: So, Mom, I know you're out there listening. And you've been worrying about this for, like, 35 years. You are mostly absolved.

KAMENETZ: Mostly?

TURNER: (Laughter) Mostly. I still harbor a little bit of resentment. But it's OK. It turns out, you know, all of the experts we spoke with say it is important for kids to face their fears.

KAMENETZ: OK. So this is a tough assignment for some parents because they know just how stressful it can be for their kids to do something that's new that they're worried about. But we heard the same thing from every single expert. So here's Dr. Lewis.

LEWIS: The more that you avoid or don't do certain things, it's almost implicitly teaching the child that there is a reason to be anxious or afraid. If we're not doing the things that are difficult, it's sending this message that, well, there is potentially a dangerous component to this. So it's important that children understand, you know, things are going to be difficult in life. Things are going to be scary. We can do them. And as I say, and I tell some of my patients, you can feel scared. That's OK. We're going to do it, anyway.

TURNER: And Rosemarie agrees. While we do have to validate our kid's feeling of fearfulness...

TRUGLIO: We can't always give in to this feeling. That - you know, you need to push them a little bit. And there's this fine line. You can't push so far because that's going to break them. Right? Then they're going to fall apart even more.

KAMENETZ: All right. So where do you find that fine line? I mean, nobody wants to break their kid. You don't get another one.

TURNER: (Laughter) No. I felt kind of broken sitting in the backseat of the car going up Lookout Mountain. But luckily, we have takeaway No. 6.

KAMENETZ: That's right. Takeaway No. 6 is to help your child build a sense of control by working on a plan and doing it in baby steps.

TRUGLIO: When you have a plan, it helps you now get a sense of control, knowing that, all right, when this happens, I know what I can do. And I'm going to have this plan because I want to be safe.

TURNER: And this is Dr. Krystal Lewis's job, helping kids face their fears. It's called cognitive behavioral therapy. And a big part of that is exposure therapy. She's a big fan of baby steps.

KAMENETZ: Yeah. So she shared the story of one 8-year-old girl who was so afraid of throwing up that she actually wasn't eating. And during flu season, she was too scared to go to school in case some of the other kids might throw up.

TURNER: Yeah. So how do you baby step your way through that?

KAMENETZ: Just a little warning. We're about to say the word vomit a lot.

LEWIS: We did a lot of practice, which included buying vomit spray off Amazon and vomit-flavored jelly beans. We listened to all types of fun vomit sounds using YouTube videos.

TURNER: Wow. Really?

LEWIS: We did a lot of practicing, up to the point where we created fake vomit and we were...

KAMENETZ: OK. OK. OK. I get the point. I get the point. Seriously.

TURNER: (Laughter).

KAMENETZ: All I need to know, Cory, is did it work?

TURNER: Slowly, but yes.

LEWIS: She got to the point where she was in school, and one of the peers had vomited in the classroom. And she comes into the session, and she was just like, someone vomited in my class, and I ran to the corner of the classroom. And she was just like, I didn't help, but I was there in the classroom, which really showed some growth. And so she was just very proud of the progress she was making. In the past, she would have ran out of classroom to the counselor's office and then missed school for, like, the next week.

TURNER: (Laughter). Man. I love that story.

KAMENETZ: I know you do. I know you do.

TURNER: (Laughter).

KAMENETZ: So Dr. Lewis says that, us parents, when our kids are making baby steps on this or really anything that's hard for them, you know, you use small, meaningful rewards along the way, like, maybe picking what movie we watch on family movie night, or maybe they get to stay up an extra 10 minutes.

TURNER: Yeah. And so that little by little, with these baby steps, you know, your child can start building confidence. Facing your fears is important. But remember, they don't have to do it all at once.

KAMENETZ: OK. So I'm thinking about Rachel and her son's fear of the splash park now, Cory. What would baby steps look like there?

TURNER: So I asked Dr. Lewis this, and she broke it down for me.

LEWIS: OK. Well, we're just going to walk up to that. We're not going to go in. So letting the child know we're not going to go in. We're just going to walk up to the gate. So it's just kind of a slow way to first just get the child out of the car and rewarding for that behavior. And then breaking it down to slowly integrating the child into that environment, whether it be the splash park, rewarding for every step of the way that you get there. But then creating more of a, you know, so this is what's going to happen when we get there. We're going to sit here. We're going to do this 10 minutes.

And so you are providing a little bit of context so the child knows what to expect, and it's not just this big, nebulous, we're going to the splash park, and the child really has no idea what's going to happen.

TURNER: Which brings us full circle, Anya, to the beating heart of anxiety. Remember takeaway No. 1? It is fundamentally a fear of the future and all of its unpredictability.

KAMENETZ: Right. So it makes perfect sense that one of the most important things that we grown-ups can do to help kids face their fears is to talk them through what the future might look like. Help them understand what might be going to happen.

TURNER: All right. We know that was a lot to throw at you. So as always, it's time to review.

KAMENETZ: Takeaway No. 1, anxiety is adaptive. That means it's helpful to a point. But it can also get out of hand, and it often does. One in 5 kids will struggle with some kind of clinical anxiety by adolescence.

TURNER: When it does get out of hand, don't be afraid to ask for help. You can start with your child's pediatrician or a cognitive behavioral therapist.

KAMENETZ: And take heart. Research shows that therapy and medication can be really effective here.

TURNER: There's also a lot you can do yourself to help the kids in your life. And that starts with takeaway No. 2, to be on the lookout for the external signs of anxiety.

KAMENETZ: Sometimes a tummy ache is not just tummy ache. Headaches, trouble sleeping.

TURNER: And most of all, avoidance behaviors. How far is the child willing to go to keep from doing that one thing that makes them really nervous?

KAMENETZ: Takeaway No. 3 is when kids are feeling anxious, especially when they're in the point of panic, don't try to reason with them. Don't dismiss their fears.

TURNER: Yeah. Start by getting them to calm down. And use the Swiss Army knife in the mental health toolbox, deep belly breathing.

(SOUNDBITE OF INHALING AND EXHALING)

KAMENETZ: (Laughter). Works every time. Takeaway No. 4, validate their feelings. It doesn't matter if you're 99% sure they'll be fine at recess.

TURNER: Or if you're pretty certain aliens are not going to take over the planet tomorrow. If a child's worried about it, you need to let her know you respect the fear.

KAMENETZ: And once you've done that comes takeaway No. 5, kids need to face their fears. Just remember, that does not mean throwing them into the deep end.

TURNER: (Laughter). Not at all. It means takeaway No. 6, come up with a plan together and then take baby steps to get there with rewards for progress.

KAMENETZ: That's right. Each little win will help your child build to a bigger win.

TURNER: Before we go, I just want to say one more thing to all you grown-ups out there, based on my own experience. If you suspect that a child in your life struggles with anxiety and needs help, or maybe you need help, don't think twice about raising your hand. Anxiety is not embarrassing. It's not a sign of weakness.

KAMENETZ: Absolutely not. It is a thing that happens. And help is most definitely out there.

(SOUNDBITE OF MUSIC)

KAMENETZ: For more NPR LIFE KIT, check out our other episodes. We have one on how to talk to your kids about climate change. You can find all of them at npr.org/lifekit. And while you're there, subscribe to our newsletter so you don't miss an episode. And here, as always, is a completely random tip, this time from LIFE KIT listener Donna Harlan.

DONNA HARLAN: When going shopping, always wear something that's your favorite. And when you try clothes on, if what you like isn't better than what you're wearing, don't buy it.

KAMENETZ: If you've got a good tip or you want to suggest a topic, email us at lifekit@npr.org. This episode was produced by Sylvie Douglis. Meghan Keane is the managing producer. Beth Donovan is the senior editor. Our digital editor is Beck Harlan. And our project coordinator is Clare Schneider.

TURNER: Special thanks to Danny Pine, Krystal Lewis, Rosemarie Truglio, Lizzy Fishman and all our friends at Sesame Workshop. Thanks, also, to Golda Ginsburg, William Stixrud and the dozens of parents who reached out to share their stories, including Amber, Rachel, Anna, Valerie and Annie. I'm Cory Turner.

KAMENETZ: And I'm Anya Kamenetz. Thanks for listening.

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