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Anxiety in Kids

anxiety in kidsAnxiety disorders are the most common mental health diagnosis in kids; ten to twenty percent of all children will meet criteria for an anxiety disorder before the age of 18. But it’s hard for parents to figure out when worry is part of typical child development and when it’s a concern.

Some anxiety in kids is normal. Anxiety can inspire children to do stuff like wash their hands and double-check their homework. Anxiety becomes an issue  when kids get stuck in it to the point where its getting in the way of their lives. For example, it’s fine if a child double-checks his math sheet; it’s not fine if he can’t sleep because he’s obsessively going over and over the numbers, erasing the paper to the point that his pencil rips through and begging you to check it for him.

When worry becomes extreme and/or intrusive, that’s when it’s time to get help. If your child is missing out on her regular everyday life or missing out on events that you know she would otherwise enjoy then her anxiety has become a problem.

Anxiety is often co-diagnosed with depression (particularly in teens) and anxious kids may also be misdiagnosed as having attention problems. (Anxious kids often have a hard time focusing particularly in contexts that worry them — at school, for example.)

Which Kids Become Anxious

Some kids are born with a more anxious temperament than other kids and these children often have anxious parents (because temperament — innate personality traits — is generally believed to be nature although how we live out our temperament depends on nurture). If you have struggled with anxiety there’s a higher chance that your child will, too.

The kind of temperament that tends to anxiety is sensitive, cautious and negative. You might recognize yourself in some of these traits, too.

Sensitivity: These kids are aware of their surroundings and may pick up on details that other people miss. They may be the first ones to notice someone’s new haircut or when someone else replaces their contacts with glasses. They may overhear adult conversations even though they’re in a room four doors down. They may detect subtle changes in someone’s demeanor and ask you later why Aunt Cora was mad. These kids may also have sensory sensitivity; the world feels less comfortable for them whether they are sensory seeking (wanting more intense sensory input) or sensory avoidant. His anxiety may be heightened because he’s uncomfortable in his socks or because he doesn’t like the way this new school smells.

Cautious: I’ve met plenty of anxious kids who go hurtling into space on their bikes or rollerblades but lots of anxious kids will be the ones hanging back from the fray. They may be the ones observing the party before they join or the ones who read up on shark attacks in Florida before your summer vacation. They may be the ones who need a lot of cajoling, the one who makes the family late for the wedding because she wants you to tell her — again — exactly what’s going to happen there. They may be reluctant to try new foods or new things.

Negative Emotionality: This is another way to say pessimistic. These are the kids who are sure bad things will happen. They’re the ones who counter your encouragement with a lot of concerning “what ifs.” Says Dad, “Let’s head to the pool!” Says child, “But what if the lifeguard isn’t on duty? What if I get a cramp? What if you don’t notice I’m drowning?” This is a child whose theme song could be Mel Brooks’s “Hope for the Best, Expect the Worst.” And when you say, “You’re being ridiculous” they’ll counter with, “I’m being realistic.” This is a genuine worldview they have and logical arguments may not make a dent in it.

You can see that these can be great traits in small doses — and the anxious kid can be a pleasure much of the time — but when taken too far, these traits can be crippling.

Sometimes there’s a specific event that triggers a child into an anxiety disorder. For example, a child who gets lost at the mall or who witnesses someone get injured. Or a big life event like a move or a change in school may impact some kids differently than their siblings or peers. Lots of children will spend their early years worrying and then when they hit their tweens, that’s when the worry turns out to full blown anxiety.

Anxious parents can inadvertently make things worse for their anxious kids both because they share certain personality traits but also because anxiety is one of those super-catching emotions. Think about it — back when we were hunting and gathering, it made sense for one person’s anxiety to trigger another person’s anxiety. If a tornado is bearing down on your tribe it’s a help if everyone gets ready to run. We have mirror neurons — so called because we reflect our emotions back to each other — to keep us all in step. This is why when faced with a child wailing about the upcoming spelling test we get revved up, too, and pretty soon everyone is yelling.

Tomorrow I’ll talk about the different kinds of anxiety and on Wednesday I’ll share ways to help. If you have questions, hit me up.

It Bears Repeating

it bears repeatingOne of the hardest thing for us parents to wrap our heads around is how often we have to repeat ourselves.

“Shut the door.”
“Pick up your shoes.”
“No, you can’t have cookies for dinner.”
“Hitting is against the rules in this house.”

You’d think they’d figure it out after the 457th time we’ve said it and yet there we go, repeating ourselves over and over and over again.

Argh! Frustrating!

There’s a reason we have to turn into broken records; our kids are always growing and so they need to learn some things over and over and over again.

When your child grows from one stage into a new stage she’s learning things in an entirely new context. She has new developmental tasks to master, new facts to contemplate, and new skills to integrate. In this entirely new environment the things you’ve taught her — shut the door, pick up your shoes, etc. — don’t mean what they used to mean and she has to learn them again.

For example, your average everyday 3-year old may be pretty good about not slamming the door. She’s anxious to please you, likes your approval and wants to prove what a big girl she is. That’s the context she’s learning that whole “shut the door quietly” rule.

That very same child as a 4-year old may start slamming the door again. Her curiosity may be more intense at this age so she may be so anxious to move onto the next thing that the door slams behind her before she even notices. 4-year olds may also be more interested in challenging adults, leading to more door slamming because now she wants to explore what happens when she breaks your rules.

Totally the same behavior happening in totally different contexts with totally different things to learn. We just see the annoying behavior, we just hear ourselves saying it yet again — “Don’t slam the door!” — but for her it’s not just a slamming door, it’s a whole new thing to learn in a whole new way.

What parents need is faith that all of our repetition is sinking in because it is. We also need to know that continued commitment to the house rules and values create a structure that makes it safe for our children to grow and that part of that growth includes challenging that structure. It’s not easy, I know, but know that with every repetition you are offering your child a new opportunity to learn.

Parenting is a long-haul operation, lemme tell you. Hang in there!

And now for your listening pleasure (because parents need a little pleasure to get through some of this rough stuff) is The Bird and The Bee singing Again & Again.

The Bird And The Bee “Again and Again” from Miky Wolf on Vimeo.

Parenting for Now

parenting for the futureWe parent our kids to help them grow into the people we hope they can be. We parent them to be their best selves, to be the most resilient, to be successful (however we define it), to be loved and we make most of our decisions based on the future we want for them. That’s the point of parenting, right? To prepare our children for the future.

Well, kind of.

Even as we work to prepare our kids for their somedays, we also need to parent for today, right this very minute.

Many of the kids who come to see me have said things like, “In first grade they told me I needed this math for second grade and in second grade they told me I’d need this math for third grade and so on all the way up to high school, which they tell me is going to prepare me for college. But what about now? Can’t I just be in the now?”

In truth, now is all we have. We don’t know what will happen ten weeks, eight months or six years from now. We don’t know what the economy will look like or what the most in demand job skills will be or who our children will settle down with (if they settle down) or anything else. We are making our best guesses and we need to do that but we also need to remember that this moment is just as important. This moment, this interaction, it matters for its own sake and not for what it might owe to a future we can’t even see clearly.

Some of us are so future-focused that we start parenting from an urgency that makes our children’s simple mistakes or struggles seem overwhelmingly scary.

Sometimes when I’m working with a parent trying to help them understand why an issue feels so consuming — a child who sleeps through her alarm or who is struggling in his friendships — we follow the path all the way to a very specific fear. What if her inability to get up on her own will ruin her career because her boss won’t put up with her being late all of the time? What if his problems on the playground mean he’ll end up in an apartment with 43 stray cats and no one to call when he’s lonely?

Those often unspoken outsized fears can make it hard for us to allow room for developmentally appropriate bumps and bruises. If everything — future partners, future careers, future success and happiness — seems to depend on the SAT scores we may forget that there are other things to learn here, too. Things like preparing for big tests, dealing with pressure, confronting uncertainty, etc.

When parents allow their imaginations to run away with them — when they let themselves do it out loud instead of ignoring the fear so it sets up camp in their deep dark worries — then we can talk about it more realistically. Sometimes a slept-through alarm is just a slept-through alarm. Sometimes it is its own problem to be solved instead of a symptom of a greater issue.

And if there are greater issues at play, it makes more sense to focus on the moment as we contemplate our options than to let our fears take us down the road to hopelessness. Because this child, sleeping through her alarm, is just as important as the adult she will someday be.

There is not one way to be happy or successful. There isn’t one path to a really good life. We may get only one shot at a specific opportunity (winning the 5th grade spelling team or qualifying for the Olympics) but that doesn’t mean that there aren’t other opportunities waiting for us.

It can be a tricky balance to both grow kids for the future and be here with the present child in front of us at the exact same time. But the dual perspective is necessary both for our child and for ourselves, so we don’t miss what’s happening right in front of us while we are looking out so far ahead.

My thoughts on Lena Dunham

questionning-sliderI’ve been asked about my thoughts on Lena Dunham and the passages in her book that detail her sexual behavior with her sister. At first I declined to post them here because I felt like there have already been so many people talking about it that I really had nothing to add to the discussion. But then I realized that as a therapist and with the understanding that you might be wondering if I’m the right therapist for you or your child, I ought to weigh in for no other reason that my clients — current or potential — have the right to know where I stand on such a contentious and difficult issue. So here are my thoughts.

First, I haven’t read the book and I have no plans to; I’ve only read the quotes and passages (that link will allow you to read them, too) that have appeared on other sites. Because of this, I can’t really discuss the context in which those quotes and passages appear, which is one reason I can only speak in generalities. Also I don’t know Lena Dunham or her sister, Grace (obviously) and I don’t know the family in which they grew up and I don’t know the way their relationship was or is now. I only have these passages, which are in Lena’s words and further words in a memoir, which means they have been shaped for a general thesis. This means that I can’t really trust their reliability. Therefore any commentary I am making about Lena Dunham and her sister aren’t really about them; my commentary is more about our general discussion of child bodily exploration, sexual play and the potential & possibility for sexual abuse between siblings.

Child sex play is a normal, developmentally appropriate part of growing up. Some children keep to a mild “show me yours and I’ll show you mine” and some may do more graphic sexual play. What makes it play and not abuse is the absence of a power differential and coercion and this can be very hard to ferret out. A six year age difference — Lena is six years older than her sister — is always concerning. Always. Whether or not it is sexual abuse or a serious boundary issue depends a whole lot on exactly what happened, how and when. Is it a one time thing? A pattern of enmeshment? Is it straight forward bodily exploration or is the more powerful sibling using the younger sibling for his or her sexual satisfaction or to act out an unhealthy power dynamic? What is certain is that a relationship that Lena describes (while acknowledging that the reality of that particular relationship may be much different) deserves more attention from parents.

This leads me to a discussion of culture. Family cultures differ and so family boundaries differ. There are families where privacy and general touching (hugs and cuddling) are more or less important, which is another thing that needs to be considered as we talk about boundaries and the violation of boundaries. While there are values that we as a broader community can agree on, there are others that are murky. When I read the quoted passages I feel I’m also missing this important context. I do not know what (if anything) her parents did about their relationship. I don’t know if Lena was reprimanded for the intensity of any of her actions towards her sister (the bribes with candy and quarters). I don’t know if Grace protested or if she was silent (not that her silence equals consent but I don’t know how much her parents were aware of their dynamic). In my office I sometimes see some parents describe a closeness that I, as a therapist, find concerning but I can’t know at first glance. It’s easy to jump to conclusions and misunderstand what’s actually happening. It takes continued discussion, questions, and observation to get a better sense of what’s going on. So when I feel my antennae go up I remind myself to go slowly and listen hard.

I also want to honor Grace’s right to label and define her own experience. Grace has said she does not see herself as a victim; I believe her and want to give space for her assertion. I also want to give her space to think differently at some point if she chooses to. Many of us think about our family of origin in one way and then we grow to think about it in another way later on. This is our right and important part of growth and empowerment. Whatever I may think of how I might feel if I were Grace, I am not her and in this important conversation about violation, I do not want to participate in a violation of her right to speak her truth.

In other words, this is a discussion that we need to be having but I think it’s extremely important that we do not expect her to uphold our own take or Lena’s take on their relationship or the scenes Lena describes.

These are things I do know.

Kids make mistakes. Some of those mistakes will certainly be violating the boundaries of siblings, cousins, friends and pets. In some cases those boundary violations may be bodily (kids who hit, hug too hard, hold down a cat who wants to get up) and sometimes those bodily boundary violations may be sexual. It is normal and developmentally expected that a child’s self-centeredness would lead to boundary violations. Remember that normal does not mean OK; I am not excusing or shrugging off the seriousness of boundary violations.

I am also not saying that normal means that no one gets hurt. One child’s normal behavior can harm another child. I mean, it’s normal for toddlers to bite but that does not mean it’s ok and it does not mean that the child doing the biting does not hurt the child who is bitten. Normal does not mean we ignore things.

If the type of activity Lena describes truly was typical of her behavior then her parents should have been intervening. (They may have been; we don’t know because we only have Lena’s side of the story.)

If one child is treating another child as a toy or as an object, that’s concerning and needs interrupting whether or not that treatment includes sex play. If a parent only jumps because the play turns sexual, that’s a problem because I would argue that there is likely a pattern of coercive play that needs parental attention and intervention. To a child, dressing up a reluctant pet and coercing a sibling into allowing genital exploration may come from the same misunderstanding of the division between self and others.

It’s our job as parents to protect our children from each other and also from themselves. Many of carry a great deal of guilt for the way we treated our siblings when we were kids but we needed adult help to figure things out. We can own our responsibility but also acknowledge that our childhood selves did the best they could with what they were taught; many of us were not taught how to treat each other.

Sometimes parents have trouble intervening because they don’t know what good boundaries between siblings looks like since we were not protected from ourselves or from a violating sibling. We see a certain amount of roughhousing and conflict as perfectly normal and it’s true — some of that is normal. But we should pay special attention when:

  • One child is always the victim;
  • One child is much older or stronger or otherwise more powerful;
  • If we detect real hostility in the interactions;
  • If the hostility is pervasive (if they never really get along).

In the case of sexual boundary play, I would also check in to ask where the children got the idea. Sex play is common in kids, absolutely, but a check in can help us know if something is happening to the child who is acting out (did they learn this from another child? from sexual abuse at the hands of an adult? unsupervised time watching HBO?). I would ask parents not to react as if sex play is always concerning but I would ask them to remember that sometimes it is.

Interventions do not have to be shaming. Parents can and should interrupt inappropriate behavior in a way that promotes empathy, compassion and an understanding of where a child leaves off and the other person begins. This starts when we protect that child’s boundaries. That means no forced hugs, no forced kisses, no forced sitting on Santa’s lap. There are lots of times where we have no choice (diapers changes of wriggly toddlers!) so when we can protect our child’s right to say no, we need to do that.

Finally parents need to be aware of their own understanding of boundaries and violation. Many parents who are struggling with their children’s sibling relationships are acting out their own experiences growing up. When I talk to parents in my office I’m always interested to know where they are in their own family configurations because this can illuminate my understanding of dynamics they are repeating (or trying not to repeat) in their own homes.

It also helps me understand why some parents are reluctant or afraid to make changes. To say, “This should not be happening to my youngest” may mean saying, “This should not have happened to me” or “This is not something I should have done to my sibling.” These are painful things to confront and I see some of that happening in the discussion around Lena and her sister.

We all come to our reading loaded down with our own baggage and it’s pretty hard not to bring that to a discussion about someone else’s very biased, perhaps somewhat fictional, and certainly manipulative (in the way that all writing — even this — is meant to sway the reader) story.

I don’t know what happened between Lena and Grace, not really. I cannot speak to it. I can only speak to the general things I know to be true and hope that I can help the individuals and families who come to me for care, informed by what I know about kids, about siblings, about families and about the truly hard work we all do growing up.

The Myths of Good Parents

GOODWe do not raise children to go out into the world and be perfect and build perfect relationships with perfect people. That would be impossible. We raise children to be good enough to build good enough relationships with other good enough people. Therefore, good parents are, by definition, not perfect. It’s our imperfections — deftly handled — that will help our children to grow up and handle other people’s imperfections with compassion, understanding and good boundaries.

With that in mind, these are some of the pervading myths of good parents.

Myth: Good Parents Don’t Get Angry.

Actually good parents do get angry. Sometimes they even yell and stomp around. But good parents work hard to manage their anger appropriately, apologize when they handle it inappropriately and work to get help if their anger feels out of control or truly scary. Good parents need to know that their children are going to deal with people who get angry (otherwise known as: everybody) for their entire lives. They also know that their children are learning how to handle their own anger so they learn to see the everyday challenges of living as learning opportunities for all of us.

Myth: Good Parents Always Enjoy Their Kids.

No. they don’t because the children of good parents are not always enjoyable. ‘Nuff said.

Myth: Good Parents Have it All Figured Out.

Actually good parents get that this parenting thing is a process and it’s changing all the dang time as kids move from one developmental stage to another. Good parents may feel great about parenting a 3-year old and absolutely lousy about parenting a 13-year old or vice versa because those are totally different kinds of parenting, which take a totally different skill set. Good parents get help (books, friends, therapists) when they feel stuck and most good parents will eventually feel stuck because parenting is hard.

Myth: Good Parents are Fair.

Nope, good parents try to be just but they are not always strictly fair. That might mean different bedtimes, different chore expectations or different privileges for different kids. Sure, sometimes good parents take the easy way out and just buy everyone the same pack of gum — no arguing! — and other times they wearily wade into explaining yet again that just because your sister gets to go to a birthday party doesn’t mean that you get to go to Kroger’s to pick out a cupcake. Good parents learn to withstand tears and sorrow with sympathy but without giving in. Sometimes they don’t because, remember, good parents are imperfect.

Myth: Good Parents are Patient.

In fact, sometimes good parents are patient and sometimes they’re not. Sometimes good parents don’t have the energy to be patient or they’re having bad days. Good parents learn to bring this experience to build empathy with their own impatient kids.

Myth: Good Parents Have Clean Houses, Lots of Home-Cooked Meals and Amazing Holiday Traditions.

Ummm, sometimes? Sometimes not. Good parents do some things really well and other things not so great. Good parents may be terrific softball coaches with filthy kitchens. Good parents may know how to make a mean pot roast but can’t make cookies to save their lives. Good parents don’t always remember to buy pumpkins in time for Halloween or advent calendars in time for Christmas. Good parents don’t always have money for the tooth fairy. Good parents sometimes don’t notice their kids have grown out of their tennis shoes until they notice them limping across the playground. Good parents forget to pack the diaper bag.

Myth: Good Parents are Confident.

Sure, sometimes good parents look at a parenting challenge and say smugly to themselves, “Yeah, I got this.” But lots of other times good parents lie in their beds wondering if that decision they made about homework or screen time or dessert was the right one after all. They work hard to model the great grand work of self improvement, understanding and relationships. They live complex lives that sometimes create challenges they hoped their children would never have to face — divorce or death or depression. They struggle and worry and fret. They move forward because they have to, not always because they’re sure.

Myth: Good Parents are Consistent.

This is one of the things every parenting book says: Be Consistent. And it’s true that consistency will save you a lot of trouble in the long run. If you always say no to the candy aisle in the grocery check out line your kid won’t necessarily stop asking (or whining) but they’ll learn that when you say no, you mean it, which will come in handy when they’re teenagers. But sometimes the candy seems like a good idea because you’ve got such a headache that you’ll say yes to anything to get them to shut up. Good parents sometimes make short term decisions just to cope because life is like that.

Myth: Good Parents are Born, Not Made.

No way. Most of us have to work hard — ongoing — to be good parents just like we have to work on our skills to do anything else well (play tennis, bake yeast breads, create killer TED-inspired presentations, etc.). Good parents sometimes get tired of all of the self-growth and effort that being a good parent takes, particularly when they look at the 2-year old wailing on the floor or contemplate the disaster-area of an 11-year old’s room or note that the 16-year old is missing curfew. Then those good parents reach out to friends for a night out or call a therapist for help or reread How to Talk So Kids Will Listen again. Sheesh, says the good parent to herself, when am I gonna get it? But the good parent keeps trying.

When kids are wrong

shutterstock_106037033I think my son was four when he decided he had to be right about everything. Four is generally the time when kids find their inner sassy. (Some kids get there earlier; some kids are born full of sass.) Anyway, he was around four and suddenly he was always right and I was always wrong. He’d make wrong statements full of confidence.

“Mommy,” he’d say. “Birds can’t fly in the rain.”

“Sure they can, sweetie,” I’d answer, thinking I was still talking to my reasonable 3-year old. “Remember yesterday when we were outside in the drizzle and we saw that cardinal flying?”

“No, they can’t. Because the raindrops hit their wings and they crash.”

“But don’t you remember? We saw the cardinal. Let’s look it up in your bird book.”

“Nope,” he’d say, casually swinging on the arm of the couch. “I don’t need to look it up because I already looked it up” (said the kid who couldn’t even read yet) “and the book says they can’t.”

I’d catch myself in these arguments several times a day. Peanut butter isn’t made of peanuts. Target sells zoo animals. Daddy has the day off tomorrow. New York is the capital of Cuba.

I don’t know why it drove me so crazy but man, it drove me crazy.

“Cheerios are made of green cheese,” he’d announce, calmly eating a bowl for breakfast. “Cats are humans in disguise. You were born during dinosaur days. I can fly on Thursdays.”

Ok, I’m exaggerating and also I don’t remember what we were arguing about, which is my point actually, because the arguments — or at least winning them — didn’t matter.

It took me awhile to figure that out. For a long time I’d try to be reasonable and then I’d try to prove my point and then I’d get louder and soon we’d be glaring at each other, our day ruined and tear-stained all because for some reason I really needed my 4-year old to acknowledge that I do SO know how to bake cake and the ingredients do NOT include ground up birthday candles.

Four year olds are practicing being in charge and they are practicing their command of their growing vocabularies. In The First Five Years of Life, Gesell writes about a 4-year old who asserts that a nursing lamb is getting gasoline from his mother. Writes Gesell:

In a vague yet concrete way he knew that gasoline is a source of energy. Gasoline makes things, including lambs, go. Four has powers of generalization and of abstraction which he exercises … frequently and deliberately. … [However] we underestimate the vastness of his terra incognita. An intelligent 4-year old, while building a playhouse, was heard to say, “Houses do not have tails.” This lucid judgment was the sober product of an inquiring mind. Four has a busy rather than a profound mind. His thinking is consecutive and combinative rather than synthetic.

In other words, four knows what he knows and does not know what he does not know. Four is figuring things out and to figure things out we have to get things wrong.

When I argued with my son I was upending his process and really for no good reason. I mean, he’s seventeen now and he knows what cheerios are made of and that birds can fly when it’s raining. I can’t remember his specific wrong assertions because he quit asserting them. It all turned out eventually but I thought it was my job to teach him things even when he wasn’t interested in my teaching.

Fortunately when my daughter hit four I understood that it was better for all of us to just roll with it. I could respond to her statement, “The sky is purple” by saying, “Oh, is it?” or even “Tell me more” without even blinking.

I know, I know, it sneaks up on you. At one point your child is looking to you for Answers to All Things and next he’s basically saying that you know nothing. It happens at four and it happens at ten and it happens in the teens and I hear tell that adult children are awfully prone to correcting their parents particularly when it comes to new technology or the proper use of slang.

Here’s my takeaway in all of this:

  1. All behavior serves a purpose and often that purpose is developmental. Kids are supposed to get stuff wrong on their way to getting things right. If it isn’t a safety issue, see if you can comfortably let it go and trust them to figure it out. So what if they think the sky is purple. Who really cares, right?
  2. Sometimes what looks like misbehavior is really just behavior. A 4-year old clinging to a ridiculous belief isn’t actually being sassy as much as looking like sassy. Their initial assertion isn’t the problem, it’s the arguing that happens if we correct them. So again, maybe we can agree to disagree and skip the arguing.

As I say — often — parenting is not for sissies. Remember whether it’s your 4-year old or 14-year old who is driving you crazy, you can come to the Thursday night group Parenting Challenging Children for support, insight and ideas. Enrollment is ongoing.

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