A chameleon possesses the unique ability to change the color of its skin.  Color change aids in camouflage, heat regulation, and light absorption; but, a chameleon also changes its color in response to its mood. Brightly colored male chameleons more easily attract females while a chameleon donning black coloring may be stressed. Similarly, youth with anxiety behave differently depending on the child and the setting. This is why I often refer to anxiety as the “the great imitator.”

We all have the image of an anxious kid – fretful, pacing, and pensive.  He asks 20 questions while biting his fingers or twirling her hair. The classically anxious child appears scared, fearful, and worried. But what about the child who is irritable and easily agitated or tense and on edge, who is so sick he cannot attend school for days on end, or who is whiny and cloying.  Well that might be anxiety, too!

A child with separation anxiety might complain of daily headaches or nausea and belly pain so severe that they miss school frequently. However, appointments with the pediatrician or family physician never uncover a medical explanation for his symptoms.  It could be social anxiety if your child gets visibly upset when you suggest he introduce himself to the neighbor’s kids or when you want to drop her off at a birthday party. Or what about the kid who cries and says he is afraid something bad is going to happen when you ask him to ride the 3rd floor on the elevator. Anxiety often mimics an array of feelings.

A common emotional response to stress, anxiety is an emotion characterized by fear, apprehension, and worry. What you see as an ordinary life event such as starting a new school year, making new friends, or going on a field trip, your child truly perceives as frightening or threatening.  He loses sleep because of fear and worry or she misses out on sports and other social activities; and, all your efforts aimed at reassuring your child prove futile.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), “anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is the anticipation of future threat.” There are several different anxiety disorders outlined in the DSM-V including Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Social Anxiety Disorder (Social Phobia), and Panic Disorder. Obsessive Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) were previously classified as anxiety disorders but not fall into their own respective categories.

Here are 5 tips for when your child might be anxious:

1) Consider that your child might be anxious

Rather than assume that your child is simply angry or frustrated when she refuses to set foot on the school bus, consider that she might be worried. Ask her if he has something on her mind that is bothering her. Ask her if she wants to share her feelings with you.

2) Acknowledge and validate his feelings

Clearly this tip is a recurring theme, so pay attention. While our natural inclination is to say, “Don’t worry … you’ll be fine,” we risk invalidating our children’s feelings. We don’t want to shame or ridicule them when they experience emotional distress as it teaches them to either hide how they feel or exaggerate the expression of those negative emotions so that you understand the magnitude of their fear.

3) Help your child differentiate between normal worry and exaggerated worry

Going to a new school, presenting a school project in front of the class, taking a standardized test, cheerleading tryouts – these are all activities that naturally engender some worry. Worry certainly has its place in our lives because it’s the brain’s way of saying, “Uh oh – danger lies ahead.” But sometimes those fears become exaggerated.  Excessive worry leads to paralysis, avoidance, and withdrawal. It controls your child’s life, dictating what he or she can or cannot do. Help them look for clues that would suggest their apprehension is out of proportion to the perceived threat.

Teach them to identify their “stinkin thinkin.”  This technique is one of the hallmarks of Cognitive Behavioral Therapy or CBT. CBT as defined by the American Academy of Child and Adolescent Psychiatry is type of psychotherapy designed to “improve a child’s moods, anxiety, and behavior by examining confused or distorted patterns of thinking. CBT therapists teach children that thoughts cause feelings and moods which can influence behavior.” By training your child to “check the evidence” when he has bad thoughts, you can help him distinguish normal from exaggerated worry. A child will learn to quickly identify a negative thought when it enters his or her mind, recognizes that thoughts and feelings are NOT facts, and then run through a mental checklist of factors that either support or refute their negative thoughts and feelings.

4) Do not avoid situations that trigger anxiety

Avoidance is the “go to” strategy that many use to combat anxiety. If school makes your kid anxious, the let’s enroll in a home school program. If your daughter is afraid of dogs, never visit anyone’s home who has a dog or go to the park if dogs might be there. Avoidance seems good in theory as you are protecting your child from undue stress – WRONG! Avoidance only reinforces an undesirable behavior and worsens the symptoms over time. You can “dose” exposure to stressors much like you adjust dosages of medications. If you kid has considerable difficulty making new friends, start with striking up a conversation with relatives first with your guidance and then progress to established neighbors and lastly the new family in the neighborhood with and then involve yourself less as he or she gains more confidence and is less fearful.

5) Practice healthy coping skills

Give your child a list of strategies to try to neutralize their anxiety.  A list might include tips like:

• Slow, deep breaths – Anxiety often manifests physically with a rapid heart rate, shortness of breath, sweaty palms, or nausea and belly pain. Slowing down your breathing helps to minimize the intensity of these symptoms.
• Progressive muscle relaxation – Progressive muscle relaxation is a technique used to reduce stress. An individual will tense and then relax each muscle group, i.e. furrow your brow then relax, squeeze your face then relax, squeeze your shoulders then relax, etc.
• Shift your focus from what might happen to what is happening – Many times exaggerated worry involves fear of the future. An anxious child will ask “what if” questions when they are nervous which leads to catastrophizing and fortune telling of all the bad things to come. Such questions negate the power of the present, the beauty in the what is right now. Help your child focus on what is currently happening rather than what could happen by weighing their negative thoughts and feelings against “the evidence.
• Create a worry corner – Make a corner in the house specifically for worry. In that safe space, give your child 10 to 15 minutes in which they can express their worries by writing a list of all their worries for the day. When the timer goes off, they must fold up their worry list and put in a worry box. Then parents can sort through the list of worries and help their child put their worries into context – is this reasonable worry or exaggerated worry? Then child and parent can discuss tools to reframe and manage their exaggerated worries