Anxiety in Kids - Part 1: Empathy and Calming

This is the first installment of a three part series about kids growing up with an anxiety disorder. It covers the physical changes in an anxious person’s body, how to achieve understanding through empathy, and how to apply your understanding to your child’s daily struggles.

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The hot days are giving way to the cool crispness of my favorite season. The trees put on their warmest colors, and the nights are brisk for cozy sleeping during the extended night. Reflecting on our summer, I see my children, slippery with sunscreen, splashing and jumping in the water. Their smiles sparkle like the sunlit water as they squeal with their special brand of joy. The one thing marring this vision is the cumbersome life vests wrapping their torsos.

My girls haven’t yet learned to swim, so I think: swim lessons. I bask in these visions as I call my six-year-old daughter over and propose the idea. Instead of excitement and anticipation—she loves water!—her eyes widen with fear, and her chest rapidly rises and falls with shallow breaths.

“Will you be there!?”

“Sure, I can watch, but you’d be in the pool with an instructor and other kids.”

She flops on the floor, her voice is grating with distress, “No. No. NOOO! I don’t want lessons!!”

“What!? Why not?”

With her eyes squeezed shut, she unleashed a hurricane of questions that blew away the pleasant scent of wet rocks and damp hair; clouds darkened the sunny picture in my mind.

“But I can’t swim! What if the other kids splash me in the eyes? What if everyone is better than me? What if I sink? Can you save me if I sink? Can I wear a life jacket? Will the pool be deep? Is the water cold? Where will I change? What if the big drain at the bottom opens up and sucks me into the abyss and the purple monkey runs away with my sparkles?! No! I don’t WANT swim lessons!”

OK, the purple monkey thing was mine, but that’s how it all sounds to me.

I make the same mistake I've made countless times and try to reassure her, “You’ll be fine. They would never let a student drown.” But her panic only deepens. That’s because I have an anxious child. She gets this way whenever we are fording to new territory. If this sounds familiar to you, you may have one too. We’re in good company, the American Academy of Pediatrics estimates that close to 10 percent of children and adolescents struggle with one of the many forms of anxiety. The good news is that there are effective ways to coach your children to learn skills for managing their anxiety, whether it is General Anxiety, Separation Anxiety, Social Anxiety, or one of the other flavors.

What’s Going On?

The culprit is a part of our brain called the amygdala. In response to alarming stimuli, the amygdala triggers the fight or flight response, charging the body with adrenaline. This releases sugar into the bloodstream, which speeds up the heart and breathing, and opens airways to fuel the muscles and the brain with oxygen.

The amygdala acts automatically, without checking with the logic centers of the brain. For our primal ancestors, that threat might have looked like a prowling lion; whereas my daughter’s lion is a pool of water, an instructor, and five other six-year-olds waiting their turn to practice forward strokes and long legs.

For people with an anxiety disorder, the amygdala is overactive, firing life or death responses when facing daily challenges, new situations, or sometimes for no overt reason. It is similar to the way the immune system of a person with a peanut allergy responds to contact with a peanut. It is an inappropriate and automatic response by one of the body's protective systems.

I'm not giving you a hard time.
I'm HAVING a hard time!

All of us experience anxious moments, but it becomes a disorder when the anxiety controls the person's decision making and/or the constant strain of daily anxiety affects their physical health.

The amygdala may not check with logic centers, but our logic centers can check our amygdala. First, my daughter must recognize what’s happening in her body, use her calming techniques, then, usually later, work through the issue that caused the anxiety. It is a difficult skill set, but it gets easier with practice. Lately, I’ve noticed she doesn’t have to work so hard to control her anxiety, and fewer situations (or suggestions) trigger the flight or fight response. This confidence is powerful; more powerful than the imaginary beasties that lurk in the shadows of her mind.

How is this done?

The first task was to understand how she’s feeling.

I am afraid of snakes. When they surprise me, I have a strong fear response. However, I don’t have anxiety so I can quickly regain control. When she started getting scared about something that seemed silly to me, I would imagine a room with several loose snakes hiding out in the furniture, and someone pressuring me to go in there.

OK, I get it.

This exercise brought to light several points about how to work with her when she’s anxious.

Point 1: Don’t shame me for my fear, I can’t help it.

Point 2: Change is hard.
Sure, some form of snake fear therapy could help, but I don’t want to. Facing a fear is uncomfortable and difficult.

Point 3: I need control of the process.
If I needed to seek snake-fear therapy, it would need to be on my terms. If you tried to decide for me and pushed me into a room of snakes (even cute little harmless ones) and closed the door, I would hate you for ever. Period.

Point 4: I want to be equipped before I face my snake.
I would want to learn and be prepared with calming techniques beforehand and know that I could go at a pace that felt safe, even if it took years.

Point 5: This is for my benefit, not yours.
My fear response to snakes might seem silly or exasperating to you, but I would need to confront this issue for me. The worry of disappointing someone else would make the pressure unbearable and almost ensure failure.

How to apply these points to a child:

Resist the urge to reassure. A crucial part of this process is to abandon attempts to reassure your child. His body is readying him for a fight to the death, telling him to calm down, that it’s just a friendly little snake (or imaginary) doesn’t help. Instead, describe what you see with genuine concern, “You’re breathing really fast and your eyes are wide. You must be really worried.” Then reflect his fear back to him, so he knows that you know there’s a snake there—you know? This practice also creates awareness of his physical responses to anxiety, so he can eventually recognize it and head off the process on his own.

Inducing physical calm. Practice belly breathing through the nose, clenching and releasing muscles, prayer, and/or meditation. These techniques can help a child to shut off the flight or fight response. Following up with a physical activity is a great way to discharge the remaining adrenaline to prevent it from causing the typical anxious child tummy ache or headache.

Distraction. Before his mind can return to what caused the anxiety, coach him to engage in a mental distraction, e.g. reading, or playing a mental game like trying to remember the alphabet backward, or counting by threes, until he feels in control.

Make a list. Once your child has refined a process that works, suggest making a list for her to keep in her pocket or backpack. It’s difficult to think clearly when under duress, and a familiar list of things to do can help be confident that she can regain control.

Recognize her effort.
If you see her belly breathing or mumbling numbers in order to induce calm, once she's regained control, notice her efforts in the same way you would with a great report card or a three-point shot.  

That’s it for now. Let that soak in then come back for the next segment in which we will explore coaching techniques to help our children work through difficult situations.

Part 2:  Coaching Your Kid Through Life

Part 3:  Just Between us Parents

I'd love for you to add your experiences and advice in the comments.  

Anxiety in Kids - Part 2: Coaching Your Kid Through Life

Now that your child has learned to return to calm during an anxious episode, (Part 1:  Empathy and Calming) let’s look further into the future and explore ways to coach your child through an anxious situation.

First two things to remember:

1. Your child's anxiety isn't your fault.
2. This is their problem to fix, not yours.

Even though we can't fix their anxiety any more than we can go to bat for them at their ball game, there is a lot we can do to help.

Be a coach. First, we must don our hat, whistle, and gym shorts. Becoming a coach can ease your own feelings of frustration. Coaches teach skills, give encouragement and recognition, but never play for their players. Coaches look for progress, not perfection. To begin coaching work together to find a time of day when she is usually relaxed.

Explain what the amygdala does. If she's little, try encouraging her to name it something silly. Teach her to recognize those feelings when they start to rise by verbally noticing the changes in her body, e.g., “Your eyes are so big, and you’re breathing so fast. Looks like Alexa Amygdala spotted a snake.”

Talk back to the amygdala. Ask her if she can think of forceful things to say to her amygdala, e.g., “Alexa, stop bothering me! I don’t need you right now!” Feeling powerful can help ease anxiety by switching to the offensive, the words also discharge some of that frantic energy. She might feel silly practicing this, but as it is with sports, practicing it when relaxed will make it come more naturally when she really needs it.  Try it during your own anxious moments; it can help if she can watch and emulate you.

When confronting a situation like swimming lessons or school fears, be persistent, but reasonable. When you automatically pull a child from an activity that triggers their anxiety, the message they receive is that you think she’s not capable, leaving her feeling defeated and ashamed--albeit relieved. Instead, explain that swim lessons (or whatever it may be) will keep her safe when having fun around water this summer, but that you’ll wait to sign her up until she feels ready.

You’ve showed her that there’s something in it for her, lots of summer fun!, and that she’s in control of the situation. That said, anxious kids should not be shoved into something scary, it may cause panic to set in and damage trust. For children with anxiety, it is a short trip from fear to phobia. When you’re ready, is the first mantra to remember. I can help, is the second. However, if a situation has become toxic for her, trust your decision to allow her to quit the program.

Hand the Question Back
Take each concern your child has in turn. First, listen carefully, then put the problem back to him using his words.

Using the swimming lesson example, “What if I sink?”
“Do you think you will sink?” or “What do you think you could do if you were sinking?”

“Will I drown?”
“Do you think you will drown?” Try your best to sound concerned; not mocking.

Keep putting the question back to the child. The feedback loop shows him that you hear his concern, but that he’s still in charge of the concern and that you are confident he can handle it. When he hears his words coming from you, sometimes he will realize it isn’t likely or logical. If he’s getting stuck and the amygdala starts firing again, get out the list of calming techniques, then try a fresh approach. But first and foremost, let you child do 90% of the talking, it’s his problem, so he gets the floor to talk it out. Listening is difficult, you may want to talk and impart your wisdom and experience, but as soon as your lecture gets rolling, he’ll disengage.

Externalize the Questions

If he’s old enough to write, suggest writing down his fears on a piece of paper. If your child is a visual person, or not able to read yet, help him draw a picture of the scenario. This process helps him unload his fears from his head onto something external so he can engage his logic centers to process them one by one. Sometimes he’ll feel better just getting them externalized--snakes don’t look so scary in crayon--but resist the temptation to stop there, the crucial part is taming each fear one by one.

For the swim lesson example, let’s draw a picture. Two square swimming pools, children in the water, the instructor, and other people swimming. Let your child draw a picture of someone struggling to swim. He might realize that other people would be alert to help the child, but if not, ask, “Do you think the other people in the pool might notice the person struggling?” He may also need information, but phrase it as a question, “Did you know there are lifeguards at our pool? Where do you think the lifeguards would stand? Do you think they would be able to help?”

Next question: 

“What if other kids splash water in my eyes!? I don’t like that!”
“You’re worried about water splashing in your eyes.  I don't like that either. Can you think of anything you can use to protect your eyes?”
“No!”
“Humm, do you think a pair of goggles might help?”
“Yeah - goggles would be cool! Can I get blue ones?”
“Yes. Do you want to draw them on your stick figure?”

Even have him draw in the purple monkey and huge drain. Then let him cross them out, thereby eliminating the irrational concerns. Ask if the drowning person can be crossed out too.

The questions are prompts for him to engage his logic centers and to separate the rational concerns from the irrational. You want him to feel as though he is coming up with the solutions for the rational concerns, even if your questions are leading. Engaging his logic centers has the wonderful side effect redirecting energy away from the amygdala--it is a mental distraction and a problem-solving exercise rolled into one.

OK, what’s next?

After working through the issues, ask if he’d like to see the pool where the swim lessons will take place. If he’s old enough, have him call the pool center to find out when lessons are and whether or not watching a lesson in session before joining would be OK. The more empowered he is, the more confident and in-control he will feel. You can take it further by asking to meet the instructor, so your child can meet the person and ask questions directly. If he gets nervous and forgets, remind him what his questions were, but try not to do the asking yourself. Feel free to break the ice with introductions and let the instructor know your child is anxious about lessons.

Ok, that’s it for segment two. Feel free to take off your cap and whistle, but keep them on hand, you need to be ready when your child approaches you with that look of an imminent anxiety attack.

In the final installment, you and I get to talk about the challenges of being parents of our anxious kids with more ideas and techniques.

Next - Part 3:  Just Between us Parents
Previous - Part 1:  Empathy and Calming

I'd love for you to add your experiences and advice in the comments.  

Losing My Dad

On Father’s Day, my life changed. The toughest, coolest, scariest, man I’ve ever met died.

My Dad.

Over the last ten years, Dad’s contemporaries have been dropping off one by one. I was sad, but also secretly relieved that I still had my dad. It was like the Reaper kept putting him off, like “Ug, really?! John Turner’s number is up? I have to go after that ornery old bastard?! Maybe next year—2016 about wore me out.” I was beginning to think he'd go on forever, like Keith Richards.

Dad was healthy and taking good care of himself. He was happy too. It was rare for me to call up and catch him in a bad mood. The kind of mood that used to make me try to feel his vibe through the phone before dialing it.

Dad and Tibs

He was making plans. He was feeling good, other than a recent issue with bradycardia which the doctors were working on, he was good. He loved being a grandpa and we were getting to know each other a whole other level; as fellow adults, as friends.

Then he caught the flu and was sick for over a week. On Father’s Day he started feeling better. He talked to me, Charley, and then later my brother Reed. Then he took a nap and died.

The Reaper finally got up the nerve to deal with him...when he was napping.

Reed and I were devastated. I couldn't believe it.  At the funeral home, I opted to see him because if I didn't, I knew it would never be real to me.

It was real.

This summer has been a whirlwind of phone calls, trips to his house to clean things out, sending and receiving condolences, and finally having a gathering to remember him.

We tried a few dates, but the only one that worked fell the day after my 40th birthday.  I felt crushed under the weight of passing time. 

I was stressed out trying to create something worthy of his life. Something loud. Something big. There should be fire and brimstone, cannons and roaring motorcycles, wailing virgins, a clashing of swords beneath a murder of circling crows, then a flaming boat to carry him to Valhalla. But all I could do is stake out a spot on the river and brings some stuff for a potluck. It all seemed so...inadequate.

Preacher Bob

It wasn’t. It was wonderful.  There were Dad’s friends old and new. There were wise words spoken by a preacher who was once Free Soul biker.  He normally holds services in a tavern and baptizes sinners in a river. There were motorcycles and leather chaps. A skunky smoke wafted in the air. There were drinks of whiskey & Coke prepared by a friend who used to tend bar when they were young. There were tears and laughter, and rambunctious kids underfoot. And there were wonderful hugs. There were stories told from open hearts about what Dad meant to them. There was a feast of delicious food. The sunlight percolated through the leaves warming us.  The river wept and told us of her remembrances too. Forest fire smoke spoke of death and renewal.

Karen, Barry, Geno, and Les

I could feel Dad there too, and he was having a helluva time.

Although I will forever miss my dad, I am grateful to everyone who has reached out. For every bunch of beautiful flowers, hugs, I love yous, and cards or notes through FaceBook. I am so lucky to be surrounded by all of you. I have been pouring all that love right into the hollow place that Dad left when he died and my heart feels full.

Doc & Ginger

For those who couldn’t make the memorial, here is what I had to say about the man who was my father.

****************

The last time I talked to my dad was on Father’s Day.

He had been sick with the stomach flu for over a week, but on that day was feeling better. His fever was gone and he’d felt well enough to shower and eat a little bit.

I talked about my girls finishing up their school year and about my new garden.

I told him about a neighborhood party we were about to have to celebrate the kids getting out of school. And that by the next summer my new berry row should be dripping with blackberries and raspberries, and how I was thinking I’d make some pies for a social, and how I’d love for him to come for that and stay for a few extra days.

He thought that sounded great.

He told me about the tomatoes he’d planted in pots and was excited to see how they’d turned out. “I’ve never tried growing tomatoes before.”

When I was cleaning out his house after he passed, there they were, two beautiful tomato plants in pots sitting in the sun. I loaded them up too and brought them home with me. They’re doing well and setting out beautiful fruits.

He told me again how much he liked Trader Joe’s.

I had introduced him to that store during his last visit. We went shopping together and he was excited about all the health food stuff: the fresh ginger, avocado oil, a stevia sweetener he liked, organic coffee… The man was always a foodie, and as of late he been reading a lot of about nutrition and holistic health too. He’d send me emails about things he thought I should know, like the dangers of non-organic potatoes and coffee because they absorbed toxins from pesticides and herbicides.

As I packed up his kitchen, there was a stack of Trader Joe’s paper bags that I loaded up with all of his organic goodies.

He sounded tired on the phone, but I didn’t want to hang up. I kept telling him how I hoped he’d feel better soon and that I wish I could make him some chicken soup and hang out and watch The Quiet Man with him.

He wished that too.

I gave the phone to Charley so they could wish each other Happy Father’s Day. They talked for a bit and Charley handed me back the phone.

Eventually, I realized he wanted to go, but didn’t want to have to say it, so I said good-bye told him Happy Father’s Day yet again and said, “I love you” two or five more times and hung up.

Reed called him later that afternoon.

Then my dad fell asleep and left us.

Two days later I got a text from Reed that said, “Call me ASAP.”

*Oh fuck.*

I called, and before he spoke I said, “Is Dad OK?”

His voice broke he said, “No.”

I don’t remember anything else from that conversation.

I do remember the fear and adrenaline that was running through my body. I can feel it now too.

I’ve been thinking about how to talk to all of you about my father. But most of you already know. That’s what it is to be among family. You can drop half formed sentences and the other person knows enough to correctly interpret what you’re trying to say.

So that’s what this is a long half sentence that I know, you know, how to infer all that I can’t find the words to say.

There’s no doubt that I was a daddy’s girl. I was the smallest of the crew that we grew up with, but I was scrappy. With a father like big JT, what did I have to fear from anybody?

Being a dad’s girl never changed. Reed and I visited our mom occasionally and she’d try to talk us into staying with her, but that was never an option for us. We knew we belonged with our dad. We loved growing up on the river and everybody in our extended family here. Several times mom challenged him for custody and each time he fought to keep us. It would have made his life so much simpler to unload us on someone else, but he didn’t. Reed and I will never forget that. My dad was far from perfect, but we belonged together. And there’s not a face out here today that didn’t in some way help keep us together.

The crew. 

Here are a few of my favorite memories of my dad:

I was about six and after a long drive home from town, I pretended to be asleep in the backseat of the car we’d borrowed for the trip. I was hoping Dad would carry me inside. He picked me up and carried me like I weighed nothing. I still remember the feeling up being curled up next to his chest. I’m pretty sure he knew I was faking and carried me in any way.

At about eight years old, we were at The Rope swimming and I had yet to work up the courage to jump off the high rocks—but I really wanted to. Dad and I walked to the top and he executed a perfect swan dive from the rocks into the pool below. He came up and shook the water from his hair and wiped it from his face and mustache and treaded water waiting for me. I stood up there, holding on to the snag trembling. He called up, telling me it was OK, that’d he’d be right there to catch me. It took me forever to work up the courage to do it, but he didn’t get impatient, just treaded water and kept sending up encouragement. Finally, I let go of the snag, shuffled up to the ledge, pushed off...it was exhilarating. And when I resurfaced Dad was there to tell me how proud he was.

Running the River

Going down the river on Dad’s drift boat was always a treat too. He was always at ease with us and the world out on the water. Fully engaged, he taught us how to fish from a boat, and to read the water to find the best holes and how currents drifted in food to the fish. He also taught us to oar the boat and explained how to read the water for hidden rocks, holes, and how to best position the boat to hit the rapids. He was always relaxed and happy on the river and in the woods. To this day that’s where I go when I find life weighing me down.

He taught us to fish, to shoot, to forage, and to take care of each other. I left home as a 18-year-old adult, fully capable of taking care of myself, holding a job, paying my bills, and keeping my home. He gave us strong work ethic and principles.

My dad also had a soft spot for cast-off animals and people who needed a leg up. Until recently, I’d never raised a puppy. Our dogs came to us fully grown, usually unwanted by their former owners. We always had two or five cats. Dad never hesitated to take in friends that needed a play to stay either, sometimes for a year or more. Kids were no exception. It was usual for us to have one, sometimes two, extra kids living with us for a while. In fact, there are really only a few times I can remember where our house consisted of just the three of us.

Even without live-ins, our house was usually full of people. He was never so happy as when he was surrounded by friends. Not just friends, but people he called “Brother” and “Sister.”

They were people he loved and who loved him in return.

All of you.

Ten years ago, I became a parent. Seeing first hand the trials of being a parent I gained a new respect for him. I think he saw me in a new light too. I could call him when my parental frustrations were causing me to lose my mind and he’d talk me down. Then we’d talk about other things and I’d hang up feeling so much better. I leaned on him a lot. I needed him and he was there. Just like he always has been.

My girls loved him. Tiberius loved him. Dad had grown into a soft touch in his grandpa years and doted on our kids. As I was cleaning out his things, all of the pictures and art the kids had made and sent him over the years were either on display or carefully tucked away. He always had the patience for their little kid ramblings on the phone. There was a wonderful day when we were all at the Blue River Boat Landing and he was teaching my littlest Berzo to fish, just as he did with me thirty-five years ago.

The thing I admired most about my father is that he never apologized for who he was. He owned his strengths and shortcomings and moved through his world with confidence. The Japanese people have a tradition called Kintsugi, which means “golden joinery” wherein they repair cracked pottery and with gold or silver, making something broken into a work of art. My dad was like that, cracked from his mistakes, but made more beautiful by the repair. And when he’d see my brokenness, he’d pour gold in those too. So I stand before you, with all my shimmering breaks accumulated over my life proud to say John Turner was my father, and I will miss him every day for the rest of my life.