Sometimes it appears that many of the adverse, current events over the past two years have opened a Pandora’s Box for children. Let me explain. When they finally caught the man and teen responsible for the series of random shootings on the East coast a number of months ago, I was somewhat surprised when a ten-year-old I was working with told me that their capture didn’t make him worry any less about being shot. When he explained, it made perfect sense. He said, “There are lots of guns and lots of people in the world.” The best analogy I can offer to this phenomena, this Pandora’s Box, is that of monetary inflation. Once it begins, there doesn’t seem to be any way to go backwards. At best, you can hope to stand still and, as our politicians remind us, low inflation rates somehow represent progress. Each world or national event involving violence, harm, kidnaping, or a host of events that stress all of us, also stress children. Yet, although many of us when an event ends, such as the random shooting, manage to feel somewhat relieved, children may not possess this capacity. There doesn’t seem to be any going back. More and more of the children I work with each day are fearful of kidnaping, bombing, or being shot. Recent studies suggest that more children are worried about more things. Researchers have clearly demonstrated that even low levels of persistent worry can, and do, have a significant impact on mental and physical health. In this month’s article, I am going to briefly provide an overview of anxiety and some questions to keep in mind with your children or students.
Some forms of fear or worry may only have a minor impact on a child’s daily life. For example, a child’s fear of the night may affect his ability to fall asleep, but eventually he is able to sleep undisturbed through the night. Similarly, a child fearful of an object or situation to which he or she would not normally have daily contact (e.g., clowns, spiders, snakes, or sharks) will probably not demonstrate a significant disruption in his, or her, functioning. Other forms of fear and worry can cause a child to suffer daily, lead to clinical anxiety, and affect the quality of the youngster’s life. For example, children with school phobia may not be able to separate from parents and attend school. Children with severe test anxiety may not be able to concentrate effectively during exams and may be more likely to fail tests despite possessing the knowledge to pass. Some children, as Drs. Robert Brooks, Kristy Hagar, and myself, noted in our book Seven Steps to Help Your Child Worry Less, (Specialty Press; 2002) are particularly vulnerable to worrying and may become anxious about many different things with little provocation. Sometimes we call these children “worry worts.” Sometimes exposure to everyday events triggers a snowballing effect of anxious thoughts in these children. Current events appear to be triggering this phenomena in more and more children. For example, just watching the evening news can be overwhelming. A news story about the depletion of the ozone layer, a natural disaster, or for that matter, an act of terrorism, may set off a chain reaction ultimately resulting in a child who becomes extremely anxious about his safety and the safety of his, or her, family.
For some children, the demands of school, friends, and family can be difficult to juggle. Even the activities that are supposed to be fun and interesting for children can become stressful. While it is unrealistic, and probably impossible, to shelter children from exposure to distressing news events and the pressures of everyday life, parents and educators should discuss and process these issues with children. It is during these dialogs that adults can identify patterns of worrisome or anxious behavior that may require attention. Below are a set of questions from our book that may help you determine types of worries and the degree to which worry may be interfering with a child’s everyday life:
- Does the child persistently talk about, or seem preoccupied with, a particular stress or feared object/situation?
- Has the child’s sleeping habits changed (e.g., nightmares, avoidance of going to sleep, waking during the night, etc.)?
- Does the child avoid activities or situations he or she previously enjoyed?
- Does the child complain of physical symptoms, particularly before certain activities, such as attending school?
- Does the child cry, or appear easily bothered or irritated by minor things?
- Does the child appear jumpy, tense, or on “pins and needles”?
- Does the child avoid sleepovers, especially when these were previously enjoyed?
- Has the child’s schoolwork, or enthusiasm towards school, declined?
- Has the child reduced time with friends, or does he or she only want friends to come over to his or her house?
- Has the child’s appetite changed?
If you have answered affirmatively to more than just a few of these questions about your child or a student in your classroom, worry may play a significant role in that individual’s life. This is particularly the case if you have observed any signs of worry or anxiety for weeks or months, and if the child appears unable to let go of these worries. In some situations, parents and teachers can effectively put strategies into place to help children worry less. In others, professional help should be sought. Consider professional help if initial efforts to reduce worry, fear, or anxiety are ineffective, if you observe sudden behavioral changes, such as temper tantrums or hysterical refusal to participate in certain activities. Finally, it is important to consider professional help if the child has been exposed to a highly traumatic event.
A number of months ago, I had the opportunity to provide a consultation for a pediatrician of a thirteen-year-old boy who had been treated, not by this pediatrician, but by a local ADHD clinic for reported symptoms of Attention Deficit Hyperactivity Disorder. The boy had been taking stimulants for two years. His parents reported an equivocal response to the medication. Eventually, the boy decided to stop the medication because he didn’t like “the way it made him feel.” As I took a history, although there were intermittent reports of difficulty with attention, impulsive behavior, and a tendency to frustrate easily, it quickly became apparent that this boy struggled with generalized anxiety. He cried over the stress of homework, but didn’t put off doing the work. He feared leaving his parents and going with others, worrying that he might somehow get lost or be left behind. He found it difficult to settle down to sleep at night, reporting that he replayed events of the day and often worried that the next day would not go well. As amazing as it may appear, this is not a case of malpractice, but rather a tendency of many specialty clinics to focus on disruptive behavioral symptoms, seeking disruptive diagnoses. Many children struggling with fear, worry, and anxiety demonstrate inattentive, restless symptoms. Many manage to function adequately at school, but at home, after the stress of working to hold themselves together psychologically during the day, can be impulsive, inattentive, hyperactive, or oppositional.
I fear, at times, future events in the world may emerge from Pandora’s Box, further fueling stress for our children, pushing more and more children to the edge of dysfunction and a need for mental health services. I believe the best means of helping all children, in regards to fear, worry, and anxiety, is for the adults in their lives to take an affirmative role, understand how these events cause problems for children, and take the time to develop strategies and skills to help all children become stress-hardy.
