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Chapter 1
“I Can’t; I’m Too Scared”
Understanding Children’s Fears and Worries
From the children:
When I was little my mom worked the “graveyard shift” at the hospital. Every night I was so worried that meant she was going to die and I’d never see her again.
I hate having to worry all the time. I can’t do anything without thinking—are my parents okay? is my family okay? It is always in the back of my mind. I wish I could just turn off my mind, but then I feel like a bad person for feeling this way, because I love my family and I don’t want anything bad to happen to them.
My parents get mad at me for staying up late working. They keep telling me to stop worrying. That stresses me out more. They have no clue the pressure I’m under. It wasn’t like this for them. Everything I do counts for college. There’s nothing to cut out, this is just my life.
From the parents:
Until he knows for sure, he can’t, he won’t. How do I convince him life is OK?
I feel like the worst parent. I want to help my son, but I lose it and I know that’s not helping anything. I start out patient, but nothing I say makes him feel better. Then I get frustrated and it’s a mess.
My son is so worried all the time; he’s constantly in this bubble of stress. The other kids are oblivious all around him. They are just being kids. I wish so much that he could be more like them.
If you want to make things better, you first need to know what’s wrong. In this chapter we’re going to explore exactly what an anxious child’s inner experience is like and the different ways that anxiety can manifest. We’ll explore the fine line between when anxiety is “normal” and when it’s not, and we’ll take a look at what causes anxiety. All of this will help you empathize with your child’s experience so that you can better help him overcome his worries and fears.
The Problem of Living on High Alert
“Don’t run into the street! Stop climbing on that. Careful, that will break!” Words like these are staples in most parents’ rule books, but most parents of anxious children find they never have to utter them. The mind of a worrying child is already fielding hundreds of internal “be careful” or “watch out” or simple “don’t!” messages every day. Rather than insisting that their child do their homework as in most families, you may be wresting papers from your kid, convincing him he has done enough and it’s time for bed. In fact, you may even find yourself kept in check by your worrying child—“Did you lock the door? Is the gas tank full? Did you send in the permission slip?”
Though it can often be confusing or frustrating to parents that their child must feel every wrinkle in the day and race ahead to prepare for every eventuality, we must understand that anxious kids are just following the instructions that their worry brain is giving: Proceed with caution; handle with care; warning: danger ahead.
Whether they are worrying too much about typical concerns such as grades or friends, or being frightened by unlikely disasters like getting a fatal disease or becoming homeless, anxious children are highly cautious because their mind is giving them unreliable, biased information and overcorrecting for the possibility of danger. But they don’t know that. They are oriented—by their wiring, or their experiences—to see danger when it’s not there. Though it sometimes seems that anxious children go looking for trouble—whether it is overhearing a conversation in the hallway about lice, or financial stress or heart attack, their hearts sink and their worry soars—they don’t want to be this way. They are equipped with a system that is programmed to be highly sensitive to any hint of uncertainty, to risk, to danger. But it’s a system that is not very good at interpreting that risk or uncertainty. So kids notice everything but don’t get any help putting those observations into perspective.
Sometimes anxious kids recognize that they are different from their peers, but oftentimes they assume that this is just who they are, rather than seeing this as a problem that can change. But to be an anxious child—at any age—is to juggle; it is to live a double life. As one articulate youngster said: My heart is telling me things that make my stomach feel bad. On the one hand, there is a constant barrage of catastrophes, worries, and disasters flashing through their minds. Their default setting is high alert. Meanwhile, on the other hand, their parents and teachers tell them not to worry, and sometimes these adults even get frustrated with them for feeling the way they do. This adds to their worry, because now they feel they’re doing something wrong!
Conducting their lives as if they’re in the middle of a fire station, anxious children are constantly on edge, waiting for the next alarm to sound, the next disaster to strike, and amazingly with all of that going in their minds, to the outside world anxious children often fly right under the radar of the best-trained eyes. It is much to their credit that they can keep all the balls in the air and do so well—but it is not without a cost.
Parents juggle too. On one hand, they feel embarrassed when it’s their child who is hiding in the corner at the birthday party, in tears at the school play, or unable to go on the school camping trip. In these moments they just want to make the problem stop. On the other hand, they feel scared: If my child is struggling with all these hypothetical fears in the midst of a pretty great life, how will they ever survive when they have a real problem? Caught between these two views and feeling helpless, they may try to diminish the fear, ignore it, or even get frustrated at their child for being anxious. But what they need to do is understand what is going on. That’s the beginning of finding a new solution.
Make It Stop! The Problem with Anxiety: The Emergency That Isn’t
All children need to know that they are safe and that their parents will protect them. Anxious children are no exception, but helping them feel safe is a complicated and often frustrating endeavor. This is the poignancy of an anxious child.
He or she comes to you, drops their fear, unhappiness, or uncertainty in front of you, and waits for you to fix it. Struggling with invisible enemies, they want you to save them as you would protect them from any concrete danger. You see your child unraveling and that the degree of distress your child is feeling is out of proportion to the situation, but what he’s experiencing feels like an emergency, and he wants you to take away the emergency or he wants to escape.
Put those two together and your child might get angry or frustrated at you for not being able to save him and make him feel better. He might think that you are being mean because you can’t make it better, or even that you’re choosing not to make him feel better because you won’t do the simple things he asks (like letting him stay home from school or assuring her for the twentieth time that morning that she won’t throw up). And you probably feel frustrated yourself that the usual magic touches of parenthood—a hug, a kiss, and some reassuring words—aren’t doing a thing. While you could do all the things that your anxious child asks, you know that meeting these surface needs will not free her in the long term, but will only engender dependence on you for reassurance forever!
Anxious children feel trapped, and they want you to get them out. The more that you understand that what is trapping your child is the faulty information their brain is telling them, the more you will be able to separate the worry from your child and help them begin to correct the distortions and mistakes—by themselves.
Fear: A Normal and Necessary Part of Life
What is the setup for anxiety? Fear. On one hand, fear is an adaptive human reflex and an essential safeguard for survival, for children and adults alike. Fears and worries can help children put on the brakes in unfamiliar situations. Rather than hurling yourself into a swimming pool when you don’t know how to swim, for example, a good dose of fearful “what if?” can keep a healthy degree of caution in the picture. Because our natural inclination is toward growth and development, we would not survive as a species if it were not for our ability to hold back and appraise and avoid danger. It is a protective mechanism and a normal part of development.
Fear can be considered the emotional response that occurs in the space between confronting a new situation and actually mastering it. Anxious children are wired to notice these gaps more than others. Rather than responding with delight and curiosity—a desire to master something new—they become derailed by an overwhelming feeling of distress and concern. The “what’s new” is eclipsed by “what’s wrong.”
Temporary fears are a normal and healthy part of development. In the same way that adults may be fearful of a new piece of technology until we have figured out how it works—and may even entertain unrealistic scenarios of blowing up the computer by pushing the wrong button—kids’ fears are fueled by an active imagination, trying to piece together an explanation for how the world works in the high-stakes context of their safety. A little information goes a long way. A four-year-old at the aquarium is afraid of seeing the sharks because she’s old enough to understand that sharks are dangerous, but she’s not old enough to understand that she can watch safely from outside the tank. An eight-year-old is beginning to understand about germs and disease, but he can’t yet grasp how unlikely it would be to get sick just from engaging in normal activities.
The Typical Developmental Sequence of Fears in Children
There is a normal unfolding of fears for all children, not just anxious ones, over time. A healthy safeguard, these fears mirror their development as their world broadens and they encounter new experiences that they have not yet mastered. As children interact with the new experiences they gain confidence and competence and move on to the next stage.
Infancy: Babies’ fears are immediate and concrete. In response to a growing ability to differentiate familiar faces from unfamiliar faces, stranger anxiety (clinging and crying when a stranger approaches) develops around seven to nine months and typically resolves by the end of the first year. Infants fear separation, loud noises, and sudden movements.
Early childhood: As a healthy attachment to parents grows, separation anxiety (crying, sadness, fear of desertion upon separation) emerges around one year of age and improves over the next three years, resolving in most children by the end of kindergarten. As children’s worlds expand, they may fear new and unfamiliar situations, as well as real and imagined dangers such as big dogs, spiders, or monsters.
Elementary school: With access to new information and a growing ability to grasp the gravity of events, children begin to fear real-world dangers—fire, burglars, kidnappers, storms, illness, drugs. With experience, they normally learn that these risks present remote, rather than imminent, danger. They continue to struggle with what is real and what is not—so fears of ghosts, witches, and zombies are common.
Middle school: The growing importance of social status leads to social comparisons and worries about social acceptance. Concerns about test grades, crime, social isolation, athletic performance, and social-group identification are normal.
High school: Teenagers continue to be focused on social acceptance, but with a greater concern for finding a group that reflects their chosen identities. They tend to worry about the narrow focus of their social relationships as well as about the larger world, moral issues, and their future failure or success.
The chart that follows provides an example of the top ten fears for typical boys and girls (in this study, ages nine to thirteen), without any anxiety or other diagnosis, and how they differ by gender.
Boys’ FearsGirls’ Fears
1. Spiders 1. Spiders
2. Predators 2. Being kidnapped
3. Being hit by a car 3. Parents dying
4. Snakes 4. The dark
5. Burglar 5. Frightening movies
6. Frightening movies 6. Thunderstorms
7. The dark 7. Being teased
8. Being teased 8. Bats
9. Frightening dreams 9. Bats/ghosts/spooky things
10. Medical operations 10. Sleeping in the dark/ making mistakes
Source: Muris, P., Merckelbach, H., & Collaris, R. (1997). Common childhood fears and their origins. Behavior Research and Therapy, 35(10), 929937.
Anxiety: Unnecessary and Disruptive
In contrast to fear, which is a natural, adaptive, immediate reaction to a stimulus, anxiety is the tense emotional state that occurs when you can’t predict the outcome of a situation or guarantee that the outcome will be the desired one. It’s the mind doing guesswork, and by always guessing catastrophe, it doesn’t guess well. It is not adaptive but disruptive—at the very moment when it would be helpful to lean in and get more information about an unknown or new situation, anxiety takes our attention ninety miles an hour into the future, into disasters that will probably never happen. Meanwhile, the real problem is still waiting for us to solve it—but we’ve been so dragged around by worry that we can’t think straight or see our options.
Even in the best circumstances children experience some fear and worry. Anxiety becomes a disorder when a child automatically exaggerates risks and underestimates his ability to cope with a given situation to the extent that this interferes with his functioning (more about this in Chapter 2). Anxiety is debilitating internally to children, causing chronic fatigue and putting children at other physical risks like hypertension, heart disease, and gastrointestinal and respiratory disorders. It is also implicated in the development of depression and substance abuse, and it is associated with decreased immune function in general. Just as dangerous, anxiety hinders and restricts children’s movement in the world around them, affecting how they function in school, how they interact with peers, and their role in their family. The familiar stereotype of the worrywart belies the serious physical and emotional risks and consequences of untreated anxiety.
Who Is the Anxious Child?
Anxiety has many faces. Some children appear visibly stressed, while others keep their anxiety under cover and worry silently. Still others are angry-anxious kids, reacting to their limitations with frustration. Approximately one in five children will develop an anxiety disorder of some kind. We know that the rates of anxiety disorders tend to increase slightly with age, but most studies of anxiety disorders draw from a sample of children over seven, so the prevalence of anxiety disorders in very young children is unclear. Girls tend to be diagnosed with anxiety disorders more often than boys. Interestingly, though, more boys are brought to treatment as the outward signs of anxious behavior, like crying, shying away, and overt distress, tend to be less socially acceptable in boys than in girls.
