Archive | December, 2013

The Lessons of Goodnight Moon

30 Dec

From Your Anxious Child: Emails to Parents by Edward Plimpton, PhD

                                      

When you have a baby, and you live in the United States or some other developed nation, then chances are you have a copy of Goodnight Moon by Margaret Wise Brown. If that book escaped your notice, then  rest assured that it is easily obtained-sometimes even in large grocery stores.   Worries, fear and anxiety have a favorite time of day to make an appearance, which is, of course, bedtime. Hence, the numerous books written about bedtime for young children. In Goodnight Moon, a mother rabbit is helping her bunny to sleep and the dialogue consists of saying goodnight to all of the objects in the room. It begins with:

“In the great green room
there was a telephone
And a red balloon
And a picture of the cow jumping over the moon.
And there were three little bears sitting on chairs…”

So at time when anxiety might be increasing, what does the mommy do? She helps the little bunny get out his/her potentially anxious thoughts by bringing attention to the concrete aspects of their surroundings. What is in the room?  A telephone. What are on the walls? A picture of the cow jumping over the moon. She is helping the little bunny get out of his/her head and focus on reality of where they are. Any thought of monsters under the bed are interrupted by reminders that they are in a very familiar bedroom. So this focus on what is in the room helps keep the little bunny grounded rather than drifting off into an anxious sea of bad thoughts.

But the mother bunny is also doing something else. She is remaining very calm. We know that anxiety is very contagious. An infant or young child has an immature nervous system and consequently relies on adults to help them regulate it. Children are consequently checking in with their parents to see how they appraise what is going on-technically this is referred to as social referencing. And the mommy is indicating to her little bunny that she views the situation as totally safe. In a similar manner, you will help your anxious child by conveying a calm and confident manner that the situation is safe and you will take care of any problem that might develop.

This classic bedtime story illustrates the importance of orienting to the external environment in dealing with anxiety and demonstrates how parents can help children manage their anxiety by providing a calm presence. A similar point is made in another essay on this blog, “Helping Your Anxious Child Get Out of His Head and Out of Worry.”

copyright@Edward H. Plimpton, PhD

Movie Worries

30 Dec

Maybe you needed some down time, or maybe the children needed to be occupied so that you could get some other things done, so you allowed them to watch a movie. Let’s say you chose Walt Disney’s Snow White, because it is so well-known and you remember it from your own childhood. The kids watch the movie, you have some time to attend to your business, and everything seems fine. But when bedtime rolls around, there is a problem. The image of the old hag who gives Snow White the poisoned apple is stuck in your child’s head, and it will not go away.

What is going on here? This is just a cartoon, after all, and it was made for children. Nevertheless, it is undeniable that movies can overwhelm some children by presenting them with frightening images from which the motion picture rating system provides only imperfect protection. For some children, the possibility presented in the movie — that people can seem one way but turn out to be another — is a very compelling idea. In addition, movies in which a character actually morphs into something else — movies such as Freaky Friday, Spirited Away, Big, and The Incredible Hulk — can produce intense anxiety. Children are often misled by appearances, and believe exactly what they see, even if it is presented in a cartoon format.

Logic cannot help anxious children reason away their fears. Long ago, the Swiss psychologist Jean Piaget did an experiment in which he presented young children with two glasses filled with equal amounts of water. Preschoolers were easily able to see that the two glasses looked the same. However, when he took one of the glasses and, in front of the children, poured its contents into a shorter but wider glass, the children invariably said that the taller glass had more water and the shorter glass had less. Although they had seen the same amount of water poured into a different shaped glass, they still reasoned on the basis of appearance. In other words, it is easy to fool young children into believing that appearances are real, even if you tell them that something is “imaginary,” or created with special effects. So it is wise to use caution in what you allow your children to see, especially those children who are more than ordinarily anxious.

The potential of movies to leave children with anxious preoccupations, of course, isn’t confined to very young children still in the grip of very magical thinking. Older children, teens and adults can be similarly affected. And with regard to some excessively explicit movies our culture produces, it may be reasonable to ask, “Who wouldn’t be freaked out?” At the same time, there are a group of children whose excessive reactivity to movies that their peers can tolerate and enjoy is a reflection of limitations in their own anxiety management capacity. While just saying “No” to movies that are too much is one perfectly acceptable approach, for some children it may result in them missing out in group activities with their peers. For the latter children, learning to build their “Movie Muscles” may be helpful and also build their capacity to tolerate tension and suspense in other areas of their life. A simple way to build “Movie Muscles” is to start with a movie such as Finding Nemo and with the remote control handy, stop the movie whenever your child is showing any fear or signs of physical tension. Ask your child whether he can notice what is happening in his body and then wait for his body to calm down. Then repeat the scene that was just played until the child is less reactive before proceeding with the rest of the movie. This exercise will help build capacity to tolerate the tension and suspense of movies.

copyright@Edward H. Plimpton, PhD

2013 Books on Parenting Your Anxious Child: A Review

29 Dec

Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD

In 2013 three new books were published on parenting the anxious child: Why Smart Kids Worry: And What Parents Can Do To Help by Allison Edwards, Anxious Kids Anxious Parents by Reid Wilson  and Lynn Lyons, and The Opposite of Worry by Lawrence Cohen. Any book written about how to help anxious children is going to contain some overlapping suggestions and that is true of these books. So in dealing with nonstop reassurance questions from anxious children, Allison Edwards has the “The Five Question Rule,” Lawrence Cohen has “The Fifteen-Second Rule” and Reid Wilson and Lynn Lyons talk about avoiding “the content trap”. And these are similar to my blog essay on reassurance seeking. At the same time, each book presents a slightly different perspective in how they understand anxiety in children and consequently what to do about it.

Allison Edwards’ Why Smart Kids Worry: And What Parents Can Do To Help makes the interesting point that when children have uneven development they may be vulnerable to anxiety. She is focusing on children who have intellectual abilities that are way in advance of their chronological age, such as the 8 year old who can read on a 12th grade level. Their capacity to take information intellectually is not in keeping with their ability to process it emotionally. As she explains, “It’s not that smart kids can’t understand the information, it’s that they can’t handle the emotional pieces that go along with it” (p108). I would suggest that whenever there is uneven development children may be vulnerable to anxiety because of the difficulty of making sense of their experience emotionally and intellectually —and it is not just a problem restricted to smart children. But being attentive to uneven development as source of anxiety is a valuable idea. Some age typical expressions of anxiety such as stranger anxiety in infants may reflect their new found awareness that there is stranger in front of them, but their not having the emotional resources to deal with this awareness. She lists 15 tools or practical suggestions that parents can use to help an anxious child, such as The Five Question Rule for repetitive anxious questions, which “…allows kids to ask only five questions about the same worry within one day” (p168). Perhaps because of the slightly more specialized nature of her book, her emphasis is shaded more towards managing anxious feelings than in articulating more explicitly ways to help face their fears.

Anxious Kids Anxious Parents is coauthored by Reid Wilson, who is one the major figures in articulating the cognitive behavioral perspective in managing anxiety.  Learning how to tolerate uncertainty and face your fears is central in this book. The authors articulate 7 parts or skills needed to solve “the anxiety puzzle,” involving: 1. Learning to expect to worry, 2. Talking to Worry or externalizing it, 3. Being unsure and uncomfortable on purpose, 4. Breathing which helps reset or reboot the system when a child is overwhelmed, 5. Know What You Want or having clear goals which is critical to tolerating the work involved in dealing with anxiety, 6. Bridge Back to Your Success because anxiety makes us forget when we were successful and 7. Take Your Plan into Action. Almost everyone who works with anxious children recommends trying to personify worry or externalize it. This book makes an important point that there are at least three ways that the child can relate or talk to his/her anxiety. 1.  A child can expect, it which would involve saying to the personified worry “I know you’re just trying to help” (p73).  2. A child can take care of it: “yes worry we are going to be nervous and then it will be over”. 3. A child can boss it around as in, “I will get back to you on that one worry”. The book also contains an interesting reading list of books for children that promote the cognitive flexibility  needed to deal with anxiety. A favorite book in their list is The Opposite by Tom MacRae and Elena Odriozola, in which a boy learns to think and do the opposite of what his worry would dictate.  In addition there is a free e-book Playing with Anxiety: Casey’s Guide for Teens and Kids, which serves as a companion volume for their book .

In  The Opposite of Worry: The Playful Parenting Approach to Childhood Anxieties and Fears, Lawrence Cohen recommends incorporating a physical and playful approach in helping the anxious child. As he explains “…like it or not, we have to deal with the physical body because anxiety clouds the thinking brain” (p 93). There has been increasing recognition that our response to danger not only involves the well described fight or flight response but also, when those options are not possible, a freeze or immobility response. The freeze response is a feature of trauma in which it is not possible to engage in either a fight or flight response. And anxious children often look frozen or immobile with an almost “deer in the headlights” presentation.  Cohen emphasizes that an empathic connection with a child is the critical foundation from which the adult can help the anxious child. He then suggests a variety of playful and sensory based interventions  including  the potential of rough house play.  His suggestion for a book is Juggling the Jitters by Deborah Miller, which as the title suggests provides a very physical solution to dealing with worries.  While emphasizing the importance of physical and sensory interventions, Cohen also is quite similar to Wilson and Lyons in stressing the importance of challenging the ever prevalent “What if” thinking found in anxiety and changing it into it with “What is” and learning to tolerate feelings of uncertainty.

Each of these new books on anxiety has something to offer the parent of an anxious child, and there is noticeable overlap despite the different perspectives of the authors. In dealing with children often the most useful advice someone can give is how to say something in a child friendly manner. And I certainly found material I could use in each of these books.

The following are Ytube videos of the authors:

Allison Edwards  http://youtu.be/_bJHJYjlcec

Reid Wilson and Lynn Lyons  http://katiecouric.com/videos/is-anxiety-ruining-your-family/ and   http://katiecouric.com/videos/teens-and-the-anxiety-to-succeed/

Lawrence Cohen  http://youtu.be/423q7PGgIj0

2013 copyright Edward H. Plimpton, PhD

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