What is the matter with my child? The answer to this distressing question typically involves giving it a name, or a label, such as “Sam is anxious, or Cindy has OCD”. Labels are effective when they suggest a course of action, such as when you learn your child has strep throat, which then leads to a course of antibiotics. It can provide some relief in removing a mystery so that you can say, “Oh, that is what is going on”. In addition, there is some evidence from neuroscience that just labeling feeling a can help the amygdala, the brain’s alarm bell, calm down. But parents instinctively worry about the potential of any label to negatively affect how their child is viewed. Labels can sometimes be used pejoratively without suggesting a course of action.
For starters, remember that childhood is a process of continual change in all areas. Children are moving targets. As a result, when it comes to matters of anxiety, it might be more accurate to think in dimensional rather than categorical terms. Simply put, we might say that a child has “flavors” of OCD, or any other condition, rather than saying anything is fixed in stone. They are emerging individuals, not fully formed, and a lot can happen over the course of their childhood. Their immature status can work to their advantage in that they can be very responsive to any type of corrective help or input. At the same time, their immaturity makes them so vulnerable. The interplay between children’s vulnerability and their capacity to be responsive to help is part of what makes predicting outcomes with children such a humbling enterprise.
Children also have feelings about any labels that are applied to them. For some it is a relief to have a name for what they are struggling with. In the absence of any explanation, they can feel like they are going crazy or that there is something terribly wrong with them. For other children, who are feeling less sturdy, a label can just add insult to injury with regard to how bad they already feel about themselves. Puberty heightens concerns about normality, so a label, whether it is about sexuality or anxiety, can be a life line for one child but for others it just confirms their worst fears about themselves.
The usefulness of a label for children depends upon how well it matches their developmental level and how easily they can relate to it. A preschool child will relate better to a question about whether a book gave them “emergency feelings,” rather than whether it made them “anxious”. They are more likely to have had some experience with “emergencies” rather than anxiety. At a slightly older age, around 8 or so, personifying anxiety, which is another way of labeling it, can be an extremely useful tool. Personifying anxiety can point to a course of action, e.g. the “Worry Monster” is a bully and we are going to boss him back. A course of action is implied by the term. It also helps them tolerate working on this problem by separating themselves from the anxious thoughts. Older children are variable in whether they prefer an adult term such as “OCD,” or whether they can amuse themselves by coming up with a snarky nickname.
A label is only helpful if it opens the door to a plan of action or clearly articulates what is going on. Vaguely describing the problem of your child as anxiety isn’t enough. Anxiety has diverse manifestations which need to be spelled out if your child is going to get help.
Your anxious child 