Archive | Age related issues RSS feed for this section

The Anxious 5 Year Old

13 May

 

Children in preschool and kindergarten are big believers in Santa Claus, the Tooth Fairy and the Easter Bunny. These beliefs are part of what gives this age group its charm and delight. But it requires some modifications in approach when it comes to helping them with anxiety–whether it is separating for school, a scary book, going to sleep or a doctor’s visit. Most books on helping anxious children are focused on elementary school-age children and universally advocate personifying anxiety with names such as the Worry Monster or a suitable name of the child’s invention. However, with kindergarten or preschool children, personifying the problem may backfire because they don’t have the necessary ability to separate themselves from their thoughts and realize that the “Worry Monster” is a convenient therapeutic strategy rather than a new thing to fret about. Children of this age are very concrete in the way they think and can’t categorize their thoughts at this point in their development.

The different ways in which young children view the world can be illustrated by a famous experiment done by the Swiss psychologist Jean Piaget. He presented children with two identical glasses of water and asked if them if the glasses contained the same amount of water or were different. If they agreed that the glasses were the same, then one glass was poured into a thinner but taller glass and the question was repeated. Very often at this age, the child will say that the glasses are different, and the taller one has more water. This is what consistently happens when I do this with the five-year-olds in my practice. They are not able to understand that a change in height is compensated by a change in width. This difficulty in integrating information has relevance for helping your anxious child.

For starters, it suggests focusing more on the immediacy of their experience, their big feelings, with a more descriptive approach. My daughter, Lesley Younis, a kindergarten teacher, gave me the following suggestions. “Rather than talk about anxiety, I would talk about those emergency feelings a child gets in his body. And I would make a simple distinction about anxious feelings between scared-scared and fun-scared. So reading a story about Hansel and Gretel might be fun-scared for most kindergarten children, but for several it would be scared-scared”. The vocabulary to talk about emotions is concrete and tied to the immediacy of their experience.

In this age group, pretend play is the primary way children make sense of their feelings. In pretend play in which, for instance, stuffed animals and toys can become a reflection or a stand- in for the child there are the possibilities for many playful interventions. A stuffed animal might be worried about going to school and then the child can help the bear go to school. For the child who won’t put on a coat to leave the house, a parent can have the coat talk to the child and explain how it wants to go on walks with her. The anxious feelings are more displaced onto another person or object rather than becoming a personified being. The displacement of feeling is more general and less specific than when older children begin talking about the worry monster, and is more useful for this younger age group.

copyright@edward h plimpton

Picture Books Part 2-The Foundation of Bravery

15 Apr

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

 

Picture Books Part 2-The Foundation of Bravery

 

Sitting on the living room couch, a parent reads a picture book to his or her young child. A small body cradled and attentive to the unfolding story-one of life’s pleasurable moments. Quietly and without fanfare, an important conversation is transpiring about how to grow up and be safe. And the following books charmingly begin this conversation: The Runaway Bunny, by Margaret Wise Brown, and Pouch, by David Ezra Stein. Children will outgrow these books, but the question gets repeated at each stage of life in more complex and subtle ways. 

 

For children to actively engage the world, they must be able to affirmatively answer the question of whether they will be safe and their needs will be met. Without an affirmative response, children will be more oriented toward protecting their bottom line of simple survival. In other words, to tolerate the experience of anxiety, there needs to be some foundation of security or safety and at a young age this especially involves a sense of connection with a parent or caregiver. In The Runaway Bunny, the little bunny is asking this question to its mother in a series of challenges. 

 

Once there was a little bunny who wanted to run away.

So he said to his mother, “I am running away.”

“If you run away,” said his mother, “I will run after you.

For you are my little bunny.”

 

The little bunny suggests a variety of ways he may run away and to each possibility the mother creatively answers how she will be there to catch him. Eventually the little bunny is reassured and can settle down and eat a carrot. 

 

In Pouch, the baby kangaroo is more confident of his mother and   goes off exploring the world.  When the tension becomes too much, it runs back to its mother with the cry of “Pouch,” mirroring the behavior of many  young children.

With its mother as a constant source of security, the baby kangaroo gains more confidence to explore the world. 

 

And how does this relate to your anxious child who has perhaps outgrown these books? Successfully overcoming anxiety involves incremental steps and building the internal resources to tolerate the tension that may go along with this process. And it starts with the foundation of safety that starts without fanfare on the living room couch. 

copyright@edward plimpton

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

The Middle School Child

14 Jul

The Middle School Child

 

You are just trying to help and you get comments such as “you’re retarded”, “no, not all the time” or “I don’t’ want to talk about it”. Is there a new way in which you are feeling ineffectual as a parent? Perhaps you have a tween or middle school child. In order to help your middle schooler with an anxiety problem, we must first acknowledge that he or she is at a very particular stage of life that is characterized by the physical transformation of puberty and an increased awareness of himself and the world around him. And of course there is a great deal of variability in how children respond to these changes. But, accommodating these changes throws his emotional equilibrium out of balance for a while. Julie Ross has described this age in her book How to Hug a Porcupine: Negotiating the Prickly Points of the Tween Years, as follows:

 

The essence of our children remains, but they are drawn inward for a period in order to develop properly. Similar to the caterpillar who spins a chrysalis to

protect itself while it changes into a butterfly, our children ‘protect’ themselves with anger, sensitivity, tears, defiance and disorganization. These behaviors are the human chrysalis, the outer shell that protects the delicate, unformed butterfly while it is most vulnerable (P. 5).

This a time in the life of your child where the words “tolerance” “patience” and “forbearance” will be needed in your vocabulary but will be perhaps hibernating in your child’s. Your best efforts to help and engage in a discussion may be met with a very off-putting “Leave me alone!” or “Nothing will help” And this reflects not so much disrespect, but rather the fragile nature of her psyche at this phase of growing up.

 

 While something different is happening to their bodies which cannot be denied, there a counter pressure to not feel that they different in thoughts and feelings from their peers. As a rule, they don’t like anything that makes them feel singled out and imagining that they get anxious in ways that their peers don’t get the alarm bells ringing. This problem is made more acute because the definition of what is normal shrinks during this time period to what they imagine is typical for their peers. But the operative phrase here is “imagine,” since they often do not have any solid evidence of what their peers may be thinking or feeling. This is an age when having a fear or anxious preoccupation can be terrifyingly embarrassing because it potentially signifies that they are different.

 

This is also the age where the development of social phobia is frequently reported to begin. As a parent, you will naturally feel some urgency to help, but any help must begin with the understanding that your child is on the doorstep of adolescence, and that this is even more important than the anxiety. The latter will be easier to address if the common pitfalls of communicating with this age group are minimized —and as Julie Ross points out in her book, there are many ways to miscommunicate with tweens. So maintaining, and even reinventing, your relationship with your middle school child is the necessary first step before other issues can be addressed.

 

 

Halloween

14 Jul

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

Halloween

 

Halloween is a bonus opportunity to acquire a treasure trove of candy, and have fun dressing up, but it is also a holiday about fear. At its best, Halloween offers a playful opportunity to encounter  imaginary fears —  ghosts, zombies and the like. By dressing up, a child can assume another persona such as a powerful superhero, or momentarily go over to the dark side by becoming Darth Vader or a zombie-ghost. In this way, the holiday retains some of its relationship to its Celtic origins, where it was believed that in this seasonal transition between fall and winter, ghosts and other roaming spirits would be out and about. By putting on masks and costumes, you could fool the spirits into thinking you were one of them, and thus, they would leave you alone. It is even possible that your mask might frighten the spirits away. And besides, dressing up is just fun by itself.   

But for this holiday to be fun and not a “Nightmare on Elm Street,” a parent needs to know whether a child can make the distinction between what is pretend and what is real. Otherwise, the child may not be able to understand that changes in appearance do not alter a person’s underlying identity. Preschool children are the most vulnerable in this regard. They are often confused by transformations in appearances, and it makes them uneasy and sometimes quite frightened. When a parent dresses in a costume or puts on a mask, the preschool child may be anxiously uncertain as to whether mommy has actually changed into a witch. This difficulty in dealing with transformations and alterations in appearances also explains why preschoolers and even some older children can be frightened by movies such as Spirited Away , an animated  film in which the parents get turned into pigs.   

The exaggeration or distortions in appearance that are part of many masks can create frightening sticky images for the child. The exaggerated smiles and eyes of clowns are often a source of distress and discomfort for children rather than a source of amusement. The vivid exaggeration of appearance, just like a frightening scene in a movie, can get stuck in the imagination and be hard to dislodge, especially at nighttime.

So for Halloween to be fun and not traumatizing, adults need to be thoughtful about how easy it is for  children to tolerate changes in appearances or to erase sticky images from their minds. As an age group, preschool children are most challenged by these issues, but school-age children are also vulnerable. Parents may need to restrain themselves in the costumes they put on and think twice about greeting trick-or-treaters with scary costumes. Remember, too, that children can be reluctant to verbalize their fears because they don’t want to be considered “ scaredy-cats,” so be alert for nonverbal signs of anxiety, and remember things that may have scared your child in the past. Rather than tell your children not to be afraid, use the occasion to help them articulate what they are afraid of. An anxious child may seem eager to go into the haunted house, only to have nightmares that night. With the knowledge that the child tends to get anxious, the parent may need to exert some authority and say no to the haunted house. The goal is to have Halloween be exciting and fun, not frightening. It helps to remember that the children themselves are not always the best judges of what they are up for.  

Sensory-Intergration

14 Jul

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

Sensory-Integration

Any parent who has more than one child knows,  every child is different from the moment they are born. Sometimes the difference is easy to understand such as when you have one boy and one girl, but that is only the tip of the iceberg.  Did your biceps get buffed when your child was an infant because the only way to calm her was to swing her in a bassinet? Did you find a new use for your washing machine as a way of calming your baby? (Placing the baby on top, not in the washing machine to be perfectly clear). Or did you find yourself driving around endless in your neighborhood so your child could fall asleep? Or perhaps you had one child who just melted into your body when you held him and another who seemed to arch away or squirm when held. What gives?

 These are examples of differences in temperament or variations in how the child experiences the sensory world.  There can be tremendous range in how we experience touch, so that some people hate to be tickled or others find it moderately enjoyable. Some people enjoy the sensation of being on a roller coaster and other experience as one step away from waterboarding.  These differences in how we experience the tactile stimulation of being held or the vestibular sensation of being on a roller coaster reflect variations in how we process or integrate sensory information.  Anxious children can often suffer from problems in sensory-integration, in which they cannot handle and process the incoming stimulation. A child who clings to you when you take her to a birthday party may be overwhelmed by the noise of the party because their ears are super sensitive.  It is not so much a problem being shy as it is of being overwhelmed by the sights, sounds and even the smells of the birthday party.

 What appears to be anxiety in trying something new might be more specifically describes as a problem in sensory-integration. It is all too much. And in such situations you might find child unable to articulate any  reason why they won’t join the birthday party other than she just doesn’t feel right. In contrast,  a child who is anxious in the more traditional sense of the term may be able to articulate some reason why they don’t want to join the party, such as   “I only know the birthday girl”. Admittedly, the distinction may not always be clear cut.  But there are a range of Sensory-Integration interventions, a subspecialty of occupational therapy, that may help your child modulate his sensory experience and consequently be less anxious and overwhelmed. This may involve providing your child with certain sensory experiences which can correct or compensate for her difficulty in processing the information that their senses provide them. If this sounds like your child, a consultation with a Sensory-Integration therapist may be helpful