We live in a chaotic and often unpredictable world, so it's only natural for you and your child to have anxieties. But seeing your child cry, cling to you, or even use aggression to avoid his or her own fears and worries may cause you to worry even more, trapping both of you in a cycle of anxiety and fear.

You can interrupt this cycle with the proven-effective mindfulness and acceptance skills taught in this book. Drawn from acceptance and commitment therapy, Parenting Your Anxious Child with Mindfulness and Acceptance offers a new way to think about your child's anxiety, as well as a set of techniques used by child psychologists to help children as young as four let go of anxious feelings and focus instead on relationships with friends, learning new things in school, and having fun. You'll learn these techniques, use them when you feel anxious, and teach them to your child. With practice, you both will let go of anxious feelings and your child will find the confidence to enjoy being a kid.

Chapter 1
Clinical Diagnosis and the Form of Childhood Anxiety

If you are reading this book, perhaps you are anticipating, or have been through, a diagnostic assessment with a school counselor, psychologist, family physician, or psychiatrist. In this chapter, I address the world of child mental health diagnosis in order to help you to understand the standard diagnostic process and to appreciate its usefulness as well as its limitations. I’ll spend some time talking about what anxiety is and describe its common features. I will also describe some of the more common subtypes of anxiety that children can experience. Finally, the impact of anxiety on the life a child and his family will be considered.

What Is Anxiety?

Anxiety is a complex reaction to a perceived threat. Many authors make a distinction between anxiety and fear. Fear is the intense reaction we experience in the face of immediate danger. It is natural, automatic, and necessary for our survival.

Consider this scenario: While walking with your child down the sidewalk near your home, a large dog in a neighbor’s yard suddenly hits the fence beside you and starts barking fiercely. Both you and your child startle and withdraw quickly. Your arm may instinctively reach out to enclose your child and pull him away from the danger. You feel the blood pounding in your ears. Your child starts to cry. That is fear. The anxiety comes later.

Parenting Your Anxious Child - Fear in the Moment: Fight, Flight, or Freeze

You may recall the fight-or-flight response from high school biology. This is a cascade of lightening-fast, automatic physiological events preparing us to fight or to flee whatever is threatening us. I add “freeze” in describing this response, since often fear results in a paralysis of mind and body. However, in the coming pages I will simply refer to this phenomenon using the standard term “fight-or-flight response.”

Deep within our brains are collections of neural circuits responsible for monitoring the body and the environment for signs of trouble. When danger is perceived, the alarm is sounded, and what happens next is automatic and almost impossible to stop once it gets going. First, adrenaline is dumped into the bloodstream from the adrenal glands sitting on top of the kidneys. Adrenaline is a multipurpose hormone that causes over twenty immediate biological responses. I’ll list just a few examples:

• Pupils dilate to let in more light and enhance vision.
• Heart rate increases to move oxygen-carrying blood cells quickly through the body.
• Breathing quickens to provide oxygen and expel carbon dioxide.
• Capillaries near the surface of the skin close off to minimize bleeding in case of injury (which is why we become pale when we’re frightened).
• Palms become a bit sweaty, which improves grip.

Unfortunately, these bodily reactions show up suddenly (an alarming event in itself) and tend to be pretty unpleasant. There are, of course, “adrenaline junkies”: people who seem to thrive on arousing their sense of danger through activities such as bungee jumping or auto theft. To a large extent, it’s all in how you think about it, as I will describe later. By and large, at least for young children, this fight-or-flight physiological roller-coaster ride is quite disturbing. But it would be a poor defense mechanism if it didn’t get our attention and make us leery of going through that again. Imagine a pleasant and softly chiming home smoke detector. It would not be helpful in an emergency. As an adult, you can appreciate the need for a robust and even alarming mechanism for calling your attention to danger. But your child just knows he is in acute distress and wants it stopped—now.

Clinical Diagnosis and the Form of Childhood Anxiety - False Alarms and Persistent Alarms

If the fight-or-flight response simply got us activated to escape real dangers in life, the way a smoke detector might rouse you from your sleep when your house in on fire, there would be no problem. Unfortunately, as I will describe below, the mind’s alarm system can naturally be set at extremely sensitive levels or be programmed through experience to respond when there is in fact no danger present: a false alarm.

Similarly there are times when the fight-or-flight system keeps putting out adrenaline and other signals long after the danger has passed. A friend recently told me about a malfunctioning smoke detector in his house. It kept beeping over and over, as if the batteries needed to be replaced. He replaced the batteries and the beeping continued, disturbing his infant son’s nap. Finally, in frustration, my friend pulled the detector from the ceiling, opened a window, and tossed it outside, where it shattered into a dozen pieces on the driveway. Satisfied, he started to close the window but stopped when he heard a faint but clear beep-beep-beep coming from the pile of debris in his driveway. It was as if the poor smoke detector were saying, “You can throw me out the window, but I’m still going to do my job!” In the same way your child’s mind may be saying, “I don’t care about rational arguments, I’m going to keep this child safe at any cost.” Unfortunately, as we will see, the cost of overreacting to or getting stuck in false alarms can be quite high.

The Stomach: Innocent Victim of an Overzealous Mind

One especially important fight-or-flight reaction is the shifting of blood from the digestive system to the large muscle groups. The muscles’ enriched blood supply is supposed to help in the fighting or fleeing that our mind thinks is necessary. Unfortunately, the stomach’s sudden loss of blood supply can create nausea—sometimes low-grade, sometimes acute. Stomachaches of various kinds are a very common complaint in anxious children and can be quite debilitating.

When children tell me about their anxious stomachaches, I give them a description of the fight-or-flight response. I will describe this to a child by saying that his brain is thinking, “We don’t have time to be digesting food. We’re under attack! Send the blood to the muscles!” Then I will ask that child, “How do you think your stomach feels about having its blood taken away and given to the muscles?” All agree that this makes the stomach very unhappy. To their delight, I play the part of a stomach, all upset and contorted and complaining bitterly about the unfairness of it all.

Parenting Your Anxious Child

I tell children that this is why their stomachs feel so unhappy when they’re scared or anxious, like on Monday mornings when they have to go to school. Their overly concerned brain has given away the stomach’s blood to the muscles, and this is why they feel like throwing up. Maybe they do throw up. But it is not because they are sick or in any real danger. In later chapters, I will describe strategies for soothing the fight-or-flight response and, importantly, for moving on from it as quickly as possible without setting off a lot of unhelpful anxious behaviors that only serve to keep your child stuck in his misery.

Anxiety: What Might Happen

Anxiety is closely related to fear, but it tends to be associated less with actual events in the present moment than with the anticipation of danger or discomfort. To return to our scenario, after your encounter with the barking dog, you or your child may begin thinking about that dog at some later time—say, prior to your next walk. You may even experience a degree of the same physical arousal you felt in that frightening moment; your breathing and heart rate quicken, for example. In your mind, you may replay the event. Your thoughts may run to anger or sorrow or annoyance. Your child may cry and state he doesn’t want to go near that yard again or perhaps not even go on another walk. That is anxiety.

Anxiety can be more complex than fear because it involves many reactions—some automatic, and some conscious and purposeful. Among these reactions is a myriad of private or internal experiences, such as thoughts, feelings, memories, and physical sensations. Just thinking about or remembering a frightening event can evoke some echo of the fight-or-flight response in the body, which elicits judgmental thoughts (“It’s happening again—this is bad”), which invites more intense feelings, and on and on. In addition to these privately experienced thoughts and feelings, there are many ways anxiety can be observed by others. There can be intense, agitated, and distressed behaviors such as crying, shaking, clinging, running away, and even anger and aggression. At other times, anxious behaviors may take the form of silence, withdrawal, or inhibition. Anxiety in children is particularly complex because these behaviors so often are attempts at obtaining an adult’s protection. In the case of an immediate threat, your response as a parent will be clear: protect my child. At other times what is being asked of you when your child is anxious may be more ambiguous, both to your child and to you. This can lead to a great deal of confusion and frustration for both of you.

Clinical Diagnosis and the Form of Childhood Anxiety

Finally, anxiety is quite contagious. When your child is anxious, you are more vulnerable to your own fear or worry, or perhaps any number of other distressing emotions, such as frustration or anger or sadness. This complicates an already challenging situation.

So I am suggesting that anxiety becomes a problem when your child’s brain is reacting to the disturbing fight-or-flight response, or milder episodes of fear, with characteristic sets of thinking and “coping” behaviors that are not helpful in the situation. Fearful and anxious thinking, his and yours, tends to be awash in negative evaluations of the initial response and the event that triggered it: “I’m scared,” “Being scared feels really bad,” “That dog scared me,” “Dogs are scary,” “There might be a dog at the park, and I will be scared again if I go.”

As I will describe in the pages to come, anxious behavior is characterized by avoidance or escape (for example, refusing to go to the park), by freezing up (not leaving your side once you are at the park), or by attempts to get help (begging you to take him home). You leave the house with one agenda (“We’re all going to have a nice time at the park”) and suddenly find yourself dealing with a new and unwanted agenda: trying to manage your child’s upset and your own reactions to that—“For goodness’ sake, there isn’t a dog in sight and we’ve been cooped up in the house all day. Buck up! Let’s just enjoy ourselves.”

How Common Is Anxiety in Children?

Fear and anxiety are commonplace in the lives of children. Virtually every child will experience brief episodes of anxiety at times. The intensity and impact of this anxiety can range from mild to quite devastating. However, to actually “have” an anxiety disorder from the viewpoint of mental health professionals, certain diagnostic criteria must be met. I will describe these diagnostic criteria and the assessment process in a moment. Many studies have looked at how common anxiety is in children—its prevalence, as we say. Looking at the research as a whole, we can see that somewhere between 6 and 20 percent of children experience anxiety to such a degree that we can say they have a diagnosable anxiety disorder (Connolly & Bernstein, 2007). The reason for the wide range in prevalence estimates has to do with how each study defines and measures anxiety, the ages of the children studied, and other variables. What is certain, though, is that anxiety is the single most commonly diagnosed mental health condition in children. Further, one in four individuals will experience significant anxiety

Reviews

"McCurry breaks new ground by applying acceptance and commitment therapy to the treatment of anxiety disorders in children. His approach is based on solid principles and offers understandable and practical guidelines to help parents treat this common but often misunderstood condition."
— James T. Grimm, MD, MPH, child psychiatrist in Eugene, OR

"This book is a tremendous contribution to parents who want to help their children with the spectrum of anxieties that can hinder optimal development. McCurry provides a whole range of techniques that parents can use to help their children accept and handle anxious feelings that can cripple them in their daily lives. He is a stellar guide to this new and exciting approach. Without a doubt, this book will be valuable to parents and therapists alike who want to help build children’s social and emotional competence through effective management of anxiety."
— Laura Kastner, Ph.D., clinical associate professor of psychiatry and behavioral sciences at the University of Washington

"For years I’ve looked in vain for books on acceptance-based strategies for anxious children and their parents. McCurry’s book was well worth the wait. His crystal clear writing, sprinkled with humor and touching self-disclosure, makes techniques such as validation and mindfulness immediately understandable and accessible. As a scientist-practitioner, I’m impressed with McCurry’s thoughtful consideration of current developmental research in the formulation of his clinical model and recommendations. The book contains many useful and concrete strategies for helping parents to regulate their own thoughts and feelings in order to help their child stand up to anxiety."
— Matthew L. Speltz, Ph.D., professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and chief of outpatient psychiatry services at Children’s Hospital and Regional Medical Center in Seattle, WA

"This book is an awesome and timely parent resource for those seeking to help their anxious child be positive, strong, and happy in this age of economic and social uncertainty. McCurry’s extensive professional background clearly shines through as he helps parents understand and intervene when their anxious child is in need."
— Steve Curtis, Ph.D., NCSP, child clinical psychologist, nationally certified school psychologist, and author of Understanding Your Child’s Puzzling Behavior