FEAR, BAD DREAMS AND AVOIDANT BEHAVIOR:
THE DEVELOPMENT OF AN ANXIOUS CHILD
By the time you notice one; all three will already be present. Children try first to solve their own problems. They keep trying until the symptom becomes obvious to someone watching. That will be a parent, teacher, babysitter or another adult. Even though many adults observed the child, only one of them may catch a glimpse of the symptom. That adult was in the right place at the right time, not necessarily more attentive.
Anxiety is a physical reaction brought about by an emotional trigger. It begins as a thought. There might be danger. It isn’t like a rock rolling down a hill towards you, making all kinds of noise as it crashes through bushes, picking up speed. That’s a clear danger. There is no question how to react to that. This is a suggestion that there might be a rock, maybe right now, in two minutes or two days, that might appear around the next corner and get you or your parents or your cat. But, maybe not. Just in case, you’d better watch out.
The physical response comes next. If there is danger there are two options, fight or flee. In order to do either, fuel is required, adrenaline. The signal goes out to load up on fuel. You are now ready to roll, engine screaming, wheels spinning when, oops, wait a minute, maybe there isn’t anything there. Maybe it was just a thought.
The adult brain has stored mountains of data which validate reasons to be concerned. Children don’t yet have that data base nor the neurological pathways needed to piece information together. Children just sense and feel. The first feeling is fear.
Children might show fear by being irritable, having a tantrum or crying. They will not be able to put words to why they are reacting. They will not be able to tell you what happened. Usually, these reactions are single events. That’s normal. But some children are acutely sensitive. Those children may develop anxiety.
Anxiety at any age follows the same route. It is the excess of adrenaline and the lingering question about danger that causes physical symptoms. Those include wanting to jump out of your skin, feeling faint, clammy, light headed, tingling in fingers and toes, heart racing or skipping beats, etc. In an adult these symptoms may come as a panic attack. In a child it is more subtle and slower to develop. It may be physical or emotional or both. Some sense first through their bodies. Others first register via a psychological process. Sensitive kids soak up stimuli and develop a reaction. It starts with feeling afraid. In time the fear might become a bad dream.
Parents often notice when the child calls out or comes into the bedroom. Many kids keep it to themselves. Bad dreams reinforce fears that pop up during the day. Even at night, when the child should be relaxed and safe, scary things can intrude and threaten.
Eventually the child may become avoidant, such as the child who refuses to enter the classroom or get on the bus or go on the field trip. Most of those children eventually settle down once coaxed to follow through. But unless there is coaching anxiety will develop and reveal itself in unfortunate ways throughout the person’s life.
Pushing a child to go ahead, while necessary, is similar to learning to cope with a fear of crowds by forcing oneself to sit in the middle of a crowded theater. It can be endured but there is no pleasure from the experience and other similar situations will likely be avoided. One learns to cope, not to overcome.
Strategies boil down to a few key points. First be knowledgeable of the child’s developmental capacity and unique characteristics. Understand that these reactions happen for a good reason. They are rarely at first a manipulation for attention. If bad dreams develop there are ways to help the child become empowered to overcome them. If avoidant behavior is present the child must learn to both push through it but also to understand why symptoms are present so that other, future situations are not similarly avoided.
Smart, sensitive kids develop anxiety because they are smart and sensitive. Help them learn to understand themselves and their own process and you have equipped them with strategies that enable them to manage a world filled with uncertainty.
HOMEWORK FOR PARENTS
By now you have had someone suggest that your child has a problem. It could be Attention Deficit Disorder with or without hyperactivity. It could be a challenging temperament. It could be a learning disability, anxiety or even depression. It could be a lot of things. Most of the time a child’s failure to thrive has a profound influence upon every member of the family.
This is complicated. Focusing on the complexity though, will only confuse matters further. It is important to pick a target and make a plan of action. In time we can rule some things out and other things in. In any case there is only so much you can do. So let’s focus.
First, have you formulated a theory? That is, do you have a working theory about why things are the way they are? That’s important because when you go into a professional’s office you need to have an organized presentation. That means you need to present symptoms which recur often, feelings you have about the situation and ideas about how it all started. That gives the professional a place to start. Otherwise the working diagnosis will begin with an impression only, not with real information. If that happens the time might have been wasted. We’ve all had the experience of entering the doctor’s office with lots to say but when the opportunity arrived we sat mute. The wrong impression was then created and we marched out with needs unmet. The professional can always challenge what you say. That’s way better than leaving it to impressions alone. So, every time you meet with a professional have a theory in mind and back it up with data.
Second, understand that no matter what the eventual diagnosis, there are a finite number of things that absolutely must be part of your child’s life. We are talking basics here. These elements must be present for health to occur. Sleep. Does the child sleep well or is there tossing and turning and waking up or trouble getting to sleep? Is there free, unobstructed breathing or choking, snoring, grinding of teeth? Does the child eat a relatively healthy diet? What about his/her weight? Does he/she have enough energy to do the regular kid stuff or is there a need to nap, rest or sit around too much? Is there a social life? Does your child make and keep friends, go to their homes, have them come over, demonstrate cooperative play? Does your child demonstrate happiness, joy, laugh often, show kindness to others and animals? Is there communication with you and the other parent? I don’t mean management functions. I mean do you really communicate to the point where you know the child, the child knows you and you both value that connection so much that you are careful not to damage it? Is there a philosophy of life in the family? That might be religion but maybe not. For sure it is a clear demarcation of right vs. wrong. Do siblings relate to each other well? Finally, does your child show the ability to exercise some control over his/her own behavior?
Those are a lot to manage but if you consider it you’ll see that when any of those go off track, everything else follows. So, no matter what medication is prescribed, no matter what psychotherapy targets, those elements need to be attended to by you and you need to report it all to the professional with whom you are working. It might be that a few sessions of coaching between you and the professional yields the best results.
If you have read this far you have the point. Often, adherence to these basic things brings about the most change. It’s not that other “treatments” are ineffective. It is that our bodies have remarkable abilities to heal if given the opportunity. Adults can choose to put themselves into more health promoting circumstances. Kids can’t. Parents need to put them there. Combine those basic elements with a targeted treatment and your child and family will advance.
Here’s where you need to start: Write it down. Keep a journal and write in it every day at the same time every day. Then just before you go to the professional summarize it all into one half page. Too much written data in session slows everything down. The session needs to be about exploring, trying on new ideas and getting motivated. It all sounds simpler than it really is. Consider this: If you slept well, ate appropriately, worked off energy, laughed, connected with somebody else and had a plan to do it all again tomorrow how would you rate your day? How would you rate your chances at success, however you define it? Lets’ work together to make that happen for your child.
Good Luck.
AGGRESSIVE KIDS
One of the most difficult and heartbreaking type of child is the aggressive one. It is most often a boy. He vents his rage on those closest, usually his mother and younger siblings. But there might also be social issues at school and as these boys age they have increasing problems with many in authority roles.
When these kids find their way to my office there is likely the suspicion that depression is a component. There have been other diagnosis' suggested too, like Oppositional Defiant Disorder. Many times there has been a significant disruption in the family circumstance, like a divorce or marital problem between the parents. There is often just enough family disruption that the boy gets credit for surviving and it might even be said, "No wonder you are having problems with that going on. I'd probably behave that way too." But it is often more than that and not that simple.
I've watched these boys act out in my office. Most of the time their anger is directed at the mother present but sometimes it has been directed at me. I am always struck by the almost total lack of social awareness. How in the world could this child think he's going to get what he wants by acting like that? By the time it starts it is very difficult, if not impossible, to get him to stop. Just ride it out.
Sometimes it almost looks like a seizure. It seems to build and blows and then the child is filled with sadness and remorse and appears exhausted. Then begins the display of I'm sorries and promises to do better. But he doesn't do better. So how are we to think about this?
It makes sense to approach it from a psychiatric angle in order to at least rule out more serious problems and to determine whether or not medication might be helpful. But for the long run it has more to do with the child learning how to be more self aware and to control himself. He needs to figure out where he is, how he should act there and what strategy might actually get him what he wants. To this point he is totally ineffective and that only adds to his anger.
I believe what is missing is a set of deeply held principles. These are the rules we live by, the things handed down. In modern times there has not been time for families to hand down these lessons so there has been increasing reliance upon the schools or churches to do so. It isn't happening. One of the most startling examples is the disrespect toward mother and younger siblings. This behavior completely disrupts the social order. Boys need to learn to be respectful of all women and the first is mother. Next they need to look for for younger siblings, be a leader, not a bully. These lessons were traditionally taught by fathers. But now fathers are often away, busy or not on the scene at all. These boys haven't learned this important lesson.
So, if a boy also has impulse problems or depression or anxiety, if he has any challenges, when he gets into a tight spot emotionally he needs a program he can call up that gets him through. It's like your arm coming up to catch the ball as it streaks toward your head. Automatic response built in by repetitive exposure and practice. But if the program isn't there what results is chaotoc, undirected, primitive, aggressive behavior. It's never too late to start teaching.
It is more complicated when the adult being disrespected doesn't really merit much respect. But this is never the call of the child. The child must learn self control. Self control allows the child to stay in the system. When the child acts out the misbehaving adult is either off the hook, due to the child's distraction, or the adult takes it out on the child and hurts him, abandons him, has him removed and blamed, etc. The child has only the control that self control affords him. Nurturing adults, other adults, can help him sort out where he should invest love and trust. Showing respect is a social skill, an all important one.
ANXIETY AND AGGRESSION
It is important to understand the relationship between anxiety and aggression. Both processes rely upon adrenaline for fuel. Both begin with the brain signal saying that danger exists. Anxiety happens when there is no place to direct the resulting energy. Aggression happens when there is a real or perceived danger or when the child has learned that acting aggressively feels better than anxiety. The begining of the road rager is the anxious boy who learned to get rid of the anxiety by turning it into aggression.
Kids like this often have at least one parent like this. Take a look at the adult driving behavior. Some people carry their anxiety about whatever is happening in life to their cars. In the car they feel a sense of power and then drive that way. Too fast, too aggressive and if anyone gets in the way they react. But then what?
Eventually they get to where they are going. Then they have to get out of the car and maybe go work in a cubicle or make dinner for the kids. Either way the adrenaline load remains and the anxiety creeps back. That results in one irritable person. The kick the dog when coming in the door syndrome.
Boys learn that they can get rid of their anxiety by clowning or anger or conflict. It is all aggressive behavior. But it doesn't address the underlying anxiety and the end result is often to make relationships more challenged. If your child is anxious help him learn to manage the anxiety before he picks up something else that might amplify it. Help him understand how his own system works and that others in the family have the same challenge. Work on it together. Sooner or later he'll get behind the wheel of a car.
THE FAMILY BOND
A lot of really smart people have spent a great deal of time studying the bond that is created between parent and child. All kinds of theories have been put out there from the notion that there is a biological connection based on scent to the notion that there is a psychic energy that flows between parent and child. In any case the idea is that there is an unbreakable connection. That’s the explanation for the situation when a child who was abandoned or abused by a parent still longs to be close to that parent. An outgrowth of all the theories is the manner in which courts deal with divorce and custody issues. The courts strongly encourage parent/child reconciliation even when the parent has acted very badly towards the child. The court strongly discourages either parent speaking ill of the other parent to the child even if one of those parents has terribly mistreated the child. There is an implicit respect for the perception of the parent/child bond.
Consider an alternative theory. Maybe it’s about familiarity and failure to develop self awareness. We learn first by absorbing information and then later by both absorbing and also by comparing new information to stored information. In time almost everything learned is a comparing process. That which is familiar is most comfortable. Familiar new input readily takes a place within out brains. It just fits and we know what to do with it. Unfamiliar input requires a bit of work, searching for a way to make it fit.
Jump ahead now to self awareness. Self awareness is the ability to understand yourself. This is not self centeredness. That’s only one half of self awareness. Self awareness takes into account both what you see in yourself as well as the perceptions of others. A complete picture is the view within, the one you perceive, coupled with the view from the outside, what others see. Allowing it all to fit together creates a rich portrait.
An individual who lacks self awareness is most comfortable with the familiar. Uncomfortable feedback from others might be quickly discarded. Only the comfortable familiar finds a quick fit. But life isn’t like that. We all stumble around, make mistakes, often do things that turn out way different than we intended. Ignoring those realities sets us up to make more mistakes.
We all crave a sense of belonging. That makes sense especially when you consider that we start out completely helpless. In that helpless state we look to the person closest to us to provide safety, nurturance, love, security. From our small frame of reference we can’t even imagine getting those needs met by anyone other than the parent in the room.
If that parent doesn’t offer what is needed and if the child never has the opportunity to become self aware then that child grows into a person most comfortable with the familiar and unwilling to venture into uncharted territory. Is this really so much different than the person who stays in a relationship with an abusive person or the individual with a long string of relationships with others having the same problems? In none of those cases would we say there is this mysterious bond. In every one of those there seems to be a lack of balanced self awareness and a great reluctance to venture into the unfamiliar.
Give some thought to that. Look around at how others behave. Consider your patterns. Think about family bonds. Anything familiar?
ADHD and Anxiety
It's the adrenaline thing. Stimulant is needed to speed up brain functioning. Kids with ADHD learn early on how to stimulate their brains themselves, by getting an adrenaline burst. They might do it by being a class clown, by creating conflict, by engaging in risky behavior or by getting overly focused on a single pleasure giving activity. When that happens their brains are focused and they feel better, in control, like someone able to manage life. But, some also come with the wiring for anxiety. That means that burst of adrenaline might also stimulate an extra beat of the heart or cause the stomach to tighten, the hands to grow cold, the breathing to get fast and shallow. There is a tipping point between feeling in control and falling into anxiety. It is really hard to manage.
Now mix in the complexity of the environment and we might have an individual with a really challenging life. We might also have an individual prone to experiment with ways to control those feelings. Drugs and alcohol come to mind. So we may have all the things associated with ADHD, then the things associated with chemical abuse and with those two really obvious targets miss completely the underlying predisposition for anxiety. And anxiety is the engine that drives the whole thing.
ANGRY ANXIOUS BOYS:
Angry boys often start out as anxious boys. Some individuals view the world as an exciting, interesting place. Others view it as frightening, sometimes overwhelming. If the world is infinitely interesting one discovers ways to embrace complexity and to enjoy the constant exposure to opportunity. Those who encounter fear may see the world as a set of situations that need to be controlled but which resist control. They tremble on the edge of chaos.
We can imagine that whichever one becomes is likely contingent upon from where and with whom one developed, mixed with an inherited program. Small children who later become anxious children are those who observe the world around them but take it all in by using all of their senses. They literally feel the world around them and if that world is too loud, too dangerous, too threatening they react to protect. But they are too little to do very much so they endure. Others observe but do so with more selective sensation and therefore become able to erect boundaries around experiences.
Anxious kids experience sensation mixing to the point of overload. They seek ways to control input as they evolve brain capacity. In part this is how temperament develops. Kids who sense too much discover that they cannot control the input but they can at least try to control those around them. That is, they can’t stop their body from sensing the tags on their underwear but they can scream at mom for choosing that particular pair of underwear. Some of those kids seek comfort as a way of quieting sensation. Others, the angry anxious ones, discover that becoming aggressive immediately affords them a way to focus energy in a way that creates the illusion of control. These characteristics develop for all kinds of reasons but we probably need to assume that there is some heredity involved. That’s called a predisposition.
Some of us just come with a greater potential to develop certain traits given exposure to certain circumstances. Mix in any variety of circumstances at pivotal points in development and the result might be a complicated, temperamental, angry, anxious child. A lot of these are boys. At least in times past the girls were better about seeking out nurturance, or maybe it was that parents were better about offering nurturance to the girls. The problem is that the boy does something to get noticed and that something isn’t usually associated with his being anxious. That might be why kids like that so often shout about how unfair the adult or the world is to them. They are focused on the first thing they experienced as a threat to their well being. They are not focused on what they did in response. We are though. So, any remedy for these kids needs to start with at least a good evaluation of who that child is and how he encounters the world. If he is an anxious boy who manages his anxiety by becoming angry then the treatment needs to focus on the anxiety. Anything else is impractical. Wait long enough and he’ll be an angry man, not a boy. Then we no longer have the luxury of trying to reshape his behavior in such an empathic manner.
WHY SO MUCH?
Is there more anxiety and depression now? Is there more asthma and strep? Are there more instances of all kinds of unusual medical problems or out of proportion behavioral reactions? Probably yes. There is no good way to track increases for many of these issues because there was no such record keeping fifty years ago.
When viewed as individuals we each experience much more complexity in our lives today than did those who were our age fifty years ago. Think about sound and the pace of life and chemical pollution and exposure to toxins, the things we eat, the radio waves that are invisible and inaudible, the fumes from new carpet and on and on. Most of these influences did not exist fifty years ago. Certainly many are benign. Certainly also, some are not.
Factor in how organisms evolve and adapt. It requires many generations for a species to adapt to a significant, long lasting environmental change. Many of the environmental changes we experience today are not even all that long lasting. Asbestos is a terrible example but a relatively short lived one. The point is that we are exposed to all kinds of things that likely result in some kind of response within each of us. And each of us have in some way a unique manner of responding.
It could be that what we generally call a stress response is really our bodies reacting to all the new stimuli we find ourselves immersed within. Often times our symptoms are behavioral and therefore a behavioral remedy is in order. But the reason we need to find a behavioral adaptation is not a moral failing on our part. Having a hard time dealing with everything there is to manage is not a sign of weakness. It may be a sign of too much input.
So when your child acts out instead of treating him/her as a naughty child stop and consider the possibility that he/she might be an overwhelmed child. The source of the stress might be something completely beyond the child’s ability to understand or manage. It might be beyond yours as well. Then consider that you are swimming in the same pool and that your exposure has been much longer.
YOUR BELIEFS
If you secretly believe it is better for your son to pop the bully on the playground then he eventually will understand that even when you say it’s not all right you really think it is. Then he will. And he will suffer consequences and you will be unable to defend him by saying, “It’s not really his fault. It's mine. I sort of encouraged him to do it”.
Talk about a slippery slope. That’s why it is important to know what you believe and to communicate clearly to your son. He can learn to be strong by taking no guff, fighting back and accepting the consequences or by avoiding conflict and seeking alternative means of dispute resolution. He can be fine either way. He just needs to know what you want him to do.
Therein lies the challenge. He needs to know your beliefs. Believe in going to church but not attend? Say it’s wrong to steal but keep the excess change mistakenly given to you by the cashier? Pronounce that it’s important to respect the law and drive fifteen miles an hour over the speed limit? Tell him don’t drink and drive than go out and drink and drive? Each discrepancy creates confusion in him.
Questions???????
Do you want to confuse your son? Do you think you are consistent? Have you examined your beliefs vs. what you actually teach. Do you know it your son is confused?
SOCIAL INTELLIGENCE
Social intelligence is the ability to read and understand a social situation. That includes being aware of your impact on another. Like, is the other person listening or tuned out? Or, is the other person getting angry with you and preparing a rebuttal? Those are all good things to know and understand. The skill necessary is learned over a lifetime. Unfortunately the teaching of social intelligence is very much neglected today.
Busy, tired parents often abdicate this teaching to the daycare and then to the school. They reason that since the child is in the social environment it is there that offers the best opportunity to teach. They assume that someone in that environment will do the teaching. But that rarely occurs. Those adults in the environment have their hands full. The teaching is best done in retrospect, at the end of the day when there is a remove from the stress and an opportunity to reflect. But that’s just the time when everyone is too tired to take on another task.
What often then happens is that kids stumble in social exchange. Some become too withdrawn while others get bossy and controlling. Enough negative reaction finally tips the child off that something isn’t right and the child’s self esteem takes a hit. When the child gets home and no discussion of the day is had the self esteem issue gets buried, only to be resurrected the next time a similar problem is encountered. Often the child retreats into video games, fantasy play or other solitary activities where imagination feels better than awkward, uncomfortable social interplay. That’s how you get a socially inept young person hooked on video/computer gaming.
SUICIDAL TEENAGERS
Few situations are more frightening for a parent than to have a suicidal teenager. Fortunately, in most cases, the suicidal feelings are just that, feelings. There is no action. But in a few cases the young person carries out an attempt. In more cases the young person engages in some other form of self harm, like cutting, burning, purging, etc. There is no way to tell if the feeling will progress to action.
In my experience the young people most likely to act live in families where parents are least likely to understand the seriousness of the threat. That is not to say that these are bad parents. Most times they are good parents. But there is a family communication style which puts the young person at greater risk.
In these families the young person is less likely to discuss how he/she is feeling at an early stage. He/she is adept at covering up feelings and parents are often not tuned into signs of trouble until the signs are past obvious. These are families where nobody shares very much, at least not until they can no longer contain the pressure. Often times also one or both of the parents has had experience with depression. For any number of reasons their actions seem opposite from what one would expect. Their actions seem more to avoid knowing.
The danger with young people is their tendency to act on impulse. It is not difficult for them to convince themselves that no other option exists. For this reason it is important for parents to intrude, to do anything to interrupt the thought process, even to make the young person angry. Better to have a mad kid than one who acts on impulse. That means to sit with them until convinced they are OK. It means to barge into their room and to read the diary they have left out. These tactics can’t fly at other times but in this circumstance the parent doesn’t know whether the threat is real or just a feeling. The parent needs to err on the side of caution.
And while intruding make sure the young person gets the message that all the pressure and attention is about how much that young person is loved. Protection is the only item on the agenda.
