'One of the first things I ask my patients about is friendships—it's a huge red flag if the kid says, "Mom is my best friend"


September 1 2008

'One of the first things I ask my patients about is friendships—it's a huge red flag if the kid says, "Mom is my best friend"


September 1 2008

'One of the first things I ask my patients about is friendships—it's a huge red flag if the kid says, "Mom is my best friend"



Q What’s the difference between first-day-of-school jitters and having a clinical problem with anxiety?

A: We want all kids to have a bit of first-day jitters, because that tells us they understand school is important, and a little anxiety actually enhances your performance, helps you pay attention. But some children and adolescents become so overwhelmed—tummy aches, headaches, feeling hot—that they can’t go into the classroom or, if they get there, they’re very frightened.

Q: How many kids are that anxious?

A: We conservatively estimate six to 10 per cent each year, but anxiety is a silent epidemic. We do know it’s the leading cause of distress among all people, no matter the age. Initial symptoms appear anywhere between 10 and 12 for all anxiety disorders, but many children will have a first bump of anxiety that’s difficult to manage in kindergarten or Grade 1.

Q: What does a school morning with an anxious six-year-old look like?

A: As soon as the child is awake, she asks, “Is today a school day?” And when Mom says yes, she’ll almost immediately get teary. She may be very resistant to eating and getting dressed, and if you can get her to school, she will have a difficult time going in—it’s almost like a dog pulling her master, you can see these parents physically pulling their kids into the school.

Q: When should this stop?

A: We’ve got lots of moms who say, “I’ll make you a deal, I’ll stay at the back of the room until you feel comfortable”—and they’re still there, two months later. If this behaviour persists after two or three weeks, I’d start doing some reading. If the kid is far more anxious than his peers, it doesn’t dissipate, and it interferes significantly with school performance, friendship development and/or home life, that’s a concern. And as kids get older, they may simply refuse to go to school.

Q: How many flat out won’t go because of anxiety?

A: Between three and five per cent of the general population. As you might imagine, usually their parents get quite angry. Sometimes the kid had a great year the previous year, but suddenly refuses to go, and the parents are thinking, “What is this?” Aside from anything else, they have to go to work.

Q: If the kid is too big to drag into the classroom, what do you do?

A: Anxiety is successfully treatable without medication. Cognitive behavioural training is the first line of defence, and there are skills we can teach kids. At first it’s tough, but pretty soon they learn the skills and start to use them more and more. Usually their thinking is catastrophic: “No one likes me, I’m going to fail the test, the teacher hates me.” You want to get them to think of alternate explanations: why else could the teacher be in a bad mood? She could have gas. She

could be thinking about the fight she had with the principal. This is called cognitive restructuring, which is just a highfalutin way of saying that you challenge a kid who’s thinking negatively to shift to a more positive, adaptive thought pattern. It’s difficult, but you can do it.

And gradually but repeatedly you expose the child to whatever he’s frightened of. You slowly get him back to school for short periods of time, then longer and longer periods. It doesn’t go down well with a lot of parents, but essentially the kid has to be rewarded for attending school even for one hour.

Q: What causes anxiety?

A: It’s a mix. We do know it has a tendency to run in families. Some kids are just born more alert, more sensitive to changes in their environment, and how the environment responds will make all the difference. Whether you go on to become confident and brave, or learn to see the world as a scary place, is influenced by the way you’re parented, how teachers react to you, how the neighbourhood responds.

Q: Is there something about the way we’re parenting today that makes kids more anxious?

A: There may be, but we don’t have good data. We do know, however, that not just highly critical parents but also overprotective parents contribute to kids having more anxiety. Let’s say there’s an anxious child who’s reluctant to go to school, and the kid gets to the schoolyard and says, “Mom, those

kids are all laughing. What if they’re laughing at me?” And the mom says, “I know what, let’s go in the back door, so we don’t have to walk through the yard.” She’s thinking, “Let’s avoid the kids and start off on a good foot.” But what starts as a noble, protective response very quickly becomes a huge part of the problem. It doesn’t help the kid problem-solve, or think about things in another way, like, “They’re probably laughing because they’re having a good time.” Instead, the child may feel the parent has confirmed that people are in fact laughing at him. Many, many parents help their children avoid activities that make them anxious. The kid may say, “I don’t want to go on the field trip because I don’t like to ride the bus—what if someone gets sick on the bus? What if I throw up?” And the parent responds, “I’ll take the day off work and drive you to the field trip.”

Q: They’re enablers, you mean?

A: Well, these are terrific parents, actually, very conscientious. It’s worth it to them to take the day off so the kid can have this wonderful field trip. But what you want are parents who encourage you to take risks every single day. School is a very safe venue for social and academic risks like making new friends, or trying out for a team, or reading a new kind of book. We provide really rich opportunities for our kids in North America and they’re meant to help children develop, but many parents see their child is distressed and rather than dealing with it, say, “Okay, you don’t have to take that class. We’ll find an online course.” Similarly, often because of anxiety, the kid says he has a stomach ache and the parent thinks, “Wow, he’s really sick,” and lets the kid stay home.

Q -. When the kid is actually faking it.

A Oh no, the stomach ache is real. When your body starts to figure out something is frightening, it distributes acids in your stomach to try to help digestion move along. I can’t tell you how many kids get referred to my clinical practice with a persistent stomach ache that starts near the end of August. This is the body’s way of saying, “I’ve got something worrisome going on.” If your child keeps talking about a tummy ache, you need to pay attention instead of dismissing it or treating it as something more invasive. Some parents go far out in terms of exploring what could be wrong, they get their kids evaluated for digestive problems with scoping mechanisms and ultrasounds and so on.

Q: What does the anxious kid look like in the classroom?

A: Generally speaking, they’re terrific kids.

They don’t want to be in the limelight and they don’t want to irritate the teacher, so they’re very shy, typically. They want to please, so even early on they’ll show traits of perfectionism, going out of their way to do really neat printing or colour in the lines. They are at least of average intelligence and very often higher. Anxiety means they’re paying attention, so they take in everything, and therefore tend to become quite good students.

Q: Do teachers even notice something’s wrong?

A: Often, yes. But if you’ve got 32 kids in your class, and one kid is beating on another one, and there’s a kid who can barely read and someone else who can barely speak English, you might recognize that a child is suffering, but he’s very quiet, so that will be the last kid who gets any attention. That’s the good kid.

Q: If anxious kids are academic achievers, isn’t that a disincentive for treatment?

A: If these kids are not treated, half will go on to develop depression. Their negative thinking pattern becomes, “I’m never going to be okay, I’m never going to have friends, I may as well not try.” There’s a set of data showing that if anxiety is untreated, girls have a tendency to drop out at the highschool level, boys have a tendency to drop out at the college or university level, and both have a tendency to go on to be underemployed and to have unsatisfactory intimate relationships. And childhood anxiety is the leading predictor for overuse of tobacco and alcohol.

Q: Are teens more or less anxious than younger kids?

A: Well, there’s another spike in symptoms at the entry to puberty, probably due to hormonal changes. Kids this age have learned to make excuses for themselves to save face. For instance, they can’t fall asleep anywhere but at home, so they’ll say they’re not allowed to go to the slumber party. In the classroom, they still have a tendency to do very well, but they start slowly withdrawing from social activities. Whereas once they were nuts about soccer, now they won’t try out for the team. They’re thinking, “Well, what if I do make the team and I’m playing wing and I miss the goal and we lose the season?” They’re wildly imaginative and they’re just waiting for something catastrophic, so by the end of the day they’re exhausted. Kids often have meltdowns when they get home, feeling they’ve held it together to avoid embarrassment in front of their friends and teachers, and just can’t cope anymore. Also, they’re so overwhelmed with all the homework they have to do that they procrastinate, so homework becomes a huge family

drama: the parents want to go to bed but the kid may just be starting and is concerned about getting 100 per cent.

Q: What do other kids think of them?

A: One of the first things I ask [my patients] about is friendships, and it’s a huge red flag if the kid says, “My mom is my best friend.” Very often, she really is, because the kid now doesn’t want to go to Joe’s house because he has a dog and dogs are unpredictable, and doesn’t want to go to Sarah’s because who knows what she’ll want to do, and besides, there’s homework and you’ve got to get an A. So they’re deprived of normal social interactions, and soon, it’s not that kids actively reject them, it’s just, they forget about them. You’ll see these kids eating lunch by themselves, deking into the library to go on the

'You want to get them to think of alternate explanations: why else could the teacher be in a bad mood?1

computer during a break—the computer is more manageable, there’s nothing unpredictable about it—or hiding out in the restroom. It’s heartbreaking, really.

Q: Is there a connection between anxiety and bullying?

A: Anxious kids are often targets, because bullies don’t have to do much to get them upset. Just looking at an anxious kid is sometimes enough. And bullies can take advantage of their desire to avoid attention. Being called to the principal’s office would be the most terrible thing in the world for a lot of anxious kids, so their attitude is, “Go ahead, take my homework, or whatever else you want.” NI