Parents of Anxious Kids–Please Join Our FREE, ONLINE Support Group!

In order to meet the needs of parents outside the New York City area, I have moved my support group from Meetup.com and am instead offering free online meetings via Google+’s video conferencing tool (“hangouts”).  To attend a meeting, all you need is access to a free Google+ account.  Setting one up is easy and only takes a minute.  Please consider joining our group, and tell your friends!  More members means more support.

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Don’t be Afraid of the Big Bad Blizzard

You might be worried about losing power. You might be looking forward to gathering around the fireplace. You might be scrambling to reschedule your afternoon meeting or that early Valentine’s dinner date with your spouse. There’s a lot to think about as this blizzard approaches, but don’t forget that your anxious child maybe struggling with irrational and agonizing fears. Follow these tips to help your anxious child through the snowy weekend.

If your anxious child has never experienced a blizzard, be sure to tell her what to expect. Address rational fears like a power outage, but emphasize positives like family time, adventure, and beautiful snow.

Indicate that you and your family will be safe by acting calm and prepared, even if you’re worried about the storm.

Involve your child in your storm preparations. Explain how each action you’re taking will help keep your family safe.

If you lose power, make it an adventure. Play board games in the dark, tell stories by candlelight, or sing songs together.

Shelter your child from sensationalist media.

Avoid using language that indicates or implies that this storm is the worst storm ever or the end of the world or unlike anything we’ve ever seen. Help your anxious child understand that major storms are common and manageable.

If your child was traumatized by Super-Storm Sandy, explicitly explain that this storm will be different.

Ask your child to voice all his fears, and help your child find reasons to dismiss each fear. Be respectful, empathetic, and calm.

Watch for signs of magical thinking. Children who suffer from Obsessive-compulsive Disorder are particularly vulnerable to irrational self-blame regarding catastrophe.

Put safety first. Make sure you have a plan to keep your family warm even if you lose power, and be careful to avoid fires and carbon monoxide poisoning. Follow these blizzard safety rules for kids and parents.

Stay warm this weekend!

Don’t Panic: How Fiction Saves Anxious Kids

All parents (and teachers) know that scary movies can give a child weeks of nightmares. We all remember that one scene that kept us up at night when we were kids. Sometimes the things that scare us aren’t even from horror films: I have a friend who spent second grade terrified of ET.

Scary movies and scary scenes in other movies (like these nightmarish sequences in classic children’s movies) can torment children with anxiety disorders. But, sometimes, a slightly scary piece of fiction can actually provide relief for an anxious kid, especially in older children.

Like many people, I consider junior high to have been the worst time in my life. My anxiety was unmanaged and unpredictable, exacerbated by hormones and life stress. At the time, my biggest fear was, for whatever reason, an alien invasion resulting in the end of the world. So when a good friend suggested I read The Hitchhiker’s Guide to the Galaxy, which basically opens with the Earth being destroyed by aliens, I was reluctant to take her advice. She insisted “H2G2,” as it’s called by fans, was “basically the best book ever,” so I took a risk and started reading.

She was right. The book is smart and witty and adventurous and, most importantly, hilarious. By the time the Earth got destroyed (and, like I said, it happens early), I was laughing too hard to feel scared. I spent the whole summer reading all five books in the “increasingly misnamed” Hitchhiker’s trilogy, and my xenophobia (in the sense of the least common usage) was nearly cured. It’s fitting, therefore, that the fictional version of the Hitchhiker’s Guide is labeled with the words DON’T PANIC.

Humor is healing, and humor typically relies on surprise and the build and release of tension, so fear can easily be a part of humor. After 9/11, the country used humor to heal. Some of that humor was hate-filled. People told awful jokes about Muslims and Arabs. Internet cartoons showed US soldiers leveling Afghan cities. This was revenge humor, and it was anything but healing. Because 9/11 terrified me so deeply, I avoided any reference to the attacks. Then, one day, I saw my brother watching an episode of South Park in which the protagonists visit Afghanistan. The episode balanced empathy with absurdity, presenting Afghan children as virtually identical to their US counterparts except, of course, that the Afghan children had nothing fun to do because their neighborhood kept getting blown up. Bin Laden was turned into a Loony Toons villain, and the jokes at his expense were crude and angry. But the episode was playful! It did help me heal. Other episodes of South Park, like one about SARS, offered similar relief. (If you aren’t familiar with South Park, it’s extremely crude and deliberately controversial, so I’m absolutely not recommending you show it to your young kids. And there are episodes that are simply terrifying, even to adults.)

I’m sharing these anecdotes to illustrate how fiction can sometimes “save” anxious kids. Sometimes laughing about a fear makes it melt away. Humor isn’t even a necessary component; a comforting story that includes your fear and has a happy ending can be just as therapeutic as a great joke. If your student or child is suffering from specific fears, look for books, shows, or movies that address the fears through humor and have a happy ending. Be sure that the media you select is age appropriate, and avoid anything that’s scarier than it is funny; “Mars Attacks” traumatized me so bad I still regret watching it, and it’s been more than ten years.

I’ve included a brief list of works of fiction that I believe may help children deal with specific fears. IMPORTANT: I find these books comforting, but that doesn’t mean everyone else will.

The Hitchhiker’s Guide to the Galaxy, 25th Anniversary Edition
Fears: aliens, end of the world, space; For teens (and adults)

A Swiftly Tilting Planet (Madeleine L’Engle’s Time Quintet)
Fears: nuclear bombs, war, end of the world; Age ten and up

also by Madeleine L’Engle
A Wrinkle in Time [Paperback]
Fears: illness of a parent; Ages ten and up

Coraline
Fears: loss of parents, kidnapping, parents changing, losing eyes; Ages 8 and up
Warning: Coraline is an excellent book with a happy ending, but it’s really creepy!

Holes (A Yearling Book)
Fears: false imprisonment, venomous animals, authority figures, dehydration; Ages 9 and up

If you’ve had a similar experience with a piece of fiction, please post it in the comments.

Asthma and Anxiety

We used to go to the emergency room in the middle of the night. I’d wake up to hear the shower running, and I’d know it meant my baby brother couldn’t breathe. At first, when he was a baby, we didn’t know why. It only really happened when he was sick, so my mom sort of figured he just reacted badly to colds. He’d wake up wheezing, and my mom would hold him in a steamy shower. When that didn’t work, we’d jump into the car and drive half an hour to the nearest ER. My mom and dad would keep all the windows open to let in the cold air. At the hospital, the triage nurse would rush my tiny baby brother into a tent filled with steam. Then they’d give him some medicine, and then he’d breathe normally again. Bizarrely, no one at the hospital ever said asthma. They said he was “croupy.” My mom finally read an article about childhood asthma in the paper and asked her pediatrician if that was what caused her son’s breathing troubles. The pediatrician was so shocked he began to laugh. “They didn’t tell you that at the hospital?” he asked. He couldn’t believe the ER doctors would fail to offer that kind of basic information. “Of course it’s asthma! I thought you knew!” (This was, by the way, the kind of pediatrician who happily woke up at midnight to meet us at the ER and tell us all jokes until we calmed down. He took calls at home at any hour and could make my brother laugh while getting a shot, so I’m not surprised he went on to become an expert in child happiness.)

Asthma is scary. It’s genuinely dangerous, and it triggers primal fear in its victims. There are few things as scary as not being able to breathe. My brother, an active, adventurous, and otherwise healthy kid, spent his childhood cursed with severe asthma that necessitated years of ER trips and a variety of unpleasant drugs. I recently asked him if the attacks terrified him, and his answer surprised me: “The fear I felt from having asthma attacks as a young kid was totally manageable, because mom would take care of me and we had all the equipment and stuff.” Wow, check out mister No-Anxiety-Disorder.

However, even my brother has experienced some mild asthma-related anxiety. “I think I subconsciously associate [anxiety] with asthma, probably because asthma attacks are the most consistently stressful/traumatic thing I’ve gone through in my life,” he told me.

For a child with an anxiety disorder, asthma can be absolutely terrifying. Feeling unable to breathe can easily trigger a panic attack, and the panic may make breathing feel even harder. Anxiety medications can speed your heart and cause shaking, so an anxious child who is having an asthma attack is very likely to experience some degree of panic even after using her inhaler, especially if panicked breathlessness prevents her from realizing that the medicine is working. A student shared her experience:

Twice I has asthma attacks while I was hiking with other families. Both times, I ended up having a panic attack. It felt like my inhaler wasn’t working, so I got more panicked. It was like a snowball.

An anxious child who suffers from asthma may also sometimes mistake a panic attack for an asthma attack. My student also described a panic attack that was caused by a stressful life event:

I felt a lot like I couldn’t breathe, and I was really really scared. My inhaler didn’t help at all, and I thought I was going to die. My dad told me to use my relaxation techniques. Once I stopped being scared, my breathing felt totally normal. This makes me think that the feeling of breathlessness was “in my head,” not in my throat.

If your anxious child or student has asthma, talk to him before his next attack. Explain that, unlike asthma, anxiety doesn’t really affect breathing ability, and help him practice distinguishing between panic and asthma. Teach him to take complete, slow breaths. Finally, consider using a peak flow meter to help your child determine whether his anxiety is skewing his perception of his breathing ability.

Of course, it’s extremely important for children and adults to follow their doctors’ orders exactly, especially regarding serious illnesses like asthma. Ask your doctor, but I assume you should instruct your child to use his inhaler or other asthma medication even if he’s not sure whether his breathlessness is caused by asthma or anxiety. Cognitive-Behavioral Therapy and relaxation techniques can be used after medication is administered.

As always, the best thing you can do for your anxious student or child is remain calm. It’s very upsetting to watch someone you care about struggle to breathe, especially when that someone is a young child. However, children look to their caregivers for clues about danger, so it’s important to behave as though you are in control of the situation.

Asthma is a serious and life-threatening disease. Children with asthma need to be in the care of a qualified pediatrician or specialist.

My brother’s asthma has gotten much better, and he’s now able to backpack through forests and float wild rivers and play with his band in front of huge crowds. He’s the coolest person I’ve ever met, and tomorrow is his 21st birthday!20130204-134428.jpg

Why I Love Labels, Part 2

Labels are limits. Labeling a child is limiting her. Children, disobedient as they may sometimes be, listen. So why would any parent want to label her child as mentally ill?

A label saved my life. A term, and a list of defining traits that flattened my complex human emotion into bullet points, saved me from a waking nightmare. I can’t overstate it. Words are pure magic.

Labels are limits, and they limited my panic. Knowing its name gave me power over it.

As an educator, I’ve been taught to use what’s called “people-first language” when describing disabilities, impairments, and differences. People-first means you say the person before the label: person with Autism instead of Autistic person. The idea, of course, is that people needn’t be defined by their conditions. If you read my blog or scan my website or follow me on Twitter, you’ll notice that I say “anxious kids” at least as often as I say “kids with anxiety.” First of all, it’s much shorter (and, on Twitter, that’s hugely important). But, more than that, I’m okay with using “label-first” language to describe my students because they are to some extent defined by their illness. And so am I. Anxiety didn’t happen to me. Anxiety is me. I have facets and layers and contradictions (upcoming post topic!) like everyone, but I can’t deny that the “self” that I acknowledge as “me” could not exist independent from childhood anxiety. Calm, prepared, responsible adult Kiri grew from panicked child Kiri, both because panic forced me to learn life skills that other adults lack and because my brain simply has anxiety wired into it.

Some modes of therapy encourage patients/clients to imagine their illnesses as separate from themselves, and I find this tactic extremely useful, especially in children. However, I believe that it’s important to ensure that this kind of thinking doesn’t lead to self-stigmatizing. I am more than my anxiety, but I am my anxiety. I once had a peer ask, “how do I know what is my [mental] illness and what’s me?” While I understand and respect her question, the truth is, brains don’t work like that. Mental illness is, as far as we can tell, pretty complex. An anxiety disorder can’t be cut out like a tumor. Rather than trying to identify a disease-free self, we should focus on becoming as healthy as we can be.

I believe that teaching children to identify and label their symptoms and conditions is the single best thing you can do to facilitate recovery. However, there are definitely some risks involved in labeling children. Children (and adults) may internalize the limitations implicit in their labels and thus impede their own success. A child diagnosed with an anxiety disorder might, for example, believe that he cannot take risks. Part three of this series will include the exercises I use to combat self-limiting in my students, and myself!

This post continues the theme of the disclosure and destigmatization of mental illness. For more information about stigma, check out the Stand Up for Mental Health campaign by HealthyPlace.

Surprising Anxiety Trigger 5: Medications

A variety of medications can cause anxiety, especially in individuals with anxiety disorders. Before giving your child even over-the-counter medications, consider the risk of increased anxiety. Because the benefits of medication sometimes outweigh the side effects, it may be necessary to coach your child through her anxiety or combat the anxiety with medication prescribed by your pediatrician.

You probably already know that stimulants, like caffeine or amphetamines, can trigger anxiety. Children with ADD/ADHD are often prescribed a stimulant as treatment. Some children with comorbid ADD/ADHD and anxiety can tolerate stimulants. Other children, especially those with Panic Disorder, may experience very rapid heart rate combined with feelings of terror. Talk to your pediatrician or psychiatrist for more information.

Some cough and cold medicines, like the decongestant pseudoephedrine (Sudafed), are also stimulants. These medications can cause increased heart rate, shaking, nervousness, and anxiety. Talk to your pediatrician before giving your anxious child pseudoephedrine or similar medications, and report side effects, especially those that are severe.

Antihistamines like Benadryl (diphenhydramine) typically cause drowsiness, but some children experience a paradoxical effect and become excited or energetic. Anxiety can also occur in this situation.

If your child has asthma, you may already have noticed that his inhaler can cause shaking and increased heart rate. If your child’s asthma medication is causing anxiety, it’s important to ensure that the child is still taking the medication appropriately, in spite of his discomfort. Talk to your pediatrician, and check back for an upcoming post about asthma and anxiety.

Oral steroids, which are sometimes used to treat persistent allergic reactions* can cause anxiety and other changes in mood. A doctor should monitor your child while she is taking oral steroids.

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*like if your mosquito bites somehow lose their minds and turn your usually beautiful leg into this monstrosity…

The above medications are some of the most likely to cause anxiety, but any drug that makes a child feel “weird,” sick, “antsy,” groggy, or dizzy can inspire panic. Warn your child about possible side effects before they start, but skip mentioning any real dangers associated with the medication. Utilize relaxation techniques and distraction while your child acclimates to new medication, and, most importantly, always discuss medication changes and effects with your doctor.

Are You Prepared for the New DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM), often called the bible of psychology, lists every official psychological disorder and includes the criteria for each disorder. It is published by the American Psychological Association (APA), “a scientific and professional organization that represents psychologists in the United States.”

Rather than focus on the experience of each disorder, the DSM exists to allow standardized* diagnosis and classification of human psychological disorders. Because psychological understanding evolves and improves (hopefully) over time, the DSM is updated as needed. The current version, published in 2000, is the DSM-IV-TR. (The “TR” stands for “text revision,” since the changes between the DSM-IV and the DSM-IV-TR were primarily related to language.) A new version of the DSM, The DSM-5, will be released this May. While you may not find yourself particularly concerned with the new DSM, The Anxiety-Free Child explains why changes can be so important:

“Although the DSM does not outline how anxiety in children or other specific conditions should be treated, it does outline what counts as an official disorder and how the disorder is classified. Classifications and definitions of mental health disorders play a huge part when it comes to insurance coverage as well as qualifications for treatment and services offered by mental health professionals, schools and other agencies.

“In other words, if you or your child’s mental health issue no longer has a valid label as per the DSM or your symptoms no longer meet the specifically defined criteria, you may no longer be eligible for treatments and coverage.”

Read The Anxiety-Free Child’s Guide to DSM-5 for a complete explanation of the upcoming changes to the DSM, including the controversial removal of Asperger’s!

*to the extent that qualitative, subjective illnesses can be standardized

Note: Fearless Learning is not affiliated with The Anxiety-Free Child and does not endorse their program. Nor do we disaprove of the program…we just don’t have an official stance at this time beyond saying you should read the above article.

Coming soon: what are the merits of labels, anyway?

NEW support group for parents of anxious kids!

Parents in the New York area: please check out Fearless Learning’s new support group, facilitated by Kiri Van Santen. Our first meeting will take place when we have enough members, so join the group now, and stay tuned for updates.

More about the group

RSVP to our first event!

Surprising Anxiety Trigger 4: Upset stomach

Welcome to part four of my Surprising Child Anxiety Triggers series!  Today’s trigger is gastrointestinal distress, or “upset stomach.”

The stomach flu is, in my opinion, the worst (non-serious) thing ever. The worst. Worse than stubbing your pinkie toe or getting ten paper cuts. Worse than reality TV. The worst. In fact, like many children with Obsessive-compulsive Disorder, many of my compulsions were done to prevent throwing up.  Gastrointestinal distress is so horrible I’ve separated it from other illnesses and given it its own post.

If an anxious child feels sick to her stomach, two separate things can cause her to panic:

First, if she’s afraid of the stomach flu/food poisoning, she’s likely to panic if she thinks that’s what’s causing her discomfort.  In fact, she might panic even if she knows she’s only sick because she ate too much or too fast, because feeling like she’s going to throw up is terrifying no matter what. (This is especially true for children who are afraid of losing control or embarrassing themselves.) If your child or student is specifically worried about GI symptoms, teach her how to minimize her risk of upset stomach by eating slowly and calmly.  A coach or a cognitive-behavioral therapist can help create a plan to help overcome fear of stomach upset.  In the meantime, have your child or student practice slow, steady breathing, and help her minimize her discomfort by addressing the possible cause.  Note: anxiety can cause or increase nausea, so address anxiety symptoms first or concurrently.

Second, like many of the triggers on this list, GI distress can mimic anxiety symptoms.   Both panic and GI distress can cause nausea, stomach pain, lightheadedness, and increased heart rate.  Anything that mimics panic can cause panic.  In part, this is because panic is terrifying, so thinking that you’re going to panic can …make you panic.  To combat this, encourage children to relax into their panic with complete acceptance.  Say, “you’re having a panic attack.  It’s very common, and it can’t hurt you.  It’ll be over soon even if you don’t do anything.”  Remind anxious children to breath slowly (without gasping or hyperventilating) and simply allow the panic to rise and then fall.  Accepting panic is extremely difficult, even for adults, but it’s extremely effective.

Coming soon: how to coach a child through a panic attack.

More in this series:
Hunger
Dehydration
Illness

Surprising Anxiety Trigger 3: Illness

Various disorders and illnesses can cause symptoms similar to those of an anxiety disorder. Some of these illnesses are serious, so it’s a good idea to talk to your pediatrician. Let me start by saying this: If your child (or student) is prone to anxiety, don’t tell him that it may be caused by a dangerous medical condition! You might be thinking aloud and benignly mumble “I wonder if it’s your thyroid.” Ask yourself: does your child (or student) know what a thyroid is? Does your child know that a thyroid problem is manageable and not going to kill her? When you’re already anxious, anything that sounds like danger can trigger full panic. If you drop some medical terminology or even an unfamiliar anatomy word, explain that there’s nothing to worry about. If you are worried (say, about your child’s heart), be extra calm and keep your fears to yourself.

Even if your child’s anxiety is a symptom of an anxiety disorder and not any other medical condition, illness can be an anxiety trigger. Respiratory symptoms may inspire fears of suffocation. Shivers from a fever might remind your child of the shivers he experiences with panic attacks, and that might be enough to cause panic. If your anxious child is ill, watch for signs of panic, and explicitly remind your child that his symptoms are the result of a harmless virus (or whatever’s causing his illness) and nothing more.

More in this series:
Hunger
Dehydration
Upset stomach