Parents and teachers are usually the first to spot the warning signs, signaling anxiety disorder. They are therefore the gatekeepers for early intervention. The following lists of clues are red flags, which suggest that the child may be struggling with an anxiety issue. Of course, many other factors come into play when diagnosing a disorder. These symptoms are not all-inclusive, nor are they a definitive diagnosis of anxiety. However, they usually are flashing lights for a situation which may warrant further attention.
- Out-of–character behaviors: The child may not act in an age-appropriate manner, showing symptoms such as sudden stubbornness, rigidity or undue cautiousness or hesitation.
- “What if”: An influx of questions upon questions, always “But what if?” regarding the trivial and the profound, worrying about friends, grades, performance, schedules, routines, safety, natural disasters, or weather are a sign of anxiety.
- Avoidance: Sudden avoidance and reluctance in previously non-issue situations may indicate and anxious child’s reluctance to encounter any perceived trigger of contamination, death or harm.
- Reassurance seeking: The anxious child has an incessant, insatiable need for reassurance, and no amount of promises ever seem to be enough.
- Frequent physical complaints: Medically unexplained aches and pains, nausea, vomiting, and stomach aches at times lead to an emotional problem lurking within.
- Sleep problems: Insomnia, nightmares and frequent awakenings, often followed by drowsy exhaustion during the day can be the result of an anxious child’s inability to relax or late bedtimes as a result of trying to get things done the ‘right way.’
- Decline in attention, concentration, and organization: A child who is easily distracted, unfocused or disorganized may be suffering from anxiety. (The difference between the oft-confused ADHD and anxiety is that the hyperactive child bounces enthusiastically from one activity to another, while the anxious child appears distant, burdened, serious, and spaced out – the result of a brain hijacked by worries against its own will. However, some children suffer from both anxiety and ADHD)
- Perfectionism: High, unattainable self-imposed expectations which result in repeating tasks, frustrations with perceived imperfection and inability to accept parents’ or teachers’ satisfaction with performance is a red signal.
- Incomplete tasks: Assignments or tasks which are well within the child’s capabilities may be left incomplete, because the child has become “stuck” with repetitive rituals or perfectionism.
- Reluctance or refusal to attend school: A child may refuse to attend school to avoid anxiety triggers or insurmountable demands of schoolwork or self-imposed expectations.
- Easily-triggered distress: Clinging, fear of being alone, restlessness, agitation, crying, irritability, unusual tearfulness, poor self-esteem, unhappiness, frequent tantrums, depression or withdrawal can be linked to anxiety.
- Wasted logic: The anxious child’s concerns refuse to be appeased by common sense and rational explanations.
Anxiety Fuel Factors
Anxiety is often a combination of predisposition and situation. Although it is impossible to alter one’s genetic, temperamental or circumstantial predisposition to anxiety, the situation dynamics can be altered. These dynamics are called anxiety’s “fueling factors,” which rev it on or calm it down through a reciprocal interaction. Three types of reciprocal interactions which fan the fires of anxiety are the anxiety triad, the vicious cycle of avoidance and caregiver interactions.
The Anxiety Triad
Anxiety is influenced by a three-prong triangle, consisting of thoughts, physical symptoms and behaviors.
- The anxious person’s thoughts over exaggerate the perceived danger of a situation. He expects the worst and feels out of control if he cannot be one-hundred percent certain that his safety is guaranteed. Since this certainty is often impossible, he resorts to extra cautiousness, checking, avoidance or seeking reassurance to help him regain control.
- The anxious person’s physical symptoms include the typical physical anxiety symptoms: sweating, heart pounding, tension, difficulty breathing, nausea, stomach aches, nightmares, and insomnia. However, these are symptoms which the healthy person’s body reserves for extreme danger and the anxious person’s body springs into action even in benign situations.
- The anxious person’s behaviors are a combination of man’s innate fight-or-flight reaction. The person tries to escape the situation or make sure the coast is sage with repeated safety check, rituals or reassurance seeking.
These three factors are interrelated. The thoughts exacerbate the physical symptoms, which compel the person to escape. The negative consequences cause the person to believe that indeed this situation did call for extreme reactions.
The negative associations cement the anxious person’s sense of constant anxiety. For example, Nicole is afraid of failing the spelling test. She thinks, “It’s too hard. I’m going to fail.” She feels tense, nervous and nauseous. So she cannot focus and rushes through the test, (behaviors,) misspelling words she knows well. Her low grade reinforces her belief that this was too hard. At the next test, she is less confident, more anxious and the pattern repeats itself. Soon, she knows that she will fail all tests and refuses to attend school on test days. Or, Peter thinks no one likes him and perceives no one will want to sit near him on the bus. When he boards the bus, he is already feeling queasy and irritable. So, he averts his gaze and feels too nervous to converse with anyone. He hesitates and then sits down in an empty seat, instead of his classmates’ seats (behavior.) At lunch, no one comes to sit at his table. Peter believes that he is right-no one likes him.
The Vicious Cycle of Avoidance
Avoidance is a vicious cycle. It may be the most powerful anxiety fuel. When faced with threat, the anxious person is more likely to choose “flight” over “fight.” He is then rewarded with negative reinforcement. Yes, negative reinforcement is not a punishment, but a reward, because the behavior of escaping the situation is rewarded by the avoidance of the negative consequences and discomforts triggered by the anxiety.
The vicious cycle of avoidance portrayed shows how anxiety rises when the person confronts a feared situation (exposure). When the pressure becomes unbearable, (panic peak), the person escapes and receives immediate relief from the anxiety. This is extremely rewarding and reinforces the belief that escape is the only way to cope with the anxiety, since he has never tried any other way of dealing with it head on. This negative reinforcement is strengthened each time the person avoids the situation once more. It results in more frequent avoidance and escapism. However, this relief is temporary, for when the situation resurfaces, the person knows no other coping method other than escape. This restarts the cycle.
For example, when Mike washes his hands repeatedly or when Theresa repeatedly asks for reassurance that her mother is safe, they are engaging in escape or avoidance. Mike is avoiding possible contact with deathly germs and feels much better once those possible enemies are washed off his skin. Theresa quiets her worries for her mother’s safety with her requests for reassurance and does not have to deal with her troubling thoughts. The immense relief they feel as a result of their avoidance and escape reinforces the belief that this is the way out, instead of conquering their fears.
Anxious, hyper vigilant parents feed their child’s anxiety. Parents who overreact, becoming easily alarmed at every perceived danger are negative role models. They create an “anxious environment” in which children learn to model anxious behaviors, exercise extra caution and avoid difficult tasks at all costs. Anxious parents may also empathize with their child’s plight, because they have had similar anxiety-causing experiences themselves. Due to their own insecurities, they feed into and fuel their child’s anxieties. They wish to protect their children from similar negative experiences and tend to be overprotective and controlling.
This squashes the child’s natural abilities to break the “vicious cycle of anxiety” since the child uses his parents as a crutch to support him instead of learning to depend on himself to fight his own anxiety battles. These parents actually strengthen their child’s anxiety. Treatment of anxiety includes changing the fueling factors. We will discuss this in the next issue.