Ask An Expert / Anxiety Disorders

My 10-year-old daughter with anxiety won’t participate in gym. Should we push her?

Incentives to participate work better than pressure

Rachel Busman, PsyD
Rachel Busman, PsyD

Senior Director, Anxiety Disorders Center, Director, Selective Mutism Service

Child Mind Institute

My daughter is 10 years old and is diagnosed with selective mutism, generalized anxiety disorder, and panic disorder. My question for you is regarding gym. She refuses to participate. So far the teachers have let it slide and her IEP doesn't really say anything about not doing gym. The school social worker, the gym teacher, and I have been trying to be on the same page about it by telling her that there will be consequences. Will this make her anxiety worse? Also, she has always been afraid to fall—could I be looking at a sensory issue as well? Does it really make a big difference if she doesn't participate?

First, I wonder about the possible sensory issues. It’s important to determine if your daughter has any motor weaknesses or anything else that would preclude her from participating in gym or make it more difficult. If she hasn’t had an occupational therapy evaluation, it would be good to get one. It might also be helpful to see if she would meet with the gym teacher alone to see if she can run, jump, throw a ball and do other gym activities without the pressure of other kids being there.

Does it really make a big difference if your daughter doesn’t go to gym? I think the answer is yes, on a bunch of levels. First, there are health reasons why it’s important. There’s also a huge social component. And her anxiety relating to gym will just be reinforced if she’s indefinitely sidelined.

If an OT evaluation finds that she has motor or sensory issues, she may need a modified gym — plenty of kids have a requirement for what is called Adapted Physical Education (APE) on their IEPs. If she needs OT that should be on her IEP too. But she also may not need this extra help — let’s say she meets with the gym teacher and it turns out she can do these activities, maybe she could do gym in a small group to start with, or maybe she could do gym at a less anxiety-provoking time.

Finally, setting up consequences as punishment is not going to be wholly helpful because it sounds like anxiety, and not willful refusal, is the real problem. But I think there might be a way to work in some behavioral incentives like earning privileges for meeting with the gym teacher or doing activities with other kids. There’s just going to be another gym class next year, and reinforcing her avoidance now will mean she’ll lose out even more in the future.