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How much to push your anxious child?

7 Apr

How much should I push my anxious child? This is a puzzle all parents face with children, especially those with an anxious bent. The challenge is how to help them face their fears in a way that truly promotes the learning experience of “I can do it”. Push too hard and the child will dig in her heels or melt down. But if the nudging is too gentle or inconsistent nothing will change. To complicate matters, often parents find themselves on opposite sides of this issue, so that one is the tough guy and the other is permissive, with tension resulting between the parents. Additionally, sometimes the parents are pushing out of their frustration rather than out of a thoughtful consideration of what the child needs.

There are three parts to figuring out this problem on how much to push. First, begin with developing a mutual understanding with your child about the nature of the problem and what needs to happen. This is a whole topic by itself, but it merits a brief mention here. There always needs to be a reason for doing something difficult and of course it is better if it is the child’s reason rather than yours. But that isn’t always possible, so that sometimes simply we need to say something  like “children have to go to school”.  Next, there also needs to be some mutual understanding about the nature of the problem, such as “this is anxiety, that is the worry monster talking, that is a false alarm”. These two elements provide a basic foundation from which to proceed.

Second, in thinking about how much to challenge your child, we need to determine at any particular moment where your child is on the arousal/anxiety scale, because this will determine what type of input she will be able to respond to. A child in the middle of a panic attack, or a child coming off the playing field in tears, needs calming down and will not be receptive to advice. So we first need to make note of the anxiety level in your child, which involves not only what she says, but  more importantly any nonverbal behavior suggesting she is in a frozen/inhibited state. In general, we tend to err more on underestimating how anxious children are. At the same time, childhood is a time of big feelings, and there is not always a one to one relationship between the intensity of expression and the capacity to deal with it. Many young children protest mightily at being dropped off to school and then quickly come around once the parent leaves and the school day has started. Sometimes the protest is out of “habit” and does not represent an emotional freeze state. So it is not always easy determining the anxiety level in your child.

Third, the idea of taking small steps to tackle problems big and small is common sense. The ability to think incrementally, breaking problems down into smaller steps is characteristic of good teaching in any domain. A first step can simply be formulating a sequence of brave steps, a fear ladder, with as much collaboration with the child as possible. We can never really know what the next steps will be for your child; actually we can only make an educated guess. Therefore, it is best to phrase the challenges as experiments and use invitational language. “Would you be willing to pick up the plastic spider or look at a picture of one?”  The next step is guided by the child’s response. Imposing a challenge or exposure on a child generally doesn’t work well, although sometimes  it can’t be avoided. But the best result is obtained when the child is given choices and determines the next step. This process can be slow but if your child is actively making brave challenges you are moving in the right direction.

copyright 2109@Edward H. Plimpton, PhD

The first three things to do when you have an anxious child

5 Nov

copyright@Edward H. Plimpton

The Importance of Breathing in Dealing with Anxiety

6 Aug

From Your Anxious Child: Emails to Parents by Edward H. Plimpton


The Importance of Breathing in Dealing with Anxiety


Got a panic stricken, hyperventilating youngster in front of you? One basic first aid  measure will involve convincing the child to take calm, deep relaxing breaths.  Perhaps you will ask them to blow into a paper bag and fill it up, or just look into your eyes and copy-cat your breathing or just imagine that they are blowing bubbles. This calm, deep belly breathing in which you can see the belly or diaphragm move, helps counteract the overactive alarm system that characterizes many anxious children. It also helps to get them physically active to burn off all that anxious energy.


But the benefits of practicing this type of belly breathing go beyond temporary first aid. When we breathe, there is a difference in our heart rate between inhaling and exhaling. Our heart rates increase when we breathe in and slow down when we breathe out. This is known as heart rate variability and it correlates with anxiety. About 10-15% of children are biologically more on the shy and anxious side, and as psychologist Jerome Kagan discovered, these children have lower heart rate variability than their less anxious peers. Fortunately, practicing calm breathing can do wonders. In one study, on the power of breathing, adults were given artificial blister wounds on their arms, one group was taught breathing skills and the control group was left alone. The group that was taught breathing skills found that their blister wounds healed much more quickly than those of  the control group. In other words, breathing helps support the body’s natural capacity to heal itself. We know that the emergency response system, the sympathetic nervous system, the part involved in the fight or flight responses, gets a “regular exercise” from all the anxious things your child does. However, the calming and repairing system has been typically sitting on the sidelines and does not have a chance to get into the ball game. Engaging in calm breathing actually helps build up the muscles in the calming and repairing system, or the parasympathetic system. As a result, the child has some calm down “muscles” that can help tame the overactive alarm “muscles” or help set the foundation so that the child can access his/her smart brain.


There are many child friendly ways to teach calm breathing and here are some to get you started.

  1. “Make Lemonade”. Get some newspaper and crumple it up. Put one newspaper ball in your hand. Now pretend the ball is a lemon, and squeeze out as much lemon juice as possible. Do one hand at a time, squeeze as hard as possible, and then relax.
  2. Pretend you are blowing out birthday candles
  3. In more tense situations, ask the child to look into your eyes and copy-cat your breathing.
  4.    This Ytube video also contains some nice suggestions for children.
  5. Consider also the following books: Lori Lite A Boy and a Bear: The Children’s Relaxation Book, Michael Chissick and Sarah Peacock Frog’s Breathtaking Speech: How Children (and Frogs) Can Use the Breath to Deal with Anxiety, Anger and Tension.


Anxious children often want instant results and can be quick to dismiss suggestions. Parental modeling of calm breathing helps as well as  incorporating it into the bedtime routine or other transitional moments. It is a skill that needs to be practiced in nonanxious moments for it to have a chance to be helpful in more high intensity situations.


copyright@Edward H. Plimpton 2014

What to do in those anxious moments: Getting out of your head

12 Jul

From Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD


Getting Out of Your Head


One effect that anxiety has on your child is that it creates intense self-preoccupation. In those moments, in whatever form his/her anxiety takes, all the child can focus on is the possibility of impending doom. And when your child is in such a state, he/she is not at his/her thinking best. When you find yourself in this position, consider some techniques that help the child get more focused and oriented to the external world. 


In a moment of panic, you might say to your child “Look into my eyes and copycat my breathing”.  The idea is to get the child really focused and task oriented on you and your relaxed breathing rather than how he/she is feeling.


54321 is a very practical orienting exercise developed by Tom Bunn in his book Soar on overcoming flying fears. This exercise involves noticing five things that you see, then five things that you hear, and then 5 things that feel, not in terms of emotions, but rather sensations. The process is repeated noticing four items in each category, then three, two and one. While doing this exercise, have your child say “I see…”, “I hear…” “I feel…” either to themselves or out loud. The exercise actually requires sustained effort and focus which in turn is helpful in moving the child’s attention away from himself. There are alternatives to this approach, one of which is to ask the child to identify 5 blue objects  in the room and if necessary continue with different colors. Or an even more open ended approach is to ask the child to look around the room and see what catches his/her eye. However, in a moment of high anxiety, most children need more structure and guidance about how to direct their attention. The car drive game of license plate is a game where the parent tries to relieve the discomfort of a long car by helping the child focus on something outside of the car. Yet another variation involves using a snow globe or glitter wand: you can ask your child to shake the wand or globe, pretend the glitter/snowflakes are their upset feelings and watch them settle at the bottom.  And as I mentioned in my essay on Goodnight Moon, in this classic book, the mother bunny is helping relieve the baby’s nighttime anxiety by focusing on what is actually in his/her bedroom. This provides a counterpoint to the growing internal anxiety as bedtime approaches.


As a point of clarification, you are not trying to distract your child, in the sense of not thinking about the worry, because we know that does not work. Trying not to think about something or thought suppression only makes the forbidden thought more powerful. To use a computer analogy, we are just trying to divide the child’s attention to multiple browsers or windows rather than have “anxiety” occupy the entire screen. In a manner of speaking, if anxiety does not get full attention, it gets bored and walks away. There are numerous variations on this idea–for example almost any hobby can serve this function. But as with any technique, it requires practice because there is no magic here and it will take some experimentation to find the variation on this idea that works best for your child.


 Copyright@Edward H.Plimpton, PhD 2014

Worry Management on the Go-A Simple Technique

12 Jul


Worry Management on the Go-A Simple Technique

 In our quest to help anxious children, we are always on the lookout for simple things to help children in those anxious moments.  A very simple and portable technique for dealing with anxiety has appeared in a book for children, Scaredies Away! by Stacy Fiorille and Barry McDonagh, and in another one for adults by Alistair Horscroft called  Beat Anxiety Now. Both involve making a fist.

There are sound ideas operating in the simple technique to be described. The basic idea is that fighting anxious thoughts or trying not to think about them does not work. On some level, you have to accept that you are having an anxious thought or feeling.  So acknowledging them with or without some humor is important. Since anxiety can take the form of thoughts or feelings, noticing where they are in the body can transform the experience by this act of observation. The act of noticing is actually a version of facing your fear or doing an exposure. Anxiety narrows the perspective on the world, so relief involves finding a different frame of reference. One way to change perspective is to imagine transforming anxiety.

In Scaredies Away! the technique is called “The Magic Finger Countdown” and it consists of 4 steps. “Step One: Say ‘hello’ to each and every one of your fears and your body. Step Two: Make a fist and squeeze all of your scaredies out through your arm and into your fist. Step Three: Squeeze your fist tight and tell your fears you have them right where you want them. Step Four: Count down backwards from five while you release one finger at a time. Blow those fears away to make sure they’re gone. Step Five: Say good-by to yours fears. Congratulate yourself on completing the technique! Trust yourself!”

An adult variation on this procedure has been suggested by Alistair Horscroft in his book Beat Anxiety Now, which may also be more acceptable to an older child or adolescent. It is also a five step process.

1. Point with your finger to the place in your head or body where your anxiety, stress or tension is located.
2. Imagine there is a window or door just over that area. Leave the window or door open.
3. Make a light fist with your hand and quietly acknowledge the thought or feeling by saying “yes” to yourself and repeat that several times to yourself.
4. Ask yourself whether you would be willing to let a little of that tension go. Then open your hand and just imagine some of that tension, worry or feeling leaving your body. Don’t try to remove all of the tension, just a manageable bit of it. If you try to remove too much of the tension, it would like the circuits of your brain would get overloaded.
5. Repeat this several times during the day.

The similarity between these two techniques is quite apparent.  And the authors both caution that this  procedure isn’t magic and it takes practice. As with any technique, it needs to be introduced and practiced in nonanxious moments. It is hard to learn anything new in a highly anxious state.   I like the simplicity of the technique and its portability. You can pretty much do it anywhere for a wide range of anxiety. One child told me that she quietly made a fist under her desk at school and did this technique and was able to inconspicuously calm herself.  The books will obviously provide a more detailed explanation of this technique.




copyright@Edward H. Plimpton, PhD 2014


14 Jul



Any parent who has more than one child knows,  every child is different from the moment they are born. Sometimes the difference is easy to understand such as when you have one boy and one girl, but that is only the tip of the iceberg.  Did your biceps get buffed when your child was an infant because the only way to calm her was to swing her in a bassinet? Did you find a new use for your washing machine as a way of calming your baby? (Placing the baby on top, not in the washing machine to be perfectly clear). Or did you find yourself driving around endless in your neighborhood so your child could fall asleep? Or perhaps you had one child who just melted into your body when you held him and another who seemed to arch away or squirm when held. What gives?

 These are examples of differences in temperament or variations in how the child experiences the sensory world.  There can be tremendous range in how we experience touch, so that some people hate to be tickled or others find it moderately enjoyable. Some people enjoy the sensation of being on a roller coaster and other experience as one step away from waterboarding.  These differences in how we experience the tactile stimulation of being held or the vestibular sensation of being on a roller coaster reflect variations in how we process or integrate sensory information.  Anxious children can often suffer from problems in sensory-integration, in which they cannot handle and process the incoming stimulation. A child who clings to you when you take her to a birthday party may be overwhelmed by the noise of the party because their ears are super sensitive.  It is not so much a problem being shy as it is of being overwhelmed by the sights, sounds and even the smells of the birthday party.

 What appears to be anxiety in trying something new might be more specifically describes as a problem in sensory-integration. It is all too much. And in such situations you might find child unable to articulate any  reason why they won’t join the birthday party other than she just doesn’t feel right. In contrast,  a child who is anxious in the more traditional sense of the term may be able to articulate some reason why they don’t want to join the party, such as   “I only know the birthday girl”. Admittedly, the distinction may not always be clear cut.  But there are a range of Sensory-Integration interventions, a subspecialty of occupational therapy, that may help your child modulate his sensory experience and consequently be less anxious and overwhelmed. This may involve providing your child with certain sensory experiences which can correct or compensate for her difficulty in processing the information that their senses provide them. If this sounds like your child, a consultation with a Sensory-Integration therapist may be helpful

Anxiety comes in waves

14 Jul



Anxiety Comes in Waves; Are We There Yet; The Law of Gravity As Applied to Anxiety

Anxiety can exert a vice-like grip on your child’s thinking and feeling that can make it hard for him to believe that anything can change or get better. Getting caught up in an intense pattern of anxious thinking, can make you think that things will always be that way. Moods get supersized. And then all your desperate child wants is relief. But as the often-quoted Greek philosopher Heraclitus stated, you can’t step into the same river twice, that is to say, everything changes. And that is true for feelings as well, even for every intense feelings. Despite what your child may think, worries don’t last forever. Following gravity, what goes up must come down. But children have a different experience of time than adults, as any parent who has taken her child on a long car drive can attest, with the backseat refrain of  “Are we there yet?” This different sense of time can make it harder for children to realize that if they wait, things will get better. Although it makes it easier to distract them and that can be a Godsend, the problem is that if they do not learn from the experience or we don’t help them to learn, ­it will only be temporary relief. Infants begin as creatures of the moment and over the next 20 years become less so, but it is a gradual process. The problem is that combination of out-of-sight out-of-mind, and having difficulty tolerating talking about difficult or unpleasant things.

But for children to be brave and take a leap of faith, they need to have a sense that things will be OK. Either they can become used to things or these things will change. So how do we help children on this front? Experience is obviously the best teacher. Getting back on the bicycle after the nasty fall and seeing that everything is OK is a cliché that works in this instance But with anxious children and especially children with attentional problems, we may need to highlight these experiences and provide a little help so they just don’t slip away.

First, it is important to underline the common everyday axiom that you can get used to things or slightly more technically, you can habituate to things. It is like jumping into a swimming pool. It can be really cold at first, but if the child starts swimming or playing Marco Polo, she gets used to the water and it is not so bad. Consider holding an ice cube in your hand. It is really cold and unpleasant at first, but eventually turns into water. Because we can get used to things, it is important not to give exclusive attention to our first feelings about a subject.

Second, to help the child learn from experience, it may to helpful to ask him questions geared toward helping him notice his experience, rather than leading him to the answer you already know. For example, if a child is anxious in the morning before school, afraid she might throw up, when she comes home, you might ask her, “So what happened to those worries about throwing up today?” This question will hopefully help her see and reflect on the fact that once she got involved in her school work, the feeling went away.

Having faith that things can change is a lesson not restricted to childhood. We continue to learn and remember this throughout over lives.

Floor Time

14 Jul


Floor Time


A recent Nielsen Company survey reports that the average American is spending an average of 4 hours 49 minutes watching TV a day — and that is those ages 2 years on up. Yikes. But then again, your TV time is probably after the children are in bed, unless your anxious child just won’t bite the pillow. TV is a problem inasmuch as it is a regular source of scary images for children that will keep them up at night and you from your late-night show. It is a lean, efficient anxiety-producing electronic machine. But also there is the issue of whether it is being used too much as a substitute babysitter and keeping you and your child from more productive activities.


It sometimes can take some time to figure out why your child is anxious or having a hard time in school. Does your child have a short attention span because he/she is anxious or because of attention deficit disorder or both? Or, does your child have some learning disabilities that need to be clearly identified? Whatever the reason, you know that you have a stressed-out child on your hands and the answers to these questions may take some time. When all else fails, consider going back to the basics. A lot of undesirable behavior in children is inappropriate attention-seeking. Children crave attention. The most basic mental health intervention you can give your child is 20 minutes of undivided attention everyday. In a way, it may not sound like much, but actually it can really do a lot to take the edge off things. The activity can take many forms, but please try something more interactive than video games. Sometimes you have to try out a few ideas to find ones that are a good match between you and your child. It will probably be more fun if you engage your child in an activity that you find interesting than one for which you have no aptitude. But then again, being a parent is a way to expand your horizons and develop some new interests.


Time spent with your child is important because children often do not respond promptly and efficiently to such well-meaning inquiries as, “How was your day at school?” The response often suggests that you don’t have security clearance to have access to such information. However, given some time, often children will spontaneously blurt out a concern or share an experience. The time you spend with your child also communicates to her that you consider her important and worthy of your time and that of, course, will help her feel that she is worthwhile. It is one instance where quantity of time is as important as the quality of time.

Two Types of Anxiety

14 Jul


Two Types of Anxiety

I would like to follow up on my previous email concerning the importance of trying to be specific about the anxious expressions in your child. For the sake of discussion, I think it is helpful to draw a distinction between classic expressions of anxiety and what I would call more derivative expressions. In the more classic forms of anxiety, it is usually easier to identify what the child is anxious about with statements along the lines of, “I am scared” or “I am afraid that …” accompanied by an apprehensive facial expression or tense posture. The more classic forms of anxiety can be thought of as an overactive alarm system, in which there are either a high number of false alarms or simply too many alarms altogether. Treatment will involve helping the child face his fear and in doing so reprograming the “alarm system” to more appropriate settings.


But anxiety can manifest itself in a more general form where it is not so much a problem of an overactive alarm system as it is a by-product of a system that has trouble regulating itself. This is what I mean by a derivative expression of anxiety. Some part of the system is not working efficiently and the anxiety is a reflection of this problem. The engine isn’t running efficiently, the machinery used to deal with unexpected/changes in plans is not working efficiently. The glitches will show up when there are transitions. This is different from just an overactive alarm system. This is more like negotiating a dark passageway with a flashlight and never knowing what might jump out at you. If the world is filled with a lot of unwanted surprises, you will be more anxious. Some examples:


  1. A      10-year-old girl with ADHD gets anxious at her summer camp because there      are a lot of field trips pertaining to their nature studies. She has      always had trouble with directions and even as a young adult can get      confused about right versus left. She is anxious because she does not      really understand where she is going and she wonders to herself, “What if      I get lost?”
  2. A boy      with very significant ADHD and dyslexia is very athletic but reluctant to      try new activities. In part he is sensitive to the noise that occurs with      indoor sports and is also unsure of what to expect. He is impulsive and      often gets corrected in school and since he is nonresponsive, voices get      raised.
  3. Children      who struggle with unstable moods will be vulnerable to anxiety. They can’t      count on how they will feel from one moment to the next and this creates a      baseline state of ongoing tension. Not being able to count on some      internal stability will lead to anxiety. So you will see children who are      afraid to be upstairs by themselves or go outside by themselves. Tracy      Anglada has written a book on children with bipolar disorder and she      quotes one child as follows “I      remember being quite anxious as a child. I would describe it as an      unexpected event, where something normal would cause me to panic, my chest      would tighten, my heart would beat rapidly and I would sometimes just      break down and cry” (p 87). And certainly nighttime is a time of      heightened anxieties and with someone with bipolar these fears can be      especially intense where dreams can be quite vivid and disturbing.
  4. Perhaps      it is not as common in children, but the experience of having a major      depression where you can’t focus or concentrate on anything can be a      frightening experience.
  5. A high      school student has experienced significant help from being diagnosed with      ADHD and receiving medication, but complains about being socially isolated      and would like to make more friends. In talking with her, one can see that      maintaining eye contact is a struggle and she does not understand jokes or      any nuances in conversation. She seems to be someone with difficulties in      processing nonverbal information.
  6. Children      with Aspergers or other conditions in which there is a strong detail      orientation and corresponding difficulty in seeing the big picture are      going to be more vulnerable to surprises.
  7. If you      are someone with pronounced sensory sensitivities, you depend on a certain      continuity in order to maintain a sense of well-being. Anything that      upsets that precarious balance will lead to more avoidance behavior. So      one of those children whom the parents had a impossible time calming down      as an infant and had a variety of sensory sensitivities is going to have a      much harder time adjusting to the school environment and may show a lot of      separation anxiety.


Although the distinctions between classic anxiety and derivative expressions in real life may be fuzzy, it is important in making a plan of action to determine whether the primary problem at the moment is the “overactive alarm system” or a larger problem in self-regulation.

So it is just “anxiety”

14 Jul


\Just Anxiety’


I often hear parents explain to me that their child is “just anxious” or that they have been told that their child is anxious. As in, “Johnny is not doing well in school because he is anxious.” By giving him the label of “being anxious,” it may appear that we now understand his behavior. It would certainly be better than suggesting he is just trying to make life difficult. But I don’t think that by itself, saying your child is anxious is very helpful. Too often it can be a catch-all phrase, like “stress,” that doesn’t really say anything. There is a good chance you already know that on some level, and the problem is just being redescribed. To be helpful, a label or description must be specific enough to point in some direction or suggest a course of action. In the most general sense, to be anxious is to anticipate some danger. But we need be more specific about what, how and why your child has anxious symptoms. Some questions that need to be pursued include the following:

  1. What      situations trigger your child’s concern?
  2. While      the situation might be anxiety-provoking for many children, such as the      beginning of the school year, does the passage of time or experience help      the fears diminish?
  3. Alternatively,      is the anxiety more a manifestation that the child has “too much on her      plate” or has too many things to deal with?
  4. Turning      more specifically to your child, what is it about her that makes her view      a situation as more dangerous than the situation seems to merit? Some      possibilities to consider include:
    1. The       child has always been apprehensive, shy or had difficulty maintaining a       steady state.
    2. The       child may have an undiagnosed medical problem.
    3. The       child may have a learning disability that makes it hard to keep up with       his classmates.
    4. The       child may have a condition such as ADHD, which in some ways makes the       world less predictable. As a result, the child feels more ambushed by       surprises on a daily basis.
    5. Finally,       it may be that your child is just “wired” with an overactive alarm       system, but it will still be important to specify the things that seem to       set it off.


It is important to try to be specific about your child’s anxiety. Conversely, you may also want to think about the situations and ways in which your child is not anxious.