Mona Potter, MD and Kathryn Boger, PhD, ABPP recently partnered with ADAA to host an engaging Q&A webinar addressing strategies for raising children with anxiety and OCD. The engaging discussion provided parents and caregivers with practical advice and recommendations, and the audience asked so many wonderful questions that Drs. Potter and Boger were unable to respond to everyone in the allotted time. That’s why they wrote this blog to address the most common topics that came up from the questions.
1. How should parents approach conversations about anxiety and OCD with their children or teens?
We suggest you lead with curiosity. Instead of telling your child or teen that you need help, we recommend sharing your observations with them (e.g., “I’ve noticed that you’ve been avoiding your friends lately”) and asking for feedback (e.g., ” Has it been like that?” Your experience about it?”).
Before you jump into problem-solving mode (which is very tempting as a parent!), first take the time to really listen to your child’s responses and show compassion (e.g., “It seems like you’ve been feeling lonely lately. I’m sorry). I imagine it is like that). been very hard).” Let them know that they are not alone and that you are here to support them. You can reassure them that there are also skills and interventions that can really help.
More generally, we recommend creating a culture of listening and sharing in your family that can help build your child’s confidence to reach out to you when they are going through a difficult time. You could start with family meals as an opportunity for your family to get together and talk about a variety of topics. You can also set aside other regular times to catch up with your child, such as during walks or car rides. Again, the key is to lead these conversations with curiosity and openness.
2. If a child has anxiety or OCD issues, who can parents talk to?
The first rule of thumb is that if you are worried about your child, follow your instincts and seek support. As a starting point, we suggest contacting your teen’s pediatrician and/or school support to discuss the problem and possible resources. These professionals can help you identify the problem and develop a plan of action. They can also provide you with a support system and a sounding board, so you don’t have to carry your worries alone. Different people may be able to offer help for different aspects of the situation, so don’t hesitate to seek support from more than one place (for example, school, pediatrician, friend).
If your child has an outpatient therapist, we recommend reaching out to that person. Then, the therapist, your child, and you could make a plan for how and when the information will be shared and what your role will be.
3. Can you summarize your tips for raising a child or teen with anxiety?
Supporting your child who has anxiety requires patience, understanding, and a willingness to continue practicing strategies. Here are some important things you can do for yourself while supporting your child:
Pay attention to your own emotions and the behavior you are modeling. Children and adolescents can be very perceptive and learn a lot by observing their parents’ behavior. Try to project confidence and calm, even if you, as a parent, are experiencing your own share of anxiety in various situations. This doesn’t mean you can’t show your feelings to your child. In fact, calmly acknowledging your own emotions and modeling how you handle them teaches your child that it’s okay to experience their feelings and that they can develop tools to cope and adapt. For example, in an anxiety-provoking situation, you might acknowledge that you are feeling nervous or fearful and narrate out loud how you are handling your feelings. For example, you could say, “I’m feeling a little nervous about talking to my boss today. I went for a bike ride this morning because I know it helps calm my body and I remind myself to prepare for this conversation and that I can handle it. Even if my boss gets frustrated, I’ll be fine.”
Name and externalize anxiety. Many children and teens who have been struggling with anxiety or OCD begin to assume that the disorder has become part of their identity (i.e., “I’m an anxious person, so I can’t speak in class”). Giving anxiety or OCD a name is a way of separating the disorder from the child’s identity, making it external and separate from who she is. You might encourage your child to give her anxiety a name or imagine her as a separate character, such as a “worry monster” or “Bob.” This can help children and adolescents begin to develop language to talk about their anxiety or OCD and can also give them more agency and confidence to respond skillfully to their symptoms.
Acknowledge and allow your child’s feelings. Instead of launching into problem-solving mode when your child is distressed, first take a moment to pause and really try to understand how he or she is feeling. Then reflect her feelings. This might sound like: “I can see how stressful you feel coming to school today. He feels very hard.”
Encourage your child to deal with difficult things. Anxiety builds on itself by causing feared experiences to be avoided. Help your child gradually confront the things that scare him so that he learns that he can handle them. You can help your child break down the fear of it into smaller steps.
Stop doing things for your child. Parents of children with anxiety often try to buffer or prevent their children’s anxiety by doing things for them, such as speaking for them in public or doing their homework for them. This makes the child feel better in the short term, but actually increases their anxiety in the long term. It also teaches them to trust you as a parent. Practice slowly removing and eventually eliminating these behaviors, one at a time (no need to rip off the Band-Aid!). Let your child know that he is doing this deliberately, not to be mean, but because you trust that he can do it. Be prepared for your child to have strong reactions at first until he finally adjusts and her brain learns that she can handle everything on her own.
4. How can parents effectively address and reinforce positive behaviors when a child is living with anxiety?
Attention is very reinforcing for children and adolescents, so one thing you can do is be strategic with your attention. When it comes to your child’s behaviors, the ones you pay the most attention to will increase. If you pay close attention to your child’s anxious/avoidant behaviors, you will see more of these behaviors. Instead, try to give a lot of attention and praise when your child demonstrates brave behaviors, even if they seem small (e.g., “I’m so proud of you for taking that brave step today”).
In addition to providing verbal praise and recognition, tangible rewards can provide incentives for behavior change in children and adolescents with anxiety or OCD. Consider creating a reward system where your child can earn points or tokens for engaging in brave behaviors. These points can then be redeemed for meaningful rewards, like extra time to play, a special outing, or a small item they’ve been wanting. The combination of attention, praise, and tangible rewards can have a significant impact on your child’s motivation and confidence when he or she faces things that are scary and difficult.
5. If their mental health professional recommends medication, will a child or adolescent eventually learn to control their anxiety without it?
The beauty (and vulnerability) of the child/adolescent brain is that it is growing and developing, constantly being shaped by experiences and actions; Therefore, how your child responds to her anxiety will determine how it progresses over time.
Research has shown that combining medications with cognitive behavioral therapy (CBT) is more effective in treating anxiety disorders and OCD than either intervention alone (although especially when symptoms are detected early). time or if the anxiety is milder, it is very reasonable to start with CBT alone). The role of medication can be seen as reducing the biological intensity of symptoms so that your child/teen can make effective use of therapy and practice new ways of responding to their anxiety and/or OCD. As this new learning is practiced, it becomes stronger and medication may no longer be necessary. After a period of 6 to 18 months of stability (i.e., improved functioning and remission of symptoms), it is very reasonable to consider a gradual taper of the medication, in collaboration with the prescribing physician.
6. How can parents and families of loved ones who suffer from anxiety or OCD take care of their own mental health or find support resources?
It can be very lonely and overwhelming when your child struggles with anxiety or OCD. Other people around you (family, teachers, neighbors) may not recognize that your child is dealing with anxiety or know how to support you or your family. Let a few trusted people in and be direct about what you find helpful (e.g., giving him a periodic break, listening, etc.) and what you don’t find helpful (e.g., making comparisons with your own experiences). The road to recovery is full of obstacles and the village you create can help you overcome the obstacles.
As you overcome the obstacles of this journey, it may be helpful to take stock of what you have control over and what you don’t. A useful exercise is to draw a circle on a piece of paper. In the center of the circle, list all the things you can control (e.g., your emotional reaction to your child, your parenting behaviors) and outside the circle, list the things you cannot control (e.g., your child’s reaction to a situation, certain events at your child’s school). This simple visual representation helps you recognize where you can exert influence and where you should focus on acceptance and letting go.
Another way to take care of yourself on this journey is to practice mindfulness. Give your brain a break from worrying about your child’s future or past by returning your attention to the present. Practice being present throughout the day and particularly in the presence of your child. For example, put down your phone, breathe in and out slowly, and use your senses to focus on your surroundings: notice the five things you can see, four things you can hear, three you can touch, two you can smell, and one you can taste. . When distracting and discouraging thoughts come to mind (and they will because you’re human!), notice them and gently push them away, returning your attention to the sensations. You can practice mindfulness alone and with your child at any time of the day: in the morning, at mealtime, or before bed.
Watch the full Q&A webinar here.
Webinar in association with ADAA member and institutional partner Health at a brisk pace
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