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Overcoming Anxiety in Children and Teens

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There are many good books on helping children and young adults with anxiety. Many of them spell out the key treatment components of programs proven to be effective in helping individuals face their fears and overcome debilitating anxiety. What they all have in common is the well-researched treatment protocol known as “gradual exposure.” Study after study has shown that if you can get anxious individuals to gradually face their fears, their anxiety will decrease and they will no longer be controlled by their fears. That is the science of treatment, to gradually face fears. That being said, how do you get someone with overwhelming anxiety to do just that? The art of treatment is figuring out what to do or say to persuade someone to gradually face their most dreaded fears. If you are a parent, teacher, or therapist with a child or teen whose anxiety interferes with the ability to function, then this book can help. Children with anxiety may not present with anxiety issues alone. They may have social or learning challenges that can lead to anxiety. They may have difficulty controlling impulses and their attention which can lead to school and social difficulties that in turn lead to anxieties. They may have autism spectrum disorders that contribute to difficulty with change, sensory challenges, and social and learning challenges that can all contribute to heightened anxiety.

In many ways the strategies described in this book are not meant to be one time strategies to “fix” an anxiety issue, but rather tools one uses for life to help manage anxiety. It’s not unlike the dieting world. Anyone can get on a diet to lose weight, but learning to eat better and exercise as a lifestyle change is what creates lasting health. Those who struggle with anxiety issues may have a more sensitive system prone to anxiety reactions. Learning lifelong skills to manage these reactions is preferable than a quick, temporary fix.

The goal is to learn ways to manage anxiety so that the anxiety does not manage the individual. We all feel anxiety from time to time, yet we do not want it to lead to a pattern of avoidance and limit what we can do in our lives.

Chapter 8: Social Anxiety

Kyle was a 12-year-old in 6th grade. He was diagnosed with Asperger’s Syndrome (AS) and social phobia. Though he had made some friends in elementary school, upon entering the middle school he no longer reached out to them. He sat alone at lunch and kept to himself in class as well. When his mother encouraged him to call his friends he refused. Like many children with AS, he was not only anxious about connecting with peers, he did not really know how. Historically, he had difficulty starting and maintaining conversations, especially on topics other than his special interest, Minecraft. For much of the first month of 6th grade, he did not socialize with any peers except online when playing his favorite video games.

Kyle was a good student, but the transition to middle school was hard as he was expected to do more homework, longer term projects, and work at a faster pace. Upon meeting with the school support team, the parents and staff agreed that his anxiety about work and interacting with others had worsened. The school agreed to provide him with a social skills group, facilitated by me, with high functioning bright peers who also had both social anxiety and skill challenges. The school also provided him with help organizing his homework in a study skills class and access to a counselor who could help him problem solve if he was having difficulty in a class and/or needed help to talk with a teacher.

The homework help seemed to lower his anxiety about getting his work done, yet he continued to resist reaching out to peers. In the first couple of weeks of the social skills group he was very quiet; however, with my help facilitating group conversation, he learned some key skills to start and maintain conversations (see Summary of starting and maintaining conversations from Baker, 2001).

He practiced talking with his peers in the school social group and learning about their shared interests. The skill sheets were shared with his parents and they had him practice with them at home over dinner. He, as well as the other boys, also learned about their many strengths and talents. Most boys had great factual knowledge of many subject areas, especially those focused around preferred interests like video gaming. They appreciated their mutual talents and then learned about a smaller number of challenges to work on, such as socializing with others.
Not accidentally, the boys in the group all shared an interest in video games including Minecraft. After three weeks, I had the boys exchange their contact information and encouraged them to get together around shared interests (like video gaming). Kyle was open to the idea, but he did not reach out at first.

During the next sessions, I began to explain to the boys how anxiety works, that we have both true and false alarms. All the boys shared some of their current or past false alarms, from social fears to anxiety about grades, making mistakes, and fears of spiders and other animals. Kyle seemed visibly relieved to see that everyone had fears like him. The boys were encouraged to think about small steps they could take to face their fears and learn that they were in fact just false alarms. They were taught about the problems of overestimating the likelihood and consequences of negative events. For Kyle, this was about assuming other kids would not like him, would reject invitations to get together, and that he would not know what to do or say if kids did hang out with him. We reviewed the conversation skills he had learned so he could see that he now knew what to say, and that he would have plenty to do if he got together with those who had similar interests. The other boys in the group all volunteered that they would like to get together with him and play video games. The stage was now set to help Kyle connect with peers outside of school.

Kyle created a fear ladder from least to most fearful to gradual face the fear of connecting socially with peers. It was determined that responding to another peers’ phone call or text would be easier than making a call himself as a first step. Thus, the other boys were encouraged to reach out to him and he was asked to just talk with them. If this was accomplished the group would celebrate with cupcakes the next session. Parents were informed about the plan and during the next week, Kyle successfully responded to one of the peers’ calls. Though they did not get together, they discussed plans to have a get-together. In the next group, Kyle was beaming. He and the other boys were heroes to the group as they were responsible for everyone getting cupcakes that day. Kyle made plans to respond to peers again the next week.
As it turned out, one of the boys made a plan to get-together with Kyle, but did not show up. He forgot to call Kyle and tell him that his mother said he had to reschedule. With my encouragement and explanation, Kyle accepted that the boy was not rejecting him and that he simply forgets things sometimes. Consequently, Kyle was able to call him when he did not show up; they rescheduled for the next day and had a successful get-together playing video games. We celebrated again the next group session and Kyle was feeling very proud of himself.

He was willing to call some of the other boys in the group who had indicated they wanted to get-together. That week happened to be a vacation week, so he ended up having three get-togethers, including one with one of his old friends. Kyle had apparently become confident enough to reach out to his old friends and realized they had not rejected him, but had pulled away because Kyle had been less responsive in the beginning of the year. This is a very important lesson, as so frequently those with social phobia assume others do not like them when really others think the individual with social phobia is the one who does not like them. Kyle began to see how his reticence made others think he was not interested when in fact he was just fearful.
As group continued through the year, other fears emerged for Kyle, like speaking in front of the class. His new found confidence from get-togethers helped him want to tackle these fears, as well. In addition to challenging his thoughts about what others might think if he said something silly in front of his class, he learned a couple of other relaxation techniques like deep breathing, and he began an aerobic exercise program at home (stationary bike). The exercise and deep breathing proved crucial in helping him improve his confidence and mood to the point where he began to answer questions in class, make comments, and eventually present an oral report.

 


Jed Baker is the author of six award-winning books, including No More Victims and No More Meltdowns, as well as a series of social skill manuals for school-aged children and adults. Dr. Baker also directs the Social Skills Training Project. His new book, Overcoming Anxiety in Children and Teens, will be available in August 2015. His website is www.jedbaker.com.

 


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Comments

  1. Candelario says:

    Only once have I had issues with antexiy in a social situation. It lasted a few minutes, while I had to speak in front of a lot of people, and was gone as soon as I stepped away from the microphone.

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