Dr John Sharry: Five steps to beating your child’s anxiety

In this series of six articles, we have looked at a number of important of principles for helping anxious children and teenagers. We described how it is important to start with their strengths, to respond thoughtfully and calmly, to coach them in problem solving and to teach relaxation strategies as well as techniques for managing their anxious thoughts. In this last article, we consider how important it is to agree a plan of action with them. Anxiety can be an ongoing problem that is not easily defeated so you and your child, need to work together over time to manage it.

Creating a step by step plan of action

One of the biggest errors in tackling anxiety is taking on too much at once. For example, you might try to help your child overcome a fear of social situations by bringing them to a busy event or a child with a fear of water/ swimming by asking them to get into the pool. In these instances you can provoke an anxiety meltdown and increase the fear for the next time. In overcoming fears a better approach is to break the problem down into small and easy steps. For example, if your child has a fear of water, you might start with the small step of playing in a paddling pool or even the smaller step of playing with a doll in a small basin of water. The important thing is to set them up for success. Make the step so small that success is inevitable which gives you an opportunity to praise them for their courage and build on this achievement to take the next step.

Deciding the first small step

Often the hardest thing for parents is to decide what the first small step might be. For example, supposing your child is socially anxious and avoids parties. Rather than insisting they go to a big party to overcome their social anxiety you might identify some easier steps such as 1) starting with a playdate in the home 2) going to smaller party where they know people 3) going early to the party when fewer people are there 4) identifying a friend that they can go with. Negotiate with your child a small step they are willing to try.

Or if your child is out of school because of anxiety – it might be too big a step to start back on a busy Monday morning. So instead you could make things easier by 1) starting on a different day 2) starting with a favourite class such as PE 3) arranging to meet a supportive teacher before class 4) going back for a half day or 5) having the option of the child going to safe place/meet a supportive person if they feel too anxious. Putting time into making a step by step plan with the child (and the school) will make things a lot easier.

Using rewards and consequences

To motivate children to be brave and face their fears, it can be helpful to use rewards such as a star on a chart for the preschooler, extra daily pocket money or a special trip at the weekend for older children. Rewards are best explained in advance – “I know it is hard for you to get up and go to school. To help you we are going to give you a special reward each time you are brave and work hard at doing this”. For young children it can be helpful to do up a reward chart with them that pictorially explains step by step what they have do to gain the reward.

Using consequences to hold children accountable

As well as rewarding children for tackling their fears it is important to make sure they don't experience any secondary gains when they don't. For example, if a child avoids going to school due to anxiety and then has a fun day at home playing on the X-Box, then it will be doubly difficult to change things the next day. For this reason it can be useful to ensure your children experience consequences for their avoidance. For example, "If you go late to school you will have to do extra work in school at breaktime" or "If you stay off from school, you will have to do homework at home for the day". Consequences can also be used to manage the behaviour problems associated with anxiety – "I know you are worried, but it is not okay for you scream at me – you will only be able to go out when you calm down". See my book Positive Parenting for more ideas on how to use consequences effectively.

The importance of prevention

As well having a plan to tackle anxiety problems, it is important to also prevent problems happening in the first place. In the long term you want to build your child's emotional well-being and self-esteem so they learn to accept and love themselves – this is the perfect antidote to anxiety. Building self-esteem can be done via a series of practical steps by helping children express their talents and passions, teaching them how to form good friendships and helping them become involved in meaningful projects. This is a topic that is covered in more details in my book Bringing up happy confident children and the previous six-part series that I did in The Irish Times that you can access online.

Tips for going forward

When helping anxious children a thoughtful step by step response is what work best.

1. Pause – Take a moment to reflect about your child’s anxiety and how you are currently responding to it

2. Tune in – What is going on for your child? What is the best way to respond

3. Plan – Take time to agree a plan of action with your children

4. Prevent – Think about how you prevent problems from happening again?, How can you address the underlying issues? How can you build your child’s confidence and self-esteem

Dr John Sharry is a social worker and psychotherapist and co-developer of the Parents Plus Programmes. He will delivering a workshop on Parenting Young Children in Cork on Saturday 1st April and Promoting Positive Self-Esteem in children in in Dublin on Wednesday 10th May. See www.solutiontalk.ie for details

This the last article in the six-part series on Helping Children and Teenagers Manage Anxiety – all six are available at The Irish Times website.