DO YOU HAVE AN ANXIOUS CHILD?

Michelle's parents don't know what to do. Their daughter is afraid of a lot of different things. She shakes when she sees the neighbor's dog, she's nervous about sleeping in her own room, and she's anxious when she's in a new situation—like the first day of the school year, starting day camp, or going away with her family on vacation.

Michelle's pediatrician says it's just a stage she's going through—that she'll "grow out of it" when she gets older. But her parents know they didn't go through this with her older sister. And Michelle's friends don't act like her.

How can they be sure what Michelle's going through really is normal? Or does she have a problem they need to pay attention to?

The elementary school years can be a stressful time for parents. Your child, who was "your baby," is now a little person.

During this period, children change in many ways. It can be hard to know whether what you're seeing is a normal phase that all kids go through or a sign that your child has a problem, something you need to give special attention to.

Children experience many fears and anxieties as part of their normal development. In some cases, though, these fears and anxieties go "beyond normal" and interfere with your child's well-being.

If you're reading this book, you probably suspect there is a problem. Maybe you've observed that your son or daughter is more fearful than his or her friends or the other children in your family. Maybe your child's doctor, teacher, or even a mental health care professional has said that your child is overly anxious.

To know for sure whether there is an anxiety problem, you first need to be aware of exactly what is normal. Which fears and anxieties are expected—are considered normal—during a child's development?

The Normal Fears of Childhood

The objects and situations that children fear most probably are not sources of anxiety to you, and it may be hard to fathom how harmless things—like thunderstorms, unfamiliar people, or a dark room—can cause your child so much distress. If this is your first child and you have not been through this before, this is particularly understandable.

All children have fears. The so-called "normal" fears of childhood are referred to as such because they occur, almost without exception, among all boys and girls—in children from all races, nationalities, religions, and ethnic groups, and among families with different financial and living situations.

Each of the common fears of childhood is linked to a particular age period. I've listed the usual ages of onset for them in the sidebar on page 5. For example, before your child is two you will see a number of fears appear, including "stranger anxiety" (fear of unfamiliar persons), separation anxiety, fear of high places, and fear of loud noises and looming objects. These fears may continue for several years, even up to the age of five. The way they look, however, changes as your child gets older.

Let's use separation anxiety as an example. Billy, who is eighteen months old, shows his fear of separation by screaming and turning red in the face when his mom leaves the room. Clara, who has just entered kindergarten, shows her separation anxiety differently, in a way that's more appropriate to her age. For the first few days of school—until she's familiar and comfortable with her new surroundings and being away from her home and mother—Clara pleads with her mom to let her stay home.

When children are a little older, at two or three years of age, fears of the dark and small animals develop. Fear of the dark can continue for quite some time, even up to age seven or eight. Seven-year-old Tyler insists on having a nightlight in his bedroom and having the door to his room left open so the hall light shines in. Fear of small animals also can go on for several years, but usually goes away by the age of five.

At ages five, six, and seven, kids start showing fears about experiencing some type of bodily harm or injury. Chad, who is seven, is afraid that burglars are going to break in at night, even though (as his parents have pointed out) their house has an alarm system and is in a very safe neighborhood. Five-year-old Sage has begun expressing concerns about "getting hurt" or getting into an accident. Crystal, who has just turned six, told her dad, "I'm worried I'm going to be kidnapped!"

The early school years also are the time when fears of monsters and supernatural beings—ghosts, witches, mummies, werewolves, and vampires—occur (you'll probably find yourself being asked to check your child's closet and under the bed to make sure your son or daughter's room is "ghoul proof"). These fears often start with movies your child has seen. For example, Tara, age five, became fearful of witches after seeing the classic children's movie The Wizard of Oz for the first time. Seven-year-old Chen also became scared of witches after seeing the new Harry Potter film.

During kindergarten or first grade (at age five or six) kids become frightened of certain adults, whom they label "bad" or "mean." This can continue for several years or even for the rest of elementary school.

Your child may determine that someone is "bad" based on physical appearance—usually a physical appearance that's different from what he or she is used to. For instance, Rachel, a first grader, told her mom that she was scared of the homeless woman with the shopping cart—"the bad woman"—who was sitting on the front steps of the library. Tory, age five, was frightened of the man at the convenience store ("the bad man") whose arms were covered with tattoos.

The use of the word mean can be a child's way of describing adults in authority positions who are perceived as critical or strict, and who make the child feel anxious. These can be people who raise the volume of their voice a lot ("yellers"), or naturally have a loud voice, or use a particular tone of voice that is uncomfortable for your child.

Fear of thunder and lightning usually appears around the age of six and then continues for a year or two. During thunderstorms, six-year-old Simon sticks his fingers in his ears to try to block out the sound. In some cases fear of thunder and lightning goes on for a longer period of time, even through the fourth or fifth grade (age nine or ten). Beth, like Simon, first became frightened of thunder and lightning when she was six. She continued to have difficulty sleeping during thunderstorms until she was ten.

Also at age six, your son or daughter may begin to show anxiety about sleeping alone in his or her own bedroom. Your child may repeatedly ask to sleep in your bed or may "slip" into your bedroom (and your bed) during the middle of the night.

Kids also may be fearful at this age about being alone in places or situations where their moms or dads are not visible, even though they are readily accessible. For instance, your child may be uncomfortable being alone in a room of your home if you are in a different room. This was Keith's situation—he was unable to be alone in his playroom, even though his parents were right down the hall.

Your child also may be afraid of "minor separations" outside the home. This was the case for Kathryn, who insisted on being inside the stall of a public bathroom that her mother was using, rather than waiting just outside the stall door. Fears of sleeping alone and being alone should subside by the time your child is eight.

Fears begin to be influenced by media events—usually things your child sees on television (particularly the news)—at age seven or eight. The following fears frequently begin in this way:

• Fear of flying (following publicity surrounding the crash of an airplane)

• Fear of natural disasters such as hurricanes, tornadoes, floods

• Fear of manmade disasters—war, terrorist attacks, nuclear explosions, etc.

• Fear of diseases like AIDS and cancer

• Fear of being kidnapped

At around nine or ten, in the fourth or fifth grade, your child's fears turn to performance and social concerns. Fears of taking tests, giving oral reports, and performing in school in general come to the forefront. Your child also may begin expressing concerns about performance or "competence" in other things—like sports, playing an instrument, dance class, or any other nonacademic or out-of-school activity. At this age kids also become concerned with their physical appearance and others' (particularly peers') perceptions of them and whether they are "popular" and have enough friends.

This too is the time when your child may become preoccupied with the concept of his or her own—and others'—mortality and fearful of death. Shortly after her dog died, nine-year-old Sharon started to worry about what would happen to her when she died. Margaret, a fifth grader, began worrying about her parents dying after her grandfather passed away.

All these fears—about performance, social status, and death—can continue until your child is eleven or twelve years old. Some even may persist (with changes appropriate to your child's increasing age and changing developmental stage) into adolescence.

Why Childhood Fears Are Universal

Research has shown there is consistency among childhood fears. As I mentioned earlier, kids with completely different backgrounds—different nationalities, religions, financial circumstances, etc.—are facing the same types of fears and at the same ages. One way this can be understood is by considering the adaptive and protective nature of fear, especially in terms of its evolutionary significance.

For over a century, ethnologists—people who study survival patterns in the animal world—have known about the positive impact that fear can have. In more recent years, psychologists also have used this concept to help explain the development of fears and phobias in humans.

According to this evolutionary theory, people are "preprogrammed" from birth to develop certain fears, ones that have, historically, contributed to the survival of our species. Through the process of natural selection children who possessed certain fears—and avoided these objects and situations—were more likely to survive, become adults, and reproduce. In this way, it is argued, fears have become inbred into human beings, or, at the very least, the predisposition or "preparedness" to develop these fears has been passed down genetically, through the generations.

The evolutionary view helps explain why certain childhood fears—such as separation anxiety, stranger anxiety, fear of heights, fear of the dark, etc.—are so common among kids. In addition, it explains why the common childhood fears occur at certain times—that is, when they are most advantageous to children's survival. The "flip side" to this is that there are times when fears have passed their normal developmental periods, when they no longer are beneficial to your child, and actually become an impediment.

A good example of this is children's fears of heights. Your young child's fear of high places can increase the likelihood of survival (avoiding potentially damaging, or even lethal, falls). However, as your child's motor coordination and visual acuity become more advanced this fear no longer may be adaptive. In fact, it actually may hinder your child from showing a healthy sense of adventure and becoming an autonomous and independent human being.

This is an example of how a normal childhood fear can persist too long and go "beyond normal," a subject I'll be discussing in more depth later on.

Environmental Influences on Normal Fears

Although the normal fears of childhood generally cross all "dividing lines" (ethnicity, religion, gender, etc.), some may be less likely to occur because of children's backgrounds and other environmental factors. For example, children who have grown up with a family pet (a dog, a cat) may be less likely to have a fear of small animals (or may have it to a lesser degree) than kids who haven't had this type of exposure. On the other hand, exposure to certain circumstances can make a child more fearful. For instance, research has shown that a fear of burglars is more prevalent among children raised in an urban, as opposed to a rural, environment.

As I mentioned earlier, the events within our society, especially those that receive extensive media coverage, also can influence childhood fears. For example, while a fear of kidnapping—in both children and parents—certainly is not new, it seems to have grown in prevalence and intensity in recent years, probably because of the enormous media attention now given to child abductions.

What Is the Difference between "Fear" and "Anxiety"?

You've probably noticed that I've used both the words fear and anxiety in this chapter. Outside the mental health profession, especially among parents, "fear" often is thought to be less severe—more normal—than "anxiety." However, this really is not accurate. Fear can reach such high levels that it greatly, adversely affects your child's functioning. (In this case, the fear usually is termed a "phobia." We'll talk about this in the next chapter, where the focus is on childhood anxiety disorders.)

So what's the real difference between fear and anxiety? Although this is a straightforward enough question, there is no simple or single answer. The exact meaning of the two terms, and the differences between them, is debated even in psychiatric and psychological circles, and, thus, there is no consensus opinion on the matter.

Some professionals distinguish between fear and anxiety by the presence or absence of an object or situation—"fear" being associated with an outside "stimulus" (for example, fear of dogs, fear of public speaking, fear of flying, etc.; in other words, fear of something) and "anxiety," by contrast, being free-floating and not attached to a specific object or situation.

Although this point of view was popular for many years, current knowledge has led us to a different perspective today. Now experts believe that anxiety is a more global, or broader, phenomenon than fear. "Fear" is one type, or one form, of "anxiety." However, anxiety includes many more things than just fear. It also affects many aspects of your child's being, including feelings, behavior, and thoughts.

Anxiety includes generally uncomfortable feelings, such as being tense, nervous, "on edge," jittery, "uptight," jumpy, panicky, or, as we already discussed, fearful, which your child may describe using these words or in other ways. Nathan, age seven, told his mom, "My insides feel like they're jumping around!" Five-year-old Selena says she feels like she has "ants in her pants."

Anxiety also can appear as specific physical symptoms—like a racing heart or heart palpitations, tremulousness, dizziness, or "trouble breathing" (usually caused by hyperventilating). Brad, a fifth grader, told his dad, "My heart's pounding so hard it feels like it's going to come out of my chest!" (You might be interested to know that research consistently has shown that increased heart rate is the single most reliable indicator of anxiety.)

The physical symptoms produced by anxiety sometimes can look like a medical problem. The most common of these are headaches and, especially, stomachaches. Your son or daughter may complain of stomach pain or queasiness, nausea, or feeling like he or she is going to vomit. Maria, a fourth-grade student, feels like she is going to throw up before taking tests. At gymnastic meets, six-year-old Tara always complains of "butterflies" in her stomach.

Anxiety also includes nervous habits, like nail biting, hair pulling or twirling, a "restless leg," or knuckle cracking. Ten-year-old Katrina constantly redoes her ponytail, taking the elastic band out and then putting it in again. Tina is a hair "flipper," repeatedly jerking her head sideways to push the hair off her face.

Your anxious child may exhibit perfectionistic behavior. This was the case for Justine. At a parents' conference her kindergarten teacher said, "Justine is never happy with her drawings—she keeps erasing and doing them over, or else she throws them out and starts again."

Sometimes there are repetitious behaviors or rituals, where your child feels compelled to do something over and over again even though it really doesn't make sense. For instance, Brittany, age seven, has to have her dolls arranged in a very special way on her bed. Mathew, age ten, turns the light switches on and off three times whenever he enters or leaves a room.

"Not doing" certain things—avoiding or escaping contact with objects or situations—also is a type of anxious behavior. Sheila, who is afraid of dogs, wants to cross to the other side of the street when she sees a dog coming her way. Sometimes anxious behaviors are less obvious than this. For example, Janice, a third-grade student, never raises her hand when the teacher asks a question. Eleven-year-old Melissa goes to her friend's party but is a "wallflower."

Ten-year-old Charlie had trouble "adjusting" during his first year at sleep-away camp. When Angela's family moved and she changed schools, she'd call her mom from school every day, pleading to be allowed to come home. Being uncomfortable in new or unfamiliar situations—as in Charlie's and Angela's cases—is a common sign of anxiety.