A roadmap for helping children with anxiety
Have you heard of SPACE?
We might have thought the worst of the pandemic for kids was the lockdown - being isolated and separated from friends and community activities. However, for some children, reentry is harder. Anxiety was the most common mental health difficulty facing children prior to the pandemic, and now it seems nearly universal. Perfectionism, separation difficulties, sleep problems, picky eating, social difficulties and even some sensory issues can be rooted in underlying anxiety. A lot of families have been asking me for advice about their children’s anxiety recently, so I figured it’d be helpful to talk about it.
Cognitive behavioral therapy (CBT) is the gold standard in treating anxiety in adults or children. Using this technique therapists focus on teaching identification of cognitive distortions, coping skills, and methods to improve regulation. CBT has been shown to decrease anxiety in more than 60% of children with the results lasting at least 4 years after the sessions are completed. What to do when you worry too much (for elementary age children) and Anxiety Relief for Teens: Essential CBT and mindfulness practices to overcome anxiety and stress are two highly recommended resources for families looking to engage in this work at home.
However, committing to CBT doesn’t appeal to everyone. It requires a substantial motivation and effort to engage in difficult work. So it’s helpful to have choices to help anxious children. Dr. Eli Leibowitz at Yale has developed a technique working on parents which has been shown to be equally effective as CBT directly with children. His Supportive Parenting for Anxious Childhood Emotions (SPACE) program is likely to appeal to a lot of families where parents would like to learn what they can do to help their children.
So what is SPACE? Over 12 weeks parents are taught supportive responses to anxiety that acknowledge the difficulty of the child’s experience while expressing confidence in the child’s ability to cope. Together with a therapist the parents map out what accommodations have been put in place to help the child. An accommodation might be not leaving your child in a different room or staying with your child until they fall asleep at night (separation anxiety) or answering repeated questions about the future and providing frequent reassurance (general anxiety disorder). Once you identify the accommodations, you select how and which to scale back and refine your message to the child to optimize the impact.
Awareness of the need to avoid excessive accommodation of anxiety has made it to the mainstream, but the nuance of how to do this while supporting your child is essential. Well-intentioned parents might struggle choosing an appropriate target, enforcing consistency between caregivers and knowing when you are pushing “just right”. So while the program SPACE probably isn’t available everywhere unless you live by Yale in New Haven CT, the techniques behind it are explained in Leibowitz’s Breaking Free of Child Anxiety and OCD. FWIW I don’t know him and I’m not being paid to write this, but after reading about his work I read the book and found myself recommending it to several friends this week.
It’s important to understand that successfully improving anxiety by targeting the parent behavior doesn’t mean the parent caused the anxiety in the first place. Mental health is far too complex to identify one causative factor, and it’s often not productive to ask why. But parents can foster an environment and provide responses to help children improve.
But… all this said, parents should not feel they have to navigate their children’s anxiety alone. These resources may help or get you started, but if your child or a child you care for is having anxiety, it’s best to discuss with a pediatrician and consider finding a psychiatrist, school counselor, or therapist to help. Some children will have other modifiable risks for anxiety such as poor sleep or abnormal thyroid function or may be best served by incorporating medication into the plan to make therapy more effective.
I shared in my stories that I am catching up on the “Reading Wars” which is the debate about the best way to teach children to read. It seems that science indicates phonics works best, but many schools have clung to the whole language method potentially to the detriment of some children. A local educator called it essential reading, and many of the teachers who follow me on instagram agree.
I have a lot of sympathy for the struggle to disseminate evidence based practice. In medicine we know it’s at least 10 years from new finding to new standard, and education is a similarly complex system so of course it takes time and can’t be solved by individuals in the system. But when you have children learning to read, it’s helpful to know the context of how they are being taught.
We are seeing a surge in typical respiratory viruses as pictured above (source here) so you may want to check out these instagram posts if hand foot and mouth or RSV is striking your family.
Thanks for reading! If you found this helpful drop a comment or share it with some friends. I’ll talk to you soon!