One of the biggest challenges of parenthood is deciding when to let your child take risks and when to be protective. Watching a kid climb a tree or ride a skateboard can be nerve-racking. How do you keep him from breaking his neck without undermining his confidence and independence? “Kids pick up on parents’ fears,” notes Rebecca Berry, PhD, a psychologist at NYU Langone’s Child Study Center. “So when you have the urge to yell, ‘Come down from there,’ take a few deep breaths. Then ask yourself, ‘Is this really something I need to worry about?’ In many cases, it isn’t.”
But not all parents are able to make such judgments easily. “If your anxiety is causing your child to miss out on activities that most of her peers enjoy, it can be helpful to seek professional guidance,” Dr. Berry advises. “Like many other mental health conditions, anxiety has an environmental as well as a genetic component. Studies show that kids whose parents struggle with anxiety are two to seven times more likely to develop an anxiety disorder themselves. But they do better when their parents’ symptoms are under control.”
Dr. Berry remembers one nine-year-old patient, Helene (not her real name), whose nervousness at school kept her from making friends or participating in class. She often went to the nurse’s office complaining of a headache or stomachache, and begged to be sent home. During Helene’s first session, Dr. Berry noticed that her mother, Doris, held open the bathroom door for her, using a handkerchief. Later, the girl explained that her mom also held her above the toilet seat, brushed her teeth for her, and insisted on holding her hand whenever they crossed the street. Dr. Berry realized that Doris, like her daughter, was suffering from an anxiety disorder. “She was terrified that something bad would happen to Helene if she wasn’t there to protect her,” she says.
“If your anxiety is causing your child to miss out on activities that most of her peers enjoy, it can be helpful to seek professional guidance,” Dr. Berry advises.
Over the next few months, Dr. Berry treated Helene using cognitive behavioral therapy, which focuses on examining the relationships between thoughts, feelings, and behaviors. By exploring patterns of thinking that lead to self-destructive actions, and the beliefs that direct these thoughts, patients can modify those patterns and improve coping. (Helene was also referred to a child psychiatrist, who prescribed medication known to improve mood and reduce anxiety in kids.) As with most preteen patients, Dr. Berry asked Helene’s mother to attend every fourth session. She also suggested to Doris that treating her own anxiety might aid her daughter’s progress. Doris agreed to see a therapist and—with Dr. Berry’s help—to work on changing her behavior toward Helene.
For patients with anxiety disorders, a central element of therapy is controlled exposure to anxiety-inducing situations. “The idea is to gradually face your fears, learning to cope with the distress and work through it,” Dr. Berry explains. Some of her “homework” assignments for Helene involved using a public restroom unaided, from opening the door to sitting in the stall; the challenge for Doris was to refrain from intervening. Helene was also assigned social challenges, beginning with making eye contact with a stranger and culminating with speaking in front of her class. Doris’s task was to encourage her, whatever her own worries.
After 20 weeks, mother and daughter had improved enough to end the therapy. “Helene’s physiological symptoms had lessened substantially,” Dr. Berry recalls. “Her expression was brighter. She laughed more. Doris was able to let her daughter be a kid.”