Written by Regine Galanti
When a child has anxiety, it often becomes a family rather than individual problem. While an adult with anxiety might suffer alone with racing thoughts of danger, or avoidance of anxiety provoking situations, children with anxiety are best viewed from a perspective that incorporates the whole family. This family-perspective is often true of adults with anxiety and OCD, but in the case of anxious children, it is the norm rather than the exception.
Take the case of Emma, an 11 year old who begins to have panic attacks. When she had her first panic attack, she was alone in her room, and felt her heart pounding, her breathing quickened, and her body began to shake. She was sure she was having a heart attack, and felt terrified, helpless and alone. When she felt better, she was determined to avoid those feelings of being alone and helpless forever. In order to feel safe, she refused to stay alone in her house, despite the fact that she used to do so easily. She demanded that her parents drive her to and from school, despite having taken the bus for years. Her father had to rearrange his work schedule to go in late every day, and her mother had to leave work early to pick her up. She was also incredibly fearful of being the last one awake in the house, and would constantly check on her parents to make sure they weren’t sleeping before she did. Her parents took to sitting in the living room to “prove” to Emma that they were awake, despite previously reading in bed, and sometimes going to sleep before their pre-teen daughter. She also asked her parents an endless string of health related questions, which she demanded the answers to, even though she challenged every answer. Emma’s mother and father were distressed by the effects of her anxiety on her own life, but recognized it was taking over their lives as well.
The term family accommodation is used to describe the ways in which family members of individuals with anxiety disorders adapt or modify their own behaviors to reduce their child’s anxiety. Accommodation in families most frequently involves parents – over 90% of parents of anxious children report that they change their own behavior to reduce their child’s anxiety in some way — but sometimes incorporate siblings as well. On its face, this may seem like a positive, as the family members are changing their behavior in order to reduce anxiety to help a child function better. Higher degrees of accommodation, however, are related to many negative factors in childhood anxiety, including a higher level of impairment in anxious children, and more severe symptoms. Accommodation sends the message to a child that their anxiety actually IS dangerous. In the case of Emma, her parents modifying their behavior to reduce her anxiety tells her that if she does stay home alone, something bad might actually happen, and that would be dangerous. Her parents are protecting her from something that isn’t actually dangerous, thereby sending her the message that she needs protecting. Instead, our goal when helping families with anxious children is to help parents support their anxious children – teaching parents how to tell their children that anxiety is a normal emotional experience, and that the best way to handle it is to face those fears even though it’s difficult rather than avoid them. The important factor to keep in mind here is that, though the child might be the one in treatment, often parents can play a role in reducing anxiety as well – though not in the way that you might think. By stripping away the layers of accommodation, parents can teach children how to face their fears in a healthy, adaptive way, and improve their long term functioning.