Gifted Issues Discussion homepage Forums Twice Exceptional Dealing with Anxiety

Highly-intelligent DS9 has been diagnosed with anxiety. I’ve posted previously on him in general, so I’ll try not to repeat too much here.

Unfortunately, he lets his anxieties rule his life, and actively (and aggressively) avoids any situation that he even thinks might cause him stress. He is completely irrational about his fears and will not listen to reason or take suggestions.

For instance, he is currently refusing to go on vacation with us because it requires a 3-hour car ride. He thinks that he will get sick in the car. He is also nervous about going to a new place, being able to find food there that he likes, etc. We have shown him pictures of all the fun things to do at our destination, such as an indoor waterpark, a zoo and a really cool-looking children’s museum. He seemed very interested in all of them. But he broke down and cried at the thought of going, and told us there was no way we could make him go, and that he would never leave the house.

This problem has been going on in one form or another for over a year.

I’ve read numerous books on how to manage children’s anxieties. However, all of these books so far seem to implicitly assume that the kid wants to discuss and overcome his fears. Not so with DS9. He is an avoider and will either shut down or melt down at any suggestion of talking about or doing something about these anxieties.

Any advice on how to get through to a kid like this?

My wife and I have already booked the trip and we firmly believe that letting him force us not to go would be a bad choice. On the other hand, we don’t think that physically tossing him in the car would be a productive solution either

Thoughts?

We have been there.

Our process most looks like "deliberate sabotage," where we have systematically put little, then big challenges into the mix so that DS learns that he can manage them. This can be as small as buying a different brand of bread, or "running out" of his favorite snack. Even if some of these challenges result in meltdowns, afterward we have debriefed and he is able to agree that yes, he's still alive even though he didn't get X, not getting X did not result in serious harm, and he lived to tell the tale. In the short term this is extremely exhausting, but over time it does yield more resilience.

You can also have HIM address his list of concerns. Look at restaurants nearby and make a food plan; or plan what he feels he would like to have with him. If he is prone to car-sickness, let him make a plan for dealing with that. Having a plan for the things you're afraid of can make a big thing feel less like an emergency, and more like a situation to be managed. If he won't talk it through, you may have to demo this process by making that list yourself within his earshot the first few times, but then gradually work up to having him do his own troubleshooting. Having an action plan can be very calming.

Our DS also found it helpful to study statistics and learn to distinguish between likely and unlikely scenarios. Your DS's concerns sound more focused on personal safety than on weather/natural disasters, so the action plan is probably the first line to take.

I definitely wouldn't cave to anxiety by cancelling the trip.

I hope it all goes well,
DeeDee

p.s. Do you have professional help for treating the anxiety more generally? An SSRI can make a world of difference, allowing a child to access behavioral treatments for anxiety...

DeeDee,

Thanks.

We have been taking the approach you suggest with gradual de-sensitization. The problem is for this instance, we do not take long trips that often (2-3 times per year). So regular driving around town, in his mind, is different from a "trip".

Nonetheless, I plan to get him in the car for a 45-minute or so drive this weekend. Hopefully without having to deal with tears.

As for his list of concerns, I think we know what they are, but like I said, he's an avoider. He'll just curl up and refuse to talk when we ask him to explain why he's getting upset.

And, he is a math whiz - loves it. I tried the statistics approach with him last night and managed to get him to admit that the probability of getting sick on a trip is less than 100%, but he settled around 50% rather than the 2% I suggested.

These are all great ideas and are in line with the approach we're planning to take. Thanks so much for the concrete suggestions!

And yes, we have a therapist. Currently we told DS that the therapist is a specialist who helps smart kids like him get what they need out of school, but we are going to back-door this into anxiety and self-esteem therapy as well.

I am probably terribly wrong in my approach, but I treat DS's anxieties as if they were possible/realistic/etc and ask, well, what do we do about that? Car sickness - okay, let's pack some sick bags, and some anti-nausea gum and is there anything else you want? A change of clothes? Let's be prepared!

I try and treat his anxieties as simply obstacles to overcome. Honestly, most of the stuff he's anxious about IS possible, though not always likely, so we discuss what would happen if his fears came true. What if that rope broke and I fell when I was climbing? Well, there's a padded mat, and if I fell funny, they'd call the awesome paramedics and they'd take me to the ER and fix me right up! You know your friend so-and-so who broke an arm, right? He wasn't rolling around crying at school was he? Nope, he was fine because doctors are awesome!

That sort of thing. It's worked pretty well so far. I do tend to have to "shiny" things up (ie, paramedics came come super fast and doctors can always fix things, etc) and we'll probably have to alter this later, but for now I focus on getting through each day!

Probably depends on the kid; we go the other way and look hard at the worst-case scenario and how likely that is and how we'd respond. DS is not a pessimist, but his anxiety tends to go toward worst-case, and he WILL NOT BELIEVE us if we give him a rosier picture. If we go there with him, though, and say, OK, if the house was engulfed in fire, you'd go out that way and meet us at the neighbor's, he actually feels better. Weird, but works for us.

DeeDee

We tend to go that route, too. As bizarre as that sounds.

We don't have the diagnosis, but DD9 has has missed five days of school lately due to anxiety. She also is refusing to eat a lot of food, imagining it has e coli on it, etc.

Since 2nd grade she has taken things she overhears from adults and turned them into huge worry monsters. She has some gift of eavesdropping. The problem is she won't always tell us what she's thinking, so we rarely know what's bothering her.

Apparently in 2nd grade she heard that pitch/sap on some trees can catch fire, so she'd spend entire recesses alone waiting for the trees to catch fire.

This e-coli thing got so out of hand that she refused to eat a potroast she cooked for Girl Scouts, despite it being well-done and despite my most rigorous assurances.

We've long shielded her from ugly facts because of her tendency to explode them into fear monsters and then not tell us. I wonder if maybe the opposite approach might be better, like finding a good website that fully discusses e coli, or even having her ask her pediatrician about it. Or would that backfire with her mind picking up on more ways things could hurt her?

Hmmm-- well I might try it with something that truly IS very farfetched and also includes a significant locus of control in terms of avoidance of poor outcomes.

Like the tree/pitch thing-- assuming that you don't live in a coniferous treehouse.

I wouldn't do this with a food pathogen worry. That one only gets scarier the deeper you look. Scares ME plenty to think about that one.

Maybe something where the consequences are less ominous? Head lice? LOL. (Another personal phobia of mine.)

Okay so disclaimer: I am pretty mainstream but I am also open-minded. I pretty much will try supplements or whatever - but I am not against science and medicine at all or anything like that. I realize that supplements, etc can be 'snake oil' but I guess I think some may be helpful and I am willing to try.

My kid is anxious and has an anxiety diagnosis... In February I started giving him this herbal supplement http://en.wikipedia.org/wiki/Rhodiola_rosea because he seemd irritable and I was researching around about herbs and such to help. I saw an immediate difference. I didn't tell my mom or DS's teachers or my husband that I was giving it to him and, I kid you not, they ALL commented on how much better DS seemed - less irritable and angry within a day of his starting the herb. One day he was annoyed and stressed and anxious and I thought of maybe those herbs really aren't doing anything after all it was just a placebo effect. Then I found the pill on the table next to his water. He put it aside and hadn't taken it (Btw, he thinks its just a kid vitamin). If you try it you have to get the kind that comes from Russia (the kind from China does nothing) I get "New Chapter Rhodiolaforce" - it's harvested (supposedly) in Russia and is also allegedly organic. I give him 100mgs in the morning a half an hour before breakfast and 100 mgs when I pick him up from school at 3pm. My DS gets fatigued due to his hypotonia issues and such, so maybe it's just that it is helping with rather than his anxiety - I don't know. I just know whatever it si doing it is working. Just a thought for you. I have tried other things (herbs and supplements) and wasted money (one made him hyper for two days - it was carintine supplement that I gave him for fatigue and low muscle tone). This is the only suppkement I have tried thus far and REALLY saw positive significant improvement and the first one where others who were unaware I was giving him something were like "what is up with DS I=he seems so much less upset and anxious and miserable." It works so well I am taking it now...

This is pretty much what I would have recommended. I think it's very useful to begin instructing a kid like this on risk management. Okay, here's a risk... how likely is this? What can we do to prepare? What can we do to respond?

For example, if the kid is worried about being carsick... has he ever been carsick before? That'll tell you how likely it is. Then you can start on your preparations, like what epoh says here. And then your response... what kind of signal should we have that you're about to be sick so we can pull over? After it happens, stop at a truck stop for a shower? Where are those along the way?

And then, of course, after it's over and nothing happened (assuming he's never been carsick before), say, "I told you so."

For the kid with the E-coli anxiety, I'd give them a blacklight, and explain how ultraviolet rays kill microbes like E-coli. Just shine the light on your food before you eat it, and you should be good to go. I'd also take the time to explain how the cooking process eliminates this as a problem. Then, a couple hours after eating the same food with no UV, I'd say, "Look, I'm fine. Told ya."

Ok. So I mean this is the most kind, respectful tone, so please read it that way if you can. And if I'm off base, just ignore completely.

In a sane world, a 9 year old would not even imagine that he has the choice or power to decide if he is going on a family trip. It would be a given, and he might raise a ruckus, campaign with tears, negotiations and drama, but it would be with the assumption that he was negotiating with the people in power of making the decisions. Somehow your kiddo has come to the conclusion he is in control and can make this kind of ultimatum, and for a child with anxiety, this is scary. He is very aware that he shouldn't be in control and isn't experienced enough to be in charge, so it actually makes the anxiety worse.

I've had two of my kids have anxiety to various extents - the youngest much worse than the older. Here are some of the things that helped:

1. We established firm rules with immediate consequences so they knew we were in charge.

2. We didn't ask when we didn't want the kids to think they had a choice, we used declarative sentences - we are going, you will be, to more the plan for all of us is...

3. We gave them acceptable areas of negotiation - several options that were all acceptable to us - we are going to our friends' house for dinner, and we're aware you're going to be bored since they don't have kids, so you can take one video game player, three games to play on it, two books, and one other item that you can run by us to make sure it is ok. That way you'll have something to do. They never got the option of negotiating whether they had to go, but we gave them ways that they could feel in control within the boundaries we set.

4. When one of them panicked or their anxiety escalated, we talked through worse case scenarios, what their plan would be if the worst happened, and I used humor a lot to break the tension. Once, right before a major competition, one of my kids completely freaked out about competing. We talked about what would happen that could be the worst - them being laughed at, breaking a bone, etc., and then about what could happen if they didn't compete - their team mates being angry, their embarrassment. And then I threw it the idea that they could still break a bone tripping on something in the parking lot. Unlikely, and it broke the tension. Somehow understanding that there were risks either way, they were able to conquer their fears.

Your kiddo needs you to be strong, in control, but still accessible and understanding. That is a huge order, and I didn't always succeed. But when I did, their anxiety was much less because they knew that someone who cared about them was in control and helping them cope.

Oh, and I totally agree with Portia about the downtime. After the three hour drive, make sure you have time in the hotel or wherever you are going to unwind and recharge before you do anything else.

It's so interesting to see all the differing opinions. DS5 has gotten more anxious as each year has passed and it really affects his life now. We hope it's a phase. And we are lucky he's still so young in that much of the time it's easy for us to see that it's his personal drama that needs to be managed rather than that the family should make some major change. If he were my DH instead of a 5 year old of course if he said he couldn't manage a long trip then we wouldn't go. Where is the magic cutoff age or level of anxiety that makes it valid to change plans?

In our family we vary in how we handle each thing that comes up with DS depending on how we as adults perceive the true level of threat and what DS thinks may help. We try not to get into the stats with DS but sometimes we do. Sometimes we laugh at him outright. Sometimes we drop everything and offer a shoulder to cry on. But we pretty much always go wherever we said we were going, to let DS dictate the schedule would be a really slippery slope. Sometimes though I do let him cut the day short, when it's been a rough day for him I'll cancel errands etc and let him get home, and here and there I let him stay home if he wants. DH mildly disapproves.

For DS, despite him thinking it is this or that that is anxiety provoking, it's more that some of the time he's anxious, and when he's anxious he's prone to interpreting normal life events to be upsetting. He then latches onto those particular things and the next time his internal state is anxious he revisits those things to think about. Sometimes he's anxious and hasn't got anything good to fixate on and I'll hear him go through several different worries one after another.

Our ability to manage him has improved a lot over the last 6 months. For us a big help was realizing that the moment we say anything at all in response we are making it feel important to him, whether it's us cracking and telling him in a tense voice to be quiet about it, or gently listening to his feelings in an effort to make him feel he's being understood. It makes it something. As master of none said sometimes the act of talking about a fear gives it more power, for DS that seems to be true. For DS even the act of us getting emotional telling him to knock it off can draw too much attention to it and make it so he feels compelled to talk about it. Whereas if I'd said nothing he might have moved on to something else. So the only thing we've found for his repeat chronic worries that reliably works is total silence on our part.

There's the repeat chronic worries and then there's times when it's obvious he's just riddled with anxiety, and in the latter times I try to give him attention for his inner discomfort without discussing any particular item he's mentioned. Like, "you look like you could use a hug".

I sort of feel like my job is not to end his anxiety because he's got to learn to live with it, but to help him avoid fixating on any particular OCD item that would really interfere with life. So basically being really supportive in terms of understanding that he's anxious, but not giving him any attention or latitude when he worries specifically about germs, modes of travel, etc.

We wrote down a list of house rules and one of them we invented (in the being polite and respectful of others category) is that people get to express their feelings twice and then if no one else wants to talk about it the issue needs to be dropped for the moment. Us adults try to remember to ask him later or the next day if he wants to talk about X that he was upset about earlier, bring it back up once he's well fed and exercised and all that. We don't always remind DS of the rule but when he has said a couple times in a row "are you sure this apple doesn't have chemicals on it?" we remind him of the two times rule and ask him to move on to something else. If he doesn't he gets a time out.

By the way, DS is eating the apple with socks over his hands because of some historical apple anxiety 2 years ago that was miraculously solved with hand socks. We let him indulge in small things as that makes him feel loved and accomodated. He doesn't eat apples in public because he really likes to wear the socks and doesn't have access to socks out in public. LOL. I'm still hopeful after 2 years that it's a phase.

DS has just about daily meltdowns. I worry (yes there's the genetics) that he may need some accomodations in school next year for being so emotional. For example this week with anxiety over a fun activity coming to a close, he melted down and cried the last 20 minutes of it because it was about to end, thereby missing that last 20 min. So for example I can see him needing unlimited time on tests, lest he begin worrying about the test ending the moment it starts and thus not being able to complete it.

Since DH and I have gotten tough about employing silence in managing DSs drama he and I have unexpectedly bonded over it. It's really hard to not engage sometimes. When we start feeling like we are about to crack and engage in some way with DS's anxiety we reach a hand out and the other takes it...

Anyways that's our take on our particular DS, ended up sort of repetitive but that's some insight to DS's genetics, LOL.

I can imagine it gets much harder with a 9 year old because they are now able to convincingly discuss subjects like an adult but can still have the irrational amorphous fears of a small child.

I hope this response happened after someone had already addressed the question, because it's a good one. What with all the talk about organics these days, it's very likely he has been exposed to information about the pesticides and other treatments our produce is subjected to.

If the child is already worried about something, legitimately or otherwise, it can only increase their anxiety if nobody in a position of power is even listening. The internal dialog starts leading to questions like these: "Does Mommy know about pesticides? What other dangers doesn't Mommy know about? Where can I turn to learn about them if Mommy doesn't?"

All of which can be headed off with, "Yes, I washed it."

Hi Dude,

Yes the ignoring part comes after the concern has been addressed. It is something we are finding helpful with chronic repeat sorts of worries.

It really is not true for my particular DS that "it can only increase their anxiety if nobody in a position of power is even listening". It is the opposite for DS for his particular style of chronic repetitive worry.

For these repeat sort of reflexive worries saying something like, "Yes I washed it" does not head anything off. For him it amplifies things by prolonging my participation in his internal conversation, it adds weight to it and makes him feel his internal reflexive thought, "my apple has cooties" is valid.

Me saying, "yes I washed it" would then lead to, "yes I washed it well" and to, "yes it is an organic apple" on to, "yes I'm sure because we only buy organic apples", "well I don't know, we could look that up on google if you want to", etc. A similar exchange would happen every single time I handed him an apple, because he feels worry every single time he looks at an apple and it comes out as questions. At some point ignoring it is what we have come up with as most helpful to for decreasing his level of worry. If instead of answering his apple question I say, "Do you want some milk with that" or "hey guess what I saw today", it distracts him from the anxious thought.

On the other hand, with a new worry such as happens when he accidently overhears a wisp of a very adult discussion (did you hear so and so has breast cancer, he wonders is that contagious?), talking to him and answering any questions he has is very helpful. In that situation engaging and talking about it does decrease further worry for him.

I do this too. I try and pace these exposures so that he's not too stressed out, but occasionally I'll deliberately not smooth things over for DS8 so that he just has to DEAL with it. Sometimes he rolls with it, and other times he melts down. I think overall it's helped though.

My son and I also deal with anxiety this way, but when the weird statistically unlikely things started happening more frequently to my family I had a lot more anxiety because I realized we could not prepare for everything. My son will have to have a six-hour surgery and stay in the hospital for nearly a week and I can't even think about worst case scenarios, but he has been playing some kind of online surgery game and I think this might be his way of desensitizing himself. I think he feels that it works better for him than seeing another doctor about his medical related anxiety.

My son and I homeschool and were working on probability and statistics when we found out that he had something that was about 1 in 5000 chance of having. I started thinking about how unlikely it is for someone to go in for routine surgery perfectly normal and come out with severe brain damage but it happened to my mother. It felt like only bad things were happening to us and we had no control, but my son said that it was statistically unlikely that we would be born and that was a good thing. He told me once that I was using gambler's fallacy or reverse gambler's fallacy or something like that when I was ready to give up trying to do something that I wanted to do because I was having a lot of bad luck and just expected it to continue.

I almost didn't tell him about a chance to be an extra on a film a few days ago, something he had wanted to do but couldn't because he wore the brace for several years. I had anxiety knowing that he would have to be there for hours, might get a migraine, would not be able to eat lunch until they finished the scene, would probably get back pain if he couldn't move and stretch like he is able to do at home, etc. I thought about what he said and decided we would just try it. He loved it. He was selected to do a classroom scene, playing a high school senior even though he is only 14. He was younger than several of the boys who were not selected, but he looks and acts like a kid several years older and his friends were always several years older. He had so much fun and he learned more about movie acting. He wants to do more things like this. He did musical theater for years, but he would like to do more film acting or voice acting. It gives him more of a reason to risk the surgery to fix his back which will get worse if he doesn't have the surgery. He knows the risks but will not let anxiety or pain stop him from doing what he wants to do.

What a great thread with a great amount of wize input.

I'd like to add a few more items. Use your child's intelligence to advantage. I'll agree that the same method isn't going to be appropriate in every scenario, however, keeping track of concerns and making a list over a period of a few weeks / months, then sitting down to say, "Here are the concerns that you've had as of late, lets go over them and see which of your concerns actually became issues in reality." Most GT kids are pretty good seeing patterns. They may very well realize that their concerns are ill founded a great percentage of the time and they've invested a great amount of negative emotion for no good cause.

If you're a family of Christian belief, take some time to review what scripture has to say about worry. That went a long way with our eldest DS.