Ask Dr. Jacque – Answers to Your Child Anxiety and ADHD Questions

When you don’t have much time to work on your plans or on the problems, start with consistent 1:1 time with your child. Or after you’ve worked on some plans and have helped your child confront some fears, you may still hit bumps in the road or stressful/busy times. When this happens, always go back to a consistent 1:1 time. It’s the best buffer your child will have for big emotions or stressful situations.

It is certainly a hard thing to balance. We don’t ever want to force a child to do something. It’s important to consider if what you’re seeing is a fear, or if it’s part of a larger anxiety problem. For separation fears in younger kids, think about if the situation is one that “would be nice for them to try” or if it’s something necessary. If it’s a “nice to try situation,” waiting it out or trying again in a few months might be the way to go when kids are resistant. When we’re talking about developmental separation anxiety, time and more experiences will also help. Another factor is how much flexibility you have in the situation. For example, the date of school starting may not be flexible, but having a babysitter for date nights is generally more flexible. With more flexibility, break down the situation into smaller steps and wait for your child to adjust and be successful with each step. When there is a specific deadline and less flexibility, you might need more active coaching to help them prepare and try.

Kids with more anxiety and fears, can also have more sensitive temperaments that may require additional consideration. The safety, trust, and supportiveness of other adults involved can contribute to how well your child adapts to the situation. If you’re able, try to partner with people that understand your child’s fears and are supportive of kids who are more hesitant or cautious. For example, let’s say you’ve hired a babysitter and your child is having a hard time staying with her. As you’re leaving, you notice the babysitter isn’t doing anything to engage your child and seems a bit distant. Instead of working more on separating when this baby-sitter comes, it might be that this particular babysitter is not a great fit. This may also be true when kids are worried about school. Try to understand if there’s anything else going on at school that could contribute to their anxiety. For example, a teacher that criticizes regularly or kids who tease can cause more anxiety. These are not times when kids should be urged to face their fears without understanding and addressing the problematic interactions that will maintain that anxiety. Situations like these that aren’t remedied may require other classroom options.

A parent’s job is so hard when we not only try to address issues, but also help our kids learn and develop at the same time. I would recommend sticking with what’s observable. “You’re crying right now. I see that you’re upset.” When you’re unsure but still trying to help your child develop their emotional vocabulary, you could say, “I wonder if you’re hungry/tired/scared.” If you name something incorrectly, you are not doing damage. Kids will usually tell you if it’s not correct.

I know in a situation like this, things can be extra challenging. The great thing with many of these strategies, is that they are meant to be adapted to fit your particular needs and situation. If a child processes things more slowly or differently, or has learning difficulties, or another diagnosis like ADHD, I would recommend a neuropsychological evaluation if you haven’t had one. Working with a qualified professional to develop a list of strengths and challenges specific for your child, will allow you to better tweak things specific to anxiety.

If you’re concerned, an evaluation by a qualified professional might be best. It might be an anxiety problem when:

• what’s happening has been going on for at least a month
• the child is over the age of 4
• it’s getting in the way of family, friends, and/or school

If you’re trying different strategies, and it’s not getting better it might be time for extra support.

Some behaviors that might be a sign of separation anxiety disorder are:

• Throwing a tantrum/meltdown before you leave
• Avoiding sleepovers and/or playdates away from home
• Refusing to go to school
• Having nightmares about something bad happening to themselves or parents. Like car accidents, burglary, or kidnapping
• Asking a lot of questions about being away from parents
• Following parent(s) around the house like a shadow
• Not wanting to be alone at home
• Calling/texting caregiver a lot while gone
• Having trouble sleeping alone
• Complaining of physical symptoms like stomachaches or headaches while anticipating separation

Talk about the drop off and transition at a calm moment. Ask your child, “what’s the hardest part about drop off?” Role-play the drop off with toys and stuffed animals. Parents should play the role of the stuffed animal that has trouble separating. See what the child can come up with to help. Also role-play your good-bye routine ahead of time. In the moment, use acceptance + confidence language. Draw attention verbally to anything brave that’s the opposite of clinging. If your child is small enough for you to pick up, you can gently remove them from your body and hand them off to the other caregiver. While you do that say, “It’s time for mommy to go. I love you. I will see you after snack time!” Keep it brief, calm, and confident. Another option, if possible, would be to have the grandparent or teacher unbuckle the child from the car seat and escort them away from the car. That way, the child does not have the opportunity to cling in the first place. If you go that route, make sure you let your child know ahead of time.

I wouldn’t worry too much about some nights here and there. With babies and toddlers, there’s a lot happening biologically and developmentally that could be affecting sleep. For example, teething, imagination development, changes in nap routine and schedule, learning new physical skills like running and jumping, speech progressions, etc. With two-year-olds, their resistance may have to do with learned routines, rather than big fears. Try to:

• implement a special time during the day
• consider a lovey/stuffed animal to sleep with
• keep routines and responses consistent

Make sure there’s an optimal sleep environment and schedule. Try bedtime check-ins. For example, stay for 5 minutes. Then, come back and check on her every minute or two until she’s asleep. Or you could space the check-ins to 5, 10, and 15 minutes.

I wonder what this child is afraid of specifically when it comes to school. When you’re able to answer that, it might help tweak how you prepare and practice. Try asking your child, “I know it’s really tough to leave for school. What’s the hardest part about it?” I would try to add some extra practice around whatever the child says is hardest. For example, “No one likes me” might call for meeting some of the kids ahead of time. Or “I’ll get sick at school,” might lead to practicing a plan if your child gets sick at school. Put pictures or words (if the child can read) on a notecard about who to tell and where to go. Role-play what would happen according to the card. In the moment of leaving for school, for kids that are small enough, I would gently and calmly pick them up and carry them to the car while using supportive language and drawing attention to brave behavior. You may also try partnering with a trusted and warm person at the school who can give you assistance in the morning. They could come to your car or to the door and help walk your child in. It might also help if you can familiarize that person with the support framework and using language about brave behavior.

This could happen for many reasons. New fears pop up for young kids frequently. I know this is hard, yet try your best to avoid getting frustrated. If you haven’t yet, I recommend watching through the Masterclass. You can say where you’re going ahead of time, so there’s no surprise. Use the supportive language that I talk about, and try practicing separation on purpose like hide and seek and playing with toys in separate rooms. You can say, “thanks for using your regular voice to ask where I was.” Or, “thanks for waiting quietly/playing until I came back.” Some of the general strategies described in the other questions may also be helpful.

Remember that facing fears is hard work. Learning to do things that make you uncomfortable is tough. If kids are stuck or stubborn, you’ve tried the language and relationship builders and practices, and you’re not getting anywhere, it might be time to add rewards for facing fears. You might also try having a motivation discussion with them. Find out why it’s important for them to work on this. Do they want to be able to go to sleepovers, or go away to college without you? What is it that they’re missing out on because of anxiety? Use that as a motivation to help them practice.

And don’t forget that change in kids’ behavior takes time. So does putting a lot of the strategies in practice. There’s a reason many of the evidence-based therapies for child anxiety and parenting are at least 12 weeks long. Behavior change requires learning something new or different. And learning requires repetition, effort, and time.