Family Chat Recap: Helping Your Anxious Child

Family Chat Video Replay Below

Our recent family chat addressed challenges related to your child’s anxiety. It featured guest speaker Lauren Moskowitz, a clinical psychologist and faculty member at St. John’s University, and our excellent panelists, who you can learn more about in the video. We share a small recap here but encourage you to watch the presentation for additional information.

Lauren integrates cognitive behavioral therapy (CBT) with positive behavior support. She emphasizes the interaction between thoughts, feelings, and behaviors, particularly in the context of anxiety.

The First Step

The first step in addressing anxiety is psychoeducation, which involves educating children and adults about anxiety to demystify it. Externalizing anxiety by giving it a name, such as a villain, helps children align with their parents against it.

The goal of treatment is to learn to face anxiety rather than eliminate it. Reframing thoughts through cognitive restructuring helps children challenge their anxious thoughts.

Gradual Exposure

Lauren encourages parents to help children tolerate uncertainty and explore coping strategies. She stresses that gradual exposure is the most critical component of treating anxiety.

Exposure should be done at the child’s pace, starting with small steps rather than overwhelming them. Exposure should take precedence over relaxation techniques in treating anxiety, as relaxation doesn’t work for everyone.

Lauren advises against forcing children to confront their fears, recommending instead to incentivize and encourage them through positive reinforcement. She emphasizes the need for significant rewards to motivate children to face their anxieties.

Structure, Predictability, and Transitions

Structure and predictability are crucial for children with autism, as transitions can be a significant source of anxiety. Visual schedules, social stories, advanced warnings (countdowns), and timers can help children anticipate activity changes.

Gradual exposure to unpredictability can also be beneficial, but it is essential to establish a foundation of structure first. Timers can be helpful tools for most children, although a small percentage may find them anxiety-inducing.

Quick and painless approaches to transitions are encouraged, likening the experience to getting a shot—it is better to get it over with than to prolong anxiety. Transition objects, songs, and routines are ways to make transitions less aversive. For example, using a cleanup song can make cleaning up more enjoyable for children.

Visual Aids and Special Interests

Strategies for nonverbal children with autism include the need for concrete instructions and visual aids and involve parents in the treatment process. Using special interests can help children overcome anxiety, and pairing exposure with their interests can be an effective strategy.

For nonverbal or minimally verbal children with severe aggression or self-injury, it is crucial to pair these exposures with high-power reinforcers.

An example shared involved a child with autism who feared doctors but was obsessed with Mr. Potato Head. By introducing Mr. Potato Head into the doctor’s office, the child began to associate the visit with something positive, gradually reducing anxiety over time.

Excitement and Anxiety Connection

Children with autism may experience excitement and anxiety similarly, as they can be intertwined, making it difficult to distinguish between the two. Parents could help their children manage this by providing structured, step-by-step guidance to navigate their feelings.

Self-talk is vital for children with autism, and they should approach their feelings like a science problem. This method involves breaking down situations into manageable steps, which can help reduce anxiety.

Parents can assist by providing clear, specific instructions and visual schedules to help their children understand what to expect.

When to Confront Fears

Not all fears need to be confronted, especially if they do not significantly impact a child’s quality of life. Parents should prioritize which fears to address based on severity and the child’s overall well-being.

For example, a child’s fear of spiders may need to be addressed if it leads to significant behavioral issues, while less impactful fears can be accommodated.

Providing Choices to Foster Control

Children with autism often have limited autonomy, so providing choices about how to complete tasks can help alleviate anxiety and foster a sense of control by making the child an active participant rather than a bystander.

While some children may thrive on making choices, others may find them overwhelming, so it is essential to gauge individual needs.

Previewing Activities

Another option is to prime or preview activities, which involves familiarizing children with new environments, such as schools or dental offices, through videos or visits before the actual event.

The importance of social stories is emphasized, particularly in helping children understand and manage their anxiety. An example is given of a boy with autism who had anxiety about getting sick and how a social story enabled him to cope by establishing new rules around his anxious questions.

A book series called “Super Flex,” which uses visual stories to help children understand and combat their anxieties by relating them to characters, was recommended. At the end of the webinar, many other resources are also listed for parents.

These Family Chats are led and sponsored by parents and professionals from Parenting Special Needs, Home, and Community Positive Behavior Support Network, Positive Behavior Supports Corporation, Bierman Autism Centers, Parent to Parent USA, and The Partnership for People with Disabilities at Virginia Commonwealth University.

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