Anxious, Fearful Children
Excessive anxiety, selfishness and anger in children can be major sources of tension and conflict in families and marriages. This chapter is meant to help parents come to a deeper understanding of how they can protect the emotional lives of their children from anxiety and fears and guide them. A number of virtues will be presented which can help children and teenagers grow in their ability to deal with their insecurities, fears, anger and sadness in an appropriate manner. A separate chapter on this website addresses the anxiety and anger in obsessive-compulsive disorders in children. Case studies from the child chapter of Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope (American Psychological Association Books, 2000) will be presented.
In a recent research update on child and adolescent psychiatric disorders the authors stated that there is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence and that methods are now available to monitor young people and to make early intervention feasible.
A national comorbidity face-to-face survey of 10,123 adolescents aged 13 to 18 revealed that anxiety disorders were the most common condition (31.9%), followed by behavioral disorders , such as oppositional defiant disorder, (19.1%), mood disorders (14.3%), and substance use disorders (11.4). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavioral, 13 years for mood, and 15 years for substance use disorders, (Merikangas, K.R.,et al., 2010.)
One of the most effective interventions in reducing emotional conflicts in children and in adolescents is that of by anger through the use of forgiveness. Dr. Bob Enright, University of Wisconsin, has demonstrated in his research that the use of forgiveness in children can diminish their anxiety, anger and sadness, as well as improve their school performance. Forgiveness can reduce excessive anger in children and in teenagers and may prevent the later development of psychiatric disorders by giving children and teenager a proven method for resolving anger.
Anxiety and Anger
The first diagram below demonstrates the relationship between unjust hurts and the development of sadness, anxiety and weakness in confidence and its relationship to anger. The second diagram shows how anger can encapsulate in a sense emotional pain and can interfere with its resolution.
A 2005 national study of psychiatric disorders revealed that the median age of onset is
- 11 years for anxiety disorders
- 11 years for impulse-control disorders
- 20 years substance use
- 30 years mood disorders
Half of all lifetime cases start by age 14 years and three fourths by age 24 years (Kessler RC, 2005).
Longitudinal studies have shown that anxiety disorders during childhood are moderately stable and predictive of other mental health disorders, especially depression, later (Rapee R, 2009).
Due to the strong relationship between anxiety and anger it is important to evaluate the degree of anger in anxious children. As the diagram above tries to demonstrate, anger can encapsulate anxiety and interfere with its resolution. Please complete the anger checklist on your child and identify the number of active and passive aggressive angry behaviors.
Now please complete the mistrust checklist which attempts to identify anxious symptoms in children below on your child .
Children who experience separation anxiety disorders, divorce and separation stress, bullying victimization or adoption usually have sustained damage to their basic ability to trust and feel safe in or outside the home. Their difficulty in trusting is often not identified adequately. The mistrust checklist below has helped many parents in understanding the nature of their children's conflicts.
Please evaluate your child on our mistrust checklist.
The common origins of mistrust or fear can be identified below.
- Parental anger or selfishness
- Loss of a parent, sibling or close friend
- Serious illness in a parent, sibling, or oneself
- Weakness in confidence
- An addicted parent
- A fearful, mistrustful or overly controlling parent
- Legacy of mistrust and fear in the family
- Betrayal by loved ones
- Parental separation or divorce
- Rejection by peers
- Victimization by the excessive anger of others
- Excessive time in day care
- Same causes as in childhood
- Poor body image
- Rejection by peers
- Difficulty in playing sports
- Used as a sexual object
- Parental separation or divorce
Behavioral Inhibition in children
The first clinically described conflict with anxiety in children is behavioral inhibition. Approximately 15 to 20% of children can be classified as behaviorally inhibited during early childhood. This temperamental style involves the tendency to show signs of fear, reticence, or wariness in response to unfamiliar situations and to withdraw from unfamiliar peers.
Approximately half of all children categorized as extremely behaviorally inhibited continue to show signs of wariness across childhood. Early reported behavioral inhibition was associated 3.79 times increased odds of lifetime separation anxiety disorder diagnosis, (Chronis-Tuscano, A., 2009).
Separation Anxiety Disorder
Separation anxiety disorder is common among children and teenagers. It is often seen in children who fear that the conflicts between their parents could result in separation or divorce. Symptoms of separation anxiety disorder are:
- recurrent excessive distress when separation from home or a parent occurs
- excessive worry about losing or harm befalling a parent
- excessive worry that an untoward event will lead to separation from a parent
- persistent reluctance or refusal to go to school or elsewhere because of fear of separation
- fearful of being alone without a parent at home
- persistent fears of going to sleep without a parent in the home
- persistent nightmares involving the theme of separation
- repeated complaints of physical symptoms.
The psychiatric diagnostic manual, DSM - IV, indicates that these children may show anger or hit someone who is forcing separation. Also, the child's demands can lead to resentment and conflict within the family.
Studies of co morbidity in SAD reveal depression in one third and other anxiety disorders in one half (Klein, 1989; Last, et al., 1987). Studies of depressed pre pubertal children and adolescents have found concurrent SAD in 30 to 60% of subjects (Biederman, et al., 1989; Ryan, et al, 1987).
Children often develop separation anxiety disorder after some major life stress or traumatic experience which can include: a mothers serious illness, prolonged separation from the mother, excessive fighting between parents, marital separation or divorce, a serious illness in the child, change in school, move to a new neighborhood, or the death of a sibling.
Children whose family histories are positive for depression, panic disorder, and alcoholism appear to be at increased risk. Clinically we find that ridicule and the experience of being a scapegoat by other children may lead to intense fears of betrayal outside the home and separation anxiety. Also, one study found that 83% of mothers of children with SAD had a lifetime diagnosis of anxiety disorder, 53% had a lifetime diagnosis of major depression, and 57% had a current anxiety disorder diagnosis (Last, et al., 1987)
While these youngsters are aware of their intense fears of separation from their mothers or fathers, most are unaware of the cause of their fears and they are not conscious of the anger they have toward those who have hurt or disappointed them. The identification of the origin of their fears and the resolution of the anger associated with the traumatic experience through forgiveness therapy facilitates the treatment of their separation anxiety symptoms. Therapists can relate to these youngsters how their fears are tied into anger from various hurts and will diminish if they can learn to resolve their anger.
This case study from Helping Clients Forgive demonstrates the value of forgiveness in resolving symptoms of separation anxiety disorder.
Marty developed separation anxiety symptoms at the beginning of second grade. He had great difficulty leaving his mother and begged her to ride on the school bus with him. When she did not join him, he would fly into a rage and tell her that he would not talk to her when he returned from school. In the evenings he became increasingly fearful and anxious. The history revealed that there had been no traumatic experiences with his peers that could produce such intense fears. His parents, however, had been separated for a period of six months and his father had only recently moved back home. For two years Marty had witnessed such intense fighting between his parents that, at times, it subsided only with police intervention.
After several therapy sessions Marty was able to identify that he was angry with his parents and that he had strong fear of another separation. "Don't you love each other anymore?", he asked perceptively. His parents were no longer fighting, but they had great difficulty trusting each other and, subsequently, they were not particularly affectionate.
In family sessions, Marty's parents apologized to him for their behavior and insisted that they were motivated to improve their marital relationship. They specified, "You don't have to be afraid. We're not going to separate again because we love each other and were going to work this out ." Although these words comforted Marty, he did not trust them fully.
When it was explained to Marty that the resolution of his own anger would help his fears diminish, he decided to work on thinking of forgiving his par parents for the hurts and disappointments of the past. His work on forgiving was aided by the fact that his parents regularly requested forgiveness from him for all the stress they had caused him.
As Marty worked at forgiving his parents, he became aware that he had much more anger than he realized with each of them. The therapist made the recommendation that he should not feel guilty because the anger was justified and if he worked regularly at forgiving, he would experience his anger diminishing in time. Over the course of several months, Marty experienced a much greater degree of comfort and sense of safety in going to school and found himself feeling much less angry with his parents.
At the same time, the therapist was seeing Marty's parents and attempting to strengthen the trust in their relationship and work on forgiveness between them. Consequently, the improvement in the marital relationship helped to diminish Marty's separation anxiety disorder symptoms in a significant way.
Separation anxiety disorder symptoms are found frequently in the children of divorce and marital separation. Children respond to absence of a parent in the home and the collapse of their parents marriage as a major traumatic emotional event. They regularly develop the catastrophic fear that they may then lose their mother.
In Catholic families when the absence the father is absent from the home, mothers have helped their children with their fears by reminding them that they have another loving father who is with them, St. Joseph, and by placing images of this saint in the bedrooms of the children. Fearful children are also helped by meditating during the day, "Lord, you are with me as a friend. Help me to feel safe and protected."
Children of divorce and anxiety/mistrust
Conflicts with excessive anxiety and mistrust, anger and sadness in children from divorce families have been reported in many studies and books (The Unexpected Legacy of Divorce, Wallerstein, 1991; Between two worlds; The inner lives of children of divorce by E. Marquadt, 2006 and The effects of divorce on America, The Backgrounder, Executive Summary by P. Fagan and R. Recto, 2000, the Heritage Foundation) and observed regularly by mental health professionals.
Dr. Brad Wilcox, sociologist at the Univ. of Virginia, has written that, “The divorce revolution's collective consequences for children are striking. Taking into account both divorce and non-marital childbearing, sociologist Paul Amato estimates that if the United States enjoyed the same level of family stability today as it did in 1960, the nation would have 750,000 fewer children repeating grades, 1.2 million fewer school suspensions, approximately 500,000 fewer acts of teenage delinquency, about 600,000 fewer kids receiving therapy, and approximately 70,000 fewer suicide attempts every year (correction appended). As Amato concludes, turning back the family- stability clock just a few decades could significantly improve the lives of many children,” The Divorce Evolution, www.nationalaffairs.com.
Children can have great difficulty controlling their strong feelings of betrayal and anger, particularly toward a parent whom they viewed as being selfish. Their anger is regularly misdirected at the other parent, a sibling, peers, teachers or a stepparent. Often, they deny their anger, but this powerful emotion can emerge in times of stress. Stepparents can also have difficulties with their anger as a result of a number of factors including residual resentment from their previous marriage.
Rachel was a thirty-five year old married woman who, in addition to her own two children, had two stepchildren in her home. The step-children had been deeply hurt by their alcoholic mother and her abusive boyfriend before they had come to live with Rachel. The children's anger that was meant for the adults with whom they had formerly lived was frequently misdirected toward Rachel and the other children. Their angry behaviors created enormous tension in the home. Rachel became so exhausted and overwhelmed that she even considered separating from her husband, Aaron. She began therapy and quickly after the first session took steps to become assertive with her stepchildren. She identified the origin of their anger and encouraged them to try to let go of their resentment by forgiving their mother and her boyfriend rather than by misdirecting their anger.
It was particularly difficult for Rachel's stepson, Brad, to let go of his anger with his mothers physically abusive boyfriend. Brad viewed that this man as being emotionally sick and his opinion was validated by the therapist. The treatment of his anger was facilitated by punching a pillow and then by thinking he wanted to let go of his impulses to strike back.
This work of forgiveness was a lengthy and difficult process for the children and, at times, they continued to overreact in anger toward Rachel. When that would happen, she would remind them that she did not deserve their anger and would encourage them to try to let go of their resentment with their mother by forgiving her. They were helped in the process by trying to recall that much of their mothers behavior was the result of her illness of alcoholism. Finally, Rachel modeled forgiveness in the home by asking for forgiveness for any ways in which she may have disappointed the children and by granting it to others who hurt her, including their father.
Some children from divorced families harbor rage and some have violent impulses against a parent. Often these young people are unable to use the word forgiveness because they sincerely believe that the parent, stepparent or parents friend should not be forgiven. In lieu of using the word forgiveness, when these children choose the spiritual form of forgiveness, they are asked to think that they are powerless over their anger and want to turn it over to God.
It is important for such strong anger to be addressed because the failure to do so can result in hostile impulses becoming misdirected internally or outwardly toward the family, school, or community. Also, the failure to face and resolve the anger predisposes these children to depressive episodes and difficulties in trusting.
Finally, in merged families a stepparent should have the freedom and the spousal support to correct the anxiety/ mistrust, anger or selfishness in a stepchild by encouraging growth in trust, forgiveness, generosity and other virtues.
Anger and forgiveness in the Children of Divorce
Children from divorced families who live with their mothers often overreact in anger because of their unresolved sadness and anger with the absent father. When a mother suspects this behavior is occurring, we recommend that she explain to her child the 3 options of dealing with the powerful emotion of anger, that is, denial, expression and forgiveness. Then we suggest telling the child, "I believe you have anger with your father that you are misdirecting at me. Please consider forgiving your father daily for all the ways in which he has hurt you. If you have difficulty in forgiving him, your anger can decrease by giving it to the Lord and by taking it to confession. I believe that forgiving your father will help you, because holding onto anger is harmful, and will help our relationship."
Children sometimes respond with a challenge that the mother needs to work also on unresolved anger with the selfish or controlling father. Such families can engage in a family forgiveness process in which they discuss their efforts cognitively, emotionally and spiritually to stop misdirecting anger and to resolve resentment with the absent, offending parent.
Obstacles to Forgiveness in Children and Parents
Since in our clinical experience the resolution of anger is essential in the treatment of anxiety disorders, it is important to identify difficulties in employing forgiveness in children and in their parents. The major obstacles encountered in trying to help children grow in the use of forgiveness include: unwillingness to work on the character weakness of selfishness, modeling after an angry parent, the sense of control their anger gives them over others, and a sense of strength and self-esteem derived from the expression of anger. It is not uncommon, either, for the process of forgiveness to be blocked by parents who excuse all angry behaviors in their children with ADHD, claiming that their behavior is solely the result of biological factors over which their children have no control. Such parents may have serious problems with excessive resentment themselves and therefore they are limited in their ability to teach their children to be responsible for their anger and to resolve their hostile feelings. Subsequently, such parents can help their children by identifying their own anger and working on forgiving those who have hurt them. Unfortunately, some parents have no desire to control their excessive anger. By modeling forgiveness, the majority of parents can bring about a marked improvement in the level of resentment and acting-out behaviors in their children.
Other Virtues Which Decrease Anger in Children:
- sacrificial giving.
The major $80 million dollar research study of day care for the National Institute of Child Health and Human Development (NICHD) included 25 researchers at 10 universities and was led by Dr. Jay Belsky.
The analysis of research produced the conclusion that early and extensive non maternal care carried risks in terms of increasing the probability of insecure infant-parent attachment relationships and of promoting aggression and noncompliance during the toddler, preschool, and early primary school years.
Dr. Belsky stated, "There is a constant dose-response relationship between time in care and problem behaviors, especially those involving aggressive behavior."
This research demonstrates that the infant and child need close bonding with the mother in order to develop a basic foundation for trust and a safe feeling with others. The absence of such bonding is resulting in sadness, anger and mistrust in children.
This research should be considered when decisions are being made about the care of babies and infants, in addition to Brian Robertson's Day Care Deception. Also, Mary Eberstadt's book, Home Alone America, is an important new work on the emotional conflicts in children today resulting from day care and other stresses.
Reasons for a decision for day care include:
- real financial necessity
- failure to be sensitive to the emotional needs of a baby/child
- placement of parental needs before the needs of a baby/child
- perceived financial need for the mother to work based on a materialism/consumerism/selfishness
- fear of divorce in the wife
- an attempt to make women believe that they will find more fulfillment in working than in raising a child
- peer pressure on women to work
- unhappiness and stress in the parental marriage and a fear that the same will happen in one's marriage
- sadness in the family of origin home with an unconscious need to avoid the home
Parental actions to decrease anxiety in children
Parents can take a number of steps to try to protect their children from anxiety. First, they should work to master their own anxiety and fears by growing in trust so that they model calm behaviors for their children. Then, they should their best to assure that children can feel safe and protected in their homes and as much as possible in their friendships. This necessitates the parental mastery over anger because excessive anger in parents is a major source of anxiety in children. Also, they should also protect their children from excessive anger in siblings or peers.
The marital anger chapter can be helpful in the parental understanding and mastery of anger, www.maritalhealing.com/conflicts/angryspouse.php.
Other steps parents can take include:
- avoid arguing in front of the children
- correcting children with gentleness and not in anger
- working to resolve marital conflicts peacefully
- attempting to be a responsible parent and not a permissive or controlling parent
- protecting the child as much as possible so that they can have trustworthy friendships
- building the child's confidence in his/her God-given gifts
- giving cheerfully to one's spouse as one's best friend
- maintaining loyalty to one's spouse by focusing on his/her goodness
- teaching children how to deal with controlling individuals.
In families with strong faith parents also report the benefit of praying with anxious children at bedtime on giving all their fears to the Lord. Also, they coach their children to make acts of trust in God each time they feel strong anxiety and fear.
The role of faith in diminishing anxiety
A number of studies have demonstrated the benefits of faith in addressing anxiety disorders in adults. They include the following:
In a survey of 37,000 men and women those who attend church, synagogue or other religious services, the higher the worship frequency, the lower the prevalence of depression, mania and panic disorder. Baetz, M., et al. (2006) How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Can J Psychiatry 51:654-61. Researcher Marilyn Baetz, MD, of the University of Saskatchewan in Canada, stated, "The higher the worship frequency, the lower the odds of depression, panic disorders and mania."
The importance of religion was a predictor of improvement in panic disorder after one year. Over time, the improvement was seen for the religion was very important. Bowen, R, et al. (2006) Self-rated importance of religion predicts one year outcome of patients with panic disorder. Depress Anxiety 23:266-73.
In a systematic review of 850 studies the majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being, life satisfaction, happiness, positive affect, and with less depression, suicidal thoughts and behavior, drug/alcohol abuse. (Moreira-Almeida, A., Neto, F., Koenig, H.G. (2006) Religiousness and mental health:a review.Rev Bras Psiquiatr.28:242-50.)
As stated in other sections of this web site, faith can play a beneficial role in the healing of emotional pain and conflicts. (See Healing and Faith at the National Library of Medicine web site, www.ncbi.nlm.nih.gov/pubmed/.) A number of spiritual interventions help in resolving anxiety and in building trust. These include employing daily modification of the first two steps of Alcoholics Anonymous and thinking, "I am powerless over my anxieties, mistrust, anger or my tendency to control and want to turn them over to God." Also, a daily meditation upon God as one's protector can decrease anxiety in youth.
In June 2008 Pope Benedict commented on the role of faith in addressing anxiety when he stated, " In the face of the ample and diversified panorama of human fears, the word of God is clear: He who 'fears' the Lord is 'not afraid.' The fear of God, which the Scriptures define as the 'beginning of true wisdom,' coincides with faith in God, with the sacred respect for his authority over life and the world. Being 'without the fear of God' is equivalent to putting ourselves in his place, feeling ourselves to be masters of good and evil, of life and death."
"But he who fears God feels interiorly the security of a child in the arms of his mother: He who fears God is calm even in the midst of storms, because God, as Jesus has revealed to us, is a Father who is full of mercy and goodness. He who loves God is not afraid," 6/22/2008.
Also, consultation with a priest has been beneficial in helping children to learn how to trust the Lord more with their fears.
Positive psychology or the role of virtues in the treatment of childhood disorders is a new area in the mental health field. However, growth in virtues has been viewed in western civilization, until recently, as being essential to the healthy character development of children in the home, school and community.
Forgiveness is a highly effective virtue in diminishing the excessive anger that is associated in most childhood anxiety disorders. In addition, growth in trust and in responsible parenting are effective in decreasing anxiety and fear in children. Responsible parenting involves understanding the needs of children for close, comforting and secure attachment relationships with a father and a mother and responding to that need even if it involves self-denial or living a more simple lifestyle.
Further information about addressing excessive anxiety is available on our anxiety chapter, www.maritalhealing.com/conflicts/anxiousspouse.php, and our webinar on anxiety, www.maritalhealing.com/angryspousewebinar.php.