The vignette above describes the difficulty in ever defining the one variable that might account for prolonged separation anxiety. It seems that once some children get frustrated or anxious, they recall other overwhelming, anxious feelings. Within two minutes, their anxiety escalates from zero to one hundred miles per hour. The comfort introduced by parents does not become part of a new template for some children. Instead, they feel hopelessness and mistrust of their parents every time they separate from parents. Some special techniques to help these children are described throughout the rest of the chapter.
Anxious children like Kaylene do not get labeled as "attachment-disordered." Parents do mention that they have "issues." It is hard for these children to trust parents' enduring love. Parents and children give and receive love, but even this relatively easy situation can push parents' resources to the maximum. Some children who start out anxious become more controlling over time. The process can deteriorate with age, rather than improve. (See Chapter 3 for a discussion on Insecure, Anxiously Ambivalent Attachment). Parents are looking for ways to help their children to calm down. The words that people say to themselves to talk themselves through difficult situations are referred to as "self talk." This resembles the encouraging or comforting talk that people have heard from their parents as children. It sounds like, "You are doing great;" or "Keep on going;" or "Remember why you came;" or "You will be fine, just get started." People elaborate on the framework that their parents laid. This self-talk is enormously helpful for most people in helping them to reduce anxiety. However, it tends fail people, the more anxious they get. The work of Bessell van der Kolk, M.D. explains why this is so. The parts of the brain that are linguistic, organizational, and thoughtful are parts of the brain that people shift away from during very emotionally intense states, or when they are accessing traumatic memories. (1998.) Unless they have rehearsed it often and have used it before they are overwhelmed with anxiety, children in highly anxious states can no longer access self-talk,. In my experience with children under the age of eight, there is usually less than two minutes of available time before children have flooded with anxiety and have started into their ranting, anxious behaviors. As children get older, they tend to gain only a couple more minutes. The suggestions, exercises, and aids in this chapter help children before they melt down. Auditory processing is the process of understanding, ordering, and deriving meaning from language. It is compromised when children are highly stressed or highly anxious. Children who have a constant high state of arousal can become over-stimulated by a small stressor. As parents try to put it into a sequence, or context, children hear the mention of the event, and move into an over-stimulated state. Even though their parents are attempting to help children to sequence events through talking, relying on auditory processing, many highly anxious children lose the sequencing when they hear the part about bedtime or parents leaving. They cannot regain the sequence to comprehend the part about parents returning.
Maturation of the brain, including its pathways for emotion and emotional regulation, is "experience dependent." That is, social interaction directly influences the way that the central nervous system develops (Schore, 1995, pp.11-51). The brain's early map for emotions influences how children react emotionally later in childhood. Children who have experienced deprivation early in life tend to have brains that do not regulate emotions well. They over-react and under-react in a way that is adaptive to their old environment. when they are nurturing, comforting, and positively stimulating, parents give children experiences that form a new perceptual map.. By three months of age, babies have the capacity for showing the excitement, distress, and delight. By six months, babies have the capacity for the development of excitement, delight, distress, fear, disgust, and anger. While infants cannot be considered as having these states yet fully developed as emotions, they have begun to build the physiological branches that will develop into emotions. By twelve months, the capacity for delight, elation, affection, excitement, distress, fear, disgust, and anger is in place. By eighteen months, even further branching in the brain occurs, with jealousy, affection for adults, affection for children, excitement, delight, elation, distress, fear, disgust, and anger states all possible. By this point, the states are considered emotions. (Sroufe, 1995, p.59-64). Experiences develop both the emotional state, as well as the beginning modulation of the emotional state. Emotional states can develop later than the early windows, but most children have a harder time sustaining positive states after over-development in states of fear, disgust, distress (wariness), and anger. Even if children have no memory of deprivation or abuse, experience impacts emotional development in the brain. After reading this, parents might say, "Then what's the use? Why even try?" Humans are adaptable, changing and reaching goals throughout their lives. It is a misuse of information to limit children. The information is helpful as an explanation. When parents have a "why" for the harder road that they are walking with their child, it helps them to make peace with the rugged terrain.
Parents are the pacesetters and emotional touchpoints in the home. If children do not have good emotional regulation, it does not make sense to give them the freedom to set the emotional tone for the home. Like music that has the accent on the first beat, parents accent the beginning of emotional interactions. They set the pacing, not the child. Some parents become so wary of children's outbursts, that they nervously observe their child, making constant adjustment to keep children from blowing up. Instead, parents should be constantly directing the child back to the parent as a person of security, calm, and joy. Parents can cue children to calm down by taking a few deep breaths themselves, and then smiling. Parents can model having a good time. When parents look nervous and harried, it only causes children to remain wary. Parents need to do some of their own work, taking responsibility for having a positive life and attitude. Children often are afraid that they are too hard for parents to handle. Parents who can project a calm assurance that children are not too much for them help their children to feel secure. Children may lean on or fight such a strong parent, but they do feel that the parent has the power to protect or stop them. If children are truly too hard for parents, additional help can be sought so that the parent can handle the child. One child began to bully his parent every Sunday night. For several weeks, his uncle arrived late Sunday afternoon to provide reinforcement for his parent. Another child spent two weeks in a psychiatric treatment facility, returning home after he got help for self-mutilating behavior. The point is not that parents can single-handedly cope with everything that their child can dish out. Instead, it is that parents can muster the resources necessary to help their child. I say to children that I want them to get the help to change and grow in their home. However, if that does not work, I am willing to get help out-of-home for them. That way, I can give them the best opportunity to return to live in their families.
Some of the following suggestions can help anxious children who use control to feel more comfortable. These suggestions are not a substitute for therapy, but work nicely with therapy in helping a child to feel better.
Play out the Positive Ending. Children who are pessimistic and fearful can be invited to tell how they wish that a certain event would go. Ask them to act out that preferred ending. Role playing the positive ending gives children control. It also helps to curb the further development of a pessimistic, paranoid way of thinking. For example, one child played out going roller skating with her brother, rather than brooding on a possibility that she would never see him again. They had been adopted by different families. Within two months she had invited him to go roller-skating and had accomplished that wished-for activity. This worked better than reassurances. She has since tried this in other areas of her life, like a successful first day of school.
Pictographs or flannelgraphs . Young children with anxiety often respond well to visual sequences of events. Small pictures of daily events may be drawn out on felt, and arranged on a larger piece of felt. Children and parents can arrange the felt pictures in an order of events, displaying what will happen for that day or the next day. Children who seem to expect abandonment can see that in the morning Mom is there, or see and talk about what it feels like when Mom picks them up at day care. A difficulty common with younger, anxious children is that they tend to stop processing information when they come to the part of a daily sequencing that involves separation. This visual aid helps them to get to the other side of the sequence in which there is reunion. This is a good aid for children with permanent auditory processing problems or emotionally produced auditory processing problems.
Brain Shift. This technique helps parents catch children who are starting to lose it, or melt down. Parents ask children questions that require them to use a different part of the brain Swanson and Thompson describe this technique by having parents ask a child, "Are you too hot? Here, let me feel your forehead. I think that you are too hot." This will give the parent a moment to also calm a child. Another question is, "Can you smell that? I think that I smell french fries?" As children shift away from the emotional centers of the brain to test this, parents have a chance to steer their child. (Swanson, Thompson, 1997). . If used in time, this technique helps children to stop processing highly stressful information. Asking children if they are hungry, or if they need a drink of water serves the same function. Or, ask children if they need to go to the bathroom. Afterwards, parents might re-start the conversation saying, "We need to practice the 'Mom comes back feeling' before we do anything else." (If children do not need the bathroom, drinks, or food, parents might want to use the bathroom, get a drink, take off a sweater, etc.) Another diverting tactic is the interesting subject. Most of us, including children, can be engaged by particular absorbing conversational topics. Typical lead questions might be, "Well, how about those Yankees?" Or, "Which rookie card do you think is the best?" Leading a child into these topics leads them out of an anxious or angry response. Over time, children often learn how to do this type of activity for themselves, because brain development is experience-dependent.
Deep Breathing. First show children how to produce anxiety in themselves. Ask them to take many shallow breaths so that they are panting. They will have some of the same feeling that they have with anxiety. Then, show them how to fill up their bellies (diaphragms) with air. Have them blow out the scared feeling first, being careful to blow all of the air out. Next have them breathe in and hold the air. Then blow all of the way out again, and breathe in again. It is important that they are really filling their lungs, and slowing down their breathing. Children like being capable of stopping an anxious response. They also begin to recognize when their shoulders are up, and they are taking shallow little breaths. With non-verbal cues from parents, who gently push shoulders down, rub their backs, and take deep breaths with them, children can correct their breathing and take control of their anxiety. In time, they can do this for themselves. Many children are so anxious, that when asked to take a deep breath, they cannot get a deep breath in unless they blow out first. I work with children until they can get a "jelly belly" (a soft, relaxed tummy). It works well for some older children to have a timer on their watches which is set to go off on the hour. The timer reminds them to do diaphragmatic breathing throughout the day. This helps anxious children feel much better. With hyper-arousal reduced, they melt down less frequently.
Showing the Correct Amount of Emotion for the Event When children are showing a great amount of emotion in proportion to an event, work on what the normal amount of emotion might be. Guess aloud how much feeling generated by something else might have been hooked onto this event. Using outstretched hands, parents can show how much emotion usually is attributed to a prior event and how much to the current event. Then, ask if children can bring their feelings down by thinking of the current event and the old event separately. Parents can talk about the current event and follow-up by supplying a strategy to cope or reassurances. They can talk, in turn, about the old event, following up with strategies for coping, or offering some comfort. At that point, children can show the amount of emotion again by holding their hands apart to indicate the size of the feeling. They are surprised and pleased that the feelings have gotten so small. They grin and giggle at their success, which is quite endearing to parents.
Fast Forward Most children are able to understand the concept of the remote control with a fast forward button. They know that when certain obnoxious scenes come on the screen, that hitting a button moves them to more pleasant scenes in the program. When children get stuck in an anxious or overwhelming place and begin to respond to it, tell them to fast forward. A little boy, who was ruminating and getting anxious over his sister's hospitalization, was told to fast forward to the part about her getting out of the hospital. He was told to go look at her in the living room. She had been well for months.
Gear Shift Describe the concept of shifting gears. Then, talk about how certain gears would not work in a neighborhood. High gear is for on the freeway. Talk about what gears work in the morning, getting ready for school. Which gear is for soccer? Talk or role-play about how to shift back down after an exciting event, using slower breathing, calm music, soothing self-talk, etc. Children can practice shifting gears, becoming proficient in moving between arousal states in order to meet the needs of the occasion. Then, parents can suggest things like, "Please shift to second, Sergei, we are entering the grocery store now." Or, "Go ahead and shift it to overdrive, Sergei. It's free time in the pool." Give rewards to children who are gaining proficiency in sifting gears. One boy was able to go see the monster truck show when he could shift down reliably.
Overexposure Sometimes it works well to keep exposing children to an anxiety-producing event until they become de-sensitized. In doing this it is important to make certain that the child is not being re-traumatized. De-sensitizing is used when possible so that life is not so restricted. As an example, a child who will not permit her mother to go the mailbox while watching her out the window might have to watch her make ten trips within one half hour. If the child was still cranky, clingy, and anxious, the mom could do another ten trips in the afternoon. We would persist until the girl no longer showed an anxious response to the mailbox run.
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