by Bob Doman

My teacher thinks I’m dumb!

I must be!

The other kids don’t like me!

Something is wrong with me!

I’m just not okay!

Granddad thinks I’m the greatest!

He’s smart—I must be great!

Mom likes me and loves me!

I’m likeable and loveable!

Everyone who comes in contact with our children has some influence on them. The more important the individual is perceived to be by the child, the more credibility and impact the individual has and the greater their influence.

I recall hearing the story about a seven-year-old girl who saw her teacher go into a restroom at school; she came home devastated. She had put her teacher on such a high pedestal that her teacher was perceived as virtually God-like, and as such she shouldn’t need to use a bathroom. Gods don’t poop and pee! If a child perceives a teacher or a coach or anyone in authority as special or important, anything and everything they say can have incredible impact.

In the past 50 years there has been a dramatic increase in the exposure of children to outside influences. Prior to the age of five, children used to be at home and were exposed to a very short list of individuals—family, family friends, and neighbors. Back then it was much easier to supervise and control the input and minimize negative input. Children today are put under the care of many people beyond the immediate family, often almost from birth. Our children are spending a significant part of their waking day under the “supervision” of daycare staff, teachers, aides, coaches, piano teachers, gymnastics teachers, ballet teachers, and on and on. All of these exposures have the potential to be positive and enriching; but the point is that even a single word or look from the “right” authority figure can have a huge impact on the developing child. And many children get a lot more than a single word or look, and, sadly, any child with any kind of developmental, behavioral, or learning issue is much more likely to receive even more negative input.

I recently saw a ten-year-old, Tim. Tim came to us with labels including Anxiety Disorder, OCD, ADHD, non-compliance, and just to add as many labels and as much baggage as possible, dysgraphia*. This boy was a major challenge for his school and his parents. He would incessantly lie and steal, and he was defiant and manipulative. His family was at wit’s end. Tim’s psychiatrist had him on Prozac and Clonidine to “address” his “psychiatric disorders.” Tim hated school and received ongoing intense negative reactions from every authority figure in his life throughout most every day. Truth was, he was a smart, hurting little boy, whose biggest developmental issue wasn’t his weak working memory and essentially an absence of executive function, it was the impact all of the negative reactions/input he was receiving that was defining him. His behavior was largely a reflection of who he was being taught that he was. He was lowering himself to everyone’s expectations of who he was. He was who he was being taught he was.

We gave Tim a program to address his developmental and learning issues and taught the family how to turn his world around, making things positive for him. We encouraged them to take him out of school and do an NACD home education/developmental program with him. Literally, within days of being home and creating a positive environment (before program could have impacted any of his developmental issues), this boy was transformed into a happy, pleasant, cooperative child. Hopefully he will be completely weaned off his medications very soon. It’s amazing what can happen when you view a child as a whole child and address the cause rather than attempt to treat the symptoms.

If we wish to have control over outcomes, we need to control as many variables as possible. Parents are continually and not-so-subtly being encouraged to abdicate their role and position by “responsible” others, professionals, institutions, and society.

To produce good outcomes, it is very difficult to beat what proactive, involved, informed, caring, loving, and trained parents can do. It is virtually impossible to direct and supervise any aspect of a child’s development and education without understanding the whole child. If the parent doesn’t know the whole child, then no one does. Rarely does anyone other than a parent know and understand the whole child as does the parent—or, as did the parent. Children are coming under the influence of more and more people who are for the most part well intentioned, but who neither know or even wish to know the whole child and often don’t realize the power of their looks and words. Their perceived job is to work with their piece of that child, not necessarily contribute to the well being of the whole child, whoever he or she might be.

The whole child is something I talk about a lot because it is so very important. Tragically the reality is that there are often so many fingers in the metaphoric pie that there is virtually no one who even knows what kind of pie is being made.

Children need parents to be in charge; children need the people who know them, know them as a whole unique human being, who are responsible for that whole precious human being, and who hopefully also have a vision for that child’s future.

But lest we forget, the most important people to most children are the parents, and it is critical that parents understand how to interact with their children, how to create a positive environment, and how to provide them with quality feedback. Our children do not come with a manual. Fortunately parents are educable.

I would suggest you read the first four articles in this series and read the ones to come.

Our children cannot become all they can be if we parents aren’t all we can be.

*Dysgraphia – Dysgraphia epitomizes the issue of labeling individual differences as diseases. Dysgraphia has been described as an issue with writing/forming numbers or letters, or simply “messy writing.” It is also used as a label for children who have issues expressing themselves in writing or typing. It is called a learning disability and a neurological disorder. What is it really? It is merely a symptom of differences in rate of development and generally temporary individual weaknesses, that when addressed individually are generally easily remediated. One of the more significant causes of “dysgraphia” is trying to teach children to write before they have even established a dominant hand or even know how to read. It’s difficult to write with the wrong hand and compose a sentence if you can’t read one. It would be nice if the educational system understood child development, individual differences, and whole children.

Reprinted by permission of The NACD Foundation, Volume 33 No. 5, 2020 ©NACD

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In my last article I mentioned that working memory is another factor to consider when looking at anxiety in our children. Bob Doman, founder and director of NACD, has been at the forefront of understanding working memory and its impact on global function since the early ‘80s. It is a big deal. It is not just big, but huge, gargantuan, as it is the foundation that permits us to think. It not only permits us to think, but it also plays a role in our ability to regulate our emotions. Let’s spend some time on working memory, defining its role in our ability to handle stress.

Let’s first review how the brain works in a simple way. Information comes into the brain through our senses. If our sensory channels are functioning normally, the information gets perceived correctly, then it gets processed through our short-term memory. Our working memory is what allows us to think about this information along with taking information that we already know out of long-term memory. For example, if I am sitting in a class and I am listening to a lecture, I am taking in what that teacher says, hearing the information, processing what they are saying, and using my working memory to think about what I already know about that topic, how what they say impacts what I already know, what client comes to mind when I think of what the teacher is saying, etc. I am visualizing, conceptualizing, and developing an opinion or my own thoughts about that particular topic and how it may or may not benefit my work.

According to Bob Doman, “Working memory is the foundation for global neurological maturity and function. It essentially encompasses most of what we think of as ‘thinking.’”

“The NACD model of cognitive function recognizes various components of thinking and learning. Of all of these functions, working memory, including executive function, encompasses the areas that impact simple and complex behavior regulation and problem solving the most. The development of various parts of executive function appears to be a good indicator of future academic success, as well as future life success. Mathematics, reading, and critical thinking are all affected by how well various components of executive function develop and work. Not only do these neurological functions impact academics, but NACD and researchers also find that they impact social skills, job skills, and the skills needed for a child or adult to navigate daily life independently. Time management, time awareness, goal setting and planning, organizational skills, social awareness, financial planning, running a household, writing a research paper, writing a paragraph, and forming thoughts into conversation are all functions that depend on this higher cognitive level referred to as working memory and executive function.” (Doman, 2016)

So what does all this have to do with anxiety? When we think of our kids, anxiety can creep up when they have too much information coming in through their senses, but not enough short-term and working memory to manipulate the information. Have you ever seen a World History textbook? If you have a smart kid who wants to do well in school, but doesn’t have well developed short-term and working memory abilities, they are very likely to get anxious just looking at the book. The pieces that allow them to manage their time with material, organize their studying, and plan how to work through the material are not where they need to be in order for that child to be successful. Now if we have that same kid with five or six classes, with similar amounts of material, imagine how much more anxiety can develop.

Many of the anxious children on our caseload, who may be pre-adolescent age and are struggling with school to the point of shutting down, have poor working memory and conceptual thought. They simply don’t have the ability, YET, to be able to perhaps even process the information coming into their brain, let alone manipulate it and problem solve, think and reason through all that is being presented to them. Let’s also take into consideration what is happening with their bodies during this time frame. They become so overloaded they shut down. With our kids that have good short-term memory but poor working memory, rather than solve a problem that they are facing, sometimes these children may ruminate on the problem itself. Rumination is simply rehashing a problem in their head over and over without having the working memory that permits them to organize their thoughts and reach a conclusion, therefore creating increased anxiety. The more developed a person’s working memory is, the more likely they are able to solve and reason through their problems.

The more a child can reason, the less likely they are to get stressed and shut down. If we look at a neurotypical 3-4-year-old, they are just learning how to reason and problem solve. If they encounter something that is stressful to them, they don’t have the working memory to process the situation and are likely to dart or hide behind their mom versus using conceptual thought to reason as to how best to approach something. The same can be true for a child who is 12 years old but has the working memory of a 3-4-year-old. The same behavior happens, only it looks more problematic because it is an immature behavioral response for a child at that age.

We also have very bright individuals on our caseload who are also anxious because of their incessant need to be the best, to be perfect, to be the straight A student. When does academic pressure, measuring kids, too much testing, and narrow competition get recognized as potentially one of the greatest causes to mental health issues in our kids? Stay tuned to next month’s article.

Reprinted by permission of The NACD Foundation, Volume 32 No. 9, 2019 ©NACD

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I know a boy. He is a very smart, fun, engaging boy. From the outside you would think this kid has lots of friends, is very social, the class clown, etc. But at home just calling a friend to go do something is a very big feat. The act of calling a friend, or even texting them, to go do something creates stress. He is so afraid of being turned down that he would just rather avoid the task, even if that means not going to a movie or going to do something fun with a friend. I noticed this about three years ago when I knew in my heart he wanted to go sledding with someone, not just his baby sister. However, he literally cried hysterically about having to call his friend. I persisted (debating in my head whether or not this was right—knowing that “Mother of the Year” was not an award I was going to win). He finally called his friend, who said yes, and they went sledding together and had a blast. He had a smile from ear to ear. Did the act of calling the friend create a lot of anxiety? Yes! But as his mother, pushing him out of his comfort zone was needed in order for him to understand that he had friends who actually wanted to be with him. Can you relate? Is it easier to just let our kids avoid things that in their eyes are hard to do, whether it be doing a chore, doing a reading assignment, or even learning how to brush their own teeth? Yes. Is it easier to let our kids avoid doing school work or avoid going to dance class or avoid going to Scouts because it is out of their comfort zone, or even worse– having to deal with an absolute tantrum or fight so we let them win? Absolutely. But when does letting avoidance patterns work become too harmful for them? Are we teaching them anything here? If avoidance behavior is a hallmark for anxiety, how can we as parents assist our children in addressing stressful situations so that they can persevere through life’s challenges?

What Is Avoidance Behavior?

Avoidance behavior is when a child sidesteps a person, place, task, or situation that makes them feel anxious or uncomfortable. In the moment it brings relief, so the brain learns to repeat it. Over time that relief becomes a habit, and the list of things a child avoids tends to grow rather than shrink. Recognizing avoidance early gives parents the best chance to help a child face challenges in a calm, successful way.

Common Signs of Avoidance Behavior in Children

Avoidance can look different from one child to the next. Some common signs include:

• Refusing or stalling on tasks that feel hard, such as homework, chores, or getting dressed
• Big emotional reactions (tears, tantrums, or shutting down) when asked to try something new
• Making excuses to skip social situations like calling a friend, going to class, or joining an activity
• Complaints of stomachaches or headaches before a feared event
• Sticking only to activities that feel safe and familiar

Spotting these patterns is the first step toward helping your child move through them.

According to Dr. Alice Boyes, Ph.D. (2013), avoidance coping (behavior) is the most important factor in anxiety and causes it to snowball. She believes that people avoid situations that may cause some of the feelings you get when you are stressed; however, if you keep avoiding those situations, this can lead to more debilitating anxiety levels. It is important to understand that all people experience stress. It is not uncommon for the human brain to engage in the process of fight or flight when it is introduced to something stressful. “While avoidance behaviors might give kids some immediate symptom relief, they don’t help them learn to cope with their triggers. In fact, the fears actually have a tendency to snowball when kids engage in avoidance behaviors” (Hurley, 2016).

It is also very important to understand that each child and brain is unique and what stresses one kid out may not the next. NACD has experienced that how we react to our children and how we provide them with the right instruction in the correct manner, along with building the neurodevelopmental pieces, allows our children to handle stress much more easily. In an upcoming article, I will discuss the significance working memory plays in handling stress and anxiety. But for now, I would suggest to parents that you try to sit back and look at your children and evaluate their behavior patterns. Do they avoid? Do they freak out when they need to do something that is within their ability to do? How do you react? If it is something that may be difficult in their eyes, we encourage parents to break down the task into smaller parts or have them do a particular task for a set amount of time that allows them to be successful, then gradually increase the duration. When you are wanting to teach something to your child, it is important that you have a calm, confident, and positive demeanor. When teaching your anxious child to ride their bike, for example, letting them know that they can do it and that you are with them and that you know that this is something that they can do is significant. How you talk to them, your demeanor, matters. Setting a timer then stopping and doing it again with frequency (not once a week but several times a day) can help decrease their anxiety and build up their confidence to do the skill. With some children, video modeling of a certain scenario can be effective. For example, if going to the dentist causes your child a lot of anxiety, making a video of going to the dentist so that the child can get a positive image in their minds of that experience can help decrease that fear. This is a common example of exposure therapy that has been used to address anxiety for many years. Avoidance behavior patterns can start at a very early age. If they aren’t addressed early, the behavior patterns can become stronger and generalize into all areas of a child’s life—to a point where they shut down completely. That is why it is important to be mindful of them and help your child face their fears in a successful way.

Is your child confident? In our experience, one reason kids can struggle with avoidance behavior, which can lead to anxiety, is that they are too afraid to fail—and parents don’t let them. Failure is a part of growing up. It is a part of learning. When I was younger, I remember ruining a bunch of whites in a load of laundry because I had a red sock in the mix. I didn’t pay attention when sorting and that was the consequence. I failed with that particular load of laundry. Did the sky cave in? No. Did my mom ground me for a month? No. Did I learn a valuable lesson in how do to the laundry? Yes. My mom didn’t take over that job. She just said to pay better attention, and I had to go without those white shirts that I ruined. In order to help our children become confident, developing independence with daily living skills, including self-help and chores, is very important. A very common scenario—a kid attempts to pour their juice, it spills, and the parent cleans it up and doesn’t let them do it again because it makes a mess. Another kid isn’t allowed to load the dishwasher for fear that he may break something. Parents, caregivers, teachers of young ones, do not be a roadblock for your child’s independence. Independence brings so much to their global mental health and function. Develop it, build it, help them realize that failure happens and that it is ok. These things, no matter what age or developmental issues your child may have, are huge for addressing or preventing avoidance behavior and anxiety later on.

Bob Doman (2013), founder and director of NACD, wrote a blog post several years ago about Herculean tasks:

“One of the great opportunities our children can have and lessons they can learn is to be presented with and accomplish Herculean tasks. Herculean tasks help your children learn what they can do if they really try. They teach them to look at a task that they think is impossible and to learn that they can really do it. As parents you should be on the alert for tasks that appear to be Herculean. The ideal Herculean tasks are those that look huge and to the child seem impossible, but which are doable, although they may take a whole lot of time and effort. The child who is used to 5-minute chores might perceive shoveling a driveway covered in a foot of snow, a yard covered in leaves to rake, an entire vegetable garden to weed, a stack of logs to move, or washing all the windows in the house all as Herculean/impossible tasks. But they are not impossible; they are possible if they try. Completion of Herculean tasks provides children with an opportunity to redefine themselves, to change their perception of what is possible, and to learn that if they try, they can in fact do it. The child who learns they can do Herculean tasks will continue raising the bar on their perception of what they can do and will learn to attack new tasks with the intention of succeeding–not just trying, not just making an effort, not just going through the motions, but having the intention of accomplishing the task. The child who learns they can do Herculean tasks won’t shut down when presented with the task of writing a twenty-page report, reading a 500-page book, learning all of the bones in the body, or pushing to take another tenth of a second off their 100-yard dash.”

A Neurodevelopmental Look at Anxiety and Avoidance

At NACD we look at the whole child. Avoidance behavior rarely stands alone. It often connects to how a child processes information, holds instructions in working memory, or manages sensory input. When we strengthen those underlying pieces, facing a hard task becomes less overwhelming, and avoidance has less room to take hold. This is why two children with the same fear may need very different support. Families navigating ADD/ADHD, the autism spectrum, or everyday anxiety all benefit from a plan built around their own child.

If you would like individualized help, join our free Get Started program and NACD will help you build a plan tailored to your child.

In conclusion, NACD understands that being a parent takes hard work. Being a parent of a child who is anxious requires patience and positive persistence and understanding! It is important to understand what avoidance behavior is and how to address it with your own unique child. We also understand that there are many contributors to a child’s avoidance behavior and to varying degrees. NACD believes in looking at “whole” kids. The more individualized we can be with understanding a child’s behavior patterns, the more confident parents can feel in how to help their child. Helping our children become more independent can also increase their self-esteem, helping them to become more confident individuals. In my next article, I will discuss another significant piece to understanding anxiety—working memory. Stay tuned!

References

• Boyes, A., Ph.D. (2013, March 5). Why Avoidance Coping is the Most Important Factor in Anxiety. Retrieved April 5, 2019, from https://www.psychologytoday.com/intl/blog/in-practice/201303/why-avoidance-coping-is-the-most-important-factor-in-anxiety
• Doman, R. J. (2013, February 01). Waiting for Hercules. Retrieved April 8, 2019, from http://blog.nacd.org/2013/01/waiting-for-hercules/
• Hurley, K., LCSW. (2016, February 3). How to Help Your Anxious Kid Avoid Avoidance Behaviors. Retrieved April 5, 2019, from http://practicalkatie.com/2016/02/03/how-to-help-your-anxious-kid-avoid-avoidance-behaviors/

Frequently Asked Questions

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We have all heard it a thousand times: eating better, sleeping better, getting physical exercise helps our overall health. While this is something that our NACD families in general are very conscious about with their children with developmental issues, it is not uncommon to hear that those rules don’t really apply to everyone in the family. Let’s face it, it is easier to be more lenient on our neurotypical kids or ourselves, but does that help everyone in the long run? It is important to really get serious across the board about our overall physical health in the family, as that impacts our mental health significantly.

Sleep is such an important part of one’s life. According to the National Sleep Foundation, children ages 6-13 years old need 9-11 hours of sleep each night to be at their best. Teenagers ages 14-17 need 8-10 hours of sleep to be at their best, and adults should have between 7-9 hours of sleep per night. This is good, quality sleep! Not being in bed on your smartphone scrolling, but actually ASLEEP! Unfortunately for most teens, their biological clocks shift during that stage, where they tend to have more energy at night, increasing the desire to stay up later and sleep in longer. If your children are like mine, they start school at 7:20. They are up and out of the house before 7am. This can leave them already sleep deprived as they aren’t always ready to fall asleep by 10pm the night before. A study from the British Medical Journal in 2015 researched the effects of screen time and lack of sleep in a substantial sample of adolescents, over 9000. They found that the more screen time the subjects engaged in each day, the longer it took for them to fall asleep. If they had four or more hours of screen time per day, they were 360% more likely to have less than five hours of sleep a night and 49% more likely to take over an hour to fall asleep (Hysing, M. et al, 2015). When our brains are tired, mental health issues such as depression and anxiety increase. We are not able to think as clearly and have more difficulty handling stress than when in a rested state. NACD recommends consistent nighttime bed routines starting when children are little, such as no screens in the bedrooms, and devices are to stay with parents. We suggest having at least an hour to an hour and a half of no screens prior going to bed. We also encourage very dark rooms (blackout shades or curtains) and white noise to help facilitate a good night’s rest.

I hear many times “my kid has a balanced diet; they eat some of everything every day.” But how much of those foods happen to be processed? Have extra or hidden sugars? Artificial ingredients? More and more research on the foods we eat are targeting how they impact our mental health. “In recent years, a direct relation between the occurrence of anxiety disorders, sleep disturbances, and mood disorders has been observed as a consequence of poor or inadequate diet. Eating habits in Western societies have greatly changed in recent decades, with an increase in the consumption of foods low in vitamin and mineral content, high in caloric value, and rapidly prepared and easily consumed.” (Fernandez-Rodriguez, M., et al., 2017) There is a direct interrelationship between physiological health and neurological function. NACD has known this since its inception in the ‘70s. Time and time again our clients have shown that those who eat better function better. In general, diets rich in plant based foods, healthy fats (in the form of plants, nuts, seeds, and fatty fish like salmon), and lean meats are far superior in promoting mental function. In contrast, diets high in sugar, dairy, breads, and processed foods have been shown to be related to depression, chronic inflammation, and anxiety. This isn’t just for adults! According to Natalie Kling, a Certified Clinical Nutritionist from NACD’s Professional Advisory Committee, “the human body is always moving towards homeostasis, or perfect balance. When a body is out of balance, we see or experience symptoms (physical AND mental). We can soothe symptoms by giving the body the interior environment it needs to return to balance. Rest, hydration, oxygen, nutrients, detoxification, and a healthy and loving environment provide the ingredients the body needs to repair, regenerate, and reorganize. In contrast, when we introduce processed foods, sugar, not enough sleep, chemicals, environmental toxins, or stress, we push the body out of balance and create obstacles to the body’s ability to thrive.”

Personally, I have noticed a great difference in my son’s “teenager attitude” when he doesn’t eat these foods. When his diet is clean, whole food based, there is a positive difference. Often times I see parents eating healthy, but their kids are eating foods loaded with sugar and the “bad stuff” because “they’re kids.” NACD suggests to parents to develop a palate for healthy food with their children in infancy. NACD recommends to our families to work with one of our nutritionists if you need help in getting started. Natalie Kling, who also happens to be an NACD mom, has suggested that parents can start by just focusing on getting more vegetables into your kids. Smoothies (without added sugars and dairy), homemade sauces, etc., are ways to start that process. If you are a new parent with young children, keep their diets high in plant-based foods so that they develop a taste for it. If you are a parent with a picky eater, they don’t have to be. By giving the brain and body the correct fuel it needs, this can help to improve your child’s physical AND mental health as well.

Many children and adults struggle with anxiety due to lack of physical exercise. If we sit back and look at our lives today, we lead more sedentary lifestyles. We watch our TVs, screens, sit and scroll through our phones, many of us work all day at a desk, and many of our children are in school for 6+ hours (sitting for a huge chunk of that), many without daily physical exercise. According to the US Department of Health and Human Services (2018), children ages 3-5 years of age should engage in at least 3 hours of physical activity with varying degrees of intensity. Children ages 6-17 should engage in moderate to vigorous physical activity (aerobic, muscle, and bone strengthening) for 60 minutes DAILY. Adults should have a similar amount. Do you get that? Do your children? Exercise stimulates endorphins in your brain that allow for improved executive function, attention, and mood. Essentially, it allows you to handle stress better and not let it handle you. NACD recommends families make an effort to include physical exercise as part of your day. Schedule it in. In fact, on some of our programs we will write screen time = chore time = exercise time. For my children, the screens, homework, and chores don’t happen after school until physical exercise does. It might be going to the gym or doing an online video. Sometimes it is going for a run or even a fast walk. Snow or sun, we make it a priority.

In conclusion, it is important that as parents we really understand how significant lack of sleep, poor diets, and lack of physical exercise impacts our children’s physical and mental health. They work together, impacting one another. NACD looks at the whole child and sees this as a huge piece to impacting the global mental function of a child.

Reprinted by permission of The NACD Foundation, Volume 32 No. 1, 2019 ©NACD

References

Fernández-Rodríguez, M., Rodríguez-Legorburu, I., & López-Ibor Alcocer, M. I. (2017). Nutritional supplements in anxiety disorder. Actas Espanolas De Psiquiatria, 45(Supplement), 1.

Hysing, M., Pallesen, S., Stormark, K. M., Jakobsen, R., Lundervold, A. J., & Sivertsen, B. (2015). Sleep and use of electronic devices in adolescence: Results from a large population-based study. BMJ Open, 5(1), e006748-e006748. doi:10.1136/bmjopen-2014-006748

How Much Sleep Do We Really Need? (2019). Retrieved February 5, 2019, from https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-we-really-need

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

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Growing up in small town Idaho, anxiety was rarely expressed as an issue with children and adolescents. Anxiety was something that adults had. Even in college 20-24 years ago, stress was an issue when papers were due, or it was finals week. The talk of anxiety and panic attacks was never common, and medication was not needed to help my fellow college companions cope. Having said that, it is hard to know if childhood friends or college roommates had these issues all along but didn’t know what it was? How many of them turned to substance abuse to cope? How many of them are now dealing with debilitative mental health issues that could have been resolved when they were younger?

While anxiety may not have been a significant issue then, it is now. With suicide rates climbing at lightning speed in our youth, we cannot ignore the growth of children and adolescents being diagnosed with anxiety and other mental health disorders. NACD is all about helping children reach their full potential so that they can be happy, contributing, productive adults to our society. As such, we must evaluate the various factors that could be impacting our children’s stress levels both at home and at school. Research in the area of anxiety in children and adolescents has grown and includes possible contributors to this epidemic.

Over the next several articles, I will discuss the following as anxiety contributors and offer suggestions from a neurodevelopmental perspective:

1. overall physiological health of children today from sleep deprivation to diet and exercise
2. avoidance behaviors in children that lead to increased anxiety later
3. children who never learn how to do basic living skills and the significance of developing working memory
4. smartphones and too much screen time
5. children not being present or “mindful”
6. lack of social connection and community
7. high stakes testing, school pressure, and narrow competition.

With this series of articles, my hope is to educate parents and hopefully provide you with some general guidelines to think about as you raise your little humans in this generation.

Reprinted by permission of The NACD Foundation, Volume 32 No. 2, 2019 ©NACD

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We love hearing from our past and present families. It’s always tough for us when we graduate a child, seeing them move on, full of expectation and hope, and hopefully armed with a solid foundation. We always appreciate hearing from the families and learning how they fared.

We just received this note from Charles Smith and Marilyng Perez Montero regarding their daughter Ilaria. I recall meeting Ilaria and her family for the first time. Ilaria was a very sweet, quiet, well-mannered 10-year-old who lacked confidence and who came to us with a combination of processing issues, academic problems, and physical strength and coordination challenges. She was very anxious to do what she needed to do to better herself, and her parents were obviously dedicated to doing all they could do to make it happen.

Ilaria’s family was very organized and hit her program running and started seeing changes almost immediately. The family kept in close contact with me through their coach, Marta Palmes, and worked not only hard, but smart. The plan from the beginning was to keep Ilaria home and do NACD homeschool, get her “pieces” put together, and then to have her go back to school. Ilaria was with us for less than 18 months, but we were delighted to see her transform into a confident and capable young lady in that relatively short period.

When Charles, Ilaria’s dad, asked me if I thought Ilaria was able to handle going back to school, I told him that I felt she was; but when he told me where he wanted her to go, I was a bit concerned. He wasn’t going to just send her to school, he wanted her to go to a very challenging, tough academic school. I should not have worried. I will let Dad’s words speak for how she has done.

Congratulations, Team Smith!

—Bob Doman

Dear Marta [at NACD],

I am writing to inform you of our daughter Ilaria’s achievement of a 4.0 GPS her first year in middle school and being recognized as a recipient of the President’s Education Awards Program—all this less than six months after graduating from the NACD program. It is a momentous achievement and I would like to express my sincere gratitude to you and Bob Doman for all the efforts you have contributed on behalf of Marilyng, myself and Ilaria.

Your support during the design and implementation of Ilaria’s NACD program has been nothing short of overwhelming. Needless to say, without your and Bob’s expertise, input and encouragement, Marilyn and I would never have been able to achieve success in carrying out the program with Ilaria.

As you may recall, we were introduced to Bob Doman and NACD in the Summer of 2016. I was doing some research online for organizations that could assist our 10-year-old daughter, Ilaria, whom had been officially diagnosed as having a “learning disorder”. Ilaria was falling behind in mathematics as well as English and was lacking in physical strength and coordination.

We had tried a number of different private companies and public resources but did not feel any were right for Ilaria’s circumstances. Some were very expensive, and others did not provide the personalized attention we felt was necessary. Fortunately, I came across Bob’s name along with NACD when I was reading reviews by a client of one of the private companies we were meeting with. That day changed our lives!

After watching the online videos of Bob explaining how a child’s brain develops and why it is important to use teaching methods that take into account, we made contact with NACD. My wife and I were very excited to work with Bob and create a personalized development program for Ilaria.

We started implementation of the program in July 2016 and found that your input and weekly support was invaluable. In addition to your encouragement and support you greatly assisted us with the practical implementation of the program. I can distinctly remember your suggestion of creating an excel spreadsheet to keep track of and monitor the daily activities and progress of the program. This helped us tremendously.

Ilaria made steady progress throughout the remainder of 2016 and through the first half of 2017. In august of 2017, she started 6^th grade at a new middle school considered to be one of the most academically challenging schools in Florida. By the end of the first semester in December, she had achieved the honor roll during both quarters and finished with a 3.6 GPA. It was at that time, during her December evaluation with Bob, that he informed her she had successfully graduated from the NACD program.

The NACD program along with the support from yourself and Bob changed our lives and gave Ilaria the confidence to believe in herself and achieve her goals of making the honor roll in her first year of middle school. Thank you very much!

NACD Newsletter, October 2018 ©NACD

The post Ilaria Smith: Making Us All Proud appeared first on NACD International | The National Association for Child Development.

Anxiety disorders are supposedly the 
most common mental health issue 
today for adolescents, with one
 national study of more than 10,000 
adolescents finding that about 31%
 qualified for an anxiety disorder at 
least at one point in their lives 
(Merikangas et al., 2010). 
Prescriptions given to children for 
these anxiety disorders are
antidepressants that include selective
 serotonin reuptake inhibitors (SSRIs) most frequently, followed by serotonin norepinephrine reuptake inhibitors (SNRIs), and rarely benzodiazepines. In other words, we could eventually have one third of our children drugged with antidepressants for anxiety alone if all parents wanted to continuously screen their children for an anxiety disorder and get an “appropriate” prescription.

The obvious question is why is the prevalence of anxiety disorders so high? First of all, anxiety is an emotion we all occasionally experience. Infants and toddlers are commonly apprehensive of strangers, young children are commonly fearful of new situations and any adult negativity, and adolescents are anxious about rejection from friends or crushes, the test they did not adequately study for, as well as any and all issues that threaten their self-images and so on (Beesdo et al., 2009). Every child will exhibit anxiety towards certain things or will behave anxiously for periods of time, and this is normal, especially if there are new stressors in the child’s environment, such as starting a new school, conflicts at home, bullying, having a fight with a best friend, or a dreaded math test coming up. Frequently, what might occur is a teacher will notice a child has been acting anxious for a couple of weeks, the teacher will tell the parent the child has anxiety, the parent will go to doctor and tell her the teacher thought the child was showing signs of anxiety, and then the doctor will write a prescription for an anxiety disorder. This would explain the research that indicates only 20% of adolescents with a current anxiety disorder diagnosis will even retain the diagnosis (Wittchen et al., 2000). Of course, the child most likely does not have an “anxiety disorder;” and moreover, medicating the child does nothing to actually address the developmental issues or neurological disorganization or the environmental/social/academic stressors that are the source of the anxiety in the first place.

For some children, anxiety issues are the reflection of neurological disorganization. In such cases, the level of neurological organization is such that the child has not yet established a strong delineation between the two hemispheres of the brain. When there is such delineation, a dominant hemisphere is established, which assists in logical and analytical thought and helps keep emotional activity of the subdominant hemisphere in check. If a dominant hemisphere is not firmly established, then the child often functions subdominant or emotionally, such as anxiously, rather than with reason. A further aspect of neurodevelopment affecting anxiety is poor auditory working memory. If working memory is weak, the child does not have the capacity to think through and resolve issues, and therefore, tends to ruminate over issues again and again, each time heightening their level of anxiety.

Selective serotonin reuptake inhibitors given to children and adolescents with anxiety include fluoxetine, sertaline, and citalopram; and common side effects include abdominal pain, nausea, headaches, and drowsiness (Birmaher et al., 2003). Furthermore, the US Food and Drug Administration issued a black box warning on SSRIs that describes the risk of suicidal ideation for patients 25 years of age or younger (Emslie et al., 2006). Fluvoxamine, paroxetine, and escitalopram may even be less safe versions of SSRIs used to treat anxiety (Siegel & Dickstein, 2012). The serotonin-norepinephrine reuptake inhibitor known as venlafaxine is also prescribed to youth with anxiety. Side effects include asthenia (bodily weakness), pain (e.g., headache, abdominal pain), fatigue, and even anorexia (Rynn et al., 2007). Finally, benzodiazepines are sometimes prescribed, despite research that shows they are no more effective than a placebo in reducing anxiety symptoms (Simeon et al., 1992). Moreover, there is a high risk for patients to develop an addiction to benzodiazepines, and pediatric patients are especially vulnerable to disinhibition and aggression caused by benzodiazepines (Mancini et al., 2005). On the other hand, non-drug intervention has the most evidence as effective treatment for anxiety, has the most long-lasting effects, and does not have any of the side effects associated with drugs (Siegel & Dickstein, 2012).

In conclusion, it is normal for all children and adolescents to experience some level of anxiety for periods of time; and in fact, lack of anxiety may be cause for even greater concern for some. Be cautious in having your child labeled with an anxiety disorder due to anxious behavior for only a short time period. If your child does appear to be experiencing persistent and uncontrollable anxious behavior, carefully investigate any relationship or academic issues, or possible social causes, such as bullying, negative teachers, aides, therapists, and so on. Also explore neurodevelopmental issues, such as neurological disorganization or weak working memory. Whenever possible, look for and treat the cause of the anxiety and do not resort to prescription drugs until other avenues have been exhausted.

Sources

• Beesdo, K., et al. (2009). Common and distinct amygdala function perturbations in depressed vs anxious adolescents. Arch Gen Psychiatry, 66, 275-285.
• Birmaher, B., et al. (2003). Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry, 42, 415-423.
• Emslie, G., et al. (2006). Treatment for Adolescents with Depression Study (TADS): safety results. J Am Acad Child Adolesc Psychiatry, 45, 1440-1455.
• Mancini, C., et al. (2005). Emerging treatments for child and adolescent social phobia: a review. J Child Adolesc Psychopharmacol, 15, 589-607
• Merikangas, K.R., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication – Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry, 49, 980-989.
• Rynn, M.A., et al. (2007). Efficacy and safety of extended-release venlafaxine in the treatment of generalized anxiety disorder in children and adolescents: two placebo-controlled trials. Am J Psychiatry, 164, 290-300.
• Siegel, R.S., & Dickstein, D.P. (2012). Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers. Adolescent Health, Medicine and Thereapeutics, 3, 1- 16.
• Simeon, J.G., et al. (1992) Clinical, cognitive, and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorders. J Am Acad Child Adolesc Psychiatry, 31, 29-33.
• Wittchen, H.U., et al. (2000). The waxing and waning of mental disorders: evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry, 41, 122-132.

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