Children with attention deficit hyperactivity disorder (ADD/ADHD) worry about all sorts of things, including things that other children take in stride. When such anxiety stems from a "comorbid" condition -- that is, a full-blown, diagnosable psychological condition that exists in addition to ADD/ADHD -- the child may need formal counseling. But many fearful ADD children can be helped by a few simple techniques (in addition to prescribed medication, of course).
Ten-year-old Terry came in for a session because she was worried about an upcoming slumber party. She wanted to attend but was afraid to. "What if I don't know what to say?" she asked. "What if I get homesick and have to go home? I'd die of embarrassment."
I discovered that Terry had had a bad experience at a sleepover months earlier. Rather than admit she was homesick and ask to be taken home, she had spent the entire night awake -- and miserable. The next day was a haze of tears, irritability, and exhaustion. When her mother asked what was wrong, Terry replied, "I wanted you to think I was more grown-up now and didn't want to have to ask you to come get me."
Embarrassment isn't all that bedevils these children, and even seemingly trivial fears can be debilitating. Some children are afraid of making mistakes at school and disappointing their teachers or parents. Still others fear being the center of positive attention at gatherings. Carl turned down birthday invitations because he was afraid that he might be startled by the sound of a popping balloon. That happened at a party once, and he was terrified that it might happen again.
Both Terry and Carl responded to cognitive-behavioral therapy (CBT), a form of psychotherapy that teaches people how to confront their fears realistically, test their validity, and become less reactive to anxious feelings. Parents can employ these techniques to help a child calm himself when besieged by the "worry words" in his mind. Here are a few ideas that might be helpful:
1. Make sure you understand the child's fear before trying to allay it
Listen carefully to your child as she explains what's bothering her. Don't jump to conclusions -- and don't assume that saying "Don't worry" will help.
For children too young to articulate fears, it may be helpful to have them draw a picture. Tony told me that he loved his grandparents but was afraid to spend the night at their house. When I asked him to draw his worry, he drew a scary-looking clown. I told his mother about the drawing, and she knew exactly what was going on: "That's the clown Grandpa put in the guest room for Tony the last time he stayed," she explained.
Once Tony learned that the clown had been taken away, his anxiety vanished. "I'm glad that clown has been moved from that room," he said. "I was afraid that he might come alive at night."
2. Ask the child to consider the fear in detail
You might ask him to rate the severity of his fear on a 10-point scale. Or ask him what triggers the scary thoughts. Does anger, loneliness, or any other feeling accompany the fear?
When the fear is utterly baseless, simple reassurance may resolve the problem: "I can give you a 100 percent guarantee that your bedroom won't be invaded by a Tyrannosaurus rex."
Don't discount the worry. Acknowledge the feelings while giving the child information. Age-appropriate books on the worrisome topic can help. A child with "weather worry," for example, might benefit from reading about lightning and other weather phenomena.
Books about the worries of other children can be especially helpful. Having your child read about how another child dealt with similar fears can be a springboard for a discussion about worries. Is there a fearful child who cannot relate to Judith Viorst's Alexander and the Terrible, Horrible, No Good, Very Bad Day?
3. Devise a technique the child can use to "banish" scary thoughts
Your child might imagine writing words on a blackboard -- and then erasing them. Or he might imagine burying words in a hole or sealing them in a rocket and then blasting it into space. A younger child might feel better by having a favorite puppet repeat "Be gone" or another incantation.
4. Ask the child what could be done to make the situation less fearsome
If a child dreads a social event because "no one I know will be there," you might say, "Let's see if we can invite your friend to come along." Or you might devise Plan B (an early exit), which can help a child feel that she has some control over the situation. Talking to your child beforehand can help him sail smoothly through a potential rough spot.
5. Teach the child relaxation techniques
Yoga, deep breathing, and other self-calming techniques are highly effective. Look into classes for kids offered in your area.
Some kids have developed their own ways to calm themselves when worry strikes -- for example, hugging a pillow, listening to a recorded story, playing with a pet, or simply holding a favorite toy or another "comfort object." Who would think that holding a "monster truck" would help a child feel safe? It just might!
Ultimately, it's up to the child to curb his own anxiety. When children doubt their ability to calm themselves, I remind them of Dumbo the elephant, whose friend, the mouse, gave him a feather to reassure him that he could fly. Maybe we all need a Dumbo feather.