How to raise kids who can overcome anxiety

Growing up means facing new challenges -- but for some kids, uncertain situations lead to anxiety that parents often seek to soothe. Psychologist Anne Marie Albano explains how constantly rushing to fix a child's problems can perpetuate a lifelong cycle of dependence and resentment -- and shares why a healthy dose of risk helps kids cultivate lasting confidence.

As a child, I had many fears.

I was afraid of lightning, insects,

loud noises and costumed characters.

I also had two very severe phobias

of doctors and injections.

During my struggles to escape
from our family doctor,

I would become so physically combative

that he actually slapped me
in the face to stun me.

I was six.

I was all fight-or-flight back then,

and holding me down for a simple vaccine
took three or four adults,

including my parents.

Later, our family moved
from New York to Florida

just as I was starting high school,

and being the new kid
at the parochial school,

not knowing anyone

and being worried about fitting in,

on the very first day of school,

a teacher takes roll and calls out
"Anne Marie Albano,"

to which I respond,
[In a Staten Island accent] "Here!"

She laughs and says,
"Oh, precious, stand up.

Say D-O-G."

And I respond,
[In a Staten Island accent] "Dog?"

The class broke out in laughter
along with the teacher.

And so it went,

because she had many more words
to humiliate me with.

I went home sobbing,

distraught

and begging to be sent back to New York

or to some nunnery.

I did not want to go back
to that school again. No way.

My parents listened

and told me that they would investigate
with the monsignor back in New York,

but that I had to keep going in each day
so I'd have the attendance record

to transfer to ninth grade
on Staten Island.

All of this was before
email and cell phones,

so over the next several weeks,

supposedly, there were letters being sent
between the Archdiocese of Manhattan

and Miami

and with the Vatican,

and each day, I'd go into school crying
and come home crying,

to which my mother would give me an update
from some cardinal or bishop

to "Keep her going to school
while we find her a spot."

Was I naive or what?

(Laughter)

Well, after a couple of weeks,
one day, while waiting for the school bus,

I met a girl named Debbie,

and she introduced me to her friends.

And they became my friends,

and, well, the Pope was off the hook.

(Laughter)

I began to calm down and settle in.

My past three decades
of studying anxiety in children

stems partly from my own search
for self-understanding.

And I've learned much.

For young people, anxiety is the most
common childhood psychiatric condition.

These disorders start early, by age four,

and by adolescence, one in 12 youths
are severely impaired

in their ability to function at home,
in school and with peers.

These kids are so frightened,

worried,

literally physically uncomfortable
due to their anxiety.

It's difficult for them
to pay attention in school,

relax and have fun,

make friends

and do all the things
that kids should be doing.

Anxiety can create misery for the child,

and the parents are front and center
in witnessing their child's distress.

As I met more and more children
with anxiety through my work,

I had to go back to mom and dad
and ask them a couple of questions.

"Why did you hold me down

when I was so frightened
of getting injections

and force them on me?

And why tell me these tall tales
to make me go to school

when I was so worried
about being embarrassed again?"

They said, "Our hearts
broke for you each time,

but we knew that these were things
that you had to do.

We had to risk you becoming upset

while we waited for you
to get used to the situation

with time and with more experience.

You had to get vaccinated.

You had to go to school."

Little did my parents know,

but they were doing more
than inoculating me from the measles.

They were also inoculating me
from a lifetime of anxiety disorders.

Excessive anxiety in a young child
is like a superbug --

and infectious, even multiplying,

such that many of the youth that I see

come in with more than one anxiety
condition occurring at the same time.

For example, they'll have specific phobia

plus separation anxiety
plus social anxiety all together.

Left untreated,

anxiety in early childhood
can lead to depression by adolescence.

It can also contribute
to substance abuse and to suicidality.

My parents were not therapists.

They didn't know any psychologists.

All they knew is that these situations
may have been uncomfortable for me,

but they were not harmful.

My excessive anxiety would harm me
more over the long term

if they let me avoid
and escape these situations

and not learn how to tolerate
occasional distress.

So in essence, mom and dad were doing
their own homegrown version

of exposure therapy,

which is the central and key component

of cognitive behavioral
treatment for anxiety.

My colleagues and I conducted
the largest randomized controlled study

of the treatments of anxiety
in children ages seven to 17.

We found that child-focused
cognitive behavioral exposure therapy

or medication with a selective
serotonin reuptake inhibitor

are effective for
60 percent of treated youth.

And their combination gets 80 percent
of kids well within three months.

This is all good news.

And if they stay on the medication

or do monthly exposure treatments
as we did in the length of the study,

they could stay well
for upwards of a year.

However, after this treatment study ended,

we went back and a did
a follow-up study of the participants,

and we found that many of these kids
relapsed over time.

And, despite the best
of evidence-based treatments,

we also found that for about
40 percent of the kids with anxiety,

they remained ill throughout
the course of the time.

We've thought a lot about these results.

What were we missing?

We've hypothesized that because
we were focusing

on just child-focused intervention,

perhaps there's something important
about addressing the parents

and involving them in treatment, too.

Studies from my own lab
and from colleagues around the world

have shown a consistent trend:

well-meaning parents
are often inadvertently drawn into

the cycle of anxiety.

They give in, and they make
too many accommodations for their child,

and they let their children
escape challenging situations.

I want you to think about it like this:

Your child comes into the house
to you crying, in tears.

They're five or six years of age.

"Nobody at school likes me!
These kids are mean.

No one would play with me."

How do you feel seeing
your child so upset?

What do you do?

The natural parenting instinct
is to comfort that child, soothe them,

protect them and fix the situation.

Calling the teacher to intervene
or the other parents to arrange playdates,

that may be fine at age five.

But what do you do if your child
keeps coming home day after day in tears?

Do you still fix things for them
at age eight, 10, 14?

For children, as they are developing,

they invariably are going to be
encountering challenging situations:

sleepovers, oral reports,

a challenging test that pops up,

trying out for a sports team
or a spot in the school play,

conflicts with peers ...

All these situations involve risk:

risk of not doing well,
not getting what they want,

risk of maybe making mistakes

or being embarrassed.

For kids with anxiety

who don't take risks and engage,

they then don't learn how to manage
these types of situations.

Right?

Because skills develop
with exposure over time,

repeated exposure to everyday
situations that kids encounter:

self-soothing skills

or the ability to calm
oneself down when upset;

problem-solving skills,

including the ability
to resolve conflicts with others;

delay of gratification,

or the ability to keep your efforts going

despite the fact that you have
to wait over time to see what happens.

These and many other skills
are developing in children

who take risks and engage.

And self-efficacy takes shape,

which, simply put,
is the belief in oneself

that you can overcome
challenging situations.

For kids with anxiety
who escape and avoid these situations

and get other people to do them for them,

they become more and more
anxious with time

while less confident in themselves.

Contrary to their peers
who don't suffer with anxiety,

they come to believe that they are
incapable of managing these situations.

They think that they need someone,
someone like their parents,

to do things for them.

Now, while the natural parenting instinct
is to comfort and protect

and reassure kids,

in 1930, the psychiatrist Alfred Adler

had already cautioned parents

that we can love a child
as much as we wish,

but we must not make that child dependent.

He advised parents to begin training kids
from the very beginning

to stand on their own two feet.

He also cautioned
that if children get the impression

that their parents have nothing better
to do than be at their beck and call,

they would gain a false idea of love.

For children with anxiety
in this day and age,

they are always calling their parents

or texting distress calls
at all hours of the day and night.

So if children with anxiety don't learn
the proper coping mechanisms when young,

what happens to them when they grow up?

I run groups for parents
of young adults with anxiety disorders.

These youth are between
the ages of 18 and 28.

They are mostly living at home,

dependent on their parents.

Many of them may have
attended school and college.

Some have graduated.

Almost all are not working,

just staying at home
and not doing much of anything.

They don't have meaningful
relationships with others,

and they are very,
very dependent on their parents

to do all sort of things for them.

Their parents still make
their doctors appointments for them.

They call the kids' old friends
and beg them to come visit.

They do the kids' laundry
and cook for them.

And they are in great conflict
with their young adult,

because the anxiety has flourished
but the youth has not.

These parents feel enormous guilt,

but then resentment,

and then more guilt.

OK, how about some good news?

If parents and key figures
in a child's life

can help the child, assist them
to confront their fears

and learn how to problem-solve,

then it is more likely that the children
are going to develop

their own internal coping mechanisms
for managing their anxiety.

We teach parents now
to be mindful in the moment

and think about their reaction
to their child's anxiety.

We ask them,

"Look at the situation and ask,
'What is this situation at hand?

How threatening is it to my child?

And what do I ultimately
want them to learn from it?'"

Now of course, we want parents
to listen very carefully,

because if a child is being bullied
seriously or put in harm's way,

we want parents to intervene,

absolutely.

But in typical, everyday
anxiety-producing situations,

parents can be
most helpful to their child

if they remain calm
and matter-of-fact and warm,

if they validate the child's feelings

but then help the child,

assist them in planning how the child
is going to manage the situation.

And then -- this is key --

to actually have the child
deal with the situation themselves.

Of course, it is heartbreaking
to watch a child suffer,

as my parents told me years later.

When you see your child suffering

but you think you could swoop in
and save them from the pain of it,

that's everything, right?

That's what we want to do.

But whether we are young or old,

excessive anxiety leads us
to overestimate risk and distress

while underestimating our ability to cope.

We know that repeated exposure
to what we fear weakens anxiety,

while building resources and resilience.

My parents were on to something.

Today's hyper-anxious youth
are not being helped

by overly protective parenting.

Calmness and confidence
are not just emotions.

They are coping skills
that parents and children can learn.

Thank you.

(Applause)