April 2023

How can I tell the difference between an accommodation and a support for my child’s anxiety?

Before I answer this week’s question, I want to define accommodation and support. I think it’s confusing because when we talk about children who have 504 plans or an IEP for school, accommodations are a good thing. And when we’re looking at the research on child anxiety or OCD, accommodations are a negative thing. This is why I use the term Pitfalls as in parenting pitfalls instead of accommodations when I talk about them on my podcast and in my program. 

For the purposes of this particular episode, I’m going to use accommodation because that’s what the person who asked the question used and again, because that’s what the literature uses. All right? So just to be crystal clear, we are NOT talking about the accommodations your child might have in their 504 or IEP program. 

I am going to use the definition offered in the 2014 study Parental Accommodation of Child Anxiety and Related Symptoms from the Journal of Anxiety Disorders, which is “changes in parents’ behavior in attempts to prevent or reduce child distress.” That sums it up. It’s parent behavior (as an aside, siblings and grandparents and other caregivers might get pulled in) but it’s parent behavior and it’s meant to prevent or reduce distress for the anxious child.

I want you to really focus in on the “prevent or reduce” part of the definition. Accommodations are all about AVOIDANCE. They’re about avoiding the feelings that come with being anxious, that feeling of distress.

Common accommodations include:

–reassuring children repeatedly, trying to help them feel better about their worries

–intervening on a child’s behalf with others such as ordering at a restaurant, speaking for them when they are questioned

–Minimizing separation such as staying with them at night (and I’ve addressed co-sleeping several times on this podcast if you want to talk more about that, I encourage you to look at previous episodes), picking them up from school when they’re upset, or even showering with the door open because they get upset if they can’t see you

You can see that these are about helping a child NOT feel worried. And it’s natural that we would want to do this. You know why a baby’s cries are so upsetting right? Because we are meant to respond and stop it. Same with whining. We have a primal urge to prevent tears and upset in our kids. Very often we are responding before we’ve even thought about it. Our child is upset, and we immediately do what we can to minimize the upset.

Accommodations can work for non-anxious children. A child says, “what if my teacher gets mad” and we say, “Oh they’re not gonna be mad” and a non-anxious child says, Great! And moves on. An anxious child needs more reassurance. They get hooked on it because they are unable to tolerate the distress of their anxiety.

We all experience an anxiety but a child with an anxiety issue, feels it more often, feels it more deeply, and finds it more distressing. Which is to say, they have good reason to want to avoid their anxiety. They are not weaker than other kids, they are not unreasonable — they are truly feeling that anxiety more intensely. It’s a bigger deal for them. And avoidance is understandable. That said, it does not help.

Accommodations allow them to avoid and avoidance does not help.

Now. Supports. Supports help them tolerate. They encourage their ability to stick with the thing that scares or worries them. They help them acclimate to their feelings of distress so they are able to increase their distress tolerance.

All right? So that’s the major difference and it’s easy to remember: Accommodations allow avoidance, Supports Help them Stick with it. See? Alliteration for the win!

Ok, so we’re all on the same page here and we understand what we’re talking about but now things are going to get tricky because a support can become an accommodation or rather we may need to accommodate a bit as we move to support. 

What I mean is, on our way to decrease accommodations and increase supports, we may need to move down the accommodation scale. 

Let me give you an example. Let’s say we have a child who is afraid of dogs and so they won’t go in the backyard because the next door neighbors have a beagles who barks its head off whenever someone goes outside. A support to help them face their fears might be that a parent goes out with them. That helps them face the barking dog.

After awhile, the presence of a parent ceases to be a support and becomes an accommodation because as they acclimate to the barking dog, they need to face their anxiety about doing it alone. 

When we’re planning to reduce accommodations and increase supports, we use a scale that helps us map levels of anxiety and we work to move the child from the bottom of the scale, where there is the lease anxiety, towards the top where there is more anxiety.

We do this in a systematic way, step by step so that we’re not overwhelming the child but also not overwhelming ourselves. This is especially important if we have kids who demonstrate their anxiety with meltdowns or other big behaviors. 

If you are curious if your supports look more like accommodations, I encourage you to take my Parenting Pitfalls quiz, which is based on the Family Accommodations Scale assessment. Have questions? Let me know!

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Does mindfulness help child anxiety?

Mindfulness is a big buzz word these days especially around anxiety and I appreciate the opportunity to talk about it here so thank you to the listener who sent this question my way. They asked not only “does mindfulness help child anxiety” they also asked, “And if so, how?” 

All right, first let’s define mindfulness and for this I’m going to head to the Oxford Language dictionary and share the second definition, which describes mindfulness as “a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.”

I’d say that’s pretty dang accurate so that’s the definition we’re going to go ahead and use for this episode. 

Now let’s go back to the question. Does that help child anxiety? Does achieving a mental state by focusing one’s awareness not etheh present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations” help child anxiety?

Well, that depends on how you’re going to define help.

Lots of people when they first begin working on child anxiety are focusing on stopping the anxiety. They call me and say, “My child is anxious and I’d like to help them learn how not to be anxious.” Or they say, “I want them to learn how to cope” but as we dig into their situation it’s clear that the proof of coping will be the eradication of anxiety.

I get that. That’s the way I thought about anxiety, too, before I had my clinical training. That’s why we say things to our kids like, “You don’t have to be nervous” or “there’s nothing to be afraid of.”

We see tears or tantrums or meltdowns and we think, “Oh gosh, this is failing. My child is feeling their anxiety and something has to change.”

Mindfulness doesn’t mean not feeling. It’s right there in the definition. It means feeling and being aware of the feeling. It means noticing thoughts. It means noticing that your stomach hurts with worry. It means noticing that and accepting that, not necessarily fighting it.

When I say that, I’m curious. What’s your reaction? When I say, your child is just going to have to sit with that tummy ache. Or just sit with that feeling of wanting to run away. Or just sit with their anger that you’re not helping them. I imagine you’re feeling a lot of yuck. Noticing that yuck, noticing that perhaps you feel resistance to allowing your child to suffer, that’s mindfulness.

I think paying attention to the similarities of our experience with our child’s experience is incredibly helpful when it comes to child anxiety. So when I talk about mindfulness and child anxiety, first I want the parents to explore their anxiety. I want them to work on their own mindfulness skills because through that they will be able to help their child. 

Let’s say our child is anxious about a new babysitter. You have plans to go out to dinner with your partner and you know you’ll be back kinda late. There’s a new baby sitter, you know them and you trust them — let’s say they’re your neighbor’s niece who is getting her degree in early childhood education. You trust your neighbor, you’ve talked to this young woman on the phone and you really like her, but you haven’t met her yet and neither has your child. You also know your child doesn’t like anyone else around at bedtime so you’re nervous. 

You want to go out, you have special tickets to a big thing, a big show that you’ve been looking forward to. You’re excited to put on grown up clothes and eat at a grown up restaurant and see this show but you’re nervous. 

You’re nervous that your child won’t talk to the babysitter. You’re nervous that they’ll meltdown when you try to leave. You’re nervous that the babysitter won’t be able to build any kind of rapport. You’re nervous that your child will be constantly texting you during dinner and during the show and if you turn your phone off or on airplane mode during the performance that you’ll miss an emergency call. 

So you’re just kind of a mess about it.

Your mess about it mirrors your child’s mess about it. Your worry about your child’s worry is a helpful lens into what’s happening for your child. 

If you can take care of your worry, you will be helping your child to find a way out of their worry.

Let’s bring mindfulness into it.

Mindfulness doesn’t mean that you ignore your worry or distract yourself away from it. It means you sit and you notice it. You don’t do anything else. You don’t try to talk yourself out of it or try to manage it, you just notice it. 

Noticing helps you step outside of yourself. You can try narrating what you observe, doing this literally can really help. 

That might sound like saying out loud to yourself, “Wow, when I think about walking out the door, I can feel my breath get more shallow. I think my heart rate goes up. I catch myself trying to talk myself out of going or into going. I feel like my mind races.”

You could journal your way through it. 

You could talk it out with someone who is willing to listen and not try to solve things. 

In mindfulness, you allow yourself to be in two places at once. You have the experience and you NOTICE you’re having the experience.

You might feel yourself drawn to look back — like at the last time you tried to go out. Or you might feel yourself drawn to look forward — projecting into how the night might go. And when you notice that, you can bring yourself back.

You can say, “Ok, I’m having all of these feelings. I notice all of these sensations in my body AND I notice the feeling of the sofa cushion I’m sitting on, the rough fabric of my couch. I notice that I can hear the wind chimes outside or the traffic. I am aware that the light in this room dims when the sun goes behind a cloud.”

That brings us back to the present. We notice the pull away, and we notice that things here that bring us back.

So how does mindfulness help? It helps by letting us sit with the feelings until they pass. 

There are different ways to be mindful. IT doesn’t have to be sitting quietly; it can be walking and tuning into the walking. 

You know how some people think more clearly when they listen to background music? It’s the same kind of thing. You’re not doing mindfulness wrong if you do it differently than someone else. The goal is to be with feelings. 

Movement can help us be in two places at once. It can help us look at our experience more objectively. 

For some kids, especially anxious kids, it might be easier to be with a feeling when they’re moving. I used movement a lot in my clinical work with children. Asking them to sit with their feeling might be overwhelming but we could pace around my playroom or play toss or they could even cartwheel and then come back to whatever they were feeling.

Again, there’s no wrong way to learn how to engage with our feelings. Remember anxiety is about avoidance and the avoidance is focused on helping us NOT feel uncomfortable. But we do need to feel uncomfortable to overcome our anxiety and mindfulness is a tool to do this. It gives us the opportunity to step into being anxious, being uncomfortable and not running from those anxious, uncomfortable feelings. It’s fine to dip in and dip out. It’s fine to build up our tolerance a little bit at a time. Mindfulness does not have goal posts. It’s a practice, which means we practice it. 

By the way, if you’d like some help in bringing mindfulness to your day to day, you can head to my site and take the Parenting Pitfalls quiz. AT the end you’ll have the opportunity to sign up for my free 7-day Get Yourself Grounded email course. Just go to Child Anxiety Support.com/quiz



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How do I address child anxiety that’s the result of trauma?

I recently had a question from a listener whose child has separation anxiety after the death of a caregiver. I did reach out to this family privately but I wanted to cover this on the podcast as well.

Before the most recent DSM update, PTSD was listed as an anxiety disorder but as the field has become more trauma informed, it is now listed as a trauma and stress-related disorder and anxiety is recognized as one of the symptoms. 

This shift recognizes that PTSD is not just a subset of anxiety and in fact anxiety is an adjunct of PTSD. The new diagnosis recognizes that the most pressing concern is to address the trauma. The anxiety may drive the behavior that inspires the intervention, That is, the child may be displaying separation anxiety and that’s the reason the family is seeking help but the underlying reason behind the anxiety is the trauma of losing a family member.

Let’s talk a little bit about trauma. It’s a word we use a lot and not always correctly. The DSM defines trauma as “actual or threatened death, serious injury or sexual violence.” You can see that’s extremely limited and doesn’t include the way we use trauma even in the therapy field. In the therapy field, we include broader upsetting or disturbing events so we might call a divorce a trauma or being fired from a job. Technically, per the DSM diagnosis, these would not be trauma although they would certainly be upsetting and deserve attention and care.

Now I personally have no interest in gatekeeping the word “trauma.” If someone tells me an experience was traumatizing for them, I’m not going to say, “Well, technically I don’t think you can claim that term” instead I’m going to offer support, right? But when it comes to figuring out what to do next and how to treat or address a situation, we do need to be clear about what is traumatic and what is not.

I mention this because I’ve talked to many parents of anxious children who are using the term “traumatized” to describe their child’s experience and this is making it difficult for the parents to address the anxiety. They are understandably concerned that pulling back from the Parenting Pitfalls and exposing their child to the things that make them anxious will further traumatize their child. They are confusing upset with trauma. And I think we need to be very clear that being upset is very different than being traumatized.

Let’s go back to that DSM definition of “actual or threatened death, serious injury or sexual violence.” The key here is threatened, which means that even if we weren’t in danger, we believe we were. Truly believed. This is a big concern about active shooter drills in schools. If children aren’t aware that it’s a drill, this can absolutely be traumatizing. 

Now we’ll talk about the symptoms of PTSD — that is, post traumatic stress disorder — in the current DSM for children 6 and under

For that diagnosis, the child must have been exposed to actual or threatened death, seriously injury or sexual violence either directly experiencing it, witnessing it happening to someone else, or learning that it did happen to a parent or caregiver. The DSM expressly states that this does NOT include media such was watching a violent movie or seeing an upsetting picture. Again, this is the DSM diagnosis and we are not saying that seeing a scary or violent movie would not be upsetting or disturbing. 

If the child has this exposure history, then we look at symptoms. These would include intrusive symptoms like:

—Distressing memories that reoccur (sometimes the child won’t seem upset but will play repetitively about the event). When I worked at a shelter, many of the children would act out the police coming to arrest someone in their house over and over again.

—nightmares or dreams about the event. This could be a child who wakes up crying because they’re dreaming about the person who died.

—Dissociative reactions, also called flashbacks, where children act as if the event is happening again, and again this can be expressed through play. 

—Distress when exposed to things that remind them of the event, like a child who gets upset driving through the intersection where they were in a car wreck,

And it would include symptoms of avoidance such as:

—Refusing to go into the room where that person died;

—Avoiding conversations about the trauma event.

—Disinterest in play or other activities that used to interest them;

—The presence of negative emotional rates like sadness or confusing or fear;

—Withdrawing socially;

—not being able to have fun.

Other symptoms might include:

—sleep disturbances;

—Irritability or anger so tantrums

—difficulty concentrating

—hypervigiliance, which is being super tuned in to the possibility of danger

—exaggerated startle response

You can see how this can be confused with anxiety since anxiety shares many of the symptoms. Sow hat’s the difference? The biggest difference is the presence of the traumatic event. 

There are several treatments with a strong evidence base for young children with a PTSD diagnosis. These include Trauma Focused cognitive behavioral therapy or TF-CBT, Parent-Child Interaction Therapy and Child-Parent Psychotherapy. All three of these treatment modalities include the parents. The younger the child is, the more vital it is that parents are included in the therapy. This is because relationships mitigate trauma. EMDR or eye movement desensitization and reprocessing is also a recognized treatment for trauma and if you’re interested in exploring this, I would recommend that you contact EMDRIA at EMDRIA.org. Doing EMDR with children is a specialized skill and EMDRIA has high standards for the people who can be listed in their directory. Sometimes a clinician will take a weekend class and feel like they are ready to go and I just want to caution you about that. EMDRIA can help you screen for a truly qualified therapist. 

Children heal best in the context of a loving, supportive, relationship with a caregiver who is dependable and trustworthy. If your child has experienced a traumatic event and you are seeking treatment, make sure that you are included in that treatment, whichever you choose.

Trauma treatment is meant to help the person process the traumatic event so they can move through it. Now I’m going to explain this super simplified but trauma glitches our brains. It gets us stuck. Note that the intrusive symptoms are all about the stickiness — nightmares, memories we can’t shake, being triggered back into our trauma response when confronted by a reminder, avoiding things that make us think of the trauma. Treatment helps us unglitch our brains. Children who may repetitively play out the traumatic event are trying to unglitch. They are trying to play through to understanding so they can let it rest. Sometimes they need help pushing through the stuck place in their play. 

It’s important that the therapist a family chooses has specific training in trauma because inappropriate treatment can be retraumatizing. For example, our thinking used to be that people needed to remember the traumatic event. You’ll see that in movies where someone has a blank space in their memory and the big climactic moment in the movie is when they remember what happened. Actually not remembering can be protective and healing doesn’t always require uncovering those distressing memories.

Ok, back to the question that inspired this episode, How do I address anxiety that’s the result of trauma? And the answer is first address the trauma. 



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What can I do when I feel like I’ve failed my anxious child?

You know, when I started this podcast I figured I’d do it for one year — 52 episodes and that would be it. But this is Episode 54 so I’ve officially gone past my goal and the questions that are coming in are more complex. Like this one. And of course the actual question has a lot more backstory, which I won’t share given that it is very personal, and I’ve tried to distill it into this one simple but complex question, which is What can I do when I feel like I’ve failed my anxious child.

Oh listener who posted this and who did not leave their email so I couldn’t respond personally, I hope you are listening now. 

I’m sorry that you’re struggling right now and that you are hurting. Being a parent can be so painful especially when we are watching our children have a hard time. AS writer Sarah Payne Stuart: said, You’re only as happy as your least happy child. 

I’m going to try to address this very big, very important topic in this extremely short podcast and I hope that I’m able to do it enough justice that you will feel comforted and more confident at the end of it.

First off, you have not failed your anxious child. The relationship between parent and child is one that is forever changing. It changes as they change, as we change, as life changes. And sometimes we are a step or so behind the changes that need to come.

I learned this for the first time when my son, my oldest child who is now 26, was two. This is when he entered what I call the bent banana stage. You know the one, the one where your toddler asks for a banana dn if you give to them and they fall on the floor wailing because the banana is the wrong shape or size or you started peeling it for them or you didn’t start peeling it for them. When my son hit that age I was totally unprepared and our days bounced from tantrum to tantrum. This beautiful relationship I’d built with him came apart like wet tissue paper. The worst day was when he had a meltdown in public and another person intervened and told me I was handling it wrong. That’s a whole story about a bagel and one day if we ever met in person, ask me and I’ll tell you the whole sordid tale .But as I left that shop in tears, totally ashamed, I felt like a terrible mother and I felt like a fraud because I’d been working with kids for about a decade and yet here I was undone by my toddler. I can close my eyes and put myself right back there and remember exactly how it felt to carry my screaming child to the car while this woman watched, my face hot with guilt and anger and grief and fear thinking, I’ve broken my kid. 

Then my friend called, my friend with a child exactly one month older than my son, and said, “What in the heck is going on, my daughter has lost her mind.” And when we compared notes I realized, oh, he’s just 2 now and he needs a different kind of parenting than I’d been offering. I was still parenting him like a baby and he was letting me know that he was ready to be parented like a toddler. I had to learn a whole new set of skills.

This was a lesson I learned over and over again and every time we hit a snag — whether it was with my son or later with my daughter — and I started having that overwhelming feeling of frustration and guilt and failure I’d stop and say, “Wait, maybe it just means something needs to change.”

So I will ask you dear parent, who is feeling like a failure, I think it’s far more likely that you’re NOT a failure, that you’re a good parent in a relationship that needs to change. The pain and frustration you have, the struggle between you, is a sign that your child is demanding something different from you and you can do something about that. You have it within your power to go and figure out what to do next.

Do you get that reframe?

So many of the parents I talk to who are committed to parenting differently than they were parented — and there are a lot of us in the respectful parenting, gentle parenting, attachment parenting, conscious parenting, etc. community — Are super afraid of getting it wrong. In fact, so afraid that we might be causing harm that we are all too ready to beat ourselves up when we are unhappy or when our child is having a difficult time. 

Parenting guilt goes with the territory, I don’t know any parent who’s going to feel like they’re 100% nailing this parenting gig all of the time. And when we slip and yell or read a parenting book that highlights our mistakes or see another parent handling a challenge with grace that we screwed up, we’re probably going to feel guilt.

But guilt is only useful when it helps drive change. Guilt that just makes us feel bad about ourselves is useless at best and harmful at worst. It’s ok to say, “all right, guilt, I’m going to do things differently so you can stand down now.” It’s ok to say, “I regret those mistakes but I’m going to forgive myself and honor my intention to do better next time.”

And then we can start putting the supports in place that will allow us to do that. That’s what I mean about finding the motivation to drive change.

A lot of parents I talk to feel guilty not just because of what they’ve done or haven’t done but because of how they feel. They feel guilty for not enjoying their child or not enjoying parenthood and let me just say, that you can love your children very very very much, you can be willing to lay down your life for them AND you can also not enjoy them because kids aren’t always enjoyable.

 you can also not always enjoy parenting because the work of parenting — the day to day work of it — is not always enjoyable.

Parenting anxious kids is really hard. It’s hard to worry so much about them, it’s hard to feel derailed by them. It’s hard to have kids who demand so much. It’s hard to feel like you’re constantly failing. It’s hard to get whined at. It’s hard to deal with meltdowns. I mean, it’s not fun. It’s perfectly ok to want to run away from home sometimes.

I tell parents this all of the time — if you’ve worked with me before you’ve probably heard me say it — but there’s a whole genre of novels about moms who leave their families and there’s a reason for that, which is many of us have days when we’d like to run away from home. It’s ok to fantasize about running away and joining a circus instead of being a parent. Sometimes fantasizing about it is just the break you need to help you come back and face your tantruming child and your overbooked calendar and your messy kitchen and your endless to-do list once again.

I bring all of this up because sometimes the guilt about failing (I’m using air quotes here) is covering up a guilt we have about wishing we didn’t have these demands on us at all. And sometimes all of that guilt — all of that messy shame and worry and regret and fear — makes it really hard to know what to do next.

I meet a lot of parents who are overcompensating — like really getting entrenched in the parenting pitfalls — because they aren’t liking their kids very much and they feel bad about it.

So for example, a parent who goes out of their way to be gracious when their child is whining and dragging at them because they feel guilty for wanting to lose it. And I tell those parents, it’s ok to be human in the relationship. You don’t always have to be an instagram worthy parenting whisperer with your kids. If the relationship between you and your child is generally healthy, is generally loving, is generally strong then there is room for your imperfection.

There is room to get it wrong, realize it, and course correct.

There is room for you to go back and say, “I didn’t know and now I do and so I’m going to do it different from here on out.”

Getting it wrong, getting stuck in parenting pitfalls, feeling unhappy —  is a sign NOT that you’re a bad parent or that you have a bad kid or that you’ve been doing a bad job, the sign is that something needs to change.

That’s it. 

Just that something needs to change. And how else are you going to know that something needs to change except by becoming dissatisfied about the way things are right now. In other words, being unhappy in your parenting relationship or with your child is healthy and appropriate and NOT a sign of failure. 

When I am working with parents, I start with the assumption that they are doing a good job. Because most parents are. And when I start with that assumption, I am looking for confirmation so I’m making a point of noticing that parents’ strengths and skills. Those are the things we want to tap into as we make change. I don’t start with what they’re doing quote unquote wrong because I don’t think in terms of wrong. I think in terms of, What’s working and what’s NOT working.

This is why I say that your parenting isn’t the problem; it’s the solution.

IF I went back in time to meet myself as the unhappy mother of an unhappy 2-year old, I wouldn’t say, “Wow, what a screw up. What a bad mom. What a mess!!” I’d say, “Oh wow, there’s a mom tuned in enough to know that this isn’t working and just needs some help in figuring out what to do next.” 

I’d look at the good relationship we had up until that developmental turning point and know that the relationship was demanding change. My son was one of those kids who hit every developmental milestone like the Wile E Coyote running into a wall. Just slammed into it and every time I’d forget and think oh my gosh, I’m failing. I think I didn’t figure it out until he was about 10. I’m hoping you get to figure it out sooner. That change is hard, that change sometimes — well often, requires some measure if discomfort. It requires us to be uncomfortable enough to change. 

So my dear listener who posted this question to me and anyone else who is feeling this way, you have NOT failed your anxious child. You are realizing that what you’re doing isn’t working and how wonderful that you’ve realized this because now you can look for supports and information to help you create change. That doesn’t mean your struggle is over but it does mean that you have begun the journey to better functioning and understanding. 

True failure would be in denying your unhappiness or denying your child’s struggle and continuing to do the things that are not working. It would be continuing to treat a toddler like a baby when they are begging for help in growing up. 

We growing parents, instead of seeing ourselves as doing things wrong, I wish we could reframe this as the inevitable course of changing parenthood. What you did and what you do works until it doesn’t and then you might be unhappy and your child might be unhappy. But you can change things. Let me know if I can help. 



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