Anne Marie Albano has been working with anxious New York City children and their equally anxious parents for 25 years—and now she’s taken decades of working through anxiety disorders and condensed her wisdom and advice into a new book, You and Your Anxious Child.
The book has strategies for helping anxious toddlers through adolescents, and focuses on giving parents of anxious children tools to manage their own worries—and to avoid helicopter parenting.
Albano is a professor of clinical psychology at Columbia and the director of the Columbia University Clinic for Anxiety and Related Disorders. She recently spoke with The Daily Beast about the most effective treatments for childhood anxiety and how young college and high-school graduates living at home without jobs are often the products of untreated anxiety disorders.
There’s a lot of writing about generalized anxiety disorder and childhood anxiety. How does your book address these issues in new ways?
I wanted to focus on the parents of anxious children in a way that’s not often addressed. As soon as the child gets anxious, the parent gets anxious; this book is intended to help parents address their child’s anxiety while also recognizing what’s happening to them as they react to their child, and how they can soothe themselves while helping their child. Other books neglect to really go after how the parent is feeling, and don’t address how the parents’ anxieties maintain and perpetuate the child’s anxiety—they become helicopter parents. That interferes with the child’s process of wrestling with and treating their own anxiety.
How do parents typically react to a child showing the first signs of an anxiety disorder?
Parents always come in with guilt, they say, “What did I do wrong?” I try to tell parents that their children are not born with a manual on how they need to be raised. Parents need to take a step back and think rationally about what’s going on with their child.
And how does the anxiety of one child affect siblings and other family members?
When you have a child with anxiety in your family everyone is affected by it. I worked with a family that had a son that refused to go to school after eighth grade because of his anxiety. His sister was four years younger and sometime during her sophomore year of high school her parents got a call from the school saying the daughter had not been to school in eight weeks. She’d been hiding in the bottom of her bedroom closet for weeks. When you have one anxious child, the siblings are likely to act out in some way, either by imitating the anxiety or getting angry.
When should parents seek help for their anxious child?
I don’t believe that children should spend their childhood in a therapist’s office. When I moved to New York City, it seemed like every child I met was in therapy two to three times a week. I would talk to parents and ask them what the goal of their child’s therapy was, and they wouldn’t know. A parent should be involved in setting up goals and evaluating whether treatment is working.
Is it ever too early for a child to start therapy?
We’ve adapted evidence-based treatment for children as young as 3. It’s a family-focused treatment in which therapists watch behind a one-way mirror as parents wearing an earpiece interact and play with their children. The parent is coaching their own child to become more courageous. It’s never too early to start treating an anxious child in therapy but with younger children the work is more with the parent than with a child seeing a stranger a few times a week and playing with toys.
What types of therapy work for anxious children?
Cognitive behavioral therapy is the only treatment parents should be seeking for their anxious children. This treatment helps them soothe themselves, to put themselves to sleep at night, how to wait in line for something in a calm way, deep breathing and relaxation strategies. CBT helps children recognize that they are talking themselves out of things and talking to themselves about being afraid of things. Trials have shown that years after children start CBT, adolescents and adults continue to use the skills they learned during their treatment. They are doing okay for the most part and there’s some evidence that CBT keeps them away from substance abuse.
What about medication?
We know how to treat children with anxiety in the short term, but there’s less research on the long term effects of medicating anxious children. We don’t have enough research to know what these medications do to a child’s developing brain. We advise children to start with CBT and add medication if it’s needed.
Is there still stigma about childhood anxiety?
The stigma is more with the parents than with children and adolescents. Parents sometimes have an attitude of, “I was brought up in the school of hard knocks, no one babied me.” There’s fear that this will be a blight on the child’s record. Kids talk more openly about their own anxiety now than ever before in my 25 years of work. De-stigmatizing has to be focused on parents and treating mental illness the same way you would treat a medical condition. We should never shame someone out of therapy.
What about anxiety in adolescents?
This book is mostly about children aged 7 to 17, so that their parents can try to make a difference early on and their kids can really have a childhood. Anxiety in children usually manifests in separation anxiety, social phobias and generalized anxiety. Adolescent anxiety is now more like adult anxiety. I see a lot of adolescents who can’t advocate for themselves, they won’t apply to college or for jobs because they’re anxious about interviews. I practice exposure with the adolescents I work with; we created a mock prom for a kid we work with who had social anxiety and was asked to prom by a girl he liked. We arranged it every which way to account for everything that could have gone wrong to show him that even the bad stuff wasn’t as scary as he thought. The window of opportunity closes very quickly when you get to adolescence.