Dr. Bob: My seven-year-old is anxious. Should she see a counselor?
Answer: This is an excellent question. We are currently in a pediatric mental health crisis – too many children are manifesting anxiety or depression and too few services are available. If you are concerned that your child’s anxiety is comprising her ability to function (family interactions, play, schoolwork or other instances) then you should seek assistance. Even anxiety not affecting functioning can be quite upsetting for a child and needs attention.
But first let me consider several things. 1) Remember that children often reflect the emotions of their parents. Try to take a step back and assess that family situation. Are there specific triggers in the current environment that might be affecting your child? Health, housing, food insecurity, parental or family conflicts and so many other things can affect how parents are processing things and in turn how children see the world. Children are not oblivious to things around them; 2) The anxiety might be situational, related to a specific set of circumstances. With appropriate reassurance and demonstration that things are improving, the anxiety might subside and become more manageable. It is fair to say that we all experience anxiety in some form at different times. When it affects behaviors leading to avoidance behaviors, then we become more concerned; 3) Situational anxiety can indeed persist and become more of a chronic problem. Simple parental reassurance often does not comfort the child in this circumstance or in these circumstances. It is in this latter condition that I think counseling should definitely be considered.
Anxiety that affects functioning (school phobia, performance anxiety, recurrent abdominal pain, severe fears and others) is often a protective mechanism for individuals that have been exposed to very emotionally charged situations. It is fair to say that the child’s perception of a certain situation (triggering anxiety) might be very different from what the parent perceives. The children’s brain might have interpreted the current situation as something to avoid. When this occurs, the brain is processing the information and determining a course of action that will minimize the perceived harm. This course of action will “help” the child but will often be interpreted by others as maladaptive or even harmful. Then a conflict might develop between the child seeking to avoid stress and the parents trying to move forward and misunderstanding the child’s behavior. Counseling is clearly indicated and sometimes medication can be of some benefit also. The latter should only be used by a pediatric health care provider. Plus it is very important for the family not to feel any degree of failure or stigma when mental health issues need to be addressed.
Counseling comes in many different forms. I would definitely reach out to your pediatrician to discuss the situation. In my experience, an assessment of the child’s well-being and a discussion of the situation with the child and parent(s) or child alone gave me great insight into the problem and helped lead to a further course of action when necessary. There are a whole host of child counselors at many levels (medical, school, pastoral, and others) that can be of assistance. I would seek a professional with well-established pediatric experience.
The bottom line – your child is anxious. Should see a counselor? I would get a medical assessment first and then get counseling. Be mindful of the situations in your household that might be triggers and be addressed to help alleviate any stress. It is useful for the parents to discuss this calmly and not around the children at the initial stages of this analysis.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com