«Sally Patton UNITARIAN UNIVERSALIST ASSOCIATION BOSTON Copyright © 2004 by the Unitarian Universalist Association of Congregations. All rights ...»
have obsessive-compulsive symptoms.13 Tourette’s syndrome is a neurological disorder characterized by involuntary movements and vocalizations (or tics). Usually, this disorder emerges around age seven, although it can start earlier or later. In addition to OCD, Tourette’s syndrome is often accompanied by conditions such as ADD, specific learning disabilities, and sensory integration problems.
Discussion The causes of anxiety disorders vary and may involve a combination of factors, including genetics, brain chemistry, personality, and life events. Children and adolescents can experience any of the major types of anxiety disorders that adults can experience, although some are more prevalent in childhood and tend to be age specific in terms of onset. And while adults and children may experience similar symptoms of anxiety, children often display and react to those symptoms differently. These differences can create problems in diagnosis, including determining whether a child’s behavior is just a phase or an actual disorder.
Despite the fact that anxiety disorders are highly treatable with psychosocial therapy and medication, only about one-third of the people struggling with anxiety disorders receive treatment, according to the Anxiety Disorders Association of America.14 Professionals who work with overly anxious children use a combination of treatments to help them develop coping skills and resilience and learn how to interact more successfully with their environment.
In our work with these children, we need to understand the rigid thinking patterns and often debilitating behaviors that they use to cope with their intense fears. A fearful child experiences
three basic reactions:
• a physical reaction, such as a pounding heart, shortness of breath, sweaty palms, lightheadedness, and tightness in the chest 150 Welcoming Children
• a cognitive reaction involving the images that promote the fear, such as inaccurate and overblown perceptions that make a harmless event seem threatening
• a behavioral reaction, or the tendency to avoid the situation that is perceived as frightening Most experts agree that the physical reaction to a stressful situation, sometimes called the fight-or-flight response, is hardwired into the human body. This response was essential in our ancestral days of hunting and gathering. However, most of the stressful situations children face cannot be resolved by attacking or running away. For example, a twelve-year-old girl may feel that everyone is staring at her and thinking she is odd whenever she is in a room full of people. At birthday parties, she may become so anxious that she leaves. Eventually, she may avoid all parties, social gatherings, and maybe even school. Ultimately, she may refuse to leave her home. A child like this needs to learn how to calm her nervous system, so she can think clearly and creatively in stressful situations.
Even if children can manage to calm themselves, many exhibit distorted thinking when highly stressed. That is, they have a faulty understanding of what they are experiencing and feeling, accompanied by inflexible thinking due to stress. These children do not seem to know how to access their imaginations to find creative coping strategies for their fears. They need to learn to become better problem solvers.
Children who are master worriers tend to magnify and distort their fears. The following list, adapted from Katharina Manassis’s book Keys to Parenting Your Anxious Child, identifies common
• Arbitrary inference: interpreting situations or events without factual information. For example, John does not say hello to Mary at lunch, so Mary immediately thinks that he is mad at her and avoiding her, even though John was friendly in class.
• Selective abstraction: focusing on a negative detail out of context and ignoring other more prominent features. For example, 151 Anxiety Disorders Harry receives resounding applause after playing his piano recital piece without any mistakes. But when his teacher talks with another student first before congratulating him, he worries about what he did wrong.
• Overgeneralization: forming a general conclusion on the basis of a single event. For example, Joan falls once during her ice skating lesson and decides that she is a terrible skater.
• Minimization or magnification: gross underestimation of an event and gross exaggeration of an event to see the worse possible outcome. For example, Tom, who is afraid of dogs, feels that all the dogs in his neighborhood are vicious and that there is nothing he can do to protect himself.
• Dichotomous thinking: an either/or interpretation of events with little tolerance for ambiguity. For example, Rachel’s older brother told her that he could not go to the movies with her because he was scheduled to play with his friend Jacob. Rachel decides her brother likes Jacob better than her.
• Personalization: an unsupported perception that an event reflects on one’s self. For example, Mario overhears a brief conversation describing someone who dresses badly, and he immediately assumes they are talking about him.
• Emotional reasoning: equating feelings with facts. For example, Shawna feels anxious talking to Sue in a group of people, so she concludes that she can never talk to someone unless he or she is alone.15 Even if they develop a plan for coping, highly anxious children tend to avoid anxiety-producing situations or give up after initial attempts to face their fears. If the anxiety becomes severe, these children may start avoiding not only the situation that caused the initial anxiety but also other situations where the anxiety may occur again. Sometimes, they generalize from the initial fear so much that it gets lost. But by then, their avoidance of situations may be so profound that they cannot go to school or even leave 152 Welcoming Children home. The avoidance that originated with the now-lost initial fear has become so extensive that it is seriously debilitating. Children need to be taught to have faith in themselves and their ability to deal with their anxiety before it gets out of control.
Ministering to Families Because anxiety is often a silent affliction, we as ministers and religious educators will most likely be unaware of the children in our program who have anxiety disorders. Additionally, families often deny that there is a problem or work hard to hide the problem from the public; many will be unwilling to talk about their child’s excessive anxiety.
We can reasonably suspect that there is a problem if a child never talks while participating in a religious education group, insists on performing certain rituals before participating, or often becomes terrified for no apparent reason. When we suspect that a child has an anxiety disorder, talking with his or her parents is the necessary first step. We must be very careful, however, not to diagnose but only to suggest that the parents talk with a professional about their child’s anxiety. Some parents are actually relieved to have an outside observer confirm their suspicions. They can experience enormous stress trying to decide if their child will grow out of a dysfunctional behavior pattern or if it is a more chronic condition.
While all anxiety disorders affect the dynamics of the family, OCD is especially powerful in this regard. Given this, we need special understanding in order to minister to the family of a child with OCD. Some professionals refer to OCD as the “hidden epidemic.”16 Children with OCD try to hide the symptoms, and many professionals are not trained to diagnose this disorder. To further complicate diagnosis, a child may have mild symptoms of OCD for years before some outside stress or trauma triggers a major obsessive-compulsive episode. OCD also waxes and wanes over 153 Anxiety Disorders a lifetime. As described by Herbert L. Gravitz in his book Obsessive Compulsive Disorder, It is like riding a roller coaster without ever stopping. The sufferer may be relatively symptom-free for days or weeks, even months, when suddenly the disease strikes again. Symptoms often come from out of nowhere and the sufferer feels like he or she has been blindsided.17 It is essential to understand that OCD is a problem with brain chemistry and biologically driven. According to Tamar E. Chansky in Freeing Your Child from Obsessive-Compulsive Disorder, Simply stated, OCD comes from a biochemical mishap in the brain. Part of the brain sends out a false message of danger and rather than going through the proper “screening process” to evaluate the thought, the brain gets stuck in danger gear and cannot move out of it. The emergency message circuit keeps repeating and is “immune” to logical thought.18 While OCD does run in families, it can occur in an individual with no genetic predisposition. Moreover, it is no one’s fault. OCD in children is not the result of poor parenting or inappropriate behavior. Children do not engage in compulsions because they want to but because doing so is the only way they know how to cope with the awful obsessions locked in their brains. When they understand that OCD is caused by a sort of misfiring in the brain, then they can start to realize that they have a choice in how to respond.
The child realizes, “I don’t have to listen to this message—it’s not real—it’s a brain trick. I can fight this.”19 The goal is not to make the OCD disappear but to change the child’s response to it. Children can learn to cope with their fears and to recognize that their obsessions and compulsions are a result of the OCD. OCD is a trap; it is not who they are.
The other anxiety disorders may be caused by a combination of factors, including genetics and brain chemistry as well as 154 Welcoming Children personality and life events. Whatever their individual causes, these disorders share the effect of bringing shame to the children who experience them. Children with anxiety disorders are often stigmatized by their bizarre behavior, such that they and their families will do anything to keep the disorder a secret. These children know that their peers do not have to do the things they do to maintain control or to stay safe, and they are usually ashamed of their lack of self-control.
With these dynamics, the family coping with a child with an anxiety disorder is in many ways similar to the family coping with an alcoholic member. In our religious education programs, we need to let the parents and if possible the children know that there is no shame involved and that effective treatment is available.
Again, our role is to suggest, not to diagnose.
When the family acknowledges that there is a problem, they can move toward healing what Gravitz calls a “traumatic wound.” According to Gravitz, We are never fully cured of our traumatic wounds. In contrast to curing, our traumatic wounds may or may not be eliminated when we heal. But the suffering is gone. We discover we are not separate but are part of the unity of the universe. Healing goes deeper than symptoms; it involves becoming clear about our real self and purpose in life.20 Thus, through healing their severe anxiety, children and their families can learn to embrace life.
overly anxious children address their fears. The ideas presented in this book will be useful in developing our programs because all children will benefit from activities that enhance problem-solving abilities, flexibility in thinking, self-worth and faith in self, and the ability to live in the present. In addition, some of the techniques Dacey and Fiore suggest for calming the nervous system will be helpful to all children.
Humor is an excellent way to distract a child who is becoming overly anxious, and performing exercises in visualization and guided mediation can increase a child’s visual ability to see himself or herself in a calming scene. The recitation of a prayer with powerful meaning can calm an overly stimulated system and bring peace to a troubled mind. The famous prayer by St. Francis of Assisi (“Lord make me an instrument of peace”) is an example of this type of prayer. Dacey and Fiore also talk about helping children create a “bank of goodwill,” in which they regularly perform acts of caring and helping others.21 This “bank” can help them during difficult times.
Finally, imaginative thinking is a critical tool for children with high anxiety, who often believe they must rigidly follow all of the rules and even make up rules in order to feel safe. Problem-solving activities that foster flexible, imaginative thinking can help anxious children begin to cope. Moreover, encouraging the positive side of children’s imaginations can help them develop persistence in the face of obstacles and failures.
Disruptive Behavior Disorders I’ve yet to meet a troubled child who wasn’t, above all else, terribly lonely. I presume loneliness even before I see the child. The misbehavior of troubled children is seldom what it first appears to be. Understanding this, I believe, is the only place to start. No child has a need to create a life of conflict.
Think about it—what need is the child trying to express?
—L. Tobin, What Do You Do With a Child Like This?
We all know kids who just have to say no, even when it is in their best interest to say yes. They seem angry and resentful all the time; some are disrespectful. These are the children who can readily blame others but cannot take any criticism themselves. They seem to fail deliberately at everything they try. They seem unhappy with life and with themselves. Sometimes, these children are impossible at home but function well in school. Sometimes, their behavior gets them into trouble wherever they are—even legal trouble.
These children are often described as having oppositional defiance disorder (ODD). More extreme, destructive behavior is considered a manifestation of conduct disorder (CD).
The children who are oppositional, defiant, and explosive may pose the biggest and most complicated challenge for a congregation and its religious leaders. Certainly, a major part of that challenge is to balance the needs of all the children in the religious education program with the needs of a child who may be a constant disruptive influence. When ministering to such a child, we 156 157 Disruptive Behavior Disorders must always remember that behind his or her troubling behavior is a person longing for love, community, connection, self-esteem, and competence.