QUESTION
I believe my nine-year-old son suffers with anxiety problems. From time to time he gets so upset and tearful that he gets a pain in his tummy and clings to me or his mother, not wanting us to leave him. No amount of coaxing can get him to tell me what is wrong. I have had him medically checked out and he is fine. I have had numerous discussions (unknown to him) with his teacher to try to get to the cause. He is a good boy who never gives trouble at home or at school and is well liked by teachers and school friends.

Recently, he has been having what appear to be anxiety attacks. One was on the first morning going back to school and another was last week when my wife and I were due to go out, even though he was being minded by his aunt, who he is very fond of. He was crying and shaking and wanting my wife to stay. We are both quite worried and anxious to get to the cause of his anxiety.

ANSWER
Rather than simply being a mental phenomenon, human emotions are always experienced in the body and sometimes they become sensory symptoms before they are fully recognised or understood by the mind. Nervousness and anxiety can be experienced as butterflies in the stomach, a heart beating faster, a cold sweat or even abdominal pain, as in the case of your son.

Sometimes, the physical symptoms are ongoing in the case of a general habitual anxiety and sometimes they are acute in the face of an immediate anxiety such as the prospect of going to school.

When misinterpreted, the physical symptoms can lead to escalating problems especially in the case of anxiety. For example, you can misinterpret your heart beating faster as a sign that there is something physically wrong with you and this will increase your worry and heartbeat, and cause more anxiety: this is the escalating cycle of thoughts and feelings that can lead to an anxiety attack.

Getting to the cause of anxiety
Some children have a genetic or personality predisposition to be anxious or to be worriers and, frequently, these children are also sensitive, thoughtful and otherwise well behaved. While there are certain life events and triggers for anxiety, frequently there is no root single cause.

Though of course you should keep tuned in and continue to check in with the teacher, there may not be something specific happening in school that causes your son’s anxiety. Instead, his worry may be in response to the daily strains and stresses that happen at school.

Help your son become aware of his worries
At the moment, your son is experiencing his anxiety powerfully in the body. You want him to bring this into his awareness and, in particular, to notice how the anxiety affects him physically.

It is best to discuss this with him in a proactive “educational” way at a time when he is calm and relaxed. For example, you might get your son to come up with a list of the emotions he feels and then to identify what bodily symptoms each one causes.

There are some workbooks and worksheets online to help children do this in a pictorial way by, for example, getting children to draw on a map of the body where their anxiety is experienced by using colours, and so on. I have compiled a list of some of these on pinterest.com/parentsplus.

Help your son express his worries
The second step is to help your son express the thoughts that underpin his worries. Often these thoughts are not rational (for example, he might worry something bad will happen to you if you go out) though they may be very distressing to him. Frequently, children may be embarrassed about these thoughts and reluctant to express them.

The goal is to help your son recognise and express these thoughts so they can be identified and evaluated. Children feel great relief once these thoughts are expressed and heard by others, and they are not thought “mad” for having them.

Help your son problem-solve in response to his worrying thoughts
Some of your son’s worrying thoughts will be rational and have a basis in truth. In those instances you want to help your son problem-solve and come up with solutions to address the problem.

For example, if he is anxious about going to school because he feels he does not have enough friends, you could explore different solutions with him. These could include inviting some friends over for playdates, thinking through how he might approach other children in the yard to join in a game, getting some support from the teacher, and so on. Have a look at other articles on this website that are about friendships.

Help your son take the lead in the problem-solving. The key to managing anxiety is to translate it into some sort of constructive action rather than useless ruminating.

Help your son challenge unhelpful thoughts
It is also useful to help your son challenge some of his unhelpful or irrational thoughts. For example, if he is worried you might come to harm when you go out, ask him does he think that is likely, or how useful it is just to focus on this thought, when the probability is to the contrary. Again, you want him to take the lead and learn to challenge his own thoughts.

Help your son learn to relax in the face of anxiety
The last and possibly the most important major step is teaching your son to relax in the face of his anxiety so he can work through worrying periods without too much fuss.

There are lots of very powerful techniques that you can teach him such as noticing and slowing his breathing, mindfulness, progressive muscular relaxation, doing physical exercise and positive visualisation. Have a look on pinterest.com/parentsplus for some good ideas on completing these with children.

Finally, do seek help from a child mental health professional if his anxiety persists. The good news about anxiety in children is that it is one of the most treatable childhood problems and children really respond once engaged in the techniques above.

Prof. John Sharry, Irish Times Newspaper, 2015. John writes in The Irish Times Health+Family every Tuesday.
John will be giving courses for parents on how to help children overcome anxiety in Dublin, Cork and Galway. See www.solutiontalk.ie for details.