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When working with children who exhibit challenging behaviors, understanding the process of externalization can be transformative. Externalization, a concept rooted in narrative therapy, involves separating a child’s actions from their sense of self, helping them see that their behaviors do not define them. By shifting how we frame behaviors, children can develop a healthier self-image, reduce shame, and improve their resilience. Here’s an exploration of how externalization can help your child and why it’s a powerful tool for parents to understand.  Understanding Externalization and Its Purpose  Externalization is a therapeutic approach that encourages viewing a child's behaviors as actions they  do , rather than as reflections of who they  are . The purpose is to help both parents and children understand that challenging behaviors are not indicative of the child's character or core identity. Instead, these behaviors often stem from underlying emotions, unmet needs, or struggles. By framing behaviors this way, externalization empowers children to see themselves beyond their actions and fosters a more compassionate, solution-focused mindset from parents.  To better understand your child's behaviors, it can be helpful to imagine an iceberg. The tip of the iceberg represents everything that is visible on the surface, the child's observable emotions like joy, sadness, anger, fear, and surprise, as well as their behaviors such as tantrums, aggression, or defiance. These are the actions and reactions that are easiest to see and often what parents and caregivers respond to.  However, just like an iceberg, much of what influences a child's behavior lies beneath the surface. Below the waterline, there are deeper layers of emotions, thoughts, and experiences that aren't as immediately visible but are just as important in understanding the child's actions. This submerged portion includes secondary emotions such as guilt, shame, embarrassment, jealousy, loneliness, and anxiety which are often harder to observe because they are more complex and require a greater level of vulnerability to express. Additionally, beneath the surface are automatic negative thoughts and self-beliefs, such as "I'm not good enough," "Nobody likes me," or "I'm not loved." These deeply held beliefs shape how children see themselves and the world around them, but they are not something you can directly see or immediately address through behavior alone. It's important to recognize that these hidden thoughts and emotions often drive the more visible behaviors at the surface.  By thinking of your child's behavior as just the tip of the iceberg, you can start to look beyond the immediate actions and explore what might be going on beneath the surface. Understanding the emotional and mental struggles your child is facing can help you respond with more empathy and support, addressing the underlying causes of their behavior rather than just the behavior itself. This deeper understanding can lead to more effective solutions and, ultimately, help your child feel seen, heard, and understood.  The Downsides of Defining A Child By Their Behavior  It's common for children to become defined by their actions, as behaviors are often the most visible part of who they are. However, when children are primarily seen through the lens of their actions, it can have unintended consequences, both for their self-esteem and for how parents respond. There are two key downsides to defining a child by their behaviors.  First, children may begin to internalize criticism of their actions, leading them to believe that they are inherently "bad" or flawed. When children are repeatedly told that their behavior is wrong, they may start to overgeneralize, assuming that their mistakes define them as a person. This can result in a negative self-image that grows over time, making them feel that their worth is tied to their mistakes rather than their potential for growth and change.  The second downside is that it can limit how parents respond to their child's needs. When a child's behavior is the sole focus, the natural tendency is for parents to respond with behavioral solutions such as reprimands, consequences, and critiques. While these strategies can sometimes be helpful in the short term, they don't address the deeper emotional needs that often drive the behavior. To create lasting change, parents need to look beyond the surface actions and understand the feelings and unmet needs underlying those behaviors. Children act out for reasons, whether it's frustration, insecurity, or a need for attention, and until the root causes are acknowledged, the behavior may continue, even with consequences in place.  By practicing externalization, parents can create a more compassionate environment where children are not judged by their mistakes but instead are supported through their challenges. This approach encourages parents to ask questions like, "What is my child trying to communicate through this behavior?" and "How can I help them understand and express their emotions in healthier ways?" When parents focus on the needs behind their actions, they can foster a more supportive, long-term solution that helps children learn and grow rather than feel trapped by their mistakes.  How Externalization Affects Behavior and Self-Perception  When children separate their behaviors from their identity, they begin to see themselves more positively because they no longer define themselves by their mistakes or challenges. This shift helps them recognize that behaviors are actions they can change, rather than fixed aspects of  who they are. By understanding that they are not "bad" because of a misstep or difficult behavior, children can develop a greater sense of self-worth and compassion. This empowers them to approach future challenges with a mindset focused on growth, rather than being weighed down by feelings of inadequacy or shame.  Externalization has the power to:  Empower children to take control  over their actions by seeing them as distinct entities. Improve problem-solving abilities  as children learn to “talk back” to behaviors or emotions, like saying, “I don’t have to listen to anger when it tells me to yell.”  Boost self-esteem  by reinforcing the idea that they are more than their behaviors.  Foster emotional resilience  by helping them feel empowered to overcome adversity, recognizing that making mistakes is okay and that setbacks are opportunities to try again.  Techniques for Practicing Externalization  Here are some methods parents can use to encourage externalization in daily life:  ●  Give the Behavior a Name : Identify a challenging behavior or feeling, like anger, and give it a name like “Mr. Grumpy.” This allows the child to view it as a character that can come and go rather than something ingrained in their identity. For younger children, it can even be helpful to encourage the child to “talk” to the behavior. For example, they could say, “I see you, Mr. Grumpy, but I’m not going to let you control me.”  ●  Use Visual Cues:  Draw a picture of the behavior and ask your child how they'd like to handle it when it arises. This visual separation can help children see the behavior as something manageable. Using art in this way not only provides a creative outlet for expressing feelings and thoughts, but it also helps children organize and process the situation. The act of drawing can make abstract concepts more concrete, allowing children to plan and visualize problem-solving strategies in a way that feels more approachable. The process can also reduce anxiety, as it turns the problem into something tangible that they can work with, helping them feel more confident and in control of finding solutions.  ●  Reinforce Desirable Behavior:  When your child successfully manages their behavior, acknowledge that they are in control and name that their actions demonstrate strength and courage. Offering praise and recognition for their effort can be both rewarding and motivating, helping to build their confidence.  ●  Reframe Negative Self-Talk:  Help your child shift from a limiting or self-critical perspective to a more balanced and constructive one by encouraging them to challenge negative thoughts and replace them with more positive, realistic beliefs. For example, instead of thinking, "I am a bad kid because I get angry," guide them to reframe the thought to, "I sometimes struggle with anger, but that doesn't mean I'm a bad person.” By practicing reframing, they begin to rewire their brain into adopting a more positive and rational mindset.  ● Acknowledge That Your Love Remains Even When Disappointment Arises:  It's important to recognize that two things can coexist. As a parent, you might be disappointed by your child's behavior, but that doesn't alter the love you have for them. It's crucial to communicate this to your child, reassuring them that while their actions may need to be addressed, your unconditional love and support remain unchanged. You can also help them understand the ebb and flow of emotions by saying something like, "I'm disappointed in the choice you made, but I won't stay disappointed in you forever." This helps children feel secure in knowing their value isn't tied to any one moment or mistake.  ● Practice Positive Affirmations:  When children use daily affirmations, they are encouraged to focus on their strengths, abilities, and values, rather than defining themselves by their mistakes or challenging behaviors. For example, instead of thinking, "I am always angry," a child might affirm, "I can be a kind person, even when I get upset." By repeating affirmations, children can build self-esteem and resilience, learning to approach difficult situations with a positive mindset that doesn’t diminish their inherent worth or potential.  ●  Remove Negative Labels and Create Actionable Steps:  Have your child create a table with two columns. In the first column, have them write down labels they use for themselves, like "I'm a bad listener" or "I'm a poor decision maker." In the second column, have them identify specific actions they can take to improve, such as "I can practice active listening" or "I can pause and think before making decisions." This process empowers them to take ownership of their actions and see that change is within their control, fostering a sense of agency and self-efficacy.  Through these techniques, children can learn to identify and manage behaviors without feeling that these actions define who they are. 


 Recognizing When to Seek Help  While externalization can be a powerful tool for change, there are times when a child may need additional support to navigate complex emotions and behaviors. If you notice any of the following, it may be time to seek professional guidance:  ● Persistent challenging behaviors that don't improve over time  ● Struggles with self-esteem or self-worth  ● Difficulty managing strong emotions like anger or sadness  ● A decline in academic performance or social interactions  ● Constant parent-child conflict  Although externalization can significantly improve your child's well-being, it's common for parents to feel overwhelmed in trying to manage this process alone. Partnering with a licensed therapist can provide valuable support, helping you strengthen your skills and create lasting positive changes for both you and your child.  Getting Support at Heritage Counseling  If you and your child are struggling with managing challenging behaviors and emotions, Heritage Counseling can offer therapeutic care that involves teaching evidence-based techniques such as externalization to help facilitate change. Our licensed therapists are equipped to help children and their families navigate these challenges with effective, compassionate approaches. Reach out to Heritage Counseling at 214-363-2345 to learn more about how we can support your family through these times. 

The Power of Externalization: Separating a Child’s Behaviors from Their Identity 

Social anxiety is a common mental health issue that can significantly impact a child’s development. When left unaddressed, it can interfere with their ability to form friendships, succeed in school, and participate in extracurricular activities. As parents, recognizing the signs of social anxiety and knowing how to support your child can make a substantial difference in their well-being. This blog will discuss what social anxiety is, how to identify signs and symptoms in children, ways parents can provide support, and how to assess when it is necessary to seek therapy.  What is Social Anxiety?  While displaying shyness and introversion can be relatively normative for children when faced with social situations, some children experience distress that goes beyond what is developmentally expected. Social anxiety, also known as social phobia, is classified as a type of anxiety disorder characterized by an intense fear of social situations. Social anxiety in children often manifests from fears related to being judged, embarrassed, or scrutinized by others. It can also be triggered by simply being in social environments and having to engage. Using social skills such as eye contact, reciprocal communication, initiating play, and joining with others can cause extreme discomfort. For children with social anxiety, this fear can be debilitating, causing them to attempt to avoid social interactions and activities they would otherwise enjoy at all costs.  Identifying Signs and Symptoms of Social Anxiety in Children  Recognizing social anxiety in children can be challenging, as they may not always express their fears verbally. However, some common signs and symptoms include:  ●  Avoidance of Social Situations:  Reluctance or refusal to participate in activities like school events, playdates, birthday parties, or family gatherings.  ●  Aversion to Meeting New People:  Presenting as slow to warm up in new social environments. Children may cling to their parents and feel insecure about introducing themselves and separating to go play with someone new. ●  Physical Symptoms:  Physical symptoms may include sweating, rapid heartbeat, dizziness, and shortness of breath. Complaints of stomach aches, headaches, and nausea, may also occur when faced with social situations.  ●  Excessive Worry:  Constant worry and rumination about being judged or humiliated in social settings. Children often ruminate on worrying about the negative outcome that could occur if they engage in social situations that feel worrisome to them.  ●  Behavioral Changes:  Clinginess, tantrums, or crying when expected to engage in social activities.  ●  Difficulty in Making Friends:  Struggles with initiating or maintaining friendships due to fear of rejection or embarrassment.  ● Negative Self-Talk and Low Self-Esteem:  Holding negative self-beliefs that they are not worthy of having healthy friendships. Children may be observed to express negative self-talk, such as using phrases like “nobody likes me,” “I don’t have any friends,” etc.  ● Poor Academic Performance:  Anxiety that affects concentration and academic engagement.  How Parents Can Support Their Child  Supporting a child with social anxiety requires patience, understanding, and proactive involvement. Here are some strategies parents can use to help their child manage social anxiety:  ●  Create a Safe Environment:  Ensure your child feels safe and supported at home. Encourage open communication and let them know it’s okay to express their fears and concerns. When children do share their worries with you, avoid dismissing or minimizing them, and instead practice providing validation.  ● Teach Children the Value of Building Friendships:  Maintain an optimistic stance on how friends can benefit your child when communicating with them. Benefits you may highlight for them include reducing loneliness, having a partner to play with, being able to converse about shared interests, etc.  ●  Gradual Exposure:  Help your child gradually face social situations rather than avoiding them altogether. Start with small, manageable steps and praise their efforts, no matter how minor. Children benefit most from utilizing imaginal exposure through role-playing social situations with someone they feel safe with first. Once they build more confidence they can begin actual exposure to reduce their fears. Exposure therapy is applied most effectively when guided by a trained therapist.  ●  Teach Coping Skills:  Equip your child with coping skills that help improve emotion regulation and reduce anxiety. Beneficial coping skills include but are not limited to, deep breathing, grounding techniques, mindfulness and meditation, and relaxation techniques.  ● Reframe Automatic Negative Thoughts:  Encourage your child to build awareness of the negative thought patterns they’ve developed so that they can catch them when they occur. Once they build this self-awareness, they can practice challenging these thoughts and replacing them with more positive and rational thoughts. Socratic questioning is an evidenced-based intervention that derives from cognitive behavioral therapy which provides a framework for how children can ask strategic questions to prove their negative thoughts wrong. This can be an extremely helpful tool to rewire the child’s brain to think more positively and less anxiously.  ●  Model Social Behavior:  Demonstrate confident social behavior yourself. Children often learn by observing their parents, so showing them how to interact positively in social situations can be beneficial.  ●  Encourage Positive Social Interactions:  Arrange playdates and small group activities with children who have similar interests. This can provide a comfortable setting for your child to practice social skills. This strategy works best when you follow your child’s interests and acknowledge their strengths when deciding which activities to arrange for them.  ●  Teach Social Pragmatics:  Social pragmatics are skills that are necessary for healthy social communication. Eye contact, active listening, initiating conversations, reciprocal communication, and reading social cues are all vital skills to boost confidence in social interactions. A great way to introduce your child to learning these skills is by having them join a social skills group.  ●  Build a Secure Attachment Style:  The overarching view of attachment theory is that children develop relationships with their parents based on emotional bonding and parental responsiveness to their needs. Children who develop a more anxious attachment style often display difficulty with separating from their parents and engaging with others. They are more likely to display social anxiety. Alternatively, children who develop a secure attachment style, are able to freely explore their social environment and return back to their secure base, their parents, intermittently when there is a need. Trained therapists can provide guidance on how to re-establish a more secure attachment style within the parent-child relationship so that their child can also feel more secure forming other social relationships.  ● Maintain a Routine:  A consistent routine can help reduce anxiety. Ensure your child has a balanced schedule with time for relaxation and activities they enjoy.  When to Seek Therapy from Heritage Counseling While parental support is crucial, professional intervention may be necessary if your child’s social anxiety significantly impacts their daily life. Here are some signs that it might be time to seek therapy:  ●  Persistent Symptoms:  If your child’s anxiety persists despite your efforts to help, professional guidance can provide additional strategies and support.  ●  Avoidance of School:  Frequent absences or avoidance of school due to anxiety should be addressed promptly to prevent long-term academic and social difficulties.  ●  Interference with Daily Activities:  When social anxiety hinders your child’s ability to participate in normal activities, such as joining clubs, attending events, or making friends, it’s essential to seek professional help.  ●  Physical Complaints:  If your child regularly experiences physical symptoms like headaches or stomachaches related to anxiety, therapy can help manage these symptoms.  At Heritage Counseling, our experienced therapists specialize in helping children and families navigate social anxiety. We offer personalized therapy sessions designed to build confidence, improve social skills, and reduce anxiety. Our approach involves working closely with both the child and their parents to create a supportive and nurturing environment for growth and healing.  If you believe your child could benefit from professional support, don’t hesitate to reach out to Heritage Counseling at 214-363-2345. Together, we can help your child overcome social anxiety and thrive in their social interactions. Contact us today to schedule an appointment and learn more about our services. 

Understanding Social Anxiety in Children: How Parents Can Help 

The stability and health of a child’s nuclear family unit can have a fundamental influence on their emotional well-being. Oftentimes, parents do everything in their power to protect this however, divorce is a reality that many families have to endure. The American Psychological Association estimates that the approximate divorce rate in the United States currently ranges between 40-50%.*  As a parent, navigating the grief, pain, and emotional hardships that come with divorce can feel extremely challenging. Carrying the responsibility of your child’s emotional response, fears, and uncertainties through divorce while in the midst of grieving yourself can be especially devastating. Divorce is a challenging journey for families, and children often bear a unique emotional burden during this transition. Understanding and addressing the impact that it has on children is crucial for fostering resilience and facilitating healthy adjustments to the establishment of a new family system.  





 Common Challenges for Children Children experiencing their parents' divorce often face a myriad of emotional and psychological challenges. While developmental ages and stages can largely impact how a child copes with divorce, universal challenges that often present include: 
 Emotional Turmoil:  The psychological impact of coping with divorce as a child can lead to them feeling flooded with a variety of difficult emotions. The disruption of the family unit can trigger feelings of confusion, sadness, frustration, and anxiety as they grapple with shifting family dynamics. Parents can best support their children by inviting open dialogue about how they are processing the divorce. Parents should practice active listening and validation when their child feels safe enough to vulnerably share how they are feeling. Parents may empathize with their children by acknowledging that they are sharing some of these same feelings as well to help normalize them. Behavioral Challenges:  Children may show an increase in irritability, meltdowns, defiance, and argumentative behavior in response to parental divorce.  This can be attributed to children trying to learn to adapt and tolerate increased distress and chaos in their home environment. Parents need to remember the underlying emotions that are the functions of external behaviors. Parents should do their best to respond with compassion, empathy, and patience rather than consequences during this time. Divorce is a form of separation that leads to an attachment disruption for children. To continue to maintain a sense of secure attachment both parents must provide reassurance that they will continue to be able to tend to their child’s needs, provide love, and care for them.  Uncertainty about the Future:  Children thrive with predictability and often struggle with ambivalence. The unknown aspects of how their lives will change post-divorce can contribute to heightened stress. Parents can mitigate this by trying their best to inform their children of upcoming changes. One of the primary uncertainties children have following divorce is how they will split their time in two homes. Establishing a set routine for this and having a calendar that the child can utilize to track their days can help them feel more organized.  Changes in Living Arrangements:  Adjusting to new living situations and routines can be disorienting and emotionally challenging. Oftentimes children are uprooted from what they have been used to their whole life and are required to transition to new ways of living. This may require them to move to new neighborhoods, homes, and schools. Creating a family story can be a helpful tool to help your child understand and process these big changes. Parents can create an age-appropriate narrative that acknowledges the divorce and focuses on providing clarity on what their future will look like.  Potential Parental Conflict:  Witnessing conflicts between parents, whether subtle or overt, can feel emotionally overwhelming for children. There is a plethora of research that has shown that children who witness contention between parents during high-conflict divorce experience adverse outcomes in regard to their mental health.** Children may develop an adjustment disorder triggered by the divorce and have an increased risk of later developing anxiety, depression, and post-traumatic stress disorder if symptoms are left untreated.** Impact on Academic Performance:  The emotional strain may affect a child's ability to focus and perform well academically. Informing a child’s teacher about the divorce may provide good insight so that they can ensure the child is receiving extra support in the school setting if needed.   Divided Loyalties:  Navigating relationships with both parents separately can create internal conflicts and a sense of divided loyalties. Parents should avoid making both indirect and direct attempts at influencing their children to choose sides. Oversharing, speaking negatively about the other parent, or naming and shaming the other parent's faults should be avoided to protect the child from feeling this pressure. Many children, especially those who are young, need to be explicitly given permission to feel positively with one parent and understand that doesn’t mean they are going against the other.  Sense of Loss:  Children may experience a sense of loss, not only of the intact family unit but also of the life they knew before the divorce. Children often cycle through the stages of grief including denial, anger, bargaining, and depression, before reaching a place of acceptance.  Misplaced Blame:  Children often want to understand why their parents chose to get a divorce. As they attempt to rationalize the reason for the divorce many children often misperceive that they are to blame. It is important for parents to make it clear to their children that this is not true. Children may alternatively misplace the blame by expressing strong resentment or upset towards a certain parent. Both parents can practice expressing apologies and acknowledging the impact the divorce has on the child to try to attempt to begin to work through this. Adjustment to Co-Parenting:  Adapting to the new dynamics of co-parenting arrangements can be emotionally taxing. Children have to learn how to adapt to living in separate homes that often have different rules and routines which can present as a challenge. Parents who strive to co-parent peacefully can promote a healthier adjustment for their children. Maintaining respectful communication with each other is one of the best ways to carry this out. For divorced parents who struggle with healthy communication due to previous contention, less directive methods can be utilized, such as the Family Wizard app, which allows parents to manage custody calendars, shared expenses for their child, and a virtual secure messenger.    
Recognizing and addressing these challenges is crucial for parents and caregivers to provide the necessary support, understanding, and open communication that children need during this difficult time. 





 Tips for Blended Family Success Over time, many parents choose to enter new relationships and marriages post-divorce. A blended family is established when two new partners who had previous relationships choose to merge their families together. Many factors contribute to how a child will adjust. Some children may express optimism and acceptance of becoming a part of a new blended family while others may feel discomfort and resistance initially. Successfully navigating a blended family requires intentional efforts to foster understanding, communication, and a sense of unity among all family members. Here are some essential tips for blended family success: Open Communication:  Encourage open and honest communication. Create a safe space for family members to express their feelings, concerns, and expectations. Establish Clear Expectations:  Set clear expectations for roles, responsibilities, and rules within the blended family. This helps create a sense of structure and consistency. United Parenting Front:  Establish a united parenting front. Consistency in discipline and decision-making helps create a stable environment for children and fosters a sense of security. Some children may be reluctant to accept discipline from their step-parent at first. Holding a family meeting to share and converse about established rules and new roles with children is an important step in the early development of the blended family, especially when the family begins to cohabitate.  Build Relationships Gradually:  Recognize that building relationships takes time. Allow relationships between step-siblings and step-parents to develop organically and avoid putting pressure on immediate closeness. The child should be in control of setting the pace.  Quality Time Together:  Schedule regular quality time as a blended family. Whether it's family outings, game nights, or shared meals, these moments foster bonding and create positive memories. Repetition of these positive experiences together will help each member join more readily with each other. Be Intentional About Getting to Know Each Child as an Individual:  Both step-parents and biological parents should spend 1:1 time with each child regularly. Parents should allow the child to lead in choosing activities and topics of conversation. This is especially important for the step-parent to practice to allow the child to feel that they have the desire to truly get to know them. Joining in a child’s interests and engaging is one of the most effective ways to build a genuine bond. Respect Individual Boundaries:  Acknowledge and respect individual boundaries. Each family member may have different comfort levels and expectations, so it's crucial to be mindful of personal space and autonomy. Celebrate Differences:  Embrace and celebrate the differences within the blended family. Each member brings unique qualities, and acknowledging and appreciating these differences can strengthen the family bond. 




 Conclusion Navigating divorce is complex, but with proactive support and understanding, families can emerge stronger. Remember, adapting to this new way of life is a process that requires patience, understanding, and a commitment to working together as a team. With time and effort, families can create a supportive and loving environment for everyone involved post-divorce. For blended families, fostering positive relationships between children and new family members is a gradual process. Building trust and connection takes time, and creating an environment of understanding and acceptance is crucial. Recognizing signs of distress when your child is adjusting and seeking counseling when needed are vital steps toward fostering a healthy family dynamic. 




 The Role of Heritage Counseling Counseling plays a vital role in supporting children in navigating the complexities of divorce within their families. Professional therapists provide a safe and neutral space for children to express their feelings, fears, and uncertainties surrounding the divorce. Through age-appropriate techniques and interventions, counselors help children develop coping mechanisms, resilience, and emotional regulation skills. Counseling also fosters open communication, enabling children to articulate their concerns and gain a better understanding of the changes happening in their lives.  Additionally, therapists work collaboratively with parents to establish effective co-parenting strategies and promote a healthy family dynamic. By addressing the emotional impact of divorce early on, counseling empowers children to navigate the challenges with a greater sense of self-awareness, emotional well-being, and the tools necessary for a smoother transition into their new family structure. Heritage Counseling is committed to providing specialized support for families undergoing divorce, offering tailored strategies to promote the well-being of each family member. If you're facing challenges during this transition, Heritage Counseling is here to provide guidance and support. Reach out to Heritage Counseling at 214-363-2345 for information on our family and child counseling options.  












 Sources 
 * https://www.cdc.gov/nchs/fastats/marriage-divorce.htm **Lange AMC, Visser MM, Scholte RHJ, Finkenauer C.  Parental Conflict and Posttraumatic Stress of Children in High-Conflict Divorce Families. J Child Adolesc Trauma.  2021 Oct 27;15(3):615-625. doi: 10.1007/s40653-021-00410-9. PMID: 35958703; PMCID: PMC9360253. 

Helping Children Cope with Divorce and Blended Families

Separation anxiety is one of the most commonly diagnosed anxiety disorders in childhood. (1) Separation anxiety is a disorder that is classified as a pattern of recurring distress and fear with high intensity triggered by a child being separated from their primary caregivers. When separation does occur, it is often met with the child becoming hysterical, clingy, and emotionally dysregulated. (2) These moments often leave caregivers feeling helpless and children feeling emotionally defeated. Developing autonomy and learning how to tolerate separation from their secure base can be a challenging milestone for many children.  
 Separation anxiety is typically seen as a developmentally normative experience during infancy and for children under the age of three years old. (1) The presence of significant separation anxiety past these early years may be an indication of the manifestation of a disorder. Separation anxiety disorder is most prevalent among children between the ages of seven to nine years old. (2) The purpose of this blog is to help answer lingering questions that so many caregivers have during parenthood. Why do so many children struggle with separation? How can caregivers best support their little ones? This blog can be utilized as a synthesized guide to provide diagnostic clarity on the disorder, helpful coping strategies, and insight on how to assess severity to understand when it is important to seek professional support for your child. 


 Symptoms of Separation Anxiety The following symptoms are commonly exhibited by children with separation anxiety when actual or anticipated separation from caregivers occurs. 
 Emotional Signs Recurring and excessive distress, fear, panic, and anxious presentation Hysteria and intense emotional reactions to parental departures Ruminating fear-based thoughts related to abandonment, caregivers leaving and never being reunified with them, or something bad happening to them such as “[…] illness, injury, disasters, or death.” (1) The child develops negative self-beliefs about their safety and wellness being at risk in the absence of their caregiver. Children may perseverate on fears of getting kidnapped, hurt, or lost when their parents are not present. (1) 

 Behavioral Signs Significant clinginess that inhibits the child from exploring environments without their caregiver in close proximity. The child is observed to prefer to play closely with caregivers and becomes distressed when the caregiver is out of sight. The child may hide behind or desperately cling to caregivers to plead for them not to leave during transitions.  Frequent tantrums and upset that involve emotional dysregulation Avoidant behaviors such as refusal to leave home or to transition into daycare, school, or play dates due to fears of being away from caregivers Regression in behaviors that are inconsistent with the child’s developmental stage (e.g., bed-wetting, thumb-sucking, etc.) 

 Physical Signs  Somatic complaints such as headaches, stomachaches, nausea, or vomiting Sleep disturbances may include the inability to sleep alone at night, reluctance to sleep away from home, and recurring nightmares with the theme of separation. (1) Symptoms must persist for at least a four-week duration and significantly impair the child’s social, emotional, behavioral, and/or academic functioning to be classified as a separation anxiety disorder for children. (1)   
 
 Understanding Separation Anxiety  Attachment theory suggests that from birth, humans are preconditioned to seek out and develop bonds with their caregivers. (9) This is first established when caregivers tend to their infant’s physical and emotional needs. Infants depend on their caregiver’s responsiveness to establish a sense of safety and security. As infants transition into childhood, they should begin to seek opportunities for independence more often. It becomes most outwardly apparent that children who develop insecure, anxious, or ambivalent attachment styles often struggle with separating from their caregivers. Although separation anxiety is more commonly correlated with these attachment styles, children who develop a secure attachment style may also experience separation anxiety when undergoing big life changes, such as beginning school. The presentation of separation anxiety can differ depending on the child’s age. Common characteristics based on each developmental stage include: 
 Infancy:  Infants are not born with the innate cognitive ability to understand the process of separation and reunification. When caregivers go away, infants typically become distressed. Infants usually don’t develop an understanding of object permanence until approximately six to nine months. (4) Object permanence is the phenomenon that people and objects can continue to exist even when they are not visibly present. Even after they grasp this concept, infants still often struggle with regulating when separating. Separation anxiety during infancy often presents as spells of crying, flailing legs and arms, and upset. Infants are soothed by the presence of their caregiver’s return, physical contact, and co-regulation. Tiredness, hunger, and sickness can intensify an infant’s separation anxiety because they rely on their caregiver to tend to these needs.   Toddlerhood:  Toddlerhood introduces a new dichotomy in which young children continue to feel strongly bonded to their caregiver while also growing curious about exploring more independently. Toddlers with separation anxiety are often observed to prefer to play very closely with their caregivers and continuously need to be reassured that they are still there. If the toddler cannot find their caregiver or perceives they are going to leave, they often engage in emotional meltdowns that can be long and drawn out. Transitions, especially into daycare, are especially difficult for toddlers with separation anxiety.   Preschool-age:  Preschool-age children are introduced to many new experiences, such as starting school for the first time and having play dates. This requires socialization with peers and new adults without the comfort of their caregiver beside them. These transitional points in their lives may trigger the onset of separation anxiety. Preschool-age children often display similar behaviors to toddlers, including emotional meltdowns and difficulty with transitions. They also become more verbally expressive in their pleas for their caregiver not to leave.    Older children:  Older children may show disinterest in leaving their homes and participating in social activities.    Many Factors Can Contribute to Separation Anxiety in Children Including: Genetic predisposition if their parents have been diagnosed with anxiety Neurological factors, including an imbalance of two brain chemicals, norepinephrine and serotonin (5) Environmental factors such as a history of early attachment disruption, trauma, neglect, death or witnessing an illness of a loved one or pet, parental divorce, moving, or changing schools (6) Insecure or anxious attachment styles   


 Coping Strategies for Parents and Caregivers Gradual exposure and desensitization:  Caregivers can slowly build their child’s tolerance for separation by gradually exposing them in small steps. Caregivers can practice this by telling their children that they are going to leave for a very brief period of time and informing them when they will come back. It is often helpful to give the child a task they can complete while their caregiver is gone to help redirect their focus to something other than their worries. A scenario to exemplify this is as follows: a caregiver may tell their child, “Mommy is going to go to the bathroom. You can play dinosaurs while you wait. Watch mommy mean what she says and come right back when she’s done.” The caregiver would then praise their child upon their return. The key to this strategy is repetition. For the child to trust that the caregivers truly will return, they will have to be shown this repeatedly throughout their day. Caregivers can gradually increase the amount of time they’re separated as their child’s comfort increases with practice. Eventually, with repeated exposure, the child will become desensitized to the fear response that separation previously elicited, and they will become more secure in their independence. Play therapists may guide caregivers on how they can practice utilizing a therapeutic technique known as  imaginal exposure , which involves using role play to help the child act out scenarios that trigger anxiety prior to actually being exposed to them. The child replicates anxiety-provoking situations by acting them out with toys. Imaginal exposure facilitates habituation and inhibitory learning, which show strong efficacy in decreasing anxiety when practiced repeatedly. (7) Establishing routines and predictability:  Children thrive when they know what to expect. Caregivers can establish daily routines to increase predictability. It is recommended that if your child struggles with separation anxiety, caregivers try their best to create consistent schedules with limited change. Creating visual charts, such as a morning or nighttime routine chart or school schedule, can be a helpful way to teach your child to track their day. These charts can be utilized as a prompt throughout the child’s day to remind them of when they will be reunited with their caregiver as well.  Positive reinforcement and praise:  Celebrate your child’s bravery by providing praise when they are able to successfully separate, even if it is only for a brief period of time. This form of positive reinforcement can be extremely encouraging for the child. Identify ways to cope with missing feelings:  It’s important to validate your child’s emotions to help them feel seen and heard. Caregivers can voice empathy with their children about how hard separation is and then help them identify what they can do when they miss someone. Coping strategies that children can practice when they have missing feelings include drawing a picture or writing a note for someone that they miss, keeping a transitional object with them to help them feel safe, asking someone for a hug, looking at a photograph of their family, or holding a stuffed animal to feel less alone. There are many children’s books that provide a narrative for managing separation as well. Anna Dewdney’s  Llama Llama Misses Mama , Patrice Karst’s  The Invisible String , and Audrey Penn’s  The Kissing Hand  are all wonderful children’s books that provide this lesson.  Teach emotion regulation skills:  Children with separation anxiety benefit from learning strategies to manage their emotions. Examples of emotion regulation skills include learning emotion identification and expression in addition to practicing breathing exercises, meditation, mindfulness, and sensory activities. Avoid drawn-out transitions:  As a caregiver, it can feel impossible at times not to give in to your child’s desperate plea to have you stay when it is time to say goodbye. Most of the time, however, prolonging the separation only worsens it. If caregivers provide inconsistent responses when transitioning, such as sometimes leaving immediately and other times giving in and staying longer, the child is left feeling ambivalent. Parents should try their best to keep transitions routine and brief. Create a goodbye ritual:  Caregivers can reduce their child’s aversion to separation by making it more fun. Hugs, kisses, high fives, and special handshakes can be shared prior to leaving to fill your child up with love for the day. (8) It may also be helpful to provide your child with a transitional object to help them feel connected to you even when you are apart. Examples include family bracelets, worry stones, a small stuffed animal, or a family photograph.    


 The Importance of Early Intervention There are tremendous benefits for children who receive early intervention, and it can help shape the trajectory for long-term improved mental wellness. Research shows that early therapeutic intervention can help decrease the severity of ongoing symptoms and reduce the risk of developing an anxiety-related disorder later in life. Therapy that targets separation anxiety often helps children and caregivers undergo a process of identifying patterns and triggers, processing emotions, building skills to work through and manage fear-based responses, and building resiliency.    


 When to Seek Help from a Mental Health Professional As a caregiver, making the decision about how to intervene and support your child best can be difficult. If your child’s symptoms of separation anxiety are prolonging beyond the age of three years old and are significantly having a highly distressing impact on the child’s daily functioning, it is recommended that you seek professional help from a mental health provider. The mental health professional can help provide diagnostic clarity regarding the possible manifestation of a diagnosable separation anxiety disorder and how to create a plan of care for how to best treat it uniquely to your child’s presentation. Play therapy and child-centric therapeutic modalities are recommended as the primary forms of therapy to treat childhood separation anxiety. Therapy is most successful when a collaborative approach is utilized, which involves both individual work with the child and a component that involves caregivers. Play therapy is effective in treating children as young as three years old.    


 Conclusion   Separation anxiety is highly prevalent during childhood. Therapy can not only provide emotional support to the child but can also help alleviate parental stress. Children can leave feeling more in control of their worries. Caregivers can leave feeling more empowered and grounded in their responsiveness.  
 At Heritage, we have skilled therapists who specialize in working with children and can provide a compassionate approach to supporting them through managing their separation anxiety. We know the power of partnership and working with the family system. We have made a vow to include parents in the process of helping children overcome their challenges. In addition to individual child therapy sessions, parent consultations are scheduled routinely after every four individual child therapy sessions to reflect on progress, introduce parenting interventions, and help generalize psychoeducation and skills learned to treat their child’s diagnosis. To schedule a consultation at Heritage Counseling we invite you to call 214-363-2345. 






 

 Sources https://www.heritagecounseling.net/blogs/how-parents-can-identify-and-help-children-with-anxiety https://adaa.org/find-help/by-demographics/children/childhood-anxiety-disorders American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental health disorders  (5th ed.).   https://www.happiestbaby.com/blogs/baby/object-permanence https://www.nationwidechildrens.org/conditions/health-library/separation-anxiety-disorder-in-children#:~:text=Experts%20believe%20SAD%20is%20caused,from%20family%20members%20and%20others . https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455#:~:text=Risk%20factors%20may%20include%3A,anxiety%20disorders%20than%20others%20are https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10104249/#:~:text=Imaginal%20exposure%20involves%20the%20repeated,Benito%20%26%20Walther%2C%202015 ). https://www.pbs.org/parents/thrive/helping-preschoolers-cope-with-separation-anxiety Bowlby, J. (1978). Attachment theory and its therapeutic implications.  Adolescent Psychiatry, 6,  5–33. 





Navigating Separation Anxiety in Children

Food Anxiety in Children Are mealtimes starting to feel like routine meltdowns? Is your child’s picky eating causing daily distress? Do you find yourself engaging in power struggles with your child when it comes to eating that makes you feel defeated as a parent? If you answered yes to any of these questions you can be reassured that you are not alone. This is an incredibly common experience for almost all parents. In fact, research suggests a broad but significant approximation that between 14 to 50 percent of preschool-age children exhibit severe picky eating and 7 to 27 percent of older children.**
 Your child’s relationship with food evolves over time as they develop. Most parents can recall memories of their infant’s first encounter with trying solid food for the first time. This milestone sets a precedent for your child’s earliest experience of building awareness of preferred and non-preferred foods. As they grow and mature, they continue to be introduced to new foods. For many children, this experience can feel scary. Food anxiety is conceptualized as the manifestation of a heightened fear response elicited by the presentation of food that is often associated with severely selective eating, strong food aversion, fear, and emotional distress during meal times.  



 Food Anxiety vs. Picky Eating  Picky eating during early childhood can be a rather developmentally appropriate experience, especially during toddlerhood. It is not uncommon for young children to experience these habits and eventually grow out of them over the course of time with continued exposure. However, it is critical to distinguish the root of why your child is engaging in food refusal or experiencing food anxiety because it provides clarity for the most optimal way to intervene. Common underlying factors that may contribute to the development of food anxiety include: 
 Food aversion:  strong dislike for particular foods  Food phobias:  Common food phobias in children include neophobia, the fear of trying new foods, and phagophobia, the fear of swallowing Sensory-related sensitivities:  smell, taste, and texture of foods trigger visceral responses  Oral motor skill developmental delays:  challenges with biting, chewing, swallowing, or manipulating foods  Power and control:  children may utilize eating as a way to exert power and control if they are feeling insufficient in their ability to do this during other times. Some children desire to exert their autonomy over what they choose to eat and feel constricted when they sense a lack of control over this. 
 Generally, children classified as picky eaters often exhibit behavioral challenges during eating such as non-compliance, refusal, and upset. Uniquely, children with food anxiety experience these behavioral symptoms in addition to prolonged and severe emotional distress and fear.  If their symptoms go unmanaged the anxiety may even manifest into an anxiety-based feeding disorder. Avoidant/restrictive food intake disorder (ARFID) is an eating disorder classified in the DSM-5 manual that is defined as, “an eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs.”* Children diagnosed with ARFID have severe food anxiety and aversion that limits their food consumption to the extent that it impacts their physical health, mental health, and development. Symptoms of ARFID include extreme nutrition deficiencies, weight loss or stunted growth, and compromised physical health.* AFRID is unique to other eating disorders in that it does not involve fixated or distorted thinking related to body shape or size. AFRID can be diagnosed at any age, however, it is most commonly assessed for beginning at age six or seven due to the nature of picky eating being more developmentally expected during early childhood.  The prevalence of ARFID is higher among children diagnosed with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and anxiety.*** Children who have experienced neglect are also more at risk of experiencing food anxiety that may develop into a disorder.*** 



 Signs Your Child May Have Food Anxiety  Children who have food anxiety experience adverse thoughts, feelings, and behaviors related to eating. If your child regularly exhibits a combination of these symptoms when presented with food it may be an indicator that they have food anxiety. 
 Expressing fearfulness when eating, talking about food, or being presented with food Limited amount of accepted foods (less than 20 accepted foods indicates a poor range) Refusal and avoidance to eat foods based on their texture, color, or taste Ruminating thoughts related to something bad happening if they eat certain foods such as being unable to swallow or the food causing illness Feeling a lack of control and a sense of powerlessness over their worries related to foods  Meal times trigger negative emotions such as anger, sadness, worry, and disgust Frequent dysregulation, heightened distress, and emotional meltdowns when presented with food  Food refusal, avoidance, and consistent noncompliance with eating Physiological symptoms including complaints of stomach aches, rapid heartbeat, fast breathing, and sweating Visceral reactions including nausea, gagging, or vomiting when eating Intolerance to having non-preferred foods placed on their plate  



 How to Help Your Child with Food Anxiety  Navigating how to help your child with food anxiety can feel overwhelming for parents, especially when it feels like you have tried everything without consistent success. The following recommendations are helpful tips to support your child through their journey of managing their food anxiety so that eating can feel more desirable and less stressful. 
 Talk openly with your child about their relationship with food and express genuine curiosity.  Showing interest in learning about your child’s interpretation of food can help uncover the reasons why they are so fearful. For example, when given the opportunity to share, a young toddler may reveal that they don’t want to eat broccoli because they’re scared it will make them turn green. To work through food anxiety for this child, exploring what is real vs. pretend to help alleviate the fear and re-establish their sense of safety with food would be helpful. They may need to be invited to experiment with food, for example bravely taking a small bite of broccoli and noticing that they did not in fact turn a different color. Eventually, with time and repeated exposure, the child can begin to trust that their anxious thought is not a real or rational thought.  Reframing the narrative of eating by helping your child view food as a way to unlock their superpowers.  Nearly all children want to grow bigger, faster, stronger, and more powerful much like the superheroes who they admire. Parents can educate their children on the benefits of eating. Teaching them that what they put into their body contributes to their growth, health, and strength can help empower them. Helping your child understand that they have control over their body’s development can make them more intrinsically motivated to eat better. This can be a helpful way to support your child in re-establishing a more positive narrative about their relationship with food. Encourage sensory exploration of food.  Historically we’ve been taught not to play with our food however, it can actually be an extremely helpful tool for children battling food anxiety. As an exposure intervention, parents can slowly introduce their child to non-preferred foods to help them feel less scared in small steps. These steps should involve sensory play, such as touching, smelling, licking, or even creating artwork with food to allow them to explore it. Positively reinforce each step, big or small.  It is important to provide positive praise for each step that involves your child encountering new or non-preferred foods. This can help reinforce their willingness to continue to be presented with it. Creating a visual scale with your child that lists 10 steps of exploring a new food, such as smelling it, eating half of it, or having it on their plate, can be a helpful tool. Make food fun.  Inviting your child into the kitchen, grocery store, or garden can help build excitement with food. This can help mealtime feel like more of a connection and less of a chore. Children can also incorporate themes of food into their play. Encouraging them to use their imagination in a play kitchen or create a restaurant of their own can help them build a more positive schema of food.  Create food challenges.  Introducing a variety of new foods or non-preferred foods at once can overwhelm your child. Instead, focus on identifying one food and focusing on that as their food challenge to practice being exposed to. To make tracking their progress fun, it may be helpful to incorporate a visual food tracker. Remember that brain development impacts decision-making. Limit choices of what foods are available.  The prefrontal cortex is one of the primary regions of the brain that is responsible for decision-making. Neuroscientists estimate that this region of the brain is not fully developed until approximately age 25.**** This helps provide a neurological explanation for why decision-making for children presents as such a difficult challenge. So, how does this relate to your child’s eating habits? Meal times are routine times of their day that require decision-making. The more that children have to choose from, the harder their decision-making process becomes. To meet them where they are in their brain development, parents can help reduce their overwhelm by reducing the number of choices they have to make when they eat. If unhealthy foods are less accessible on their plate or in the pantry, children will be more inclined to be open to trying healthier foods. Try offering multiple foods on your child’s plate, most ideally one from each food group. If tolerable, their plate should have preferred foods and at least one non-preferred food that they are working on trying. If they refuse completely, parents may opt into allowing for one alternative choice, for example, stating that your child can have an applesauce instead of carrots today. Practice this with caution as allowing too much negotiating can lead to power struggles. Visit the pediatrician.  It’s important to inform your child’s doctor if they are struggling with eating. Physical assessments can help rule out medical factors such as gastrointestinal issues, acid reflux, or allergies that may also contribute to your child’s eating habits. Doctors may also help keep a close eye on your child’s physical health and monitor whether their eating is negatively impacting their growth.  



 When to Seek Help The battle of helping your child cope with food anxiety and re-establishing a positive relationship with food doesn’t have to be fought alone. Making the decision to partner with a mental health professional can be a crucial step in creating positive change for not only your child but also for your entire family’s wellbeing. Heritage Counseling and Consulting has licensed therapists who specialize in working with children and are skilled at utilizing  play therapy  and  cognitive behavioral therapy  to guide the treatment of food anxiety. To begin your journey with helping your child heal we warmly invite you to schedule a consultation at Heritage Counseling by calling 214-363-2345. 








 Sources:
 *American Psychiatric Association. (2013). Diagnostic and       statistical manual of mental disorders (5th ed.). Washington, DC:       Author. ** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/ ***  https://childmind.org/article/what-is-arfid/ ****  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129331/ 



How to Help Children with Food Anxiety

Childhood Anxiety 
Anxiety is universally defined as an emotion that elicits fear, nervousness, and worry. Anxiety occurs as a mental and physical response to what our brain perceives as a threat. Anxiety can be helpful when threats are real and rational. For example, when a child is walking home from school and a large dog runs towards them, their anxiety signals their flight response to protect them from danger. Anxiety can also present as harmful when it becomes excessive and triggered during situations in which there is no real threat. This is when the emotion can manifest into a disorder.  Anxiety can occur across the lifespan. In fact, the prevalence of childhood anxiety is growing. The Centers for Disease Control and Prevention (CDC) estimated that in 2016-2019, approximately 9.4%, 5.8 million, children between the ages of three to seventeen years old were diagnosed with anxiety. (3) Anxiety disorders can present as highly distressing to children and lead to disruptions in their functioning across their home, school, and play environments. Anxiety can negatively impact a child’s self-esteem, emotional wellness, behavior, sleep, eating, and mood.  



 What Causes Childhood Anxiety? Research suggests that both nature and nurture likely play a part in the manifestation of anxiety in children. (8) Children who have parents with anxiety or who are part of a family with a transgenerational pattern of anxiety may be more at risk to develop it as well. (8) In addition to genetics and heredity, environmental stressors may also present as risk factors for the development of childhood anxiety. Stressors that are commonly associated with childhood anxiety and that may increase risk include frequent exposure to parental conflict, bullying, the death of a loved one, having an injury or illness, being involved in an accident, and a history of trauma, abuse, or neglect.  
 Anxiety is a diagnosis that often presents with high comorbidity, meaning that many children who have anxiety also have a co-occurring diagnosis. Research supports that children diagnosed with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and depression are more likely to have a comorbid diagnosis of anxiety. (4,5,6)  



 Symptoms of Anxiety in Children Common symptoms of childhood anxiety may include: Excessive worry, fear, and nervousness that feels uncontrollable  Avoidance of stimuli or situations that elicit fear Heightened startle response  Crying or tantrums  Upset stomach or nausea Headaches  Increased heart rate Poor concentration Muscle tension Sleep disturbances 
 For a child to be formally diagnosed with an anxiety-related disorder, the presentation of their symptoms must cause distress, take place during at least two daily activities, feel uncontrollable, be persistent, impair functioning, and impact development. (1) 



 Types of Anxiety That are Most Prevalent Among Children  
 Separation Anxiety Disorder Marked by a significant pattern of distress that occurs when a child is separated from their caregivers to who they are attached. The act of separation leads to the child exhibiting excessive fear and anxiety. Common worries include persistent fears that are often related to their personal safety and the safety of their caregivers. The child may express worry that their caregivers will never return or that something bad will happen to their caregiver. Children diagnosed with separation anxiety disorder typically will display refusal behaviors to go to school, leave their home environment, or go to playdates. When separation does occur, it is often met with the child becoming hysterical, clingy, and emotionally dysregulated. Separation anxiety is typically seen as a developmentally appropriate experience during infancy and for children under the age of three years old. Clinical assessment is recommended when symptoms prolong beyond this age and continue to have a debilitating impact on the child’s functioning due to the possible manifestation of a diagnosable separation anxiety disorder. Separation anxiety disorder is most prevalent among children between the ages of seven to nine years old. (2) Social Anxiety Disorder (Social Phobia) Marked by high anxiety and fear of social situations. Children with social anxiety disorder often present with low self-esteem when they are around others and become self-conscious. They fear being judged, embarrassed, or humiliated by others. A diagnostic feature that must be present for children to be diagnosed with social anxiety disorder is that the anxiety must be present in interactions with peers, not just in situations that involve interactions with adults. Children with social anxiety disorder often avoid busy environments such as the playground or a birthday party. Even simpler social interactions, such as being called on to answer a question or having to choose a partner in their classroom trigger immense anxiety.  Specific Phobias Marked by excessive worry and anxiety related to a specific fear of an object or situation. Common specific phobias that children develop include fears of thunderstorms, flying, animals, heights, and seeing blood. Children with specific phobias often perseverate on this fear and make diaristic attempts to avoid the stimuli or situations that they are fearful of. For example, a child who has a specific phobia of flying on an airplane may experience nightmares about flying, refuse to go on a family vacation to avoid flying, avoid playing with airplane toys, and become distressed when they notice an airplane flying above them while outside playing. Generalized Anxiety Disorder  Marked by excessive worry and anxiety that occurs across multiple settings and impairs the child’s functioning. There is not one specific trigger to the anxiety, but instead, the anxiety persists during various unpredictable times.  


 Ways Parents Can Help with Childhood Anxiety Externalization : Externalization is the process of separating anxiety from the child’s identity. Parents can help their children understand that anxiety is something they experience but it does not define who they are. Reframing the narrative of what anxiety is can help children feel more in control of it. This reduces the negative effects anxiety can have on a child’s self-esteem. Catch the triggers:  Parents can work alongside a therapist to help their child build awareness of what triggers their anxiety. They can learn to become familiar with their body’s signals of anxiety, such as helping them notice their heart beating faster or their palms becoming sweaty when anxious, and their brain’s signals of anxiety, such as noticing when ruminating thoughts are occurring or difficulty with concentration. Once they develop an understanding of what makes them feel so worried, they become more readily able to notice when it’s a beneficial time to practice a coping strategy. Coping strategies:  Common coping strategies that focus on regulation that are helpful for anxious children include breathing exercises, progressive muscle relaxation, guided imagery, meditation, yoga, stretching, mindfulness, and grounding exercises. Additionally, providing child-friendly ways for children to communicate and process their anxiety is helpful. Techniques to encourage this include drawing or journaling about their worries, writing a letter to their anxiety, or creating a comic about them defeating their anxiety. Children often feel supported when parents join them in practicing these coping strategies. Model bravery:  Parents can model being brave in worrisome situations and share stories with their children about their experiences facing their fears and how they worked through them. This can boost their child’s confidence.  Practice pre-living:  Often the anticipation is the most anxiety-provoking for children. To ease this uneasy feeling, parents can pre-live situations in advance to help their children know what to expect. Children thrive with predictability.  Gentle exposure involving play : Exposure therapy is one of the primary and most effective interventions to treat anxiety. It aims to rewire the brain’s fear response by exposing the child to their fear in small manageable steps. With repetition, the fear can reduce and eventually subside. Exposure therapy should be prescribed and led by a professional therapist, however, parents can provide their children with gentle exposure to what they are afraid of through play. For example, if a child is afraid of spiders they could read the book “Charlotte’s Web” with their parents and then role-play parts from the story that depict a spider in a positive way rather than a scary way. This is a form of imaginary exposure.  Allow Distress:  As parents, it is normal to want to shield your child from experiencing negative emotions and the easiest way to do this is avoidance. Although allowing your child to avoid what makes them anxious may provide temporary relief it won’t cure their anxiety. Instead, parents should help their child build a tolerance to being exposed to what makes them anxious with guided support from a therapist, allow them to have a natural emotional reaction, and then praise them for their courage.  



 When to Seek Help Don’t wait for your child’s anxiety to grow before reaching out for support. Cognitive Behavioral Therapy (CBT) and play therapy are utilized most frequently to treat anxiety in children. At Heritage Counseling and Consulting, there are therapists who specialize in providing quality care that integrates both therapeutic approaches to treat children with anxiety.  At Heritage, we know the power of partnership and working with the family system. We have made a vow to include parents in the process of helping their child overcome their anxiety. In addition to individual child therapy sessions, parent consultations are scheduled routinely after every four individual child therapy sessions to reflect on progress, introduce parenting interventions, and help generalize psychoeducation and skills learned to treat their child’s anxiety diagnosis. To schedule a consultation at Heritage Counseling we invite you to call 214-363-2345. 






 Sources: Three, Z. T. (2016). DC: 0-5:  Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. https://adaa.org/find-help/by-demographics/children/childhood-anxiety-disorders https://www.cdc.gov/childrensmentalhealth/data.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353196/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162631/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267783/ https://adaa.org/about-adaa/press-room/facts-statistics https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954816/ 


How Parents Can Identify and Help Children with Anxiety

What is Emotion Regulation? Emotion regulation is the process that allows a child to notice, identify, and manage their emotions. During infancy, babies form attachment bonds with their caregivers based on the responsiveness they receive to getting their physical needs met in addition to receiving support with regulating their emotions. As children grow, they develop an increased ability to identify and regulate their emotions more autonomously. The first three years of a child’s life is a critical period for them to begin to develop emotion recognition and regulation skills, however, the development of emotional regulation for kids is an ongoing process that takes time and practice throughout childhood.   


 Signs of Poor Emotion Regulation in Children Many factors may contribute to a child’s ability to regulate their emotions. Internal factors, such as temperament and genetics, in addition to external factors, such as the child’s environment and life experiences all may impact their ability to regulate their emotions. Factors that may predispose or put your child at risk for having increased challenges with emotion regulation include a history of trauma, attachment disruptions or an insecure attachment style, and baby colic during infancy.  
 Outward externalized behaviors such as emotional meltdowns, excessive crying, tantrums, decreased academic performance, low frustration tolerance, angry outbursts, and physical aggression are often indicators that your child is experiencing emotional turmoil. If your child experiences intense negative emotions for long durations of time, challenges with talking about their feelings, and difficulty accepting regulatory support from others, they are likely exhibiting signs of poor emotion regulation.  


 Ways to Help Your Children With Their Emotions Make naming emotions a regular practice:  Emotion identification is the fundamental first step to building emotion regulation skills. Your child must build awareness of how they feel before they can learn tools to work through those feelings. Caregivers can model noticing and naming their own emotions such as sharing how happy they felt when they received a hug from their child or how disappointed they felt when they accidentally burnt the cupcakes they were baking. When caregivers name negative emotions they experience, such as sadness or frustration, it helps normalize that all feelings are okay, while also providing a window of opportunity for the caregiver to be able to share how they work through those challenging feelings with their child. In addition to modeling, caregivers may also utilize various visual tools, interactive games, and emotional regulation activities, such as an emotion chart, books about feelings, and feelings charades to help prompt their child to verbalize their emotions. When your child is resistant to using their words to express how they are feeling, caregivers can offer non-verbal alternatives, such as prompting their child to draw a picture of how they are feeling or act it out with toys. 
 Validate emotions and establish safety:  Children with a secure attachment relationship with their caregivers can regulate their emotions more effectively. Caregivers can provide emotional security by maintaining a warm demeanor and consistently meeting their child’s emotional needs through providing comfort, validation, and active listening. To validate your child’s feelings, you can simply tell them that all of their feelings are okay to have. To help your child feel heard, you may echo the child’s language and reflect it back to them.  Connect before you correct:  The key is to help your child calm before requiring them to work through or process their feelings. Helpful tips for building a connection with your child during dysregulation include getting down on their level, remaining calm, and reminding them that you are there to help them. Practice co-regulation prior to expecting self-regulation:  The most significant way a caregiver can help their child regulate their emotions is to act as a “co-regulating partner.” Co-regulation occurs when a caregiver builds a connection with their child by being present with them through dysregulation. Techniques for co-regulation include modeling, teaching, and practicing emotional regulation activities alongside your child. With practice, your child will eventually learn to self-regulate and practice regulation skills more autonomously.  Start simple. Focus on deep breathing:  A caregiver can engage in deep breathing to synchronize the child’s breathing with theirs which helps promote feelings of relaxation. The caregiver may pair guided imagery with deep breathing to encourage the child to participate in the deep breathing exercise. For example, the caregiver may tell their child to imagine they are blowing up a balloon as they take each deep breath or imagine that they are blowing out birthday candles. For younger children, a caregiver may give their child bubbles to blow to help familiarize them with deep breathing. The caregiver can encourage their child to notice how they create a bigger bubble when they take a slower breath. This helps them build awareness of their breath. Incorporate physical movement:  Engaging in physical movement can help release emotional stress. The Mayo Clinic reports that, “physical activity may help bump up the production of your brain's feel-good neurotransmitters, called endorphins” and further suggests that, “exercise can provide stress relief for your body while imitating effects of stress, such as the flight or fight response, and helping your body and its systems practice working together through those effects.” Child-friendly movement exercises that may help promote regulation include yoga, stretching, running, dancing, jumping, or tossing a ball back and forth.  Create an “emotion regulation toolkit”:  To create an emotion regulation toolkit, place tangible objects and emotional regulation activities into a bin your child can access to help them regulate such as fidgets, stress balls, stuffed animals, an emotion chart, a journal, and headphones. To supplement this, you may create a “calm-down corner” in your home to store the emotional regulation activities. This provides a way to direct your child to a safe place to go when they’re experiencing dysregulation with their regulation tools readily available. It is often helpful to identify a “calm-down corner” with their familiar emotional regulation activities in the child’s school setting as well as to promote generalization of the skills across their settings. 


 When To Seek Help It is incredibly common for children to experience challenges with emotion regulation. In fact, all children can benefit from learning skills to help them identify and work through their emotions.  If your child struggles with emotion regulation, seeking mental health support can be life-changing. If your child’s inability to regulate their emotions is interfering with their learning, socialization, family relationships, sleep, health, or other areas of their functioning, it is a critical time to seek out support from a mental health professional. Mental health support during childhood can help shape the trajectory of improved emotional wellness throughout their life.  Heritage Counseling and Consulting has therapists who specialize in treating children and adolescents through providing counseling and play therapy. Child-focused therapy is largely centered around building emotional regulation for kids. To learn more about how trained professional counselors at Heritage Counseling and Consulting can help partner with caregivers to improve their child’s emotion regulation and overall mental well-being, we invite you to call 214-363-2345. 






 Sources https://www.apa.org/topics/parenting/emotion-regulation   https://www.gottman.com/blog/age-age-guide-helping-kids-manage-emotions/   https://www.parentingforbrain.com/self-regulation-toddler-temper-tantrums/   https://www.mightier.com/resources/5-emotional-self-regulation-skills-for-kids/   https://illinoisearlylearning.org/ielg/emotional/   https://srcd.onlinelibrary.wiley.com/doi/abs/10.1111/1467-8624.00291 https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469#:~:text=Physical%20activity%20may%20help%20bump,contribute%20to%20this%20same%20feeling 

Muranna Sherwood