435. Q&A: Does my child have anxiety or are they just highly sensitive?

Dr. Sarah Bren (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:41):

Hello, welcome back to the Beyond the Sessions segment of the Securely Attached podcast where we’re going to answer a listener question. And I have Dr. Emily Upshur here to help me answer this question. Hi, Em.

Dr. Emily Upshur (00:57):

Hey.

Dr. Sarah Bren (00:59):

Okay. So this is her question. Hi, I have a question about anxiety. I listened to your podcast about space and it really resonated with me. I’m wondering about a three and a half year old who seems to have an overall anxious nature. She’s constantly asking, what was that noise? Even when it’s something ordinary like the fridge. And she often assumes it’s an animal or something scary. She’s very focused on making sure the door is locked so strangers can’t come in. If I’m cooking and I casually tell her, “Honey, move away from the oven. It’s hot.” She reacts with a lot of alarm and jumps very far back. At night, she’ll notice a shape from her bed, like a toy or object on the floor and become convinced it’s a monster. So it’s not really one specific anxiety like school or sleep. It feels more like a general sense of anxiety throughout the day. Recently, she’s also started picking at her lip a lot and mouthing items, which I wonder might be related. What would your advice be?

Dr. Emily Upshur (01:54):

Oh, a thoughtful question. It’s a good one.

Dr. Sarah Bren (01:56):

Yeah. So sensitive three and a half year old.

Dr. Emily Upshur (02:00):

Definitely. Yeah. It feels like that. With these, I have so many questions. Yeah.

Dr. Sarah Bren (02:07):

Okay. Well, I want to hear your thought process diagnostically or even just like though process. What would the questions you would want to ask this parent be?

Dr. Emily Upshur (02:17):

I guess you’re saying sensitive. So I’d want to do a little bit of like, is this anxiety, in my clinical mind, I’m thinking, is this anxiety or is this a highly sensitive, sensorily sensitive kid? Noises are louder for them. Touches, feelings are bigger. Just to get a little bit of a sense of that, because it does sound like it’s all over the place for what this parent’s reporting. But the other thing I would sort of want to see is, can we see if there are any things that hang together, like patterns or thematically, are there things that we can sort of group together? Because I think that gives us a much better sense of how to run interference, discuss this with the kid, help the parent sort of determine their approach. And that’s sort of like where I would start with some questions around like, where are you noticing this? Are there times of day that it’s more than others? Just sort of trying to get a sense of, can we give mom some guardrails about how to approach this kiddo?

Dr. Sarah Bren (03:31):

Yeah. And how do we respond to the anxiety? Mom saying I might casually tell her, “Hey honey, move away from the oven. It’s hot.” And she’s having a really strong reaction to that. It sounds like that’s being kind of met with calm, down regulated responses from the parents, but is there other places that she might be sort of absorbing implicitly like some anxiety in the environment? Are there people in the environment who are also sensitive to noise and might have strong. Or worry about checking the lock a bunch of times? I’m just curious if she is generating these ideas out of nowhere or if there’s some learned that the child might have extrapolated maybe some magical thinking or something, she’s taking the story to a scarier place, but is there some narrative around like, “Ooh, we need to make sure things are safe. We need to make sure things are locked.” Is there some perception of danger that somebody might be inadvertently kind of amplifying and then this kid might be taking it like two or three steps outside of that range?

Dr. Emily Upshur (04:51):

Well, sometimes I think that happens with an incident, even at home or in a movie or something. And you don’t even, as a parent, it’s not on your radar because it was not a big deal. But sometimes kids hold on to a nugget of that, “Oh, in that very Disney appropriate, age appropriate movie, somebody got locked out of their house.” And that’s the only thing that can sometimes happen. And I appreciate it does sound like, it’s so hard to tell, but it does sound like this parent is aware of their own reactions, which I do think is a big piece of how to interact with a kid that’s very sensitive is also to not match their level of intensity when those things happen. And that is one of the interventions that I would be thinking about as I’m talking to this parent is helping them create a very regulated self. So when she has these reactions, they’re a little bit of the pad that she’s landing against instead of like bouncing off of.

Dr. Sarah Bren (05:51):

Right. And also going back to your idea of like, can we look for a pattern? Can we start to see if there are certain themes or times of day or whatever? I think that’s really, really helpful. And another place I would look beyond like timing or thematic sort of daily life events is her play, to look at her play. There might be clues in her play about things she’s revisiting if there is something she is worrying about. Whether it’s because she observed something, nothing scary, but little kids could see something and they’ll pull one piece out of context and they, for some reason, hold onto that and they’re having trouble fitting it into their schema, fitting it into their understanding of the world in a way that doesn’t keep lighting this worry light up, their amygdala, their threat detector. It’s like something arbitrary potentially that could be just like looping for her, which if that is happening, is very likely that you might see some sort of repetitive revisiting of it in play.

(07:04):

I don’t know what it is. I don’t even know if there is an it. It’s just something I’d rule out in terms of like, or not even rule out, but just it’s another avenue to explore when looking for patterns, potential patterns that could give you some insight into like, hmm, is this generalized, arbitrary, random, pervasive anxiety that’s just seeping out everywhere? Or is there something that kind of like turned it on? And now we have to kind of work backwards to figure out how we can settle her system again.

Dr. Emily Upshur (07:36):

Definitely. I think that’s a really good point. And also how do we can sort of not turn it into something bigger inadvertently, accidentally. Some of these things, I’m curious what you’ll think of this. Some of these things I would almost not respond to. I would respond non-verbally to rather. If she jumps back from the oven, I might just like calmly put a hand on her and not say, “It’s okay. It’s not that hot. Don’t worry about it.” I might just do something very down regulating but reassure a little bit of actual reassurance.

Dr. Sarah Bren (08:19):

It’s almost like a, because this mom mentioned space, which is a, we talked a little bit about space. But space talks about how when you have an anxious kid, we can offer a supportive statement where we validate the experience and then we also communicate confidence they can cope in a way that just touching their back in that scenario you described is like a nonverbal supportive statement. The hand on the back is both validating. I hear you. I see what’s happening for you. It’s real. And I am showing you how safe I feel this situation is. You don’t have to say anything to do a quote supportive statement.

Dr. Emily Upshur (08:59):

Right. And I think back to the space a little bit, you’re kind of not accommodating. You’re going to put the hand on the back and continue cooking. You’re not changing your behavior. And I think that sort of instills that confidence, that piece in space, which is like the part of the support statement in space, which is we’re okay. We got this because we’re just going to continue doing the thing we’re doing. And I think at three and a half, like I’m really mindful this is a very young child. And I think a lot of that, I loved that you brought in play. And I think a lot of nonverbal communications and ease in your own regulatory system as a parent and your own body as a parent really helps communicate the message of safety without over accommodation.

Dr. Sarah Bren (09:49):

Yeah. And I mean, we keep talking about space as mom references space. So I feel like for those of you listening who don’t know what we’re talking about, it’s not a NASA program. I feel like it’s confusing. So we’ve done a bunch of episodes on space. So I will link those in the show notes because we don’t need to go that deep into it. But just in a very, very high level nutshell, space is an acronym for a therapy modality. And it stands for supportive parenting for anxious childhood emotions. And it was developed at the Yale Child Study Center by Dr. Ellie Leibowitz. And it’s a therapy protocol, but you can pull elements out of it just to inform parenting in general because all kids experience worry and anxiety even if they don’t meet criteria for an anxiety disorder. But it’s a therapy protocol that helps parents track ways that they are helping a child avoid anxiety by accommodating or rescuing them a bit and inadvertently then maintaining the anxiety because inadvertently kind of communicating like, “Oh, this is dangerous.

(11:02):

I need to rescue from this feeling.” And so a lot of it is about helping parents kind of reorient to, “Ah, this is a really tough feeling. Okay. And I think you can handle this feeling.” And both explicitly communicating that to the kid, but also like living that out in family life, that core message.

Dr. Emily Upshur (11:27):

Yeah. And that’s sort of what we’re talking about when we’re like, there’s these ways you can communicate to your child that they’re okay, you’re okay. And not necessarily accommodate them, but give them a bit of that support, which is like, you got this. This is hard. You might feel this way, but you got this.

Dr. Sarah Bren (11:48):

And so that, frankly, to a lot of these things that this child is doing, that the mom is observing, a lot of the sort of supportive statement approach I think would be a helpful starting point. And Ellie’s book, Breaking Free from Anxiety and OCD is also a good resource. But she also says one other thing that I feel like I don’t want to skip over, which is that she said recently she started picking at her lip a lot and mouthing items. And I wonder that that could be related. And I definitely wanted to flag that because I do think when kids have kind of a lot of fight or flight stimulation in their systems, they generate a lot of energy, a lot of kinetic energy that’s not necessarily getting out, resolved, released. And it can manifest in this restlessness or gross motor, fine motor stuff. And these sort of like repetitive little, sometimes tick, but really also just self-soothing behaviors like picking or biting or like mouthing things or chewing on their hair or their clothes or picking their nails, like biting their nails, things like that. It could be a little bit about a regulatory behavior.

Dr. Emily Upshur (13:17):

Yeah. I definitely read that too. Thinking specifically this person’s question, like picking her lip or mouthing items, which is oral stimulation is very soothing. That’s why kids stuck their thumbs. And those are things that I think she might be sort of, to your point, expressing or releasing some of this nervous energy or sort of this energetic buildup from all these little things that mom is mentioning around. And I think that’s definitely worth picking up on. I guess I’m curious what you think. In terms of a three and a half year old and those types of things, I think we can talk about how to approach it. I think at first though, I would start with the thing we talked about before.

Dr. Sarah Bren (14:04):

Right. I mean, I think that if you really focus on the lip picking and the mouthing items, you’re going to be sort of playing whack-a-mole because I think that’s the expression of something else.

Dr. Emily Upshur (14:15):

Exactly.

Dr. Sarah Bren (14:16):

And so I think we have to address the something else first. I think her system is in a state of sort of like a little bit of heightened arousal. And I think that’s what we have to start with first. And my assumption is if we can support her system to downregulate a little bit, whether it’s through helping her make sense of the thing that she’s looping on or just helping her practice continuing to let the wave pass and actually not kind of holding on and getting stuck in it. If her system can sort of settle, I think that there’s a fairly good chance that these oral stimulation or whatever these behaviors she’s observing might lessen. The more we put attention on those, the more we’re just going to like kind of amplify a secondary issue. It’s almost like adding more stuff to her system now, which is what we want to do.

Dr. Emily Upshur (15:16):

Yeah. I think it’s a little bit of my gut around like also like less words, less highlighting the troublesome, what the parent’s reading is troublesome behaviors. Sort of not shining a light on those I think is a helpful intervention in and of itself.

Dr. Sarah Bren (15:35):

And let’s think too, so okay, we can address some of the nervousness directly with a child by either giving them some verbal or nonverbal supportive statements or supportive messaging. Or in addition to this, I think we can do something kind of indirect that’s not actually touching it on the nose. For me, I’m like, if her system is in a height of sort of like slightly elevated arousal because she’s kind of on high alert, because she’s picking up on so much. I’m also looking for ways to just offer down regulation for this kid. And it depends on her. I don’t know what her sensory preferences are. What are the things that are calming to her system? For some kids, it’s like maybe we do a lot of bath times. A lot of like bath play, water play, sensory play. Maybe it’s movement. Maybe she needs to really move around a lot.

(16:40):

Maybe it’s she’s a cuddler and having a lot of like close contact of like snuggle time is helpful. Three and a half, I’m thinking about developmentally appropriate offerings for her that are hitting on certain, just like how do we help create some sensory regulation, like sensory down regulation for her that it’s not even about content of worry. It’s not about helping her manage anxiety or manage worry or make sense of something. It’s just unrelated to a worry. We’re just going to spend a little bit of extra time doing like some tactile play. It’s like we’re pre-regulating the system. We’re trying to compensate for this slightly hyperactive arousal response this kid has by creating a lot of opportunities for physiological release and reset prophylactically or like just parallel to the things that she’s focusing on as making her worried.

Dr. Emily Upshur (17:45):

Yeah. No, I think what you’re saying is like balance out the system more. I think there’s so many ways to do that. I love sort of a lot of practical occupational therapy techniques for this kind of thing like trampoline work and bear walking and just sort of like a way to engage and specifically to address sort of this like lip picking, mouthing piece is like, let’s not focus on that specifically. Oh, but we can release in these other ways that you’re describing and this other more occupational therapy way, which can I have a heavy blanket? Can I squeeze things? Can I have a fidget? There’s a lot of other ways to approach that. And I love the idea of sort of balancing out the system and it’s gestalt rather than targeting one thing.

Dr. Sarah Bren (18:34):

Right, right. And honestly, I also just want to say, I think it’s on the one hand I’m like, this could really, I think all just starting with some of the, we’ve thrown a lot of ideas out there. A lot of this is just throwing spaghetti at the wall and figuring out what works for your kid. And if you do some of these things, you might find that things kind of start to settle. And it also might be that you’ve got a kid who’s got some anxiety that you could try all these things and it doesn’t really change it. And so I also want to just remind you that you aren’t your kid’s therapist. You don’t have to diagnose them, you don’t have to create a treatment plan. You can get a consult with a therapist to see if what you’re dealing with is worth doing some sort of clinical intervention or not.

(19:25):

And it’s also possible to get a consultation that reassures you, nope. I’ve gotten more specific details about your specific child, the setting, the history, all that stuff. And it seems like this is really just like kind of where they’re at and we can monitor it, but there really isn’t any critical need to intervene clinically. But you can also just go get a consult.

Dr. Emily Upshur (19:52):

Well, I love that idea actually because I really want to give this parent credit. I think at three and a half, I think I trust this parent. I always say the parents are the experts and their children. And if they’re picking up on something, at three and a half, you have such an opportunity to curtail something from developing to something bigger. And I think that, or sort of just more unwieldy or that needs more of a clinical intervention. So just getting a little advice from a professional that really understands parenting approaches to these types of situations is really wonderful. This person is obviously doing a great job educating themselves through listening to the space episodes and that type of thing. But I would also put that asterisk in it to the same thing. You can get one or two consults from somebody on this and you might feel really empowered for a couple of years with a highly sensitive kid who might continue along those lines, but you’ve really learned how to contain it a bit better and give yourself that confidence like, okay, I’m on the right track. Or, oh, I can tweak it here. So, I love that.

Dr. Sarah Bren (20:59):

Yeah. Well, thank you so much for writing this in. I really appreciated this question. And thank you for listening to our other episodes about space and good luck.

Dr. Emily Upshur (21:09):

Bye.

Dr. Sarah Bren (21:09):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.