Feeling the stress (Part 3): Little kids, big tech and the 'Worry Monster'

Anxiety is handled differently in young children than it is in teenagers.

For one thing, the word "anxiety" isn't usually used, at least not in front of the kids.

Instead, young children are encouraged to use terms like "worried," "stressed," or "in the Yellow Zone" to describe how they're feeling.

Since kids are still getting to know their emotions, their stress triggers and their bodily responses to worry, adults who work with anxious kids try to teach them self-awareness and how to identify when they're feeling worried, and why. They focus on building basic coping skills, and provide a language for kids to process and communicate their feelings.

Rossman Elementary School, for example, has recently implemented a linguistic framework for talking about emotions. Called "The Four Zones of Regulation," it designates a different color to describe each of four emotional "zones": the Green Zone is for kids who feel calm, happy and ready to learn. The Yellow Zone is reserved for students who feel frustrated, excited, nervous or anxious. The Red Zone is for unbridled rage, terror and devastation—that's the one everyone wants to avoid. And the Blue Zone is for kids who are feeling sad, tired, sick or bored.

Rossman School Counselor Kari Gloege said students and teachers use these terms on a daily basis at the school. A math teacher, for example, might advise a frustrated student who's in the Yellow Zone to "try and get back in the Green," while a physical education teacher might encourage his or her players to "get into the Yellow Zone" during a competitive game.

Another popular strategy that child psychologists and counselors use with anxious young kids is the use of a "Worry Monster"—a plush toy that looks like a cartoon monster and has a long zipper for a mouth. Kids write their worries on a slip of paper (or tell the monster their worries) and then have the monster "eat" those worries. The process externalizes the worry and packs it away somewhere else; the general idea being, goodbye and good riddance to that worry.

Sheila McLeod, a Detroit Lakes school counselor who works with 5th and 6th graders, uses the Worry Monster a lot with her kids.

"It shows them they don't have to do it alone," she said.

Child psychologist Jodi Boerger-Wilder, of Essentia Health's Detroit Lakes Clinic, uses a very similar approach with her young patients. She sees about eight kids a day, half of them for anxiety disorders. She lets the kids yell at and tackle the Worry Monster, so they can "put it in its place" and get back in charge of their fears.

"They get to be really bossy, and they like that," she said.

She uses cognitive behavioral therapy, helping kids identify the irrational thoughts in their minds, as well as the corresponding feelings they're having in their bodies. "My parent is never coming back," is a common irrational thought she hears from her patients. She coaches them to replace that thought with a different, positive one, like, "My parent is always coming back," and has them shout that at the Worry Monster. She also teaches them relaxation strategies, like deep breathing and calming their bodies, so they don't start to panic.

Anxiety is diagnosable around the age of 3 or 4 (2 in extreme cases), and usually starts with separation anxiety. Most babies and toddlers experience separation anxiety as a normal stage of development, but for some kids it never goes away as they get older, or it gets worse.

"These young worriers develop 'what if' thinking," Boerger-Wilder said. "'What if' mom gets in an accident? 'What if' a storm comes? They constantly worry."

If left untreated, anxiety becomes "a neverending cycle" that can lead to other mental health issues, such as depression, she added. Treatment rarely involves medication. Rather, it's about giving kids the tools they need to help themselves.

"Kids have to build up their own strength to fight that anxiety," Boerger-Wilder said. "Good parents, when they see their child is in distress, they want to fix it. But with anxiety, our job as parents is to...take a step back and let the child do it themselves."

Anxiety in the schools

Not long ago, McLeod counseled a young girl and her family who were "beside themselves" over a behavioral issue that none of them could figure out. The girl was a good student and she liked school, but every morning "she would just be a wreck" at dropoff, McLeod said. She would cry and get emotional. Her friends would see this and ask questions, which would embarrass her and make things worse. Neither she nor her parents knew why it was happening, or what to do about it. After talking their morning routine through with McLeod, they figured out that the girl was simply feeling too rushed. Rushing made her feel panicked; it was a trigger for her. Waking her up 15 minutes earlier solved the problem.

Figuring out what triggers a child's anxiety is a huge part of the treatment puzzle, according to McLeod. Once a trigger is identified, it can be dealt with directly—and that can make a big difference in behavior (the above example is a case in point).

One way to deal with triggers—especially when they're recurring and the child knows they're coming—is to do what McLeod calls "prep work." Sometimes anxiety can be prevented by taking advance action, such as by convincing students to get their homework done right away so they don't have to worry about it later on.

When kids are stressed, McLeod and her fellow middle school counselor, Alyssa Haugen, focus on the basics first. They think of common-sense wellness practices and habits as coping strategies, working with anxious kids and their parents to make sure the kids are getting enough sleep, eating well, spending time outside, exercising, and not getting too much screen time.

They also exhort the importance of mindfulness. They coach their kids to recognize when they're starting to feel overwhelmed and to take breaks as they need to.

"I remind them to 'be the pond,'" McLeod said. "You have all these fish swimming around you, and you don't have to interact with them. You can just be the pond."

By the later middle school years, the conversation shifts, and kids start using words like "stressed" and "depressed." Haugen said these feelings tend to get worse as the kids get older. By 7th and 8th grade, academic and social skill gaps between students start to widen, and that heightens anxiety for the kids who feel they're behind. Students are more self-aware by this age, and they care a lot about what their peers think. They start experimenting more with drugs and alcohol, and some start to have attendance issues at school.

Haugen said she tries to ensure that her kids have a solid foundation of healthy coping skills to rely on, so that they can use those strategies on their own as they get older and move up into high school. A challenge with kids this age, however, is that they're not always willing to use the suggested strategies.

An advantageous thing about working with younger kids is that they're more open to trying new and different things, Gloege said. Unlike the typical middle or high school student, young children aren't too concerned about what might be perceived as uncool, and they still care about pleasing their elders.

"You teach them the language and the vocabulary and the skills, and you teach them prompts and coping strategies," said Gloege, "but it takes repetition, repetition, repetition."

A growing issue

Local school counselors and psychologists all say they're seeing more and more young kids with anxiety these days, and those kids are coming from all different family types and backgrounds.

It used to be generally true that "anxious parents breed anxious kids," said Gloege, but that only paints a partial picture today.

Gloege sees about 120 kids per week at Rossman Elementary, supporting them in some social or emotional part of their lives, and anxiety is a regular topic of discussion. Rossman's Behavioral Specialist sees another 20 to 30 kids a week, and anxiety is an issue for most of them, as well.

"I'm seeing more identification of worry in kids," said Gloege. "I feel like kids coming from solid, stable families are showing signs of being anxious more now."

At the middle school, both McLeod and Haugen lead a number of specialized sessions with small groups of students, such as a boys' group, and anxiety is a topic that comes up often. The counselors also visit social studies classrooms once a month to teach lessons related to social and emotional skills. That way, every student in grades 5-8 gets the message.

And it's becoming increasingly important that they do: McLeod and Haugen said they're "definitely seeing a rise in kids being worried in recent years."

It could be that more kids today are feeling worried than they were, say, a decade ago; or, it could be that people are talking about anxiety more, so more kids are identifying themselves as worriers (or are being identified by someone else and referred for treatment).

Boerger-Wilder suspects that a higher referral rate is behind the recent bump she's seen in childhood anxiety cases. She said the disorder has been more prevalent recently. Anxiety disorder is the most common mental health disorder she treats, with separation anxiety the most common in younger children.

The root causes of anxiety in kids today are the same as they've always been: a combination of genetic, environmental, psychological and developmental factors. Experts believe it's been on the rise recently due to post-9/11 fears of terrorism, media fears, increased parental pressure, overscheduling, less time for free play, and the added stresses of social media and technology.

The role of tech

"There's definitely a causal link between media—use of smartphones and things—and anxiety, and the prevalence and treatment of anxiety, in younger kids," according to Boerger-Wilder. That statement echoes what experts across the country have been saying in recent years, amid mounting evidence.

It's not screens themselves that cause problems, but the way they're used—context and content matters, as does the amount of time a child spends in front of them.

Boerger-Wilder and all the school counselors interviewed for this story said video games are one of the biggest contributors to anxiety in younger kids. They said too many kids are spending too much time playing video games, and often those games are not age appropriate (Grand Theft Auto and Call of Duty are examples).

Spending time gaming, instead of engaging in free play and having face-to-face interactions with other people, leads to a lack of social skills in kids, and can also cause relational anxiety and depression.

Television, too, is a factor in anxiety. Violent and overtly sexual TV shows and movies can leave lasting negative impressions on kids. And Boerger-Wilder said a lot of her patients express fears of war, school shootings and other disturbing things they've seen on the news.

"We really need to be mindful about what children are hearing and seeing in the news," she said. "I advocate for not having it on at all in the home with young kids, or even as old as 12 and 13, if they're overthinkers."

Around 5th and 6th grades, smartphones and social media start coming into play, though counselors said the majority of kids in Detroit Lakes don't have their own phones until the later middle school years. At that point, it's a whole new ballgame.

Like teens, younger kids with access to digital tech are susceptible to all the perks and pitfalls that go with it. Many of them use Snapchat, Instagram, Twitter, Facebook and other social media, and they text regularly. As these new methods of communication enter their worlds, the online realm becomes an extension of their realities, and all the familiar perils of adolescence—peer pressure, bullying, etc.—are given a virtual platform.

Kids who get smartphones earlier are exposed to the anxiety they can cause sooner, but kids who don't have smartphones have anxiety over that. They feel like a "have not," and that separates them from the kids with means, Haugen explained, "and kids really want smartphones—it makes them feel like they fit it."

For most middle school students, fitting in is a top priority. They get anxious and upset if they're not invited to certain online circles or events, or if their friends don't seem to be responding fast enough to their texts or social media posts.

Boerger-Wilder said it's this fear of missing out that leads to the overuse of social media, including nighttime use, which disrupts sleep, and it all increases anxiety.

Cyber-bullying is also an issue with young kids. Gloege said she's seen it happen at the elementary school, and McLeod and Haugen said they've had students create fake social media accounts just to torment fellow students. A 5th grader once created an "I hate so-and-so" Facebook page, though Facebook has become less popular with kids recently. Haugen said Snapchat is now the favored app for bullying.

Another cause for concern are selfies. McLeod said she sees a lot of young girls frequently post pictures of themselves online and then anxiously await a response.

"It has to happen immediately or it creates anxiety," she said. "They need to be told how beautiful they look; it constantly comes from the outside... You want kids to have that confidence come from within, not need to be told."

Gloege recommends that parents prolong their kids' use of social media for as long as possible.

Sidebar:

Signs and Symptoms of Anxiety in Kids

• Refusal to separate from their parent/guardian

• Constant worry and "what if" thinking

• A need to know where everybody is at all times

• A need to know what's going to happen next

• Often perceived as being very rigid; doesn't like change/surprises in their environment (may have strong reactions to minor changes)

• Behavioral issues (oppositional, won't listen)

• Stomachaches/headaches

• Moodiness/restlessness

Sidebar:

Children and Media: Tips for Parents

• Treat media as you would any other environment in your child's life. The same parenting guidelines apply in both real and virtual environments. Set limits, and know what your child is doing online.

• Be a good role model. Teach and model kindness and good manners online, and limit your own media use.

• Create tech-free zones. Keep family mealtimes and social gatherings tech-free. Recharge devices overnight, away from kids' bedrooms so they won't be tempted to use them when they should be sleeping.

• Develop a family media plan. Take into account the health, education and entertainment needs of each child as well as the whole family.

• For children younger than 18 months, avoid use of screen time, other than video-chatting.

• Some media can have educational value for children starting at around 18 months. It needs to be high-quality programming, and parents should watch with their kids to help them understand what they're seeing.

• For kids ages 2 to 5 years, screen time should be limited to one hour per day of high-quality programming.

• Children 6 and older need consistent limits on the time spent using media, and the types of media used.

• IN A NUTSHELL: Media and digital devices are an integral part of our world today. The benefits of these devices, if used moderately and appropriately, can be great. But face-to-face time with family, friends and teachers plays a pivotal and even more important role in promoting children's learning and healthy development. Keep the face-to-face up front, and don't let it get lost behind a stream of media and tech.

From the American Academy of Pediatrics