Dr. Main-Wegielnik treats panic and anxiety by helping her clients begin to recondition their brains to react differently to panic.
When a panic attack begins, it takes root in the brain. But very quickly the body begins to react to the brain’s urgent messages. The heart races. The sufferer gets “tunnel vision,” and the world starts to look narrow and scary. The brain is triggering the parasympathetic nervous system, the part of the nervous system that says, “That was a good meal. Just sit back and relax.”
Then there is the sympathetic nervous system, the one that tells a person to run when the need arises, triggering the fight or flight response. Blood begins to flow faster, reaching the limbs so the confronted individual can physically run away—which, of course, is no help to a child who is seated at a desk or cafeteria table when their anxiety is triggered. Breathing is shallow. A person can feel faint, or even actually pass out in the throes of a major panic attack. The entire body is doing one thing: trying to get away. And many years ago, when humans were hunted by bigger creatures in the wild, this was most helpful. For a child trying to learn, this is not the case.
After a brain has had this terrifying experience, it will do what it can to keep the panic to a minimum. For example, some kids may not feel they will throw up if they carry a plastic bag with them. If that security blanket is in their pocket, then things are OK.
Avoidance of a specific situation is another coping skill that the brain will develop on its own. Main-Wegielnik speaks of a client who was afraid of one specific fellow student. So, in order to stave off that fear, he did all he could to avoid an encounter: He would not go by classrooms where his nemesis was; he would avoid entire floors of the school to not deal with the fear.
But that is not the way to deal with it, say professionals.
“Anxiety feeds off itself,” says Main-Wegielnik. “Avoidance creates a circle of anxiety. That circle needs to be broken.”
The right therapy will help the child confront the fear and adapt.
Dr. Laura Cohen offers the example of a child who sees another child vomit in school.
“Our anxious student witnesses a classmate vomit, empathizes, and then remembers a time that he vomited. He thinks, ‘That could have been me. I might vomit in school and that would be terrible,’” says Cohen, who runs basic parent skills training workshops focused on things like behavioral problems, anxiety and divorce. “So now, school or even the thought of going to school becomes a trigger for anxiety.”
The child is taught to think differently about the situation. New coping skills are put in place to help the child avoid the onset of a panic attack.
Now, with the first day school upon us, many of these fears will come to the surface. A big part of anxiety—in younger children especially—is the fact that many of these kids will not be with Mom and Dad.
“Separation anxiety is very big with children of young ages,” says Syosset-based Dr. Jay Saul.
Many kids have not yet been without the comfort of their parents for more than a few hours. Being catapulted from the home to a classroom filled with other children and new authority figures is a recipe for anxiety in many cases.
“These are crucial days for the young child,” says Saul.
Dr. Main-Wegielnik has seen extreme cases of this type of anxiety. One child would pitch a complete tantrum when it was time to leave the house, and when he arrived at school, would once again have to be taken—physically—into the building. Treatment for the child included a reward of sorts—when the child did enter the school willingly, he was allowed to have computer time right away.
It is a combination of behavioral therapies, and many times medications, that finally helps children cope with anxiety. Snyder says that early assessment is essential.
“How much interference or dysfunction does it cause, and is it impacting school, family and peer relationships?” asks Snyder.
And, most importantly, it must be dealt with and not accommodated. Snyder offers the story of one patient who suffered from selective mutism for years. He was popular, played football, had friends and got good grades. But for years people just spoke for him and recognized him as the kid who did not speak.
“This is not something you want overlooked, or especially not accepted,” says Snyder. “Then nobody gets better.”
And children can and will get better, although many never shed their fears.
As Ashley listens to her son Brendan playing outside, she notes that middle school orientation is scheduled for the next day. He is happy to be done with elementary school, she says. Maybe this year, she will be more anxious than he is, as she sees her son move into another phase of life. He’s growing up. Ashley tells her son not to be nervous.
“But Mom, I’m always nervous,” is his answer.
He’s not alone.