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The M.D.: Anxious parents, anxious children? It’s not a sure thing.

I come from a long line of worriers and have been something of one myself as far back as I can remember. As a child, I worried about bad guys hiding under my bed; as a teenager, I got worked up about exams at school.

These days, the world economy, finances and my children’s safety (not in that order) are just a few of the things that keep me up at night.

While I’m tossing and turning struggling to keep my fears in check, my husband drifts off into a sound sleep. Very few things trouble him enough to lose sleep over. When it comes to anxiety, we fall on opposite ends of the spectrum.

Navigating these differences as parents can be challenging sometimes. I get nervous when my teenagers don’t answer their cellphones, while my husband has no qualms about teaching our 10-year-old to rock climb, use power saws and scuba dive.

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Sometimes I can’t help but wonder whose approach is healthier for our kids. Is he being reckless and putting them at risk? Or am I being too protective and setting them up for a lifetime of fear and worry?

Anxiety in children shows up in a number of ways. Among the most common are social anxiety (fear of being embarrassed in public), separation anxiety (fear of being away from home or close relatives) and generalized anxiety (fear of, well, just about anything).

Children can also suffer from obsessive-compulsive disorder, an anxiety disorder characterized by unwanted and repeated thoughts or feelings that prompt ritualized behaviors, such as repeated hand-washing or checking.

Many, if not most, children experience some anxiety when they’re young. “Because it’s such a normal developmental phenomenon, people don’t take anxiety seriously,” says Dr. John Piacentini, director of the Child OCD, Anxiety, and Tic Disorders Program at the Semel Institute for Neurobehavior and Human Behavior at UCLA. “People think it’s relatively innocuous.”

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But anxiety disorders can be disabling. Worry or anxiety that is pervasive and severe can undermine a child’s ability to navigate his or her day-to-day routine.

A child with separation anxiety, for example, might sob uncontrollably at school or refuse to go altogether; a teenager with social anxiety may be too frightened to participate in class discussions or socialize with peers outside of school.

Although some anxious kids manage to get through their days without any outward signs of distress, the effort that’s required to do so takes an enormous toll on them, frequently causing symptoms such as fatigue, irritability, sleep difficulties and trouble concentrating.

No one knows exactly what causes excessive anxiety in kids, but a fair amount of evidence suggests that there’s a genetic component to it. “It seems we’re born with a genetic predisposition,” Piacentini says. “In the face of stress, some kids react more quickly or in a more extreme way.

“It’s a pretty strong relationship. In fact, it’s not uncommon for anxious kids to have at least one anxious parent.”

This doesn’t mean that every parent who’s anxious will have an anxious child. (Even kids with two anxious parents can end up not being anxious.) Anxiety in children is about more than just heredity. A child’s environment — and that includes the way that child is parented — also influences susceptibility to these disorders. It seems you can teach your kids that the world is a scary place.

“The teaching takes place on so many different levels,” says Tara Peris, assistant professor of psychiatry and biobehavioral sciences at UCLA. Anxious parents use more cautionary language than non-anxious parents; they might, for example, repeatedly tell their kids to “be careful,” their teens to “drive slowly.” They also tend to give their kids less independence, even when it comes to fairly routine day-to-day tasks. A 12-year-old might not be allowed to use the oven or a teenager may be forbidden from walking to see a friend who lives nearby.

Of course, kids pick up on the way parents approach situations themselves. Parents who model a calm, confident stance to new situations send a very different message than those who display fear and apprehension.

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Anxious or overly protective parents can exacerbate the problem for children already prone to worry. “It can be really hard for parents to watch their kids get anxious,” Peris says. To decrease children’s discomfort, parents frequently try to protect or guard them from the things that make them uneasy. But though it may temporarily relieve their anxiety, it does nothing to help them get better.

“Allowing them to avoid the things that make them anxious reinforces their maladaptive beliefs,” Piacentini says. “The more they avoid, the worse the anxiety can get.”

Children need to face their fears if they’re to overcome anxiety. They need to confront anxiety-provoking situations and learn how to manage and tolerate their distress.

And for that to happen, parents often need to learn how to manage their own anxiety. Numerous studies have examined whether it’s helpful to treat parents alongside their children — and most show that it is. At least one study found that kids often get better just through their parents being treated.

Like so much of parenting, getting it right is a balancing act. You don’t want to overshelter or overprotect your kids, but you don’t want them taking unreasonable risks either.

I’m really trying with my own children. I find myself constantly reining in my own fears and allowing them to take on things that, while they may scare me, are probably perfectly appropriate for them to try.

Last winter, in the name of marital harmony and against my better judgment, I permitted my husband to lead the family down a double-black-diamond ski run. My heart was pounding as I lost sight of my children over the cornice. And when I heard my daughter scream that my son had fallen and couldn’t stop himself, I thought it might stop altogether.

We got really lucky that day. Our son narrowly avoided hitting any trees and skied off with everything but his confidence intact.

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Interestingly, it was my husband who was most upset by what happened and by his own poor decision-making.

That night, for the first time in years, I fell asleep before he did.

Ulene is a board-certified specialist in preventive medicine in Los Angeles.

themd@att.net


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