I've just finished Eli Lebowitz’s amazing book, Addressing Parental Accommodation When Treating Anxiety in Children. I wanted to share my reflections with you, as we head into a new school year. It was an absolutely heartening-read for the most part and yet, at the same time, a book that left me somewhat disheartened.
Lebowitz says that even seasoned, well-meaning parents, mental health professionals and sometimes teachers - including whole systems like schools - are making child anxiety worse, not better. How?
Well, according to Lebowitz, they are accommodating children’s anxiety rather than engaging with children to help them learn to face life’s normal stresses. Lebowitz says that a rule of thumb for making the distinction between helpful and unhelpful ways to treat child anxiety is that:
Accommodations that help a child to gradually cope more independently, to increase functioning, and to lessen avoidance are usually helpful. In contrast, accommodations that help a child to avoid more, to reduce their independent functioning, or to become more dependent on parents or others are likely to be unhelpful over time.
Over the past two years, I’ve heard many teachers complain about the number of times children are given excuses to opt-out or to not attend school by mental health professionals or by their parents. These teachers tell me that students are using stay-at-home letters from GPs or other mental health professionals so they don’t have to deal with what would objectively be considered moderate-level challenges. Worse still, in most instances, these opt out alternatives are being provided without a treatment plan to help children return to the classroom. This would appear to be not just a case of ‘helicopter parenting’ as much it is a case of ‘helicopter systems’ as well.
Hard to hear I know, because no mental health professionals or significant adult in a child’s life would want to think that what they are doing is contributing to child anxiety. While no-one would want to see children suffer, it's really important that children gain help to engage with adversity, if they are to learn how to deal with it.
I ‘get’ why this is happening. Mental health professionals want to be compassionate. However, we shouldn’t be acting contrary to the best clinical advice on treating children with mild anxiety, which is to not accommodate anxiety. Rather, it is to devise clinical plans which help the child to overcome a mental health impairment.
The strength of Lebowitz’s approach is that he shines a light on the path forward. Children need those around them, to help them manage their anxious feelings and not to ‘avoid’ situations. In fact, the significant adults in a child’s life need to ‘stop the bus’ when a child's anxiety is getting the better of them. This involves adults helping children to learn the cognitive skills to solve emotional problems and to apply arousal reduction skills when they’re feeling anxious.
Unfortunately, the longer children’s anxiety is accommodated, the worse they’ll become. And then, the harder it is to reverse out of a pattern of accommodation. I’ve seen many parents face significant challenges, including child or teenage aggression, when they try to change a pattern of accommodation.
What somewhat disheartened me about the Lebowitz’s book was his further confirmation of the size of the problem of child anxiety. I already knew it was significant and that 80% of primary school leaders had said that child anxiety is a significant problem in their schools. Lebowitz’s book showed me that the problems of accommodation are being exacerbated within systems and by some mental health professionals.
We have a mammoth task before us to reduce child anxiety. A first step is in acknowledging and recognising how we might be contributing to the problem
Parentshop is currently working with schools to counter the problem of child anxiety. Parent-led strategies are gaining currency in recent years and research has shown that the results for these forms of intervention can be as good as seeing a psychologist for children with mild-level anxiety.
We’d like to talk with you about our whole of school approach to treating child anxiety. Please contact us.
We’d be happy to send you a prospectus about the work we are doing in schools contact Caitlin at firstname.lastname@example.org
Michael Hawton, MAPS.
Click here for upcoming No Scaredy Cats courses for family and community workers and guidance counsellors.
 The meaning of the term accommodation in this context is not used in the same sense as educators talk about adjustments or accommodating student learning. Rather, it refers to how the adults in a child’s life are making changes to what they might normally do, such as not going out or through adults acting pre-emptively to forestall a difficult situation.
 Types of Parental Involvement in CBT with Anxious Youth: A Preliminary Meta-Analysis. Manassis,
et al (27 other authors) Journal of Consulting and Clinical Psychology 2014, Vol82, No6, 1163-