Addressing Child Anxiety by Reducing Accommodation

For Part 1 of this two-part series, see The Risks of Accommodating a Child's Anxiety.

Research suggests there is a lot parents can do to improve their child’s anxiety. While many of us have the heartfelt tendency to jump in and fix minor problems, rescue, or do things for our children, research suggests that accommodating the anxiety can make the situation worse over time.

In a large, randomized controlled trial, a parent-based treatment program was found to be as effective as a child-focused treatment in improving child anxiety symptoms. The program, developed by Eli Lebowitz at the Yale Child Study Center, focuses on two main changes: 1) helping parents respond more supportively to their anxious child, and 2) helping parents reduce the accommodations they have been making to the child's symptoms.

What are the benefits of reducing accommodation?

The advantages of allowing children the opportunity to build tolerance to developmentally appropriate and reasonable life experiences they have the capability of handling are many. When we allow children to avoid a feared situation, this amounts to less practice in coping, persisting, and dealing with fears and challenges. “Avoid more, cope less,” says Lebowitz.

In contrast, when a child stays in the anxiety-provoking situation long enough to observe the anxiety diminish—a process called habituation—their attributions of the feared activity change. Behavioral experience leads to cognitive change. The child recognizes his ability to cope with something difficult. He has the opportunity to watch his fear response rise and fall. He learns to regulate his own anxiety and gains feelings of mastery and confidence over time.

All of this becomes possible when we take a step back, manage our own emotions, and avoid jumping in to rescue. Instead, we support kids through typical life challenges while providing just the right amount of support, not too much and not too little. Tamar Chansky explains it eloquently in her book Freeing Your Child from Anxiety: “By underfunctioning in kind, strategic ways, you enable your child to function up.”

In other words, by collaborating instead of taking over, doing with your child instead of doing for, and allowing him to struggle a little and arrive at a solution, we are establishing opportunities to build grit and persistence, learn from difficulties, and regulate emotions in the middle of an emotional storm.

Maintaining appropriate limits and expectations also sends a powerful message to our child that we believe in his ability to handle these life situations. By viewing him as resilient, he is more likely to perceive himself in the same way.

How can I set limits while also being responsive?

Many parents worry that this approach precludes the ability to be the warm, nurturing parents we desire to be. But in fact, effective parenting approaches combine both warm and empathic responding with firm and calm limits. That is, parents can validate the child’s experience and express confidence, while simultaneously maintaining reasonable limits and expectations.

For example: Heather does not want to attend swimming practice. “I don’t like anyone there and the teacher is mean!” She digs in her heels and refuses to go.

An example of an accommodating response might be: “It’s OK if you don’t want to go” or “I don’t want to take you if it's not what you want.” In this case, the child has full reign to avoid the life experience altogether.

Alternatively, the response could lack warmth or validation. “You need to go because I said so” or “Stop being a baby and get in the car.” In this case, the child learns that her needs are not considered and is criticized for experiencing negative emotions.

Instead, a parent may respond with both empathy and appropriate limits. “It sounds like you are feeling scared. I know doing new things can feel hard. And I also know how strong you are and how important it is to learn new skills. I believe you can do this. I will help you get started."

Is accommodation ever helpful?

The answer is sometimes and it depends on the situation. For example, support and scaffolding around tasks that have not yet been mastered can foster the willingness to participate and give something a try. In order to determine whether your accommodation is potentially helpful or harmful, ask yourself if the action will help your child approach new tasks and build coping skills or avoid more tasks and situations.

If your child doesn’t know how to swim, throwing him in the water would be both a harsh and unpredictable parenting behavior that is potentially harmful. In contrast, responding to his demands and threats to not attend swim practice in a firm and empathic manner that sets appropriate expectations for participation is beneficial.

In this particular situation, you might stay for the first part of the lesson to provide support and encouragement before you leave. You may introduce him to the swim instructor in advance. Consider actions that allow him to take the necessary steps to engage. Over time, accommodations should be reduced as he gains confidence. This might mean taking a walk during the lesson so he can practice being independent or answering fewer fear-based questions as you drive him to the lesson.

Accommodation can also be helpful in schools when support is needed to remove obstacles to participation and learning. For example, a child who panics during test-taking might be provided extra time on tests and an alternative testing location. This can be of benefit when it allows the child to make progress facing the test and taking it effectively.

While to be sure, many children require some reasonable accommodations to fully participate and manage their anxiety in stressful situations, accommodations can be a detriment when they serve solely as a means of escape or a removal of the child’s opportunity to practice handling their emotions. Therefore, accommodation should be considered in conjunction with an intervention focused on systematic goals to face situations and tasks more fully.

Another important consideration is deciding when and how hard to push. Aim for expectations that are within the realm of what your child is capable of and will push him outside of his comfort zone within a tolerable level. If parents encourage behavior within children’s capabilities and support the process, children will often rise to the occasion.

In contrast, if we have too many or too difficult challenges that are beyond the child's capabilities, children are more likely to refuse, melt down, or give up easily. And if you have already been accommodating a given behavior, take it step by step when fading out your support.

What about accommodation for children with social anxiety and selective mutism?

For children with severe social anxiety or selective mutism (a condition in which children selectively speak in only certain settings), accommodation may manifest as the parent ordering for the child in a restaurant, answering questions that relatives pose directly to the child, encouraging the use of nodding or gesturing, or allowing the child to avoid activities that create social discomfort. These are all forms of rescue that are likely to keep anxiety high over the long term.

To be sure, a child with significant selective mutism may refuse to speak in a variety of situations and an attempt to force them to speak is not the answer. Instead, there are a number of effective ways to help your child develop new skills and face his fears while simultaneously reducing your accommodation over time.

First, when someone asks your child a direct question, don’t assume he will not speak and answer immediately for him. If a question is presented, wait five seconds to give him the time and ability to consider a response. It is OK if this creates discomfort in you and your child.

If he does not respond, consider possible adjustments to the situation that might encourage a response. For example, he might have an easier time responding if you repeat or rephrase the adult's question, provide multiple-choice options, lean in or face your body to block the view of the other adult, or ask the adult for a minute and see if he will answer the question a few steps away from the adult. In these ways, you can encourage your child to participate in some way in the interaction, slowly pushing him outside his comfort zone in order to practice new skills and behaviors.

How can I find support for reducing parental accommodation?

Working with a therapist to reduce accommodation can be the missing link that fits together the pieces of the treatment puzzle. It can provide a foundation for parenting in a healthy way that supports long-term coping for your child. Many cognitive-behavioral therapists provide support for parents in reducing accommodating behaviors while simultaneously building a child’s coping skills through individual therapy.

In addition, resources, videos, and research articles can be found on the website for the Supportive Parenting for Anxious Childhood Emotions (SPACE) program, developed by Lebowitz. Parents can also find a list of providers that have received training to provide the SPACE intervention on this website.

So, roll up your sleeves. A little discomfort goes a long way.

To find a therapist, please visit the Psychology Today Therapy Directory.