How to help a foster child with their anxiety
Anxiety in a foster child can be crippling. Not just for the young person experiencing it, but for you, as their carer, not knowing how to help.
Dealing with anxiety in children and, specifically, giving young people mechanisms to cope is the idea behind Cheeky Worries — a special book written by Dr Anna Smith, a clinical psychologist, and Dr Patrick Davey, a consultant psychiatrist.
Both work in the NHS and specialise in treating anxiety disorders. Dr Patrick has also worked before with young people fostered with Lika carers.
So, we thought we’d ask this pair of experts for their best advice on how foster carers can help young people handle their anxiety.
Here’s what they had to say.
What sorts of anxieties or anxiety-related issues do we tend to see in young people? Do we know where they come from?
Dr Anna: What you tend to see is younger children have more concrete phobias. So, fear of dogs or a fear of monsters.
As they get older, they might start fearing things that are less concrete. They might start developing separation anxiety, where they feel anxious about being apart from their main caregiver, for example. They might worry about people dying.
As you get into early teens, you’re more often seeing worries like Obsessive Compulsive Disorder. So, that’s an anxiety about contamination or dirt or germs.
Then, as you get into mid-teens, it’s more things like social anxiety, anxiety about body image, and that kind of thing.
Children in foster care have usually experienced some kind of trauma. How might that create anxiety and how can we identify it?
Dr Anna: For people who’ve experienced trauma, it’s about helping them link and understand how those experiences might have impacted on the way they interact with the world now.
For example, if they have experienced a traumatic loss, they might be more anxious about things like separation, the possibility of having another loss in their life, or the possibility of being left again in some way. So, their fears, later in life, might mirror some of their earlier experiences, if that makes sense?
The thing is, there’s no single cause of that anxiety. Five children can go through exactly the same event and all respond in different ways.
But I suppose what we pick up on are signs in the child of something different, like in their behaviour, for example. A child who was really happy to go to bed alone might suddenly start to appear a bit more needy at night-time. They might keep coming downstairs for something, when they should be asleep in bed. It’s not necessarily that they would ever say ‘I feel anxious’.
What the foster carer needs to be doing is tuning in to subtle changes in behaviour that might indicate there’s something that is making the child feel anxious and behave in a different way.
What sorts of behavioural changes or signs are we talking about?
Dr Patrick: We talk a lot in the book about people not doing the things they might normally want to do.
So, for example, not wanting to go to school in a child who’d normally been quite happy going to school, not wanting to meet their friends in a child who had previously enjoyed seeing their friends, not wanting their foster carer to go out when before they might have been quite happy for their carer to go out.
Also, look out for any physical health complaints — a grumbling stomach, aches and pains — which suddenly appear around a certain period of time, or ahead of something. Recurrent stomach ache, that kind of thing.
The difficulty is children are not always able to explicitly say ‘this is my anxiety’, but saying they have a funny sensation in their body repeatedly, or complaining of a tummy ache, is much easier.
If you observe this kind of behaviour in your foster child and you think it might be anxiety, what should a foster carer do next?
Dr Anna: You want to be able to find a way to open a dialogue, because what we want is for these experiences to be completely normalised.
You might say: ‘It’s totally fine and normal that you’d feel anxiety about this. I understand what anxiety is; I have anxiety myself. Let’s talk about anxiety; let’s not keep it something that’s really hidden away’.
The first thing you want to do is just gently explore and to ask things like, ‘Oh, you used to love going to the park and it seems like you’re not so keen to go to the park anymore. Is there anything different about the park, or is there anything you’re worried about going to the park’?
We always say don’t be scared to ask the questions. Ask if something is making them feel scared or worried. It’s actually just so important to just dive in.
Children don’t always want to tell the truth in these situations, do they? How do you know if they’re maybe not telling you what they’re actually feeling?
Dr Anna: You can use a technique where you name an anxiety of your own, to model that it’s okay to talk about these things.
Or you could say ‘some children might feel a bit worried if… [insert what you think the worry might be here]. Do you ever have worries like that’?
Often, we don’t want to do that because we worry we’re going to be planting things. But we’re really trying to validate these experiences for the children.
Once you’ve opened that door, what techniques can carers use to help a young person deal with their anxiety?
Dr Anna: The important thing in younger children is just getting them to share their anxiety. Then the caregiver should acknowledge it, give them a hug, validate it.
We’re not trying to reassure them by saying, ‘Oh no, don’t worry about that, nothing is going to happen’. Reassurance doesn’t actually work. It keeps the anxiety going. But it’s also not true — something bad could happen. You have to allow that anxiety to be there, to be okay, and to be okay to talk about it. Younger children are quite resilient.
Acknowledge that it’s really sad, it’s really scary, or it must make them feel horrible.
With older children, you’re trying to get them to build their own resilience and build their own little set of coping strategies. So, it’s about acknowledging, ‘OK, so you feel really anxious and horrible. What can we do right now that might help you feel a little bit better’?
Then offer suggestions. ‘Would that be sitting down and doing a game with me? Would that be doing some baking? Should we go for a walk’?
You’re not trying to say ‘I’m going to take this anxiety away’, which is what lots of adults want to do, but you’re saying, ‘it’s all right; you can cope with this anxiety; you can manage it. It feels horrible. It feels scary, but let’s try and do some things to make our bodies feel better in the moment’.
What does success look like? How do you know you’ve made a change for the better in that moment?
Dr Anna: The sad fact is you can’t get rid of anxiety. But the change would be that a child is able to still be as involved in life as they would like to be despite their anxiety.
Acknowledging sometimes that they have anxious thoughts, and being able to say to their caregiver, ‘I feel a bit nervous about going to this party’, is success. It means you can have a discussion about it, but that they still go on to the party. So that even if the anxiety’s there, which it might be for a lot of children who are in a position where they’re being fostered, the important thing is that I can still carry on with their life.
When the child comes back from the party, to use your example, do you have a follow-up conversation about how it went?
Dr Anna: One hundred percent, yes. Because for the child, we want them to learn it’s okay to say ‘I felt a bit nervous, but then I talked to my friend and actually I felt a bit better, and then we played a game and that was quite fun’.
Then it’s up to the foster carer to say ‘Brilliant. You did so well there because you felt anxious and you didn’t feel like going, but you did it anyway. You were able to carry on doing a thing you wanted to do, even though there was this whirl of anxiety there at the same time’!
If a foster carer is trying these techniques but doesn’t feel like they’re making progress, what should they do?
Dr Patrick: It’s important to remember that you’ve got all these skills. It’s about human-to-human communication, letting the young person know you’re there, that they can talk to you about it, that you are curious and want to understand what they are finding difficult.
In terms of when to get help, I would suggest that if things are persisting and continuing to have an impact on a child’s ability to enjoy their life fully then it’s worth considering getting some advice. There are some very good online resources or you can speak to your GP for their thoughts and signposting.
Do you have a last piece of advice for foster carers helping their young person deal with their anxieties?
Dr Patrick: Just that it’s normal to have anxiety. Everyone experiences it at different times — adults and kids — and we have to be careful we don’t pathologise (treating as abnormal) normal, perfectly healthy worry and anxiety.
Dr Anna: The other thing is, in this particular group of young people, the anxiety might present in all sorts of different ways. Particularly if you’ve had quite a difficult early life, or multiple caregivers at an early age, your anxiety might show itself in slightly different ways.
It can be quite easy to just view it as a behavioural problem, but it’s always worth asking yourself ‘is this driven by anxiety? What is this young person thinking or feeling that might be making them act in this manner’?
You can find out more about Cheeky Worries, here.
Lika foster carers have 24/7 support to help them with any issues their young person might be experiencing, including anxiety.
If you’re in south or east London and you’re interested in becoming a foster carer, give the helpful team at Lika a call on 020 8667 2111. We’re here to answer all your questions.
We’re in the London boroughs of Croydon, Sutton, Bromley, Merton, Lambeth, Westminster, Wandsworth, Lewisham, Southwark, Islington, Camden, Hackney, Tower Hamlets, Ilford, City of London, Haringey, Newham, Redbridge, Barking and Dagenham, Hammersmith and Fulham, Kensington and Chelsea.