Madeline
Madeline, who’s eight now, is small for her age, a charming little girl with long brown hair and a shy nature. She’ s bright, precocious verbally, and very self-aware. The first time her parents brought her to my office she was only three, but she was able to describe the things that worried and frightened her. She became anxious “when there are too many people;” “when there are things I don’t know about happening and I can’t watch out for everything;” and “when it gets dark and I worry that mommy and daddy have disappeared.” She particularly hated the airport, with its swirling crowds and loudspeakers and confusing hallways. While the rest of the family looked forward to vacations, she dreaded them.
We have also worked to discover which situations are stressful and to prepare her for them, by discussing what she might expect. Before Madeline will be traveling, for example, we show her images of airports, act out going through security, and go online to look at pictures of the hotel where she and her family will be staying. Gradually she has developed a much greater tolerance for the barrage of the new at airports and in strange surroundings.
Very early on, Madeline started treatment with a psychotherapist, who has helped her understand her feelings and has given her tools to control her anxiety. By the time she entered school, Madeline had improved greatly, but the classroom proved to be an overwhelming source of nervousness. Again we worked to master stressful elements of her surroundings, and when her anxiety proved pervasive, we added medication. First grade went extremely well.
But by second grade, things were getting worse again. Madeline experienced anxiety about lunch, the kids in her class, and new curriculum areas that she feared she might not be able to master. Most upsetting to her were the small quizzes second graders start having, to gauge their knowledge of spelling or vocabulary words or math facts.
Despite the fact that she is liked by classmates and performs well academically, Madeline was so worried about school that Sunday nights usually saw a total melt down. Her parents sometimes found her sitting outside their bedroom door in the middle of the night. She was too considerate to disturb them, but full of dread and unable to sleep because she would be returning to school the next day.
Her therapist added a relaxation technique to help control her anxiety. Madeline has learned to take deep breaths and to place one hand on her chest to feel that her heartbeat and breathing are becoming slow and regular. Madeline’s mother discussed this technique with the classroom teacher, in part because Madeline worried that other children would see her do it and think it was peculiar that she was “ getting so nervo,” as she called it.
But here’s the great part. Her teacher, who had long been worried about the stresses imposed by modern education on children, loved the exercise Madeline had learned and decided that it would benefit the whole class. “This is a wonderful skill,” she told Madeline’s mom, “so we’ve all started to do it before every test or quiz. I tell my students that feeling a little nervous is fine, and a sign that your body is preparing you to pay attention and do well. So our deep breathing will help us go from too nervous to just right. And you know, Madeline seems much more at ease, and everyone is performing better on quizzes!”