No adult wants to prolong an anxious child’s misery. So it’s no wonder that adults respond by removing their child from the scary situation. But a CU Anschutz child psychologist believes this response – however well-intended – may be compounding the problem, fueling the anxiety that now defines a generation.
Allie Morford, PhD, is an assistant professor of child psychiatry. In her clinical practice at Children’s Hospital Colorado, she helps children and parents understand and manage anxiety disorders.
Based on data from 2022-2023, 11% of children ages 3-17 were diagnosed with an anxiety disorder. Between 2020-2021 and 2022-2023, there was an 18% increase in the number of children ages 3-17 who were diagnosed with anxiety. Contributing factors include pressure at school, family dynamics, societal stressors and social media.
Key points:
- Rates of anxiety among children and adolescents are increasing, and so are requests for classroom accommodations by parents.
- While well-intentioned, providing children with long-term accommodations for anxiety can compound anxious cycles and perpetuate anxiety disorders.
- A CU Anschutz child psychologist created an educational workshop for school administrators to reduce anxiety-related accommodations over time.
Recently, Morford developed a workshop in response to inquiries her clinic received from school leaders seeking guidance on supporting students with anxiety disorders. The workshop provides educators with practical information to help develop or revise school accommodation plans for these students.
Schools are required to provide accommodations for students with disabilities, offering supports such as extended test time or preferential seating. Students with an anxiety disorder may receive a 504 plan to help reduce barriers created by anxiety.
While accommodations can be necessary for some students to learn, Morford is concerned that parents and administrators alike may not understand the differences between healthy anxiety and anxiety disorders. And while well-intentioned, accommodations may be feeding cycles of anxiety, resulting in continued avoidance that can stifle growth.
Like all emotions, anxiety is a messenger. It tells us when something is dangerous or threatening. So removing anxiety is not a goal of treatment.
The issue is knowing the distinction between anxiety and an anxiety disorder.
“In anxiety disorder, there’s an outsized reaction to a threat. Eventually, this causes avoidance of anything that inspires a feeling of anxiety. To continue feeling safety and relief, avoidance of the trigger becomes essential,” Morford said.
“When kids overcome that fear of uncertainty – of not knowing what’s going to come next – they feel so proud of themselves. And there’s a ton of relief in knowing that you can overcome that fear so you can do the things that really matter to you. But it really is incredibly terrifying to approach these things initially, and that can’t be understated.” – Allie Morford, PhD
In the workshop and in the clinic with families, Morford reframes how to approach anxiety in children through the gradual reduction of accommodations.
“Kids with anxiety disorders may need classroom accommodations initially, but they benefit from learning that it’s safe to approach the things that make them feel scared, so long as there’s no real danger or threat. They need to learn that there’s safety on the other side of sticking with something and persevering, rather than avoiding it altogether,” she said.
Which, Morford acknowledges, can feel terrifying for the child with anxiety and their parents.
“Those initial few times when someone with anxiety approaches the ‘thing’ will be met with intense fear, and they will be asked to sit with the discomfort and uncertainty, and that’s really hard.”
Growth comes from disrupting the anxiety cycle.
“When kids overcome that fear of uncertainty – of not knowing what’s going to come next – they feel so proud of themselves. And there’s a ton of relief in knowing that you can overcome that fear so you can do the things that really matter to you. But it really is incredibly terrifying to approach these things initially, and that can’t be understated.”
The current “gold standard” anxiety treatment is ERP – exposure, response and prevention. It’s a treatment that continues to evolve, Morford said, and at its basis is a term called habituation.
“In anxiety disorders, what’s happening is that you ‘habituate’ having really intense emotional responses,” she explained. “In treatment, we learn how to stick with and resist the urge to avoid what happens as a result of a really intense emotional response.”
This helps the child begin to recognize the feeling of safety that occurs once they’ve sat in the uncomfortable, intense emotional response long enough to feel it lessen. The urge to avoid eventually lessens, reducing the need for anxiety accommodations.
“Anxiety prevents us from doing the things that really matter in life. We stop taking risks – in school, in relationships – and we miss out. As a society, we want our kids to explore the world and push boundaries in ways that are safe. Keeping them trapped in avoidance due to anxiety isn’t the answer.” – Allie Morford, PhD
Morford said research has shown that 97% of parents of children with anxiety accommodate their children’s anxiety, typically through avoidance of triggers.
“Our innate response to somebody suffering is to try and reduce it. The problem is that it accidentally perpetuates the anxiety disorder. We have to resist those instincts to reduce suffering to truly support kids,” Morford said.
Helping their child grow to be a confident, independent human is a goal for most parents. So treating a child with anxiety disorder requires parents to also make brave choices that can help their kids evolve.
Morford acknowledges that it’s a big ask. But she encourages parents and educators to consider that the short-term relief provided by an accommodation isn’t reducing anxiety in the long term.
For educators, changing how anxiety is approached in the classroom is especially challenging. Morford’s workshop includes worksheets that help guide conversations with parents, so educators can feel confident and comfortable having conversations. She stresses that accommodations aren’t bad – but many kids can succeed in a traditional classroom by having a plan in place to reduce accommodations over time.
She acknowledges that it’s a complex issue.
“We recognize that this recommendation doesn’t always flow with what the educational system has available,” she said. “So until we have research that supports a good solution, it’s about educating everyone involved that avoidance perpetuates anxiety disorders.”
It’s hard for parents to hear that their protective choices may be perpetuating harm. It’s a hard pattern of behavior to break, even for therapists.
“It’s my job to help, and it’s my instinct to reduce the suffering of these kids in the moment,” Morford said. “So I understand how difficult it can be. But I also know how kids can thrive when they do the things that scare them the most.”
For a generation that’s already been labeled as anxious, it’s important to consider how we treat anxiety-related accommodations.
“Anxiety prevents us from doing the things that really matter in life. We stop taking risks – in school, in relationships – and we miss out. As a society, we want our kids to explore the world and push boundaries in ways that are safe. Keeping them trapped in avoidance due to anxiety isn’t the answer.”