Everyone gets nervous, has fears, and has experienced anxiety at one time or another. Heart pounding, racing thoughts, shakiness – we have all been there. Anxiety is not supposed to be a bad thing. It can be beneficial in preparing us to handle difficult situations, such as taking a test. The true purpose of anxiety is to prepare our bodies for a threat. Except with chronic anxiety, it can feel like a “threat” is constantly there. This is when anxiety is no longer beneficial to us, and rather, a draining condition. Children as young as 6 years of age suffer from anxiety. The Minnesota Association for Children’s Mental Health reports, “1 in 10 young people may suffer from an anxiety disorder.”

Often, people ask me what an occupational therapist’s role is in mental health with children and how it differs from a clinical psychologist’s role. The American Occupational Therapy Association describes our role as, “Occupational therapy practitioners can play an important role in addressing anxiety disorders in children in a variety of settings, including schools, communities, and home. In each setting, intervention may focus on a number of areas, including establishment of routines and habits, enjoyable activities that promote optimal levels of arousal or relaxation, and strategies for managing symptoms to enhance occupational performance. These services can help children build self-esteem and establish supportive relationships with family members, school personnel, and peers.” Occupational therapy is all about function. So, if something interferes with a child’s function in everyday activities, occupational therapists step in. Children’s primary occupations are to play and learn. If anxiety interferes with these occupations, occupational therapists can intervene with tools and strategies to help children alleviate their anxiety in these specific areas.

I have been an occupational therapist for under a year and have already seen several children at Fingerprints Therapy Services, Inc. (http://fingerprintstherapy.com/index.html) who struggle with anxiety. Every therapist has a different approach in helping children with anxiety.
I have put together some of my “go to” techniques I use for helping children with anxiety and ideas you can implement at home:
When your child is anxious, the first thing to do is to encourage them to breathe – smell the flowers, blow out the candles. You can make breathing fun by purchasing whistles (https://www.therapyshoppe.com/category/P2191-whistle-kits-oral-motor-ot-therapy-tools-sampler-kit), blowing through straws moving pom pom balls (http://www.pbs.org/parents/adventures-in-learning/2014/01/racing-activity-straws-pom-poms/), blowing bubbles, or blowing through straws into soapy water for more bubble fun (http://bouncebackparenting.com/calm-down-kids-blow-bubbles/).
When I’m feeling anxious, exercising always helps decrease my tension. When we are stressed, our bodies release the stress hormone, cortisol, which if chronically released, can cause long term damage to the brain. Exercising has the power to destroy the cortisol that was released from stress. When your child is anxious, encourage any activity that will get them moving!
As I spoke about in my last guest post, http://nooneaskedmebut.com/sensory-proprioception-vestibular/, I incorporate activities that involve lifting, pushing, pulling, and weight bearing to provide input to our clients’ proprioceptors, which is calming and organizing for their systems. Anxiety is truly a sensory experience. It can make our limbs numb and tingly; it causes our pupils to dilate, which can make us more sensitive to light or cause blurry vision; it can make us more sensitive to scents, so people who are anxious notice a scent that others may not notice at all. Incorporating heavy work activities will help regulate your child’s sensory system to decrease some of the uncomfortable systems of anxiety. With that, children with sensory regulation and modulation difficulties are prone to anxiety.
Something I like to incorporate in therapy sessions is having my kids draw what their anxiety looks like. Maybe it is a monster, maybe a sad face. Any drawing to give them a visual of what is causing them to feel symptoms of anxiety. Our bodies have so many physiological responses to anxiety that we cannot control. Our minds race from one thought to the next. Sometimes having a picture that symbolizes all of those abstract feelings helps make anxiety less scary and gives us more control.
Research has found that the essential oil, lavender, can have a therapeutic effect on decreasing anxiety symptoms (http://www.livestrong.com/article/365229-lavender-and-anxiety/). I am a big proponent of lavender. The internet has several resources for how to use lavender. Lavender must be diluted when used with children (http://www.joys-of-lavender.com/diluting-essential-oils.html).
A Cognitive Behavioral Therapy (http://effectivechildtherapy.org/content/cbt-anxiety) technique I often use with children is to write the worry on paper and then write and discuss the reasons we think this is scary and the reasons we should not worry about it.
For example: “I am worried about my test.”
What might happen/Why is this scary? “I might fail. It is timed.”
Why shouldn’t we worry/What really will happen? “I will study as hard as I can and do my best.”
It is always tempting to tell someone with anxiety, “Stop worrying.” or “Don’t be silly” or “It’s not a big deal.” These are the last things I want to hear when I am anxious! If you are a clinician or a parent, it is important to respond appropriately to our kids’ anxiety. We want to validate their feelings while also helping them to see that they are safe and in control of their anxieties. Researcher and author, Brene Brown Ph.D., LMSW, says, "“Me too” – two of the most powerful words we can ever use to help others feel safe and understood" (Brown, 2012). When my clients tell me about their worries, I think of some of my worries and help them to see that they are not alone. Remind your kids that you are in it together.

Thank you for reading my post about anxiety. Feel free to ask any questions in the comment section below!

Some of the most common questions that parents ask me pertain to our internal senses, the vestibular sense and proprioception. Questions I often hear include, “How is swinging calming?” “How does the vestibular system work? and “What is proprioception?” Every client of mine benefits from some form of vestibular and proprioceptive input – children who struggle with attention and focus, children who have sensitivity to clothing or food, and children who are under responsive to the senses, to name a few examples. I have a feeling there are many more parents or clinicians out there wondering why occupational therapists incorporate swings, scooter boards, and heavy work activities into our sessions and how these activities improve our children’s function in everyday life.

As you know, we have 5 senses: taste, smell, hearing, vision, and touch. Nobody talks about the other two very crucial senses to our functioning, the vestibular sense and proprioception. These senses begin forming before birth and continue to develop with the other five senses as we grow. When children’s senses are not regulated, it is very difficult for them to properly use their senses – listening to directions, paying attention in class, completing an activity with background noise, wearing clothing without feeling the texture of it on their skin all day, or tasting and enjoying food. Occupational therapists aim to regulate our clients’ sensory systems in order to help them feel comfortable in their own skin, with others, and with their environments.

Many of my clients come in with tactile sensitivity (sensitive to clothing or human touch), or the opposite in which kids do not sense tactile input accurately, oral sensitivity (sensitive to food taste or texture), and auditory sensitivity (sensitive to sounds), olfactory sensitivity (smell), and visual sensitivity. You would think that I should target that specific sense that is having difficulties in order to solve the problem. While we still have specific interventions for balancing each sense individually, such as feeding therapy, the amazing thing is that we can help regulate the five senses by organizing our internal regulators.

The vestibular system tells us where our head is in space, the speed of our movement, and in what direction we are moving. It is a major organizer of sensory input. It functions like a traffic cop, telling each sensation where and when it should go or stop. It organizes the data received from the senses. The vestibular sense is important for the development of balance, coordination, eye control, attention, and some aspects of language development. It is composed of small receptors in the inner ear. When you swing and move, these receptors send nerve messages to your brain. Your brain then tells your body how to stay balanced. So much is happening in our ears every second of the day! When choosing vestibular activities, we think about how we can challenge that system in ways that it is not used to and in doing so we help regulate the vestibular system. That’s why we choose activities that will change your child’s head position, such as prone in a swing. All vestibular input is calming and regulating.

Proprioception tells us where our body is in space. We have proprioceptors in our muscles, joints, and skin. They allow us to know where our joints are positioned as well as the amount of force against our body and the effort our muscles need to apply for any action. It is needed for body awareness (resource for body awareness). So, we incorporate activities that involve lifting, pushing, pulling, and weight bearing to provide input to our clients’ proprioceptors, which is calming and organizing for their systems.

Think about behaviors you see in your kids or clients that may be inappropriate. Do they spin through the house? Crash into the couch? Chew pencils? In many cases, your kids are not just doing this for fun! They are communicating with you that they are seeking sensory input to organize their internal regulators. Spinning – they are seeking vestibular input. Crashing, chewing, jumping – they are seeking proprioceptive input. Instead of saying no to them, respond to their needs by providing them with a structured sensory task. They will love that they can still do the things that they are craving, and you will love it because it is a structured task and nobody is getting hurt! Think about when your child demonstrates similar inappropriate behavior and what triggers him or her to do sensory seeking type things. Is it during transitions? In the morning? Is it before bath time? Before dinner? It will be beneficial to plan sensory breaks before those trigger moments.

• If your child is running through the grocery store knocking down food, have him or her push the grocery cart for proprioceptive input.
• If your child is chewing pencils, provide him or her with something else to chew: gummy bears, gum, chewable toys, candy necklaces, or Bubba straws (chewing provides proprioceptive input!)
• If they will not go to bed no matter what you do, have your child do animal walks (resource for animal walks) to get that deep calming pressure , carry a heavy ball upstairs, bury them in pillows. Then as they get into bed, give them a big bear hug for even more deep input.
• If your children are having a hard time sitting in their seat completing homework and cannot focus, don’t push and instead let them have a wiggle break. Tell them to do jumping jacks, bear crawls, frog jumps: all of these movements organize the vestibular system and proprioception and will help your child attend to the homework.
• Think about how much sensory input parks have to offer. If your child is crashing and spinning at home, bring him or her to the park to climb monkey bars, climb up slides, slide down slides, and swing.

Think about how you used to comfort your infants when they were crying. You would swaddle them tight and rock them in the rocking chair – vestibular input and proprioception. Your toddler or teenager still needs just that for calming and regulation, just in different forms now. The internet is full of more ideas for providing vestibular and proprioceptive input. Here are a couple sites I have referred to:

• http://mamaot.com/40-heavy-work-activities-kids/
• https://www.sensorysmarts.com/sensory_diet_activities.html

Thank you for reading my post about our internal regulators. Comment below to share how you incorporate vestibular input and proprioceptive input into your children’s or clients’ daily routines! And, feel free to ask questions too!
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Sources:
Kranowitz, C.S. (2003). The out-of-sync child has fun. New York: The Berkley Publishing Group.
Szklut, S.E. (2007). The art of clinical reasoning: Enhancing sensory integration perspectives for assessment and intervention.