Mayo Clinic: For kids, avoiding risks can be risky

It was always the introduction for Georgiann Steely — the ringing of the doorbell, the approach to the man at the cash register — that made her palms sweat and knees knock.

As a grade-schooler, she avoided these moments — ducking her face into her wavy auburn hair and waiting for her mother to escort her into crowded rooms or order her food. And her mother obliged.

Instinctively protective, Amy Steely figured it was the lesser evil to keep her timid daughter safe and comfortable.

"I was definitely very protective and she will still say I am overprotective," said Amy, who lives in Rochester, Minn., with her husband, son and daughter, who is now 16. "It's true. I am."

The conflict of whether children should be protected from fears or pushed to overcome them is familiar to every parent who has pulled a frightened child back from a diving board or coaxed the kid to plunge. It's familiar to mental health professionals as well, who have long understood that avoiding fears is the hallmark of clinical anxiety.

But new Mayo Clinic research this month has yielded important insights on "avoidance" behaviors, showing they predict which children are more likely to suffer severe anxiety later on.

Anxiety builds on anxiety

Mayo researchers asked parents how their children responded to challenges. A year later, they found higher anxiety in kids whose parents said they tended to avoid things that scared them.

"Kids who avoided tended to be more anxious, even after controlling for how anxious they were to begin with," said Stephen Whiteside, director of Mayo's child and adolescent anxiety disorders program.

The study doesn't mean that avoidance causes anxiety, or that "helicopter parenting" dooms children to therapy. The origin of anxiety is often hereditary. But doctors said the findings reinforce the need for parents to present their children with opportunities to learn resilience.

"It's OK for your child to be upset sometimes," Whiteside said. "It's valuable for them to struggle and persist. Being a good parent doesn't mean your child is always happy."

Understanding the warning signs of anxiety is becoming increasingly important, although it is unclear whether child anxiety is a growing problem. The popular theory is that U.S. children are more stressed these days and that anxiety is on the rise, but there is little data to support that.

The National Institute of Mental Health estimates one in four children ages 13 to 18 have suffered anxiety and one in 20 have suffered severe anxiety.

Avoidance behavior is key to detecting anxiety early when it is most treatable, said Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders. "Parents report ... that their kids are not going to school dances or calling up friends. It's the avoidance that the parent observes that helps a clinician to make a diagnosis."

The signs that Georgiann had a problem emerged in high school, after her father left the Air Force and the family that had frequently moved settled in Rochester. Georgiann's shyness had been dismissed at times because she was always the new kid in school. After entering Mayo High School in fall 2011, her freshman year, it became clear her worries were holding her back.

"She would do everything she could not to be involved, but if she was involved, what you would see is somebody very withdrawn, head down, not having eye contact, not wanting to participate," her mother said.

After seeing Mayo doctors, Georgiann was diagnosed with depression and anxiety. The latter is an umbrella term that includes social phobias, general anxiety or fears of specific things such as enclosed spaces.

Georgiann started attending group therapy and participating in "exposure" therapy in which she was gradually exposed to things that made her anxious. To address her fear of engaging people, she would go into another room and call her therapist, or run to the coffee shop and work up the nerve to buy a cup.

One by one, her fears have started to melt.

Violin recitals are no longer exercises in terror. On Valentine's Day last year, she braved asking a boy in chemistry class to a turnabout dance, and lived with the "epic fail" of being turned down. She still feels bashful dialing the phone, but not frightened.

Understanding, not blame

While there is no blame going around the family, there is plenty of looking back at possible opportunities to head off Georgiann's fears.

Amy Steely said her husband was every bit as protective: "I don't know when he stopped carrying Georgie around."

For her part, she knows that hardships in her childhood influenced her parenting. "I wasn't going to let those things happen to my kid," she said.

Albano said parents often feel guilt, but shouldn't harbor blame: "Some parents are very aware, especially for their older children, that they started giving in and accommodating the anxiety — letting the children sleep in their bed, letting their child take days off school. It was harmless in the moment, but then they do recognize the pattern that emerges. So parents do beat themselves up, but they're not to blame."

Her new book, "You and Your Anxious Child," helps parents differentiate anxiety from everyday stress and spot warning signs even in toddlers.

"Take your toddlers into the Mall of America. If they're not running off from you to the candy or the toy store, you need to ask yourself, 'Why are they clinging to me?' " she said. "Take a note of it and then encourage them. 'Let's take a look at the rides. Do you want to go on [one]?' There are different things parents can do that will help to encourage their kids before these things take hold."

Solutions must be gradual

Parents shouldn't overreact at the first sign of kids avoiding fears, said Dr. Mike Troy, head of behavioral health services for Children's Hospitals and Clinics of Minnesota. "Kids who are more anxious in lots of situations are often the most sensitive. They're often the most thoughtful about other people's feelings. The goal isn't to remove how they are in the world."

Solutions need to be gradual — somewhere between dumping a socially frightened child at a birthday party or letting the child skip it. Skipping might bring relief, Troy said, but "reinforces the avoidance behavior that can build on itself like a snowball coming down a hill."

Georgiann still participates in therapy and has a phobia of spiders, which she is trying to conquer by viewing and touching images of them on her computer. But the sophomore honor student is in a better place.

Last week, she stood before the student body at Mayo High and talked about her struggle, as part of a program to spread awareness and tolerance. She was fidgety, aware of where she rested her arms and how her hair kept draping her face, but confident.

"I wasn't, like, shaking. I wasn't nervous," she said. "I was kind of just, like, 'OK, don't screw up.' So I was focusing ... I've been focusing on helping other people — getting out of my comfort zone, not just for myself, but to help others."

Jeremy Olson • 612-673-7744