Developmentally-Appropriate Anxiety: How to Help, and When to Seek Help

Presenter: Yevgeniya Ratnovsky, Ph.D.
View this webinar by clicking here
Download this webinar’s corresponding slides here.
Dr. Ratnovsky discussed how to recognize when normal childhood fears/worries become potential anxiety disorders and when intervention is warranted. She also clarified how appropriate treatment in childhood can have lasting impacts into adulthood. Dr. Ratnovsky coached us in using strategies to help an anxious child.


  1. KelleyT says:

    My niece is 13 1/2 and has extreme anxiety when she is expected to ahve a sleep over at her grandparents, cousin’s or a friends house. She tried to attend a sleep away camp that was 4nights away and then home for the weekend and she had a total breakdown. She was hysterical …made it through the first week crying most of the time, but then refused to go back. Should she be strongly encouraged to go again aas she did have some fun, or should she be allowed to stay home ii her comfort zone. I am assuming she should be strongly encouraged to try again…

    • Dr. Ratnovsky says:

      Since the trial of overnight camp caused an overwhelming amount of anxiety the last time your niece tried it, I would recommend trying to figure out what situations cause some anxiety, but are not so difficult to handle that anxiety is overwhelming. It would be useful to come up with a list of situations ranked from “least scary” to “scariest” that have to do with sleeping away from home and begin confronting situations that are the easiest first. As the child become better at handling the easier situations, she can work her way up the list and slowly get to the point where she can go to an overnight camp in the future.

  2. KelleyT says:

    my daughter, who has TS and OCD, has tics that are many times directly related to moments when she is in a situation that sets off her tics, like lip smacking. Lip smacknig is unavoidable at a meal, but she tics anyway. how much should we allow our kids with TS to “Approach” their anxieties if we know it will make them tic off?

    • Dr. Ratnovsky says:

      It’s not uncommon for tics to worsen during the times when the child becomes anxious. It may be helpful for you and your daughter to decide what you would like to work on first: tics or OCD. This decision will partly depend on which symptoms are most upsetting to her and interfere most with her functioning. Often, if the tics are severe and upsetting to the child, the treating psychologist would choose to work on the tics first, and once the tics are reduced, the “approach” strategy can be utilized for anxiety. However, if you and your daughter feel that OCD is more severe than the tics, and you would like to treat it first, then facing the situations that cause her anxiety and abstaining from doing the rituals during that time will be a necessary part of treatment despite the increase in tics. Once the child gets used to the anxiety-provoking situation after facing it multiple times, anxiety will go down, and in many cases so will the tics.

  3. KelleyT says:

    Is there an appropriate age to consider therapy? It would seem that starting when the child is not ready can almost ensure failure. Is there a developmentally appropriate time to begin to ensure success?

    • Dr. Ratnovsky says:

      There is no specific age at which a child would be considered to be ready for therapy. Therapists can work with children as young as 2 or 3 years old, though much of the work with young children would likely focus on teaching the parents how to handle problematic behaviors at home. With children, as with adults, motivation to change and willingness to engage in treatment even when it is difficult (e.g., when facing a feared situation) is essential for maximizing treatment results. However, even if the child is reluctant to engage in treatment initially, there may be ways to help motivate him or her with using such methods as contingency management (e.g., rewarding the times when the child chooses to face an anxiety-provoking situation).

  4. KelleyT says:

    Is it unusual for kids to have a physical reaction, such as throwing up, when they find themselves in a social situation they are uncomfortable with?

    • Dr. Ratnovsky says:

      It is not at all unusual for children with anxiety to experience a variety of physical symptoms when they are facing a feared situation. Throwing up is a relatively common symptom of anxiety in children.

  5. KelleyT says:

    When using scaffolding method, should there be a designated parent to interact with the child with regard to brainstorming and evaluation. If parents are not on the same page it could be very confusing and counterproductive. Is there a recommended way of using this method to ensure the right outcome?

    • Dr. Ratnovsky says:

      Ideally, both parents would work together to figure out what will be said to the child and how that information will be presented. However, if parents’ opinions significantly differ on how to use this method, they may decide to choose one parent who will handle “approach” practices with the child in order to reduce the confusion and potential arguing about this issue.