Helping young brains fight off anxiety by training and raising cognitive control

Anx­i­ety is one of the most com­mon child­hood men­tal dis­or­ders. About 7% of chil­dren suf­fer from it at any giv­en time, with near­ly 1 in 3 ado­les­cents expe­ri­enc­ing it some­time dur­ing their teen years.

For an anx­ious child, seem­ing­ly nor­mal activ­i­ties can be hard. Wor­ried kids have trou­ble adjust­ing to school, mak­ing friends, and learn­ing. They can feel inhib­it­ed, avoid­ing chal­lenges by run­ning away or retreat­ing into them­selves. While par­ents may feel des­per­ate to help, their approach­es can back­fire. For exam­ple, try­ing to talk kids out of their feel­ings or keep them away from anx­i­ety-pro­duc­ing sit­u­a­tions may inad­ver­tent­ly make the anx­i­ety worse.

To help anx­ious kids, clin­i­cians have devel­oped sci­ence-based treat­ments, like cog­ni­tive-behav­ioral ther­a­py, to alle­vi­ate symp­toms. But the treat­ments can be cum­ber­some and expen­sive, and they don’t always work. Anx­i­ety in kids as young as preschool-aged can be a sign of future trouble—a pre­cur­sor to lat­er dis­or­ders, like social anx­i­ety, pho­bias, or obses­sive-com­pul­sive dis­or­der. But less is known about how to stop anx­i­ety in its tracks at very young ages, when kids may not even have the cog­ni­tive capac­i­ty to ben­e­fit from the treatment.

What if very young kids could be inoc­u­lat­ed against anx­i­ety some­how, spar­ing them from a future of wor­ry and inhi­bi­tion? A new line of research con­duct­ed by Kate Fitzger­ald, pro­fes­sor of Psy­chi­a­try and Obstet­rics at the Uni­ver­si­ty of Michi­gan, sug­gests this may be possible.

Fitzger­ald has been study­ing very young chil­dren with anx­i­ety symp­toms and mak­ing impor­tant dis­cov­er­ies about the brain mark­ers for child­hood anx­i­ety. Build­ing on this work, she and her team have cre­at­ed a train­ing pro­gram for young chil­dren aimed at increas­ing their cog­ni­tive capac­i­ties, help­ing to lessen their anxiety—both imme­di­ate­ly and, pos­si­bly, in the future.

We hope our work will show that child­hood anx­i­ety is not inevitable, but might be pre­vent­ed with the right inter­ven­tion,” says Fitzger­ald. “So far, it’s look­ing promising.”

The neuroscience of anxiety

When we face chal­leng­ing or scary sit­u­a­tions in life, our brains nat­u­ral­ly go into action. The amyg­dala sends out neu­ro­chem­i­cals (like adren­a­line) to make our hearts pound and pre­pare our bod­ies to “fight, flight, or freeze” in case of dan­ger. At the same time, the frontal lobes engage our cog­ni­tion to assess the sit­u­a­tion, draw from past expe­ri­ence, and prob­lem-solve to come up with an appro­pri­ate response. In healthy peo­ple, these dual sys­tems work in tandem—one putting on the gas and the oth­er apply­ing the brakes—depending on what’s needed.

In the con­text of this process, a lit­tle bit of anx­i­ety can have a pos­i­tive side—like when it moti­vates us to prac­tice hard to mas­ter a piano piece or study for a test. But, in anx­ious peo­ple, that gas ped­al goes to the met­al every time, mak­ing them want to run or flee chal­lenge. It can be debil­i­tat­ing and exhaust­ing, too, as they often have to exert a lot of effort­ful con­trol just to get through. Fac­ing stress­ful sit­u­a­tions while tamp­ing down that fear response is key to over­com­ing anxiety—in adults as well as old­er kids.

But in young kids, Fitzger­ald and her team are dis­cov­er­ing, the brain may respond a lit­tle dif­fer­ent­ly. For exam­ple, four to sev­en year olds have a high­er-than-nor­mal star­tle response in “neu­tral situations”—where noth­ing threat­en­ing is happening—but have a nor­mal star­tle response in scary sit­u­a­tions that any child might react to. That sug­gests that they have more to over­come when fac­ing every­day chal­lenges, like going to school or meet­ing new people.

Her team has also dis­cov­ered that a part of the brain that responds when peo­ple make a mistake—the error-relat­ed neg­a­tiv­i­ty (or ERN)—is weak­er in anx­ious five to sev­en year olds than in wor­ried old­er chil­dren and adults. That’s like­ly because young kids don’t have well-devel­oped cog­ni­tive capac­i­ties that could help them under­stand that errors hap­pen, aren’t scary, and can often be fixed. With­out more cog­ni­tive con­trol, their star­tle response wins out, mak­ing them anx­ious, says Fitzgerald.

A young child with low cog­ni­tive con­trol is also more like­ly to devel­op anx­i­ety lat­er on in child­hood, while one with a high­er capac­i­ty will be more resilient to stress. Rais­ing cog­ni­tive con­trol (which can be mea­sured by the ERN) could both treat anx­i­ety in young chil­dren and poten­tial­ly pre­vent it from becom­ing worse over time.

If we could just help kids gain some cog­ni­tive con­trol when they are anx­ious, it could real­ly make a dif­fer­ence in how they deal with stress­ful sit­u­a­tions,” says Fitzger­ald. “We just need to empow­er them.”

Preventing harmful anxiety

To test this idea, Fitzger­ald and her col­leagues con­duct­ed a pilot study (as yet unpub­lished) with anx­ious four to sev­en year olds. The chil­dren came to a “camp” the researchers designed called Kid Pow­er for four half-day ses­sions over two weeks. At the camp, chil­dren played fun, ordi­nary child­hood games, like “Simon Says” and “Red Light/Green Light,” that help strength­en cog­ni­tive control.

Coun­selors at the camp grad­u­al­ly increased the chal­lenge with­in the games to help kids mas­ter the skills need­ed to do well—like being flex­i­ble, using their work­ing mem­o­ry, and inhibit­ing unde­sir­able respons­es (like mov­ing when they’re sup­posed to freeze). They also enjoyed the com­pa­ny of oth­er kids, with whom they brain­stormed ways to improve their per­for­mance. And par­ents par­tic­i­pat­ed at the end of each ses­sion, learn­ing the games from their kids so they could prac­tice play­ing togeth­er at home.

To see the effects this train­ing had on the kids’ brains and behav­ior, Fitzger­ald and her col­leagues mea­sured their star­tle response and ERN before they attend­ed the Kid Pow­er camp and four to six weeks after. To do that, they had kids play com­put­er games that required cog­ni­tive con­trol, while wear­ing spe­cial mon­i­tors that could cap­ture their star­tle and ERN respons­es when they made mis­takes. Addi­tion­al­ly, the researchers gath­ered infor­ma­tion from the par­ents and the kids them­selves about anx­i­ety symp­toms before and after the camp.

After ana­lyz­ing the data, the team found that the children’s ERNs increased (sig­ni­fy­ing greater cog­ni­tive con­trol), while their star­tle respons­es went down—a pat­tern asso­ci­at­ed with less anx­i­ety at that age.

The brain sig­nal that relat­ed to detect­ing an error actu­al­ly increased, but in a good way,” said Fitzger­ald. “Kids were get­ting bet­ter at doing hard things, stop­ping instinc­tu­al respond­ing, includ­ing the fear response.”

This mir­rored the children’s (and their par­ents’) own assess­ments. They report­ed few­er anx­i­ety symp­toms, includ­ing fear and avoid­ing chal­leng­ing sit­u­a­tions, after the training—something Fitzger­ald found par­tic­u­lar­ly rewarding.

It’s excit­ing to link the brain to behav­ior, but what’s even more reward­ing is the indi­vid­ual chil­dren we’ve seen go through the pro­gram who are expe­ri­enc­ing less anx­i­ety symp­toms,” she says.

For exam­ple, one par­ent report­ed that her daugh­ter, who’d had symp­toms of obses­sive-com­pul­sive dis­or­der pri­or to attend­ing the Kid Pow­er camp, had made notice­able improve­ment, even while the camp was still going on.

She didn’t want to leave while she was here, and she was in a bet­ter mood dur­ing the week in between—a lit­tle less rigid and able to expe­ri­ence more joy,” the par­ent wrote in an evaluation.

Fitzger­ald recalls anoth­er five-year-old camper who’d been very afraid of mak­ing mis­takes in his kinder­garten class, which led to bouts of cry­ing and oth­er dis­rup­tive behav­iors, requir­ing dai­ly calls home. After attend­ing the camp, though, and learn­ing how to calm anx­i­ety, every­thing changed.

After a week of play­ing those games that were part of the inter­ven­tion, those calls from home stopped,” says Fitzger­ald. “His mom was impressed, because ear­li­er coun­sel­ing with a trained ther­a­pist had not led to improve­ment. Only after Kid Pow­er did he suc­cess­ful­ly adjust to kinder­garten and begin to enjoy it.”

With encour­ag­ing results from this pilot study, Fitzger­ald applied for and received a $3 mil­lion Nation­al Insti­tutes of Health grant to expand the Kid Pow­er pro­gram and con­duct fur­ther research. She hopes future stud­ies will help her nail down the key ingre­di­ent in the pro­gram that led to reduced anx­i­ety and, poten­tial­ly, find a way to tai­lor treat­ment to indi­vid­ual children—some of whom may need a stronger dose of the train­ing or slight­ly dif­fer­ent activ­i­ties to improve, she says.

If her ini­tial find­ings hold, her work could have broad impli­ca­tions, pro­vid­ing a tem­plate that oth­ers can fol­low for treat­ing and pre­vent­ing child­hood anx­i­ety dis­or­ders in the future.

Inter­ven­tions are with­in reach,” she says. “As we work to under­stand the sci­ence behind anx­i­ety in young minds, we can use that sci­ence to devel­op treat­ments that are more effective.”

— Jill Sut­tie, Psy.D., is Greater Good‘s book review edi­tor and a fre­quent con­trib­u­tor to the mag­a­zine. Based at UC-Berke­ley, Greater Good high­lights ground break­ing sci­en­tif­ic research into the roots of com­pas­sion and altru­ism. This arti­cle was orig­i­nal­ly pub­lished by AIM Youth Men­tal Health, a non-prof­it ded­i­cat­ed to find­ing and fund­ing promis­ing youth men­tal health research that can iden­ti­fy solu­tions to make a dif­fer­ence in young people’s lives today, which con­tributed to fund­ing Kate Fitzgerald’s research.

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About SharpBrains

SHARPBRAINS is an independent think-tank and consulting firm providing services at the frontier of applied neuroscience, health, leadership and innovation.
SHARPBRAINS es un think-tank y consultoría independiente proporcionando servicios para la neurociencia aplicada, salud, liderazgo e innovación.

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