There is an old medical saying that goes: “When you hear hoof beats in the hallway, think horses, not zebras.” This means, of course, that we should use common sense and look for the expected cause first, rather than the exotic. This saying is valuable to keep in mind if your child develops a problem such as anxiety, depression, or bad behavior. 

All too often these days, a child is diagnosed with a “mental disorder” when the actual problem is far less exotic. Like most of us, children are sensitive to their social environments, which include family, school, and friends. When there is a stressor in one of these areas, a child can develop a problem. The key to solving the problem is not to label the child with a “mental disorder” and move toward medication or individual child therapy, but rather to make targeted changes in the social environment that removes the stress on the child.

For example, 11-year-old Cindy was having such severe anxiety attacks that she sometimes vomited. Her parents tried to comfort her, but when Cindy’s anxiety went on for more than six months, her parents took her to the pediatrician. After the pediatrician ruled out medical causes for the anxiety, he suggested family therapy. A few days later, Cindy’s parents brought her to see me. 

“She’s always been a nervous child,” Cindy’s mother said. “But now her anxiety has become severe. She sometimes vomits while we’re driving in the car. She is even afraid to go to school at times. Do you think she has an anxiety disorder?” 

I don’t think of a child’s anxiety as a “mental disorder.” Instead, I see it as a response to a stressful, anxiety-provoking situation. I wondered what was causing Cindy to be so upset.

When I talked with Cindy alone, she told me that her greatest worry was hearing her parents argue about her grandmother (her mother’s mother). “My father hates my grandma,” she confided. Then she broke down in tears. “My parents argue so much that I’m afraid they are going to get divorced.”
Hearing parents argue – whether about in-laws, financial problems, or other matters – can be very frightening to a child and is a major source of many childhood problems. Children have active imaginations and tend to magnify arguments between parents in their own minds, often making mountains out of molehills.
My strategy to help Cindy get over her anxiety was to meet with her parents alone and help them air out the tension between them that was undoubtedly affecting their daughter. 

Cindy’s father felt resentful because he felt that his in-laws were intrusive in their life. Once her husband was able to express his feelings, Cindy’s mother was able to create an appropriate boundary with her own parents. She could also voice her own resentments about her husband coming home from work so late, and not backing her up about discipline. After a few sessions with the parents, their arguments ceased and Cindy’s anxiety ebbed and soon disappeared altogether.

Children tend to become overly worried about parental disagreements (however small), and this worry can lead to anxiety, distractibility or bad behavior. Keeping parental arguments away from little ears can have an almost magical effect on a child’s well being. 

Other problems in the home environment – inconsistent discipline, illness or injury of a parent, parental worries overheard by a child, and even the death of a grandparent – are also frequent contributors. Remember, being “honest” with our children does not mean telling them every detail about the family finances or a parent’s stressful work situation. 

School, too, is an important influence. When 6-year-old Len refused to go to Kindergarten day after day, his parents consulted a child psychiatrist. The doctor diagnosed Len with school phobia and recommended talk therapy and anti-anxiety medication. Len’s mother took matters into her own hands and went to the school to observe in the classroom. There she found that Len’s teacher sometimes made fun of the students. When she moved Len to a new school, his “school phobia” disappeared as quickly as it had begun.

Once parents start to see the underlying cause of their child’s problem not as a problem in the child but in the child’s social environment, they are on the right track to finding an effective solution. Parents can advocate for their child by asking their pediatrician whether family factors could be contributing to the child’s problem, and by seeking out a professional therapist who is experienced with family therapy. 

If a therapist starts talking right off the bat about your child’s “diagnosis,” “disorder,” or “chemical imbalance,” she might not be the best choice. You want a professional who is going to think first of horses, not zebras! 

Marilyn Wedge, Ph.D., MFT, is a family therapist in private practice in Westlake Village, with more than 20 years of experience helping children, adolescents and families. Dr. Wedge is the author of Pills Are Not for Preschoolers: A Non-drug Approach for Troubled Kids out in paperback from W. W. Norton.