Family Front and Centre: A Support Resource Promoting Healthy Child Development

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Book 3: Anxiety

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Production of this resource has been made possible through a financial contribution by Health Canada prior to the announcement of the establishment of the Public Health Agency of Canada on September 24, 2004. Any reference to Health Canada should be assumed to be to the Public Health Agency of Canada.

Table of Content

• What is Anxiety ?
• Inside this book
• Infants (0-18 months)
• Toddlers (18 months-3 years)
• Preschoolers (3-6 years)
• Factors That Affect Anxiety
• When Anxiety is a Serious Problem
• Strategies and Activities
• Summing It Up
• Glossary

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National Advisory Committee

Nancy Engels Project Coordinator, JFS	JoAnn Gillan Kristie Gomuwka Myrna Martin Kate O'Brodovich Lynda Stewart Irene Szabla Annette Thexton Michelle Ward
Lisa Fiorentino Writer/Researcher
Susan Karpman Director, Family and Children's Services, JFS
Marilyn Turnley Health Canada Consultant

Consultants

Andrea Borod editing
Rebekah Frojmovic research assistant
Jacinte Gauvin translation/adaptation
Carey Gold marketing/website consultant
Davina Mill clinical consultant
Richard F. Schmid evaluation
Rose Marie Scissons research/indexer
David Wells evaluation

Family Front and Centre
A Support Resource Promoting Healthy Child Development

Production of this document has been made possible by a financial
contribution from the CAPC/CPNP National Projects Fund, Health Canada.
The views expressed herein do not necessarily represent the official policies of Health Canada.
c 2004 Jewish Family Services of the Baron de Hirsch Institute.
ISBN 0-9734557-4-8

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What is Attention ?

Anxiety can be defined as a feeling of uneasiness in anticipation of an experience. Feeling anxious relates to the development of fears during infancy and childhood and to reactions to new and different situations. Some feelings of anxiety and fear are normal; however they can become a concern if they are unusually intense, and if they occur frequently in different contexts.

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Inside this book:

• A description of the development of anxiety from infancy until six years of age, highlighting developmental issues for the specific age groups.
• Factors that affect the development of anxiety and a discussion of when children may be at risk for more serious anxiety problems.
• A list of strategies and activities to help children cope with feelings of anxiety.
• A glossary of terms.

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Infants (0-18 months)

During the first 18 months of life, infants are introduced to new people, situations, and objects. While these new experiences provide opportunities for learning, new situations can also give rise to feelings of anxiety.

From Fearlessness to Caution

Between the moment of birth and 6 months of age, infants are open to new experiences such as meeting new people. At this age infants have difficulty telling people apart; thus young infants are often comfortable with being approached by strangers.

Around 6 months of age, infants begin to act cautious when they encounter new people, situations, and objects. The infant may look at a new experience with hesitation and uncertainty or a wary look. A wary look is characterized by the following:

• Becoming quiet
• Staring
• Knitting one's brows
• Gloomy expression
• Looking away

This hesitation and uncertainty are expressions of mild anxiety and distress towards a new experience.

Acquired Fears

New experiences may create feelings of anxiety and distress for infants. Infants may also develop an acquired fear, which may occur when a safe situation reminds the infant of a difficult situation experienced in the past.

Marc is 11 months old. A month ago, Marc met the neighbourhood dog that barked loudly and frightened Marc. Today, Marc goes to the pet store with his mother to look at the puppies playing in a cage. Upon seeing the puppies, Marc begins to cry and appears distressed and anxious.

Marc was frightened in the past by the loud noise that the neighbour's dog made. It was the first time Marc had heard such a noise and it was distressing. In his second experience with dogs (the puppies in the pet store), this safe situation (the puppies were in a cage and could not hurt him), reminded Marc of the fear that he experienced the first time he met the neighbour's dog. As a result, Marc learned to feel fear around dogs. He had acquired this fear while encountering a new situation involving other dogs.

Stranger and Separation Anxiety

Stranger anxiety and separation anxiety usually develop between 9-12 months of age. Stranger anxiety occurs when infants feel distress about a person with whom they are unfamiliar. Separation anxiety occurs when the infant becomes upset when separated from his/her caregivers.

Jacob is 11 months old and has been resting comfortably in his father's arms. His visiting aunt, excited to see him, decides to pick him up and starts to cuddle him, while his father goes into the kitchen. Jacob becomes distressed in his auntie's arms and starts to look around for his father. He cannot find his dad and as a result begins to cry and fuss.

In the above example, Jacob demonstrates stranger anxiety towards an aunt with whom he is unfamiliar. Jacob also experiences separation anxiety, as he was taken from the comfortable arms of his father who has suddenly disappeared.

Separation anxiety is a normal and healthy stage of development that all infants experience, providing it does not continue over long periods of time. A healthy level of separation and stranger anxiety also involves an expression of joy and relief when the caregiver returns to the infant. Separation and stranger anxieties are important because:

• Jacob demonstrates that he can tell people apart. He knows that the adult holding him is not his father and he reacts to this stranger by becoming upset.
• Jacob demonstrates object permanence (when infants realize that objects, including people, exist even when they are not within their view point). He realizes that even when his father is not around him that does not mean that his father does not exist.
• Jacob demonstrates a sense of self. He asserts his individuality through developing preferences (i.e., his father's company).

Caregivers also experience separation anxiety. When a caregiver is stressed about a separation, the infant can pick up on those feelings and be affected by them. Understandably, some caregivers, particularly new caregivers, may be nervous or uncomfortable when leaving their infant with people who are less familiar to the infant.

Older Infants and Coping

Older infants (i.e., 12-18 months) are more experienced at dealing with fears and their feelings of distress and anxiety. Their ability to cope enhances their interests in investigating and learning while exploring their environment. Despite their growing capability, it remains common for older infants to return to their caregivers for comfort and attention after approximately 5-10 minutes of exploring.

One way older infants lower their feelings of anxiety is through developing an attachment to soft objects. For example, it is common for infants who are 18 months and older to become attached to blankets and toys. These toys are helpful when a caregiver cannot be around. Older infants demonstrate coping skills through their attachments to objects. Although attachment objects do not replace Mom and Dad or other caregivers, they can help older infants cope with stressful situations.

Stella, 18 months old, and her mother visit the doctor. Lately, Stella has become attached to her cuddly toy dog and takes it everywhere. Visiting the doctor is still a new experience for Stella and as they approach the tall building and enter the elevator, Stella hangs on to her toy. As she meets the new doctor, Stella insists on keeping her toy dog in the doctor's office and holds onto it as the doctor checks Stella's eyes, ears, and throat.

The attachment to the toy object serves as a source of support and comfort to Stella. Instead of crying, as younger infants often do, older infants like Stella may cope by turning to soft objects as sources of comfort.

Consider This...

Infants are like first time tourists. They discover new places, persons, and objects in their new world. This new world holds potentially difficult and stressful experiences for the infant. It is important to be aware of these experiences and help provide comfort and security while infants begin to discover their surroundings.

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Toddlers (18 months-3 years)

Toddlers are known for their curiosity and endless amounts of energy. Through new discoveries, toddlers begin to grow more independent. However they may feel distress and anxiety in certain situations.

Independence

In the second year of life, important changes occur in toddlers. As they explore their environment and encounter new individuals, situations, and objects, toddlers develop a sense of independence. Toddlers are becoming their own separate person from their caregivers. While toddlers still rely on their caregivers at this age, they also start to assert themselves.

At 2 years of age, toddlers also begin to understand their environment better. They develop a greater ability to explore and manipulate their surroundings, realizing that they too can make changes in the world. They are starting to develop mastery and initiative.

Marie-Helene is 2 years old and loves when her mother reads stories to her. Today Marie-Helene decides that she will read a book by herself. She goes to the book cupboard. She begins to go through the books until she finds one with her favourite cover of a big yellow dog. Marie-Helene takes the book to a quiet corner in the room where her mother has set up pillows for them to sit on when they read together. Marie-Helene sits by herself and begins to 'read' the book, making up words to accompany the pictures on each page.

Marie-Helene demonstrates mastery and initiative of her environment. She has mastered the reading routine that she and her mom engage in routinely and recreates the same situation. Marie-Helene also demonstrates her initiative by engaging in the reading activity on her own. Both mastery and initiative help toddlers establish their independence.

With this growing independence, toddlers demonstrate coping skills in dealing with distress and anxiety. They are better able to handle stressful situations. They may use objects such as stuffed animals and blankets in order to help them to feel more comfortable with new and unfamiliar situations.

Adaptive Fears

Although feeling scared is unpleasant, it has its benefits. Experiencing fear and anxiety are normal reactions to events that are unknown and could act as a physical or emotional threat. These fears are considered adaptive, or helpful to engage in. Toddlers experience new situations everyday, so it is easy to see how they may become fearful and anxious during unknown and perhaps threatening situations. While some situations are new and safe, others are harmful. Toddlers learn through their explorations how to discern between which situations can be hurtful and which they can adapt to safely.

William, 2 1/2 years old, crosses the street with his mother. As they approach the curb, a car door slams loudly close by, followed by a screeching of car wheels. This frightens William and he starts to cry. He wants to be picked up and soothed by his mother. William's mother picks him up and both mother and son wait for the car to pass before crossing to the other side.

William's fear of sudden noises serves a useful purpose. In a potentially dangerous situation such as crossing the street, being cautious of loud noises helps William and his mom avoid an accident. The following is a list of some of the things that may elicit fearful reactions in toddlers:

• Loud noises
• Falling down
• Sudden movements
• Sudden sounds
• Animals
• Imaginary objects (e.g., monsters)

Fearful reactions can become a concern when they persist over a period of time (i.e., over 1 month) and interfere with the toddlers' everyday activities (e.g., family and day care activities, making friends, important daily routines).

Consider This...

Toddlers are like explorers; full of energy and excitement they discover new worlds. They are most comfortable exploring while knowing that they still have a secure place or relationship to return to. This proves especially helpful, as there are many unknown and potentially threatening experiences out there that can make toddlers anxious about their new discoveries.

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Preschoolers (3-6 years)

Preschoolers continue on the path of independence as their experiences lead to the creation of routines and a growing sense of control. Despite this growing independence, preschoolers still experience anxiety.

Fear and Anxiety

Preschoolers have developed a background of experiences that is now familiar to them. New experiences can still produce feelings of anxiety among preschoolers, but there is a noticeable decline in more basic fears such as noise, sudden movements, and strangers.

Preschoolers have grown considerably in their cognitive development (i.e., the development of their thought processes and abilities). They are now able to anticipate threats and have developed more sophisticated fears. Preschoolers may now become fearful of the experience of pain, and the possibility of experiences like traffic and fire accidents. Some may also have nightmares, where they experience their fears and anxieties through dreams. Other fears that are developing include fears of failure and being ridiculed by others. The following list includes some fears that preschoolers may have that become problematic when they appear to be intense and persistent (i.e., lasting over 1 month long).

• Failure
• Physical injury
• Dangerous situations
• Fear of the unknown
• Criticism
• Animals
• Medical fears
• Death

The Anxiety of Separation from the Home

Separation is an issue for preschoolers as many begin to attend day care/community centres or schools during the day. These environments can stimulate preschoolers to learn basic skills and routines and develop social skills while they learn how to interact, play, and work together with other individuals their age.

Separation from a caregiver can be anxiety provoking for preschoolers because they are separated from their caregivers during the day and cannot see them upon demand. The early feelings of separation anxiety can reappear during this stage of development.

Mary is 4 years old and has started to attend nursery school at her local community centre. Mary feels upset when separated from her caregiver. She cries and pleads for her caregiver to stay with her. When this does not work, Mary has a tantrum, kicking and screaming on the floor as her caregiver tries to say goodbye to her. Her caregiver stayed with her for 15 minutes before leaving. Throughout the rest of the day, Mary stayed very close to her teacher, clinging to her and shadowing her as she went about the various nursery rooms.

Mary's behaviours suggest that she is upset at being separated from her caregiver. She cries and pleads and has a tantrum. These are common reactions, and most children learn to cope with separations over time. Most preschoolers are able to calm down with the help of the caregiver and are content to reunite with their caregivers at the end of the day.

Julio is 6 years old and has started grade one. Lately, it has been difficult for Julio's father to get him to attend school. On some days, Julio complains of stomachaches and headaches before going to school. On other days, Julio completely refuses to attend school, and appears anxious about being separated from his dad. When he does go to school, he spends a lot of time worrying about his father, wondering if he is safe and hoping for the day to end soon. This pattern has continued for over 1 month and is causing concern on his father's part.

Julio demonstrates excessive anxiety about going to school and being separated from his father. Julio has physical symptoms such as stomach and headache pains and worries about being separated from his dad. Julio also developed unrealistic worries about the safety of his father while he is at school. Julio's reluctance and refusal to go to school demonstrates that he may have strong reasons for not wanting to attend. These reasons must be understood so that Julio can adapt to this situation, deal with his fears, and develop a sense of comfort while he is separated from his father.

Consider This...

Preschoolers require the whole picture when they are embarking on something new and potentially stressful for them. This includes a clear map of events so that they have a picture of the upcoming experience, thereby making the situation more familiar to them. This picture makes life experiences more pleasant and less threatening for them.

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Factors That Affect Anxiety

Health Factors

There are numerous stress factors during pregnancy that can contribute to an infant's level of stress. Stress experienced by mothers can affect the infant's development. Examples of stress factors include some of the following:

• Unplanned pregnancy
• First baby in family
• Fear of childbirth
• Older sibling is still an infant
• Large family
• Lack of proper nutrition
• Lack of prenatal care

If any of these factors are present, see what type of support can be provided to help to deal with the factor(s) and prevent unnecessary stress.

Another health factor is having a physical illness, which can also increase feelings of anxiety in children. Firstly, the experience of pain and discomfort symptoms is difficult for children. Feeling ill may lead to anxiety and children may feel distress in anticipation of the pain and discomfort they feel while ill. Secondly, physical illnesses can become serious and may require children to be separated from their caregivers and placed in the care of hospital staff. Separation from one's caregivers and care from strangers can lead to separation anxiety and stranger anxiety, which can also be distressing for children.

Environmental Factors

Factors in children's environments, such as their homes and child care centres, can increase their feelings of anxiety. For example, children living in households where there are stressful and challenging situations (e.g., a death in the family; parental divorce) may experience more anxiety. Caregivers who experience stress may also contribute to anxiety in their child as they have difficulty providing a comfortable and predictable environment for them.

Caregivers may also demonstrate behaviours in their interactions with their children that may lead to feelings of anxiety. For example, caregivers who are over involved or uninvolved in their child's life can contribute to their anxiety. Over involvement can occur when a caregiver interferes with their child's independence and self confidence. This interference prevents children from attempting new experiences and learning from them. Instead children may develop feelings of anxiety in anticipation of new experiences. They may also be unable to face new situations with confidence. A lack of caregiver involvement can also lead to feelings of anxiety in childhood. Children require a trusting relationship with their caregivers that acts as a secure base from which to explore their world. Caregivers who are uninvolved in their child's life may not provide the same trust and security that a caregiver who has a healthy level of child involvement does (i.e., the caregiver is not interfering with the child's development). Caregivers may also unintentionally model anxious behaviours, leading children to mimic their caregivers' behaviours.

Personality Factors

Sometimes personality characteristics affect the levels of anxiety that children experience. Children who act timid or shy may be prevented by these behaviours from exploring their environment and this may lead to a pattern of hesitation and anxiety in anticipation of new situations. Hesitant and shy children may also spend a lot of time staying close to their caregivers, looking for guidance, support, and discipline from them. Other children show little hesitation and fear in new situations and may put themselves in dangerous situations, which lead to feelings of stress and anxiety. Both of these examples may be causes for concern for caregivers and should be brought to the attention of a health care professional if they occur in duration (i.e., over 1 month), with intensity (i.e., well above normal feelings of anxiety and energy typical of a same aged child), and in multiple environments (e.g., home and day care centre).

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When Anxiety is a Serious Problem

Experiencing high anxiety is seldom a concern in infancy, but it can become one during the preschool period and on occasion during the toddler period. It is important to be aware of and to keep track of anxiety difficulties in children if they appear problematic. Any serious anxiety problems should receive the help and guidance of a health care professional when they occur in:

• Duration (more than 1 month period);
• Intensity (well above normal occurrences of feeling anxious and energy typical of the same aged child);
• Multiple environments (e.g., such as the home, child care centre, and/or school environment).

Serious Fears

While feeling anxious can be adaptive in some situations (i.e., for safety reasons), there are also situations when the fear and anxiety a child experiences is not helpful. Fears that are intense in feeling and that continue over 1 month can be harmful to children. Strong fears and anxieties can also be harmful when they are out of proportion to the seriousness of the situation. These fears are considered maladaptive.

Kate is 3 1/2 years old and has been attending the community centre for the past year. Recently, Kate has been avoiding interactions with her peers. For over 1 month, active social games frighten Kate, causing her to withdraw and become upset. She avoids playing with her peers. Kate is uncomfortable around her friends and does not engage in fun free play activities with them.

Kate's fear of playing active social games is maladaptive. Engaging in these activities has caused her to feel anxious and prevent her from enjoying free play activities with her friends. It is important to understand the underlying causes of Kate's anxiety so that she may be able to participate in social activities with her peers.

Some children experience prolonged separation anxiety when separated from their caregivers. This is a more serious form of separation anxiety, where the child demonstrates excessive separation behaviours such as worrying and feeling fearful. Please see the table below for a description of these behaviours and the User's Guide for information on this and other resources relevant to the topic of anxiety.

Separation Behaviours	Examples
Worries/Distress	Excessive distress in anticipation of or during a separation from caregiver. Excessive worry about the loss of or harm to caregiver.
Fears	Excessive fears of being alone or without caregiver at home. Fears of separation leading to refusal or reluctance to go places (e.g., day care, school).
Other Symptoms	Recurrent physical symptoms (e.g., headache, stomach-aches, nausea, vomiting, nail biting) when anticipating or experiencing separation from caregiver. Recurrent nightmares about separation.

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Strategies and Activities

The following information contains strategies and activities to help infants, toddlers, and preschoolers cope with their feelings of anxiety. Some of the following strategies and activities can be used with infants, toddlers and preschoolers, while others are specific to one age group. All of the strategies and activities can be modified to suit the child's or the setting's needs.

Strategies and Activities for Infants, Toddlers, and Preschoolers

1. Regular health and developmental check ups.
   • Sometimes children may have health problems that cause them to feel anxious. For this reason, children must regularly see a health care professional such as a doctor or nurse.
2. Help caregivers to understand their child's temperament/personality.
   • Educate caregivers about temperament/personality differences.
   • Ask questions about their child's personality, including a discussion of their:
     1. Routines.
     2. Levels of crying.
     3. Moods.
     4. Activity levels.
     5. Reactions to change.
     6. Levels of frustration.
   • Help caregivers to create routines in the home and other care environments to accommodate their child's needs.
3. Help the child to deal with separations.
   • Introduce the child to potential caregivers before leaving the child in the care of someone new.
   • Tell the child what is going to happen several times before it actually happens (remind the child at least 5-10 minutes beforehand).
   • If you are leaving, tell the child when you will be back and include a time frame that can easily be understood (e.g., "I will see you right after snack time.").
4. Encourage the child to choose a favourite toy or other objects to help cope with new situations.
   • Soft and comforting objects such as blankets and toys are healthy substitutes to help children deal with new and possibly stressful situations.
5. Have caregivers recognize their own emotions toward a separation experience.
   • A child looks toward a caregiver for reassurance of safety and confidence.
   • Caregivers need to recognize their own feelings and any apprehensions they may have concerning situations where their child may experience anxiety.
   • Set a positive tone to the situation while acknowledging the child's feelings
   • Encourage the caregiver not to dwell on the situation, as this may increase the child's anxiety. A quick good-bye can sometimes be the most helpful thing a caregiver can do.
   • If the caregivers still feel uneasy, encourage them to call the centre and check on their child.
   • Some centres also feel comfortable with caregivers staying with the child during programming. Check with the policies of the centre for what can be done to make the child and caregiver more comfortable.
6. Remember that some fears are age appropriate.
   • Be aware that it is normal for children to have fears that, by adult standards, may seem farfetched (e.g., monsters under the bed).
   • These fears may actually disappear on their own, as children develop and have more experiences.
7. Follow the ABC's when observing behaviours.
   • The ABC's (antecedents, behaviours, consequences) is based on a behavioural model of observing and understanding behaviours. When trying to understand a child's feelings of anxiety, try using the following to understand their behaviours better

   Antecedents
   What are the events that happened before the anxious behaviour occurred?

• Who was involved?
• Where did it happen?
• When did it happen?
Behaviours
What did the child do or not do in the situation?
• Describe all of the behaviours that occurred (i.e., verbal and physical actions) with the child and anyone else involved.
Consequences
What occurred after the behaviour?
• What type of intervention was used?
• How did the caregivers/peers respond?
• How did the situation end?
  Did the behaviour continue, gain intensity, or stop?
• How did the child respond


8. Support caregivers with children who experience anxiety.
   • Ask the caregivers about their own developmental history. Sometimes earlier experiences of caregivers may affect the care they provide for their children.
   • If a caregiver experiences a stressful situation, a referral to an agency or support group may help.
   • Also, encourage caregivers to support one another by sharing experiences and discussing different techniques and strategies.

Infant Strategies and Activities

1. Help the infant to interact with new people.
   • Approach the infant slowly. Both caregiver and stranger should be sensitive to any signs of wariness (e.g., an upset face) or withdrawal (e.g., such as an infant clutching his/her caregiver) when they occur.
   • Let the infant get to know the new person on his/her own terms and at his/her own pace. Do not rush the infant but let the infant determine how close to get.
   • New people should be introduced gradually before the infant is left in their care:
     1. Infant is left with the new person, while caregiver is in the room.
     2. Infant is left with the new person, while caregiver is just outside the room.
     3. Infant is left with the new person for short periods of time, gradually increasing to the desired length of time.

Toddler and Preschooler Strategies and Activities

1. Explain the new situation to the child.
   • Describe what will happen briefly and clearly.
   • Try to have eye contact with the child as you are speaking (if this is a culturally appropriate way to interact).
   • During the week, remind the child regularly about the situation and what will happen so that the child is prepared to some degree.
   • Let the child know ahead of time (5-10 minutes) on the day when the separation may occur.
   • Visit the location in advance. Show the child where things are located. Introduce the child to the educator/teacher.
2. Talk about the anxiety with the child.
   • Help the child describe or label what frightens him/her and to ask questions about the situation.
3. Be empathetic to the child's feelings of anxiety.
   • Use phrases such as, "It is ok to feel this way."
   • If the child is stressed, reassure the child before, during, and after the situation through words and physical comfort (e.g., hugging).
4. Help the child feel in control.
   • Let the child create a routine. This may include allowing him/her to choose clothes, or encouraging him/her to set up a calendar where he/she can keep track of the days of the week. This will help the child feel that he/she has control over his/her life.
5. Try distracting the child.
   • Sometimes anxiety can be reduced if the child has a familiar toy or object nearby. Present the child with familiar objects with which to play and interact.
     • These objects can include items like stuffed animals and blankets.
   • Introduce activities where children can manipulate objects and be soothed by the activity such as arts and crafts, water play, sand play, and play dough.
   • Objects such as puppets, dolls, blocks, and toy cars may help distract and provide relaxation for children and may help them to cope with their anxiety.
   • Engage in physical activities such as 'Ring around the Rosie,' and 'Duck, Duck, Goose.'
   • Engage in interactive activities such as story telling and songs. Stories that deal with fearful situations may help children cope with stress, while songs may help them channel their energy and communicate their feelings.
   • Use humour to help the child laugh and feel less distress during an anxious situation. Find creative ways to help the child feel at ease.
6. Set an example for the child.
   • Be calm, assured, and relaxed in new situations, and demonstrate a level of confidence.
   • Children can learn by example and may also begin to feel success in situations where they feel anxious.

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Summing It Up

• During infancy, young infants start out rather fearless in new situations. As they begin to recognize their caregivers and the familiarity of situations, they begin to develop feelings of distress and anxiety. They express these feelings through being wary and cautious in new situations. They also begin to feel separation and stranger anxiety when they are separated from their caregivers and placed with adults unfamiliar to them.
• Toddlers are known for their energy levels and sense of adventure. Their explorations encourage them to become more independent from their caregivers. They also develop mastery of situations and take an initiative in recreating these situations.
• Preschoolers have become more sophisticated in the fears they experience; situations that caused anxiety in the past do not do so now. They also remember events, and therefore can anticipate different situations that in the past would have caused them grief. Attending a preschool or child care program can be a stressful experience for a preschooler, as they must adjust to separating from their caregivers for longer periods of time.

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Glossary

Acquired fear: A fear that develops when a relatively safe situation reminds the child of a fearful situation experienced in the past.

Adaptive: Having a thought, emotion, or behaviour that is helpful to engage in.

Anxiety: A feeling of uneasiness in anticipation of an experience.

Coping skills: Behaviours and attitudes used to help one deal with a situation.

Distress: Feelings of anxiety and unhappiness.

Fear: Emotion caused by a feeling of worry, anxiety, or distress towards an object, person, or experience.

Independence: To rely on one's self and not others.

Initiative: The ability to take a lead in an activity/situation.

Maladaptive: Having a thought, emotion, or behaviour that is unhelpful to engage in.

Mastery: Having accomplished an activity or gained control over a situation.

Object permanence: A development in infancy around 8-10 months of age where objects (including people) are permanent and exist when out of the infant's view.

Separation anxiety: A feeling of anxiety and distress a child feels when separated from his/her caregiver; initially develops between 9-12 months of age.

Stranger anxiety: A feeling of anxiety and distress when a child is with a person other than his/her caregiver(s) and with whom he/she is unfamiliar; initially develops between 9-12 months old.

Wary look: A look of hesitation and uncertainty. In infancy, can include the following behaviours: becoming quiet, staring, knitting one's brows, sombre (i.e., gloomy) expression, looking away.

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