Using the stepladder approach for anxiety in children

The stepladder approach works like this:

  • Start with a situation or thing that causes your child the least anxiety. Sometimes you might need to put your child in this situation a few times until she feels comfortable with it.
  • Move on to another situation that makes your child feel a bit more anxious. Again, go through it a few times until your child can handle it. Practice is important.
  • Work with your child to gradually master more challenging situations. By the end, you should be working together to tackle the situations your child finds most difficult.

When using the stepladder approach for anxiety in children, you can encourage your child by:

  • giving him lots of praise for achieving each step on the ladder
  • using rewards as incentives for your child to move forward.

Rewards might include an extra book in the evening, more cuddle time with you, or a trip to the park. Make sure the reward matches the degree of difficulty – for example, give a big reward for the most difficult step.

The stepladder approach can be used with children of all ages. Grown-ups can use it too.

Benefits of the stepladder approach

The stepladder approach has several benefits for children:

  • Children get used to facing the situations that make them anxious. This is better than avoiding them.
  • Children face their fears and find out that they might not be so bad after all.
  • Children get to use and practise the skills and techniques that they’ve developed for coping.
  • Children get a great sense of achievement as they progress ‘up’ the stepladder.

Below you can read through some sample stepladders. The idea is for you to adapt them to your child’s age and particular fear or anxiety. If you’re unsure about how to do this, consider talking to a professional – perhaps a child and family health nurse, GP, school counsellor or child psychologist.

Stepladder approach for a four-year-old with social anxiety

This child has social anxiety. She’s afraid of meeting and talking to new people.

Here’s a stepladder for this child:

  1. She says ‘goodbye’ to one friend that she has met a few times.
  2. She says ‘goodbye’ to a child she doesn’t know at the park.
  3. She says ‘hello’ to a child she doesn’t know at the park.
  4. She says ‘hello’ to the person at the supermarket checkout.
  5. She says ‘hello’ to an adult she has just met.
  6. She says ‘hello’ to an unfamiliar child at preschool.
  7. She says ‘Hello – can I play with you?’ to a child she doesn’t know at the park.
  8. She talks to a child she doesn’t know very well at preschool about what happened on the weekend.
  9. She visits a new group or class and says ‘hello’ and ‘goodbye’ to one of the children in the class.
  10. She visits the new group or class and talks with one of the children in the class.
  11. She visits the new group or class and talks with two of the children in the class.

Stepladder approach for a seven-year-old with separation anxiety

This child has separation anxiety. He’s afraid of leaving his mother, even for a short time. At the start of the stepladder, this child can’t sleep alone and sleeps in his parents’ bed.

Here’s a stepladder for this child:

  1. He stays inside and plays while Mum puts the washing on the line.
  2. He stays in his bedroom and plays for half an hour while Mum is in a different room.
  3. He stays at home with Dad while Mum visits the neighbour for 10 minutes.
  4. He sleeps on a mattress on the floor, next to Mum and Dad’s bed.
  5. He stays at home with Dad while Mum goes shopping for half an hour.
  6. He stays at home with Dad while Mum goes out to lunch.
  7. He sleeps on the mattress on the floor but moves it closer to the door, away from Mum and Dad’s bed.
  8. He stays at home with an aunty while Mum and Dad go out for lunch.
  9. He stays at home with Dad while Mum goes out for the night.
  10. He stays at home with an aunty while Mum and Dad go out for the night.
  11. He sleeps in his own bedroom.
  12. He stays at home with an aunty and sleeps in his own bedroom while Mum and Dad go out for the night.

Stepladder approach for an eight-year-old with generalised anxiety

This child has generalised anxiety and fears being late, especially for school. She likes to arrive early instead. She also constantly asks questions like ‘What’s the time?’, ‘Are we going to be late?’ and ‘What will happen if I’m late?’

Here’s a stepladder for this child:

  1. She asks no more than two questions about being late to music class, and arrives no more than five minutes early.
  2. She asks no more than two questions about being late to a friend’s house, and arrives on time.
  3. She asks no more than two questions about being late to another friend’s house, and arrives five minutes late.
  4. She asks no more than one question about being late to school, and arrives at school five minutes before the bell goes.
  5. She asks no more than one question about being late to music class, and is late by one minute.
  6. She asks no more than one question about being late to school, and arrives at school one minute before the bell goes.
  7. She asks no questions about being late to a friend’s house, and is 15 minutes late.
  8. She asks no questions about being late to school, and arrives at school as the bell goes.
  9. She asks no questions about being late to music class, and arrives five minutes late.
  10. She asks no questions about being late to school, and arrives at school 10 minutes after the bell goes.

Using the stepladder approach and coping in difficult situations

You can help your child develop some tricks and strategies for coping in any anxious situations that come up while he’s using the stepladder approach:

  • Younger children (3-6 years): help your child to come up with a phrase she can say when she’s in an anxious situation. For example, ‘I can be brave’, ‘This is a friendly dog’ or ‘Mummy will come back’.
  • Older children (seven years or older): your child might learn more quickly during the steps on his ladder if you help him to think realistically. For example, encourage your child to ask himself questions like ‘What happened last time?’ and ‘How likely is it to happen?’

Children learn how to cope with difficult situations by watching other people (their role models) and listening to what those people say. So think about how you act and what you say in situations that you find stressful. For example, you might want to avoid saying things like, ‘A spider! You should stay away from spiders. They can kill you, you know’.