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 they feel 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 on gradually tackling 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 your child plenty of praise for achieving each step on the ladder
• using rewards as incentives for your child to move forward
• talking together after each step about how it went and what your child could do next time.

Rewards might include an extra book in the evening, more cuddle time with you, or a trip to the park. You can also try using reward charts.

Make sure the reward matches the degree of difficulty – for example, give a bigger reward for the most difficult step.

You can use the stepladder approach 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 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 situation and 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, psychologist or school counsellor.

Stepladder approach for a 4-year-old with social anxiety

This child has social anxiety. They’re afraid of meeting and talking to new people.

Here’s a stepladder for this child:

1. They say goodbye to one friend that they’ve met a few times.
2. They say goodbye to a child they don’t know at the park.
3. They say hello to a child they don’t know at the park.
4. They say hello to the person at the supermarket checkout.
5. They say hello to an adult they have just met.
6. They say hello to an unfamiliar child at preschool.
7. They say ‘Hello – can I play with you?’ to a child they don’t know at the park.
8. They talk to a child they don’t know very well at preschool about what happened on the weekend.
9. They visit a new group or class and say hello and goodbye to a child in the class.
10. They visit the new group or class and talk with a child in the class.
11. They visit the new group or class and talk with 2 children in the class.

Stepladder approach for a 7-year-old with separation anxiety

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

Here’s a stepladder for this child:

1. They stay inside and play while Mum puts the washing on the line.
2. They stay in their bedroom and play for half an hour while Mum is in a different room.
3. They stay at home with Dad while Mum visits the neighbour for 10 minutes.
4. They sleep on a mattress on the floor, next to Mum and Dad’s bed.
5. They stay at home with Dad while Mum goes shopping for half an hour.
6. They stay at home with Dad while Mum goes out to lunch.
7. They sleep on the mattress on the floor but move it closer to the door, away from Mum and Dad’s bed.
8. They stay at home with another trusted adult while Mum and Dad go out for lunch.
9. They stay at home with Dad while Mum goes out for the evening.
10. They stay at home with another trusted adult while Mum and Dad go out for the evening.
11. They sleep in their own bedroom.
12. They stay at home with another trusted adult and sleep in their own bedroom while Mum and Dad go out for the evening.

Stepladder approach for an 8-year-old with generalised anxiety

This child has generalised anxiety and fears being late, especially for school. They like to arrive early instead. They also constantly ask 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. They ask no more than 2 questions about being late to soccer training, and arrive no more than 5 minutes early.
2. They ask no more than 2 questions about being late to a friend’s house, and arrive on time.
3. They ask no more than 2 questions about being late to a friend’s house, and arrive 5 minutes late.
4. They ask no more than one question about being late to school, and arrive at school 5 minutes before the bell goes.
5. They ask no more than one question about being late to soccer practice, and arrive one minute late.
6. They ask no more than one question about being late to school, and arrive at school one minute before the bell goes.
7. They ask no questions about being late to a friend’s house, and arrive 15 minutes late.
8. They ask no questions about being late to school, and arrive at school as the bell goes.
9. They ask no questions about being late to soccer practice, and arrive 5 minutes late.
10. They ask no questions about being late to school, and arrive 10 minutes after the school bell goes (after their parents check that this is OK with the school).

Using the stepladder approach and coping in difficult situations

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

• Younger children (3-6 years): help your child to come up with a phrase they can say when they’re in an anxious situation. For example, ‘I can be brave’, ‘This is a friendly dog’ or ‘Mummy will come back’.
• Older children (7 years and older): your child might learn more quickly during the steps on their ladder if you help them to think realistically. For example, encourage your child to ask themselves 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, if you see a spider you might calmly say, ‘It’s a spider. What do you know about spiders? Do you know how to spot one that might be dangerous?’