It was always the introduction for Georgiann Steely -- the ringing of the doorbell, the approach to the man at the cash register -- that made her palms sweat and knees knock.
As a grade-schooler, she avoided these moments, ducking her face into her wavy auburn hair and waiting for her mother to escort her into crowded rooms or order her food. And her mother obliged.
Instinctively protective, Amy Steely figured it was the lesser evil to keep her timid daughter safe and comfortable.
"I was definitely very protective and she will still say I am overprotective," said Amy, who lives in Rochester, Minn., with her husband, son and daughter, who is now 16. "It's true. I am."
The conflict of whether children should be protected from fears or pushed to overcome them is familiar to every parent who has pulled a frightened child back from a diving board or coaxed the kid to plunge. It's familiar to mental health professionals as well, who have long understood that avoiding the source of fear is the hallmark of clinical anxiety.
But new Mayo Clinic research this month has yielded important insights on "avoidance" behaviors, showing they predict which children are more likely to suffer severe anxiety later on.
Mayo researchers asked parents how their children responded to challenges. A year later, they found higher anxiety in kids whose parents said they tended to avoid things that scared them.
"Kids who avoided tended to be more anxious, even after controlling for how anxious they were to begin with," said Stephen Whiteside, director of Mayo's child and adolescent anxiety disorders program.
The study doesn't mean that avoidance causes anxiety, or that "helicopter parenting" dooms children to therapy. The origin of anxiety is often hereditary. But doctors said the findings reinforce the need for parents to present their children with opportunities to learn resilience.
"It's OK for your child to be upset sometimes," Whiteside said. "It's valuable for them to struggle and persist. Being a good parent doesn't mean your child is always happy."
The National Institute of Mental Health estimates one in four children ages 13 to 18 have suffered anxiety and one in 20 have suffered severe anxiety.
Avoidance behavior is key to detecting anxiety early when it is most treatable, said Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders. "Parents report ... that their kids are not going to school dances or calling up friends. It's the avoidance that the parent observes that helps a clinician to make a diagnosis."
The signs that Georgiann had a problem emerged in high school, after her father left the Air Force and the family that had frequently moved settled in Rochester.
After seeing Mayo doctors, Georgiann was diagnosed with depression and anxiety. The latter is an umbrella term that includes social phobias, general anxiety or fears of specific things such as enclosed spaces.
Georgiann started attending group therapy and participating in "exposure" therapy, in which she was gradually exposed to things that made her anxious. To address her fear of engaging people, she would go into another room and call her therapist, or run to the coffee shop and work up the nerve to buy a cup.
One by one, her fears have started to melt.
Violin recitals are no longer exercises in terror. On Valentine's Day last year, she braved asking a boy in chemistry class to a turnabout dance, and lived with the "epic fail" of being turned down. She still feels bashful dialing the phone, but not frightened.
Parents shouldn't overreact at the first sign of kids avoiding fears, said Dr. Mike Troy, head of behavioral health services for Children's Hospitals and Clinics of Minnesota. "Kids who are more anxious in lots of situations are often the most sensitive. They're often the most thoughtful about other people's feelings. The goal isn't to remove how they are in the world."
(Contact Jeremy Olson at Jeremy.Olson@startribune.com. Distributed by Scripps Howard News Service, www.shns.com.)