It began with the “sock problem.”

My daughter Ellie and I spent an agonizing ten minutes every morning finding the perfect pair of socks for her tiny, three-year-old feet. The nubby seam across the toes bothered my daughter to the point of such intense aggravation that she’d kick, cry, and throw socks in frustration. At Target we’d sit on the floor tearing open plastic packaging so she could try on socks before we bought them — whatever it took to avoid the ones that were uncomfortable and angst-producing.

I tried to be calm and sympathetic, but the truth is I thought she was willful and finicky. I didn’t recognize Ellie’s tactile discomfort as a symptom of a larger problem. I missed the significance of the early signs, unaware that her sensitivity and shyness foreshadowed an anxiety disorder so severe that it eventually morphed into a full-blown phobia known as school refusal.

When she entered kindergarten, my daughter and some neighbor kids walked to the elementary school less than a block away. I usually made sure our front door was unlocked when she came home in the afternoon, but if I’d forgotten to flip the deadbolt, Ellie would ring the bell.

In a matter of seconds, I’d open the door to find my little girl’s blue-green eyes welling up with tears and panic, as if she’d been abandoned.

“Oh, honey,” I’d assure her, “Mommy’s right here. I’m not going anywhere!”

After I’d hugged her and kissed away her tears, I didn’t think any more of it.

Wasn’t this the girl who, at age three, had shown off her dribbling skills on the basketball court at church camp? And wasn’t this the same girl who’d narrated the entire “Rainbow Fish” in a preschool performance when the four-year-old who was supposed to share the duties got stage fright?

It was also the same girl whose first grade teacher took me aside one day in the early weeks of school.

“Ellie’s so quiet. Is she okay?”

“Oh, she’s fine. She’s just taking everything in,” I assured her.

painting of a sailboat on turbulent waterA few years later, my daughter admitted that she’d sat in that class filled with uneasiness and dread. I’d overlooked the seriousness of the signs. I didn’t know she was percolating a paralyzing anxiety. By high school, when it became obvious her angst was brimming over, I felt guilty and ashamed that I hadn’t connected the dots sooner.

In its most recent Children’s Mental Health Report, the Child Mind Institute states that more than 20 percent of American youth will have a diagnosable mental illness with “serious impairment” at some point before they turn 18, and that anxiety disorders are most prevalent. Early diagnosis is important because childhood anxiety can be a predictor of serious problems down the road, including panic attacks, depression, and suicide.

I’d rationalized that my daughter’s teacher expected her to be a raging extrovert, same as her older brother, Ben. Ellie was bright, talented, and athletic, excelling in music and competing at an elite level in sports. She’d been identified as gifted, just like her brother, but she was certainly her own person.

Did she feel compelled to live up to unspoken high expectations? My husband and I never would have intentionally set it up that way, but what if we had done so unwittingly? What if it’s an unwelcome byproduct of having an intelligent and über capable older sibling?

I had assumed my daughter’s reticence was due to shyness, and I had chalked up her preschool sock problem as an annoying quirk the same way I dismissed her refusal to nap and, later, to stay in bed at night — inconveniences but nothing to be overly concerned about. She won’t nap because she’s too busy and doesn’t want to miss anything, I told myself.

But as Ellie’s anxiety ramped up in middle school and high school, sleep became a major issue. Bouts of severe insomnia were followed by sleep so deep I could barely rouse her. It became a daily battle to get her up and out the door for school. Tardies and absences piled up as this debilitating anxiety gripped my daughter and wouldn’t let go.

In an article for the journal of the American Academy of Family Physicians, Wanda P. Fremont, M.D. asserts between 1 and 5 percent of school age children will experience school refusal. Although it is not a formal psychiatric diagnosis, students like Ellie who exhibit school refusal often suffer from significant emotional distress, especially anxiety and depression.

“The anxiety is paralyzing her,” our psychiatrist said. “This is why she cannot go to school.”

In the spring of her junior year, our district provided homebound schooling while we went to therapy and waited for a merry-go-round of medications to kick in. Ellie decided on her own that organized sports were too stressful. She quit basketball, softball, and horseback riding. Instead, she found catharsis in playing the guitar and drums.

Once we had a diagnosis, I understood, on an intellectual level, both the psychology and physiology of Ellie’s anxiety. But in my mother’s heart, I questioned myself anyway. I wondered if the intensity of travel teams and a competitive academic curriculum were to blame, or if we’d unfairly compared her to her older brother, or unconsciously pushed her too hard. Mostly I rued the fact I hadn’t picked up on the signs early on.

I finally accepted that my daughter is wired to be anxious. She also has an innate perfectionism and puts more pressure on herself than her father and I ever could. We had some false starts trying to find balance and healing, but ultimately we found the right combination of professional treatment, lifestyle choices, meds, and family support. Ellie manages her anxiety well now, and has not only returned to school, but enjoys it and is excelling.