Anxiety Disorders in Childhood

Major Anxiety Disorders

There are many different “types” of anxiety problems that can affect children and adolescents and all of us throughout our lifetimes. With children, you may have heard terms such as separation anxiety, social anxiety, test anxiety, performance anxiety, obsessive-compulsive disorder, anxiety related to specific events such as divorce, post-traumatic stress disorder among others. It can be very confusing for parents when the child they love seems to be very anxious or is having much difficulty in dealing with a situation. Where do you turn?

It is first important to remember that anxiety is a part of life. We don’t want to over blow it but we also want to recognize when it is becoming a real problem for the child or individual. I usually recommend that you first seek out help and support from those people who have been trained to help you and are readily available. This includes school counselors, school psychologists and church counselors among others. Even friends who have dealt with a similar situation may be able to help you.

If you determine that seeming anxiety appears to be significantly affecting your child’s life and interfering with daily experiences such as school, social events, interaction with others and willingness to participate in activities it would be time to go further. At this time you may want to seek assistance from a licensed therapist, counselor or psychologist. Be sure to look for someone who is quite familiar with and works regularly with children as the treatment of children with anxiety problems/disorders is quite different from dealing with adult situations. Don’t be afraid to ask a potential therapist about their experience with children and the particular anxiety issue you are dealing with. I do advise that you start with a therapy approach, rather than jumping to use of medication for your child.

Should your therapist feel that medication may be a necessary treatment approach, it is also important to find a psychiatrist who specializes with children and particularly with anxiety disorders if that is possible. Your regular medical doctor can prescribe medication as well; however, may not be as familiar with the nuances of medication use in this context. Generally, if therapy is not as successful as anticipated, a continued use of combination therapy and medication can often be quite helpful.  In some cases that are more complicated, either the parent, therapist or psychiatrist may request a formal neuropsychological or psychological evaluation to get more in depth understanding of concerns. So you can see there is a hierarchy of intervention that can be traveled depending on the severity or intensity of anxiety symptoms.

It is also important to note that anxiety problems are often associated with other childhood learning and emotional disorders or problems. A child with a learning disability can often be quite anxious about their school performance and display test anxiety. Anxiety problems are often associated with students on the autism spectrum, with nonverbal learning disabilities and with ADHD with variations in how such anxiety may be exhibited. For example, if a student on the autism spectrum has a change in plans in what was expected, the student may react seemingly out of proportion to the situation either physically or verbally. A student with an anxiety disorder may ruminate excessively about a situation leading to a major panic attack. A child or adolescent who has experienced a traumatic event may have an episode of reliving the event leading to major anxiety and fear. A child who has felt either external or internal pressure to do well in school, may exhibit high levels of anxiety about school performance and how they would be viewed by others.

So isn’t this very confusing!

What are some other common characteristics of students with anxiety issues?

Sometimes these anxiety problems are like free agents that can attach to anything. New situations, in particular, can often set off a cascade of fears and need for information. Children with this anxiety predisposition tend to anticipate the negative and so they worry before, during and after a situation. They develop their own coping mechanisms, for example, they may become real fact finders and ask constant questions to gain more details. They are also prone to physical signs of anxiety, particularly stomachaches, headaches and sleeping disturbances. Worry and oversensitivity often seemed to rule.

Children and adolescents with anxiety may often try to avoid and escape from situations that contribute to their anxious feelings. Sometimes, they may avoid homework because of their fear of not being able to do it. It may take the form of social anxiety and avoidance of situations where they would have to interact with others. They may fear they will make a mistake and be laughed at and so remain quiet and withdrawn in school to avoid humiliation. Children may study well for a test but when faced with the actual dilemma, anxiety takes over and they can’t think (I think this has happened to almost all of us).

In situations such as Obsessive Compulsive Disorder, the student may often have hidden or silent compulsive rituals. Suppose you are told to read a paragraph (you can use the paragraph just above this one) and you were told that while reading you must count all the times the letter “e” occurs.  That is reading and counting simultaneously.   Try it.  If you must perform this ritual in order to feel safe imagine how difficult it would be to read. These may be hidden from teachers who can’t understand what is going on internally with the child and just conclude that the student is a poor reader. As a child with OCD you may end up feeling very frustrated, exhausted and irritable and you may try to just give up. Young children may not realize that these silent or hidden compulsive rituals are “abnormal”. However, older children, teens and adults are often embarrassed by the rituals and will not tell you about them. Such symptoms wax and wane. You may begin to see now that much of what causes anxiety in individuals are  there actual thought processes – a clue to some of the most effective ways of dealing with anxiety.

So how do parents and therapists help the student with these anxiety issues? There are numerous different techniques which may include for the milder issues some behavior reinforcement techniques but for the majority of anxiety issues strategies which help the person change their thought processes are the most effective.  In the “Interventions Section” you will see some of the common principles of Cognitive Behavioral Therapy – which is the approach I usually recommend and have found to be the most effective. But there are other approaches that can be used in conjunction with it such as providing rehearsal and role-playing for students with social anxiety including instruction in how to act in certain social situations. Children will have less anxiety about situations if they feel competent and rehearsing situations can add to their feeling of competence. Imagery techniques can also be used to help a student see herself coping with situations in a relaxed, positive manner.

Visual techniques may be especially helpful for young children feeling anxious. The Turtle Technique encourages the child to think of himself as a turtle and if something anxiety-provoking occurs, just like a turtle, he pulls himself inside his shell and visualizes a calm place in his experience and perhaps says some thoughts taught  to him by his therapist or parent, e.g. “I can handle this”. He then comes back out of his shell to proceed. Having a visual of the turtle can be a helpful reminder to use this self-strategy. Just like in many other learning and emotional situations, children can learn to deal with anxiety by developing strategies to do so. If they cannot be taught by the parent or school personnel, then they can be taught to use strategies through teaching and rehearsal by therapists and counselors.

 

Relaxation methods and desensitization to fearful events have also been found to be effective in reducing tension and anxiety. Students can also be taught to use certain types of physical activity, talking or writing for release of anxiety. This is often most helpful in situations where the adult, e.g. teacher and the student have a signal to indicate that this activity is needed and it’s okay. Some anxiety can be related to fear of the unknown, like going into a new situation or going to a new place. Taking the time to thoroughly explain about the feared situation and perhaps a visit ahead of time with a trusted person may reduce situational anxiety.

After working with children for so many years in both private and school situations, I strongly believe that early curriculum on social and emotional development and competence is a necessary and highly valuable instructional goal. Having this incorporated  in the general curriculum in both public and private schools that didn’t print with could help so many children learn the coping strategies necessary to navigate life.

Please visit the Interventions Section for more information on Dealing with Academic and Performance Anxiety and with understanding Cognitive Behavioral Therapy in dealing with fears.