By Kurt L. Klinepeter, M.D. Pediatric Behavioral Medicine Specialist
With the start of school and other changes happening this time of year, we thought this blog would be timely. If you are seeking advice regarding anxiety, be sure to consult our directory of Counselors & Therapists for local professionals! ~ Katie
From our adult perspective, we typically think about childhood as a care-free time without significant worry or anxiety. Certain situations may cause children and adolescents to be acutely anxious — but not for long and not in a chronic, life-changing way. However, childhood anxiety is more common than most people think and if it is sustained for longer periods of time should be addressed.
Many children and adolescents, just like adults, can have situational anxiety – or become nervous in a situation that makes them uncomfortable. For example, speaking in public or going to a party in a new neighborhood where you know no one. However, many people experience significant behavioral, emotional, and physical symptoms that affect their day-to-day lives. Anxiety disorders are estimated to occur in 5-10% of children. Children with anxiety disorders will panic when placed in an uncomfortable situation. The child will appear to “freeze” or become paralyzed.
Some anxiety symptoms are the same for children/adolescents and adults, but some symptoms are unique to children and adolescents. The age of the child/adolescent and their developmental stage are major determining factors in how they express anxiety. In general, adults are able to identify the sources of their anxiety. Children and adolescents, however, may react to anxiety by crying, throwing tantrums, participating in other disruptive behaviors, develop sleep difficulties, or by withdrawing from everyday activities. This makes anxiety disorders more difficult to diagnose in children. Often parents will attribute it to a “phase” that the child is going through. In addition, it is not unusual to have a mixture of different anxiety subtypes – separation, social, obsessive, and generalized anxiety – and overlap with other childhood behavior disorders. However, if a child experiences extreme behavior in a particular situation more times than not, parents need to discuss the situation with their pediatrician.
Social anxiety can occur at the individual relationship level or as a reaction to group social settings. Some children respond by obsessing or “stressing” before going to group social functions. Other children go to the extreme and shut down altogether. For example, selective mutism is a rare type of social anxiety in childhood. Affected children do not talk in some social settings while being perfectly able to talk with parents or other family members at home.
Obsessive anxiety may be paired with compulsive rituals, such as washing your hands over and over, and may occur with or without other types of anxiety disorders. Social anxiety and obsessive-compulsive behaviors may be part of other conditions such as autism spectrum disorders. It is not unusual for these types of anxiety disorders to overlap and for children to have more than one type of anxiety disorder.
Anxiety and depression are common in teenagers and often go undiagnosed and unrecognized by their parents. Depressed teenagers rarely act out and parents often think their teenager is “going through a phase” or having trouble with a boyfriend/girlfriend. In fact, teenagers often self-report their anxiety and depression before a parent.
Treatment strategies are generally split into two categories: non-medical and medical. The challenge from a non-medical standpoint is that children and young adolescents do not recognize the dysfunctional nature of their anxiety and the effects that it has on them and others. Therefore, individual counseling is rarely an effective treatment strategy until the individual (usually in adolescence) can identify his or her own anxiousness and actively participate in treatment. Until that developmental stage, non-medical treatment is really about parents, teachers, and others who supervise a child’s daily life to avoid known anxiety triggers. The ability to “read” one’s child and respond proactively before an acute episode occurs or be able to effectively moderate acute anxiety is the mainstay of treatment for young children. This requires a great deal of understanding on the part of parents and others. Behavioral-emotional symptoms in children can be indicators of a real and significant behavioral health disorder.
Medication management for anxiety is popular in treating adults and many different types of FDA-approved medications are available. But, response rates to medication management in children and, to some extent, adolescents are much less predictable. Only a small group of anti-anxiety medicines have been proven to be effective and even with that, not all of them are approved for use for all ages. Nevertheless, in extreme situations, medication management may be used along with non-medication treatment techniques in an attempt to improve the lives of children/adolescents and their families.
Childhood anxiety can be stressful for both parents and the child, but help is available. If you think your child is experiencing more than episodic anxiety, talk with your pediatrician about what resources are available to your family. Recognizing the issue is the first step in successful treatment.
Visit www.brennerchildrens.org for more info on childhood anxiety.
Thank you, Dr. Klinepeter, for this wealth of information. To any moms out there who may have children or teens struggling with the issues above – we hope this has helped.