When Anxiety Attacks Kids

Does your child worry about tests for months in advance, have trouble eating or sleeping, or refuse to go to school on a regular basis? All children and adults suffer from anxiety, but how do parents define what’s within the boundaries of normal?

One in 10 children suffers from an anxiety disorder, the most common mental health problem in children. Research suggests some of us are born with more sensitive wiring that makes us susceptible to anxiety.

If anxiety is taking a front seat in your child’s life, the good news is that professional help can result in dramatic improvement. A Temple University Study published in the 2001 issue of the Journal of the American Academy of Child & Adolescent Psychiatry tracked results of cognitive behavioral therapy in 173 children between the ages of 8 and 13 who met the criteria for various anxiety disorders. At the end of 16 weeks of treatment with cognitive therapy alone, 66 percent of the participants were free of their primary diagnosis.

One of the biggest mistakes parents can make is ignoring a serious anxiety problem with hopes their child will outgrow it. Early intervention can help children with anxiety disorders do better as adults; untreated anxiety disorders may lead to substance abuse and major depression.

Parents of anxious children sometimes create a vicious cycle by being overprotective instead of teaching children to face life situations. Experts say teaching children to live with anxiety, just like they live with a sad moment or an angry feeling, is paramount.

When is anxiety an anxiety disorder?

Children often exhibit anxiety at milestones, like the first year at school, or the beginning of adolescence. But a child with a true anxiety disorder consistently withdraws from family or social situations and shows signs of distress, such as irritability and trouble eating or sleeping. It’s important to note that anxiety and depression can go hand in hand.

Allison Ford, Ph.D., a therapist and licensed professional counselor at NC Neuropsychiatry in Chapel Hill, encourages parents to view anxiety as a continuum. “Some anxiety is considered normal and helpful,” says Ford. “For example, if a child is nervous about a test, nervousness can be motivating to the child to study for that test.”

The hallmark of an anxiety disorder is avoidance of situations. “We are concerned about anxiety when it is so severe it interferes with a child’s ability to navigate in the world,” says Ford. Examples of worrisome behavior, she says, include ” … when a child’s anxiety interferes with his or her ability to perform in school, establish friendships, and participate in family activities.”

When determining whether anxiety is moderate to severe, parents should consider the intensity, duration and frequency of anxiety as well as the child’s ability to stop worry thoughts, says Ford.

Ford suggests lots of encouragement for shy children. “These feelings of shyness can come from feelings of incompetence.” Giving children small chores or activities to boost confidence in their abilities is helpful.

How are anxiety disorders treated?

An ongoing study at Duke University is currently comparing treatment options for children with anxiety disorders. Therapy alone has been successful in children with anxiety disorders, but medication also is a viable option.

Duke is one of six sites across the country participating in phase one of the six-year study funded by the National Institute of Mental Health to determine the most effective treatments for anxiety disorders in children by comparing the use of sertraline (Zoloft), cognitive behavioral therapy, a combination of these two treatments, and a pill placebo. Scott Compton and John March are co-principal investigators of the study, which began in 2003.

Compton says cognitive-behavioral therapy focuses on first teaching children new skills to better manage anxiety. Children then practice those skills in a stepped process that gradually exposes them to feared situations.

Children also learn to identify less effective thought patterns and replace them with a more balanced perspective. Compton notes that instead of a child thinking, “If I get up in front of the class and everyone laughs at me, my life is going to be over,” a child might think, “I know I’m nervous, but I can do it. Even if I fail, I’m going to survive.”

“Kids with anxiety often end up avoiding an ever increasing number of things,” says Compton. “What kids learn in therapy is that if they can lean into their anxiety rather than avoid it, they can develop confidence in their ability to handle the situation.”

If you’re concerned that your child’s anxiety is impacting his life more than it should, talk with your pediatrician. You may also find helpful advice in books, including: Keys to Parenting Your Anxious Child by Katharina Manassis and Nurturing the Shy Child by Barbara and Gregory Markway. — CP

Common Anxiety Disorders in Children

Generalized Anxiety Disorder — Uncontrollable and recurring fears and worries

Separation Anxiety Disorder — Intense anxiety about being away from home or caregivers that interferes with the ability to function socially and in school

Social Phobia — Constant fear of social or performance situations

Obsessive-Compulsive Disorder — Frequent and uncontrollable thoughts and performance rituals done to eliminate the thoughts

Post-Traumatic Stress Disorder — Children who experience a physical or emotional trauma such as witnessing a shooting or disaster, surviving physical or sexual abuse, or being in a car accident may develop post-traumatic stress disorder (PTSD).