07/20/2012

by Janine DeFao

Feeling anxious or worried is a normal part of childhood. But some kids have trouble getting beyond that worry and develop an anxiety disorder, in which worry and fear become persistent and disruptive. Here's how to spot it and what to do.

Jamie Williams’ son, Tanner, was always a sensitive child.

 

“It seems he was born with anxiety,” she says.

 

But after his grandfather died, the 4-year-old’s anxiety level reached a crisis point. He wouldn’t let his mother out of his sight. He refused to sleep alone. He worried when his father was working late, fearing he’d die and never come home.

 

“He was having panic attack after panic attack – hyperventilating, throwing up, his muscles would be convulsing,” Williams recalls. “I felt like a bad mother that I couldn’t comfort him. No matter what we said, it made no difference.”

 

Finally, one night, “he said, ‘Mommy, is there someone who can help me? I need help. I don’t like feeling like this,’” Williams says. So the family turned to a specialist in childhood anxiety.

 

While it’s normal – and even healthy – for all children to worry sometimes, up to 20 percent of  kids  – and 25 percent of teens – have an anxiety disorder, in which worry becomes persistent and disruptive. Those statistics from the National Institute of Mental Health make anxiety disorders the top mental health problem for youth.

 

And yet serious anxiety can often be overlooked in children. Because childhood worries are common – from fear of dogs to taking tests – “it biases us against seeing when a child is really struggling. We assume it’s a normal thing,” says Tamar Chansky, Ph.D., who worked with Tanner’s family and is the director of the Children’s Center for OCD and Anxiety near Philadelphia.

 

In addition, anxious children don’t always act out, but may keep their worries bottled up. “These are not the squeaky-wheel kids. A lot of them are people pleasers,” says Chansky, a nationally known expert in anxiety disorders and the author of numerous books, including Freeing Your Child From Anxiety. “They don’t want their friends or teachers to know, then they come home and fall apart because they’ve been holding it together all day.”

 

Red Flags

“Anxiety is normal, worry is normal, fear is normal,” says Michael Tompkins, Ph.D., an expert in anxiety disorders and cognitive therapy and author of My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic. “They’re relatively transient in childhood. Kids outgrow them.”

But persistent stomachaches or headaches, an aversion to school or other activities, and trouble sleeping or sleeping alone are all red flags for possible problem anxiety. If it appears that your child is not outgrowing her worries, Tompkins says to consider “four D’s” in assessing whether it’s normal or reaching the level of an anxiety disorder:

 

• Is the child’s anxious response disproportionate to the situation?

• Is his anxiety disruptive to his or the family’s day-to-day functioning?

• Is the anxiety itself distressing to the child?

• What is the duration of the anxiety?

 

“If a child is fearful and worries in the same way for longer than six months, that may suggest there’s an anxiety disorder,” says Tompkins.

 

Parenting the Anxious Child

Ironically, parents who are naturally wired to protect their children may respond to anxiety in ways that actually aggravate it in the child.

 

“You may say to a young child, ‘Don’t worry, you won’t have to go to the party alone. I’ll just stay there with you,’ or ‘I’ll sit in the parking lot while you’re at school,’” says Donna Pincus, Ph.D., director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University’s Center for Anxiety and Related Disorders. “The child never learns appropriate coping skills when parents do this.”

 

Or parents might be overly reassuring, telling an anxious child, “You’re going to be fine. I’ll have my cell phone with me at all times so you can call,” or “Just relax; it’s going to be fine. Just breathe.”

 

“It’s really the initial tendency of some parents. But it reinforces avoidance in the child. Suddenly they’re doubting themselves, thinking they can’t do it” says Pincus, who has written a new book, Growing Up Brave, with strategies for parents to help their kids learn to cope with anxious situations and hopefully prevent more serious anxiety later on.

 

As was the case with Tanner, Harper Atkisson’s parents knew she was unusually anxious from a young age. Harper’s separation anxiety and long tantrums were particularly in contrast with her happy-go-lucky twin sister.

 

Pincus describes irritability, anger and tantrums as signs of anxiety that parents may confuse with child misbehavior or defiance. Actually, she says, it’s anxiety displaying itself as avoidance – “the child will do anything he can to avoid something he’s anxious about.”

 

Harper’s anxiety will often play out as a sensory problem, her father, Erik Atkisson, says. If she’s worried about going to school, for instance, she may instead complain that her clothes don’t feel right. “The biggest challenge has been to recognize when she is starting to feel anxious, as opposed to the kind of childhood behavior you would need to punish or reprimand,” he says, recalling the time Harper had a tantrum over ski pants, nearly ruining a family ski outing. “You can become angry instead of realizing that she’s really hurting right now. I try to remind myself and her, no matter how much she’s making life miserable for her siblings and parents, she feels worse.”

 

Working with therapists has helped Harper make big strides. “Day to day, it can still be tough, but we’ve had huge improvements,” Atkisson says.

 

Giving and Getting Help

Citing research over the last decade, Pincus believes that parents can create a home environment to help children learn to cope with anxiety. Rather than provide constant reassurances, she tells parents to remind an anxious child that, “anxiety is a very natural human emotion. Somehow the emotion of fear just isn’t accepted as much even though we can actually do a lot of things while we’re a little afraid. And sometimes, if you’re really excited about something, like camp or a party, it can feel a lot like fear.”

 

Among her recommendations for parents:

 

• Model good coping skills. Instead of worrying aloud that you’re lost while driving with your child, calmly verbalize out loud: “Hmm, I don’t know where I am right now. I’m going to pull over and look at a map or use my phone to figure it out.’”

• Provide opportunities for new experiences. If your child fears sleepovers, set up a one-nighter with a favorite cousin or grandma. Take small steps that allow the child to practice.

• Teach kids to play detective with their thoughts. “If they say, ‘I think if I go to that party I’m going to get a stomachache,’ ask if there are any facts that support that. … Teach them to look at that thought and decide whether it’s true,” Pincus says.

 

But if you believe your child needs professional help, don’t wait. Your pediatrician is a good place to start, but may advise watching and waiting, cautions Tompkins. “As a parent, you may have been watching and waiting for years. … Go through the ‘four D’s’ with your pediatrician and say, ‘This has been going on for a long time, I think it’s disruptive, and we need to have an evaluation with a mental health professional.’”

 

Also, look for any underlying causes that could be provoking anxiety, such as a learning disability or ADD, which can result in school stress.

 

Cognitive behavior therapy is usually the primary treatment for childhood anxiety. Medication can be necessary for some children, including those with severe anxiety or other factors such as depression, attention deficit hyperactivity disorder or bipolar disorder, says Chansky. But the safety and efficacy of psychiatric medications for children is still being researched, and kids using such medications should be monitored by a child psychiatrist, she says.

 

When Tanner, now 5, began seeing Chansky, her cognitive behavior therapy approach gave him a new way of looking at and responding to worry. She emphasized that Tanner’s “worry brain” wasn’t necessarily telling him the truth and that his “smart brain” could counter with the facts.

 

Armed with a new vocabulary, Tanner’s family started to address his fears, including his separation anxiety, in small steps. They started with Tanner sitting at the bottom of the steps with his mother at the top, talking the entire time. Gradually, she moved farther and farther away, until she could be out of his sight without him having a panic attack.

 

Cognitive behavior therapy also involves teaching patients breathing and other relaxation techniques to combat the very real physical symptoms of anxiety, including nausea, stomachaches and headaches, breathlessness and a racing heart.

 

One thing Jamie Williams learned was to slow down and take time to listen to her son and to not dismiss his worries. “I was rushing us through the day, saying, ‘It’s going to be all right’ or ‘That’s a silly thing to worry about,’” she says. “If I’m discounting his emotions, he’s not going to trust me.”

 

With therapy, Tanner has improved significantly and in a relatively short period of time, William says happily. “He’s ready for a sleepover at our in-laws!” n

 

Janine DeFao is an associate editor with Dominion Parenting Media. Senior Editor Deirdre Wilson contributed to this article.

 

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When to Worry About Your Child’s Worry

 

Your child’s anxiety may be a problem if he or she:

• Is easily distressed or agitated in stressful situations;

• Asks repetitive reassurance questions, has “what if” concerns, or is inconsolable and won’t respond to logical arguments;

• Has headaches or stomachaches and is too sick to go to school;

• Has anticipatory anxiety and worries hours, day or weeks ahead;

• Has difficulty falling asleep, sleeping alone or has frequent nightmares;

• Is a self-critical perfectionist with high standards that make nothing good enough;

• Is an overly responsible people-pleaser who apologizes unnecessarily or has excessive concerns that people are upset with him or her;

• Demonstrates excessive avoidance, such as refusal to attend school or participate in activities;

• Disrupts family functioning; and/or

• Needs excessive consolation or coaxing for distress over ordinary situations

– Source: The Children’s Center for OCD and Anxiety

 

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Resources

 

Books

• Freeing Your Child From Anxiety, by Tamar E. Chansky, Ph.D., Broadway Books, 2004.

• Growing Up Brave, by Donna Pincus, Ph.D., Little, Brown and Company, August 2012.

• My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic, by Michael A. Tompkins, Ph.D., and Katherine Martinez, Psy.D., Magination Press, 2009.

 

Helpful Websites

• American Academy of Child & Adolescent Psychiatry – www.aacap.org

• Anxiety and Depression Association of America – www.adaa.org/living-with-anxiety/children

• Children’s Center for OCD and Anxiety – www.worrywisekids.org

• International OCD Foundation – www.ocfoundation.org

• Child Anxiety Network – www.childanxiety.net