Health Watch: Anxiety and Children

Dr. Brett Parkinson with Mountain Medical breaks down the facts.

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Anxiety is defined as a fear resulting from the anticipation of a threatening event. Although it is generally unpleasant, it can be a positive influence if it motivates us to accomplish tasks we might not otherwise tackle. Anxiety over possible failure may motivate us to study for a test. But anxiety can get in the way. It can sometimes be so intense that it paralyzes people, rendering them incapable of coping with life. It affects children as well as adults. As a matter of fact, approximately 13% of children will suffer from some type of anxiety disorder.

An anxiety disorder is any condition in which causes one to feel excessively frightened, distressed and uneasy during situations in which others would not experience those symptoms.

If left untreated, anxiety can lead to reduced productivity and decreased quality of life. Specifically, it can lead to poor school performance, low self-esteem, deficient interpersonal skills, substance abuse and relationship problems.

There are several different types of anxiety disorders:

• Generalized Anxiety Disorder

• Separation Anxiety Disorder

• Phobias

• Social Anxiety Disorder

• Obsessive-Compulsive Disorder (OCD)

• Panic Disorder

Generalized Anxiety Disorder

• Worries excessively and uncontrollably about events that are unlikely to occur

• Anticipates some sort of disaster at every moment

• Overly concerned with health issues, money, family problems or difficulty at school

• Can’t turn off worry

• Often accompanied by symptoms such as muscle aches, concentration difficulties in school, sleep disturbance and irritability
Separation Anxiety Disorder

• Fears being away from home or parents/primary caretakers
• Worries about safety of parents/caretakers
• Often refuses to sleep alone; crawls into parents’ bed during the night
• May refuse to attend school
• Frequent stomach aches or nightmares
• Clingy

Phobias

• Fears a specific thing or situation: dogs, insects, needles, heights, enclosed spaces

• Avoids objects or situations that cause fear, leading to a restricted life

Social Anxiety Disorder

• Fears meeting or talking to people. Often characterized as “painfully shy.”

• Usually emerges in the mid-teens

• May experience physical symptoms such as sweating, blushing, heart palpitations, shortness of breath or muscle tension

• Worries about being negatively evaluated, rejected or humiliated in front of others

• Fears wide range of social situations: engaging in conversation, participating in sports or social events, giving an oral report in class

Obsessive-Compulsive Disorder

• Usually begins in early childhood or adolescence

• Characterized by repeated, intrusive and unwanted thoughts (obsessions); and/or rituals that are impossible to control (compulsions)

• Obsessive behaviors often include excessive hand washing, counting, rearranging objects, repeating words silently or rechecking completed tasks

• May engage in repeated behaviors to avert some imagined disaster. “If I count to fifty five times, my father won’t die.”

• Obsessive behaviors may take up so much time they interfere with daily living.

Panic Disorder

• Experiences unexpected and repeated episodes of intense fear

• Often begins during adolescence

• Can last for a few minutes up to several hours

• Often accompanied by physical symptoms: racing heartbeat, shortness of breath, sweating, dizziness and nausea

• Feelings of imminent death

Anxiety disorder can be effectively treated, through a combination of cognitive-behavioral therapy, relaxation techniques, biofeedback and medication. Cognitive-behavioral therapy is a type of psychotherapy which teaches children to deal with their fears by modifying the way they think and behave by practicing new behaviors.

There are several types of medication that doctors use to treat children with anxiety: Selective Serotonin Reuptake Inhibitors (SSRIs) are the medication of choice. This includes Prozac, Zoloft, Paxil, Luvox, Celexa and Lexapro. Older, tricyclic antidepressants (imipramine) and benzodiazepines (lorazepam) are used less frequently. Generally considered safe. However, in 2004 the FDA issued a warning that antidepressant medications–including SSRIs–might increase suicidal ideation in a small number of adolescents and children.

Note, medication will not work immediately. The child’s symptoms may begin to improve after a week or more. Sometimes an initial trial of four to six weeks is needed to assess a clinician response. If a child improves on medication, you should not stop medication without consulting the doctor. It may lead to a worsening of symptoms.

However, the child will not necessarily have to take medication for life? Many children may not need more than one course of medication, usually a year or so. Symptoms and treatment response should be reassessed at regular intervals.

If recognized in childhood or adolescence, anxiety disorders can be effectively managed before disabling thoughts and behaviors interfere with a fulfilling life.