Recognizing and Treating Anxiety Disorders
No parent wants to see his or her child suffering. When the distress is emotional, it can be harder to address because nothing hurts; everything hurts.
Writing on PsychCentral.com, psychologist Marla W. Deibler, a specialist in anxiety and obsessive-compulsive disorders, has some guidance for parents to recognize their child’s anxiety problems, and what to do about them.
Deibler says anxiety disorders are among the most common psychological problems children and adolescents experience—about 13 in 100 U.S. kids suffer from them. Such problems are the greatest predictors of adult problems including substance abuse and a variety of mood disorders. So identifying them early and getting them treated is key to positive long-term outcomes.
Anxiety itself is neither good nor bad—it’s an appropriate response to many circumstances, it’s how our bodies register stress so that we can confront and diffuse it. But if anxiety is excessive, it’s hard to turn off. It can become so overwhelming that we’re unable to function, to perform our regular routines.
Deibler identifies six common anxiety disorders parents should watch out for.
1. Generalized Anxiety Disorder (GAD) is characterized by persistent, pervasive worry that is difficult to control.
Children with GAD are chronic worrywarts. They fret about family, friend and romantic relationships; academic performance; recreational performance. They concerns might be legitimate, but they exaggerate them, and obsess about them.
They worry about not measuring up to the expectations of others. They might have a hard time sleeping, they might constantly seek reassurance. They’re often irritable, and have stomach- or headaches.
2. Separation Anxiety Disorder is expressed by severe distress when kids are separated from their caregivers. Generally, it begins when they are younger than 10.
Separation anxiety is a normal stage of child development from late infancy to several years later. But cause for concern is when it the degree is extreme and acute every time a child is separated from the caregiver(s). Such an extreme is clinically significant if it interferes with a kid’s ability to engage in age-appropriate activities—school, play dates, sports, etc.
Children with separation anxiety might seem excessively clingy, reluctant to do anything requiring separation. They, too, can complain of stomach- and headaches.
3. Social Anxiety Disorder is recognized by excessive concern about being judged by others. It’s not just being shy—it’s being anxious and extremely worried about embarrassing yourself. Kids with this disorder freeze at the prospect of performing or speaking in public; even doing such simple acts as eating or writing if somebody’s watching. And, either imagined or real, judging.
These kids are afraid of being criticized or humiliated. Older kids might avoid situations they believe will make them anxious, and younger kids might act out--crying, or having a tantrum. They also might feel breathless, dizzy, lightheaded, have a racing heart rate or stomachache.
4. Selective Mutism (SM) makes a child unable to speak in certain settings, even though he or she is otherwise able to talk and interact.
SM typically presents in a child as being able to talk freely at home and other comfortable settings, but unable to do so at school or in the presence of strangers. These children might gesture or use other nonverbal efforts to communicate, but can’t seem to speak.
5. Specific Phobias are characterized by excessive and irrational fears about things or situations not usually considered to be dangerous.
The source of the fear might be dogs or other animals, storms, insects, blood/injections or heights. The fear is so strong as to be debilitating. Youngsters might not understand how unreasonable their fear is. Often, they address this by avoiding the stimulus. They also might act out and experience a racing heart, breathlessness, trembling, dizziness, lightheadedness, sweating or stomachaches.
6. Obsessive Compulsive Disorder is recognized by persistent intrusive thoughts, images or impulses (obsessions) and repetitive behaviors and/or mental acts a kid feels he or she must perform as a response. It’s like a rule that must be followed.
The compulsive behavior is done with the goal of reducing or neutralizing anxiety or distress caused by the obsession.
This disorder, which can present in early childhood, may be exhibited by excessive hand washing, locking and relocking doors, touching or tapping items or spots in a certain order, counting, rewriting, rereading or doing anything in a certain sequence.
Common obsessions include a fear of germs or illness, or harm coming to oneself or one’s family if the child doesn’t engage in compulsive rituals.
The time to treat your child’s anxiety disorder is when it interferes with his or her ability to function every day. Your child’s anxiety is excessive when:
- It’s unrealistic or irrational.
- The level of distress far exceeds the seriousness of its cause.
- It results in perfectionism, or the child having unrealistically high expectations of himself or herself.
- It’s unwanted and uncontrollable.
- It results in avoidance or inability to engage in activities the child would otherwise enjoy.
Discuss fears with your child. Be open, honest and listen. Ask open-ended, nonjudgmental questions to learn more about how he or she is feeling. An open-ended question is: Why do you think you’re so afraid of dogs? A closed, judgment-laced question is: “You’ve never been bitten by a dog, why are you afraid of them?
Don’t dismiss any of your child’s feelings, don’t express in words or body language that you think their problem is silly or dramatic.
Don’t reinforce the fear by appearing anxious yourself or by allowing avoidance behavior or school absence. That might reduce anxiety in the short-term, but it prevents children from having to learn adaptive coping skills.
Remember, anxiety tends to increase when what causes it is unpredictable, unfamiliar or imminent. So prepare children for anxiety-provoking situations by discussing them in advance, talking about what could happen, how they might feel, what they might do and, if the worst were to happen, how would they manage that.
But if anxiety is excessive and isn’t getting better, seek professional help from a psychologist who specializes in treating children. Sometimes behavioral therapy is sufficient; sometimes medication must be prescribed. (See our blog about combining therapy and medication to treat anxiety.)
To learn more and to find a child psychologist, link to the American Psychological Association.
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