A review of recent treatment recommendations, provided by Gregory Sowles, PhD, HSPP, CornerstoneVision Counseling & Psychological Services
Anxiety is a normal reaction to stress and can actually be beneficial in some situations. For some people, however, anxiety can become excessive, and while the person suffering may realize it is excessive they may also have difficulty controlling it and it may negatively affect their day-to-day living. There are a wide variety of anxiety disorders, including post-traumatic stress disorder, obsessive-compulsive disorder, and specific phobias to name a few. Collectively they are among the most common mental disorders experienced by Americans.
Children and Teens
Anxiety is a normal part of childhood, and every child goes through phases. A phase is temporary and usually harmless. But children who suffer from an anxiety disorder experience fear, nervousness, and shyness, and they start to avoid places and activities. A child who sees a scary movie and then has trouble falling asleep or has a similar temporary fear can be reassured and comforted. But that is not enough to help a child with an anxiety disorder get past his or her fear and anxiety.
Anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse. Since the terrorist attacks of 9/11, most adults have accepted that we live in a new era of trying times. Tornadoes, hurricanes, and other natural disasters, as well as explosions, and other traumatic events threaten our sense of safety and security, and they occur around the world on any given day. Adults often struggle with the effects of trauma, even though they understand them. But children react differently based on their personality, age, and circumstances. Anxiety disorders also often co-occur with other disorders such as depression, eating disorders, and attention-deficit/hyperactivity disorder (ADHD).
Strategies to Help Children Manage Traumatic Events
Children rely on the support of parents and teachers to help them deal with their emotions during and after traumatic events. Parents should decide how much information their children can handle. With treatment and support, your child can learn how to successfully manage the symptoms of an anxiety disorder and live a normal childhood.
ADAA member Aureen Wagner, PhD, Director of The Anxiety Wellness Center in Cary, North Carolina, offers this recommendation for parents:
“Remain as calm as possible; watch and listen to your child to understand how upset he or she is. Explain a traumatic event as accurately as possible, but don’t give graphic details. It’s best not to give more information than your child asks for. Let your child know that it is normal to feel upset, scared or angry. If older children or teenagers want to watch television or read news online about a traumatic event, be available to them, especially to discuss what they are seeing and reading.”
These tips are important for children and adolescents of all ages:
- Reassure them that you’ll do everything you can to keep them and their loved ones safe.
- Encourage them to talk and ask questions
- Let them know that they can be open about their feelings.
- Answer questions honestly.
- Protect them from what they don’t need to know.
- Avoid discussing worst-case scenarios.
- Limit excessive watching and listening to graphic replays of the traumatic event
- Stick to your daily routine as much as possible.
Children and teenagers can recover from fears. Watch for these signs of ongoing distress:
- Difficulty sleeping
- Change in eating habits
- Re-experiencing the event through nightmares, recollections, or play
- Avoidance anything reminiscent of the event
- Emotional numbing or lack of feeling about the event
- Persistent fears about another disaster
If after a month or so your child is still showing signs of distress, professional help may be indicated. Children who have trouble getting beyond their fears may be suffering from PTSD, or posttraumatic stress disorder. And that’s when it’s time to seek the assistance of a mental health professional. Many effective treatments are available for children and teens.
The following section centers on “two key questions” and related material (provided by ADRIANA BARTON):
The “Two Key Questions” that all parents of younger children could ask themselves center on understanding one’s child in the context of their age related development. Parents are surprisingly good at detecting anxiety disorders in kindergarten children if asked the right questions, researchers at the University of British Columbia have found. In a study of 200 kindergarten children in B.C.’s Lower Mainland, a two-question test given to parents was 85-per-cent effective in identifying children who met the criteria for anxiety disorders, says lead researcher Lynn Miller, an associate professor of education at UBC.
Researchers asked parents:
- Is your child more shy or anxious than other children his or her age?
- Is your child more worried than other children his or her age?
“If the parent says ‘yes’ to [either] then there’s a high degree of predictability that the child will go on to develop an anxiety disorder,” says Dr. Miller, who presented the research at the American Educational Research Association’s annual meeting in Vancouver.
The research confirms that parents of anxious kids – who often suffer from anxiety themselves – are attuned to their child’s unusual behavior, Dr. Miller says. Miller added: “They do know that something is up, but they may not understand what it is.”
Anxiety disorders take different forms in kindergarteners than in adults. Red flags include persistent stomach aches, reluctance to go to sleep or problems sleeping through the night in a separate room. Anxious children may refuse to attend birthday parties and sleepovers or be unwilling to go on school field trips without a parent.
It’s normal for kids to feel jitters from time to time. The difference is that children with anxiety disorders experience their fears as something catastrophic, Dr. Miller says. “It will impinge on their functioning in school, with friends and in their family life.” Left unchecked, anxiety disorders in kindergarten may lead to educational problems and increased risk of substance abuse, depression and other mental-health problems down the road.
Studies have shown that up to 10 per cent of kindergarten-aged children suffer from an anxiety disorder – a rate that jumps to more than 15 per cent of high-school students, notes Dr. Miller. Although anxiety disorders are the most common mental-health problem in children, they tend to get the least attention.
Teachers may not pick up on anxiety disorders because fearful behaviors don’t normally interfere with students’ learning, Dr. Miller says. Anxious children are often people pleasers and “very clever,” she says, “but they’re suffering and they don’t have to.” She advises parents to read about anxiety management on websites such as AnxietyBC.com. “I would go online first and see what you can do at home and if you’re not getting anywhere, then go to a mental-health professional.”
Cognitive-behavioural therapy is effective for all ages, notes Katharina Manassis, a psychiatrist and director of the Anxiety Disorders Clinic at The Hospital for Sick Children in Toronto. She adds that young children are unlikely to be put on medication to treat anxiety unless their symptoms are severe and persist after professional therapy.
Dr. Manassis describes the two questions developed by the UBC team as a “good screener.” But she cautions parents against jumping to conclusions based on the test. In some cases, shyness is simply a personality trait, Dr. Manassis points out. The two-question test may identify behaviors that warrant a closer look, “but not necessarily that the child has a horrible problem,” she says.
If a child is diagnosed with an anxiety disorder, one of the best things parents can do is to get treatment for underlying anxiety disorders they may have themselves, says Dr. Manassis, author of Keys to Parenting Your Anxious Child. Parents can then act as role models in coping with anxiety, she says, adding that early treatment for anxiety disorders increases the chances of “nipping it in the bud” if symptoms reappear later.
Watch those labels:
The downside of labelling a young child as having anxiety is that some parents become overprotective, Dr. Manassis says. “The child’s anxiety becomes a kind of excuse for bad behavior or an excuse for withdrawing the child from activities or school requirements,” she explains. “That’s actually the opposite of what you want to do because you want the child to face those things.”
Dr. Miller acknowledges the risk of stigmatizing a child but she emphasizes that teaching young children how to manage anxiety increases their chances of building a positive self-identity. While parents of anxious children often say, “We’re a family of worriers,” the goal is to “turn that self-talk around,” she says. With practice, the child will internalize the message that “I can be confident and brave no matter what,” she says.
As early as kindergarten, children can learn skills to cope with anxiety, says Lynn Miller, an associate professor of education at the University of British Columbia. Here’s how parents can help:
- Explain to the child that his or her feelings of worry or dread are caused by a condition called anxiety.
- Help the child notice the connection between anxiety and shallow, rapid breathing. Teach the child how to breath slowly and into the belly.
- Encourage the child to replace anxious “red light” thoughts (“that dog will bite me”) with more helpful and realistic “green light” thoughts (“most dogs don’t bite kids”).
- Help the child face fears in a gradual, systematic way. A child who is anxious about swimming lessons could start by dangling feet, then legs, into the pool. The child could play in the shallow end the next day and keep taking small steps from there. “You don’t just throw the kid into the pool,” Dr. Miller says.
Please contact the ADAA website, etc. and related authors for their most recent perspectives
VANCOUVER — The Globe and Mail
Published Sunday, Apr. 29 2012, 4:00 PM EDT
last updated Thursday, Sep. 06 2012, 12:50 PM EDT: Follow Adriana Barton on Twitter: @AdrianaBarton
- Anxiety and Depression Association of America (ADAA)
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