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November 24, 2014

Not Just Jitters

By Otis Lyons

Imagine that while you are taking your morning walk, a long, slithering snake suddenly crosses your path. Or maybe a car unexpectedly comes to a screeching halt in front of you while driving. Undoubtedly, you will experience the unpleasant sensations of anxiety. Your heart begins to pound rapidly. It’s difficult to breathe, and you may begin to sweat or shake. Anxiety is a normal reaction that can serve as a warning sign for dangerous situations and can be critical for survival and life skills.

But what happens when you experience these same unpleasant feelings consistently in ordinary life situations? Anxiety disorders are among the most common mental disorders in America. While we often associate these disorders with the stress that comes with the responsibilities of adulthood, children can suffer from anxiety disorders. In fact, anxiety disorders affect one in eight children in the U.S. For some children, anxiety can become excessive and lead to thoughts and behaviors that negatively impact daily living for everyone in the home.

Warning Signs

Many times, parents do not realize their child’s behavior is a direct result of an anxiety disorder. The words “anxiety” or “nervous” usually trigger thoughts of a shy, timid child hiding behind his mother in a crowded room of children. While this is a form of anxiety, there are many other presentations that are common among children of various ages.

For instance, David may begin to scream, cry and throw himself on the floor because his toy isn’t working the way he wanted or his macaroni and cheese looks different than normal. Or Julie may have an outburst when asked to do her homework or take a shower. Many parents interpret these behaviors as defiance or anger and may even blame themselves, thinking they have done something wrong in their parenting techniques.

All of these are possible scenarios in which it may actually be anxiety creating or exacerbating a child’s negative thoughts and behaviors. It’s helpful for parents to know the warning signs of an anxiety disorder in order to respond to their child in the best way possible.

Depending on the disorder and the child, anxiety may present itself in a number of ways, including:

Irritability: This is a common symptom of anxiety in children, stemming from their difficulty understanding and expressing their feelings. Also, children with anxiety are often attempting to cope with anxiety-provoking situations constantly throughout the day, resulting in feelings of irritability or even anger.

Avoidance of Social Situations: If your child never wants to attend her classmates’ birthday parties or she stays close to you during social outings rather than playing with other children, social anxiety may be the reason.

Extreme Reactions to Minor Events/Situations: Children with anxiety disorders may have more extreme reactions – crying, throwing things, hitting and yelling – than most children have to minor nuisances/inconveniences. For example, if your son expects to go to the park in the afternoon and then learns he cannot go because it’s raining outside, his crying and yelling may be spurred by the anxiety of an unexpected change in his schedule. Or your child may become tearful and/or angry while furiously erasing his writing over and over because he can’t seem to make his sentence read the way he wants.

Tics: Some children with anxiety disorders develop tics – specifically facial tics – at a young age. Tics are a quick tensing of muscles, usually a couple times in a row. If your child frequently shuts his eyes tight or his mouth often tenses into a grimace, these may be facial tics brought on by anxiety or stress. Repetitive throat clearing also is a common tic in children with anxiety. There are many causes of tics, and a thorough evaluation should be conducted to rule out underlying medical conditions.

Physical Complaints: Some children experiencing anxiety will often complain of minor stomachaches or headaches. They may be fearful of becoming sick while at school or in public places and even experience panic about becoming sick. Physical symptoms are a common expression of anxiety (especially in children) and even though there is no medical cause for their complaints, the symptoms are very real to your child.

Repetitive Behavior: Repetitiveness can be a coping mechanism for children who have anxiety, which is more commonly associated with obsessive-compulsive disorder (OCD), but also can occur with other forms of anxiety. Children with anxiety have a tendency to repeat things, engage in the same routine over and over, and/or talk again and again about specific events or topics. They may also be very attached to objects they carry around or play with, and have extreme reactions when these objects are not present.

Picky Eating Habits: A child who is very picky in his or her eating habits may be exhibiting symptoms of anxiety. For example, he may not want to try new foods, will only eat one or two kinds of food, or will only eat foods with certain textures, colors or smells.

Tantrums/Aggression: Tantrums and aggression are more commonly caused by anxiety when children also have attention deficit-hyperactivity disorder (ADHD) or difficulty with impulse control. There is a difference between defiance and anxiety. If your child seems to have tantrums more frequently than most children his or her age, and if the tantrums seem to have clear triggers – such as when there are changes in routine, during transitions or when they are working on homework/projects – anxiety may be a factor.

Common Anxiety Disorders

Among the most common anxiety disorders in children are generalized anxiety, social anxiety, separation anxiety and obsessive-compulsive disorder (OCD). These disorders typically become more apparent when a child goes to school and is confronted with the pressure of teachers, homework, friends and transitions/flexibility.

Social anxiety also may be associated with selective mutism, which is an inability to speak in certain situations, such as in front of the class or to an unknown adult. And children with separation anxiety experience significant distress when away from their caregivers. They may excessively worry about their parents’ health and refuse to go to school or otherwise be away from them.

If your child is exhibiting any of the warning signs outlined in this article, the best thing to do is make an appointment with a mental health professional. This may include a clinical psychologist (Ph.D. or Psy.D.), licensed mental health counselor (LMHC) or licensed social worker (MSW or LCSW). It’s important to find a professional who specializes in working with children with anxiety and related disorders.

Research shows the most effective treatment plan for children with anxiety disorders is a combination of cognitive behavioral therapy and medication. However, in instances where therapy alone is enough, medication may not be needed. It is generally recommended that your child begin therapy first, and if the therapist believes that medication may be needed in conjunction with therapy, he or she can recommend a consultation with a medical professional as needed.

As the name implies, cognitive behavioral therapy is comprised of two parts. For kids with anxiety, the behavioral component of therapy includes systems that reward them for engaging in activities that may be difficult for them. It may also include exposure therapy, which involves slowly introducing the child to feared situations and making that scenario rewarding rather than scary.

Because our thoughts are what cause us to become anxious in the first place, cognitive therapy helps children recognize and understand their feelings. For kids younger than 6, cognitive therapy may be basic or limited in the treatment plan. But for older children, cognitive therapy helps them gain awareness of the thoughts that lead to their feelings of anxiety, and then gives them the ways to cope with these feelings.

Research shows that, left unchecked, anxiety disorders in children may lead to problems in school and increased risk of substance abuse, depression and other mental-health problems. Of course, this is largely determined by the child, the disorder and the intervention to address the anxiety disorder.

While it’s normal for kids to feel jitters and express worry from time to time, children with anxiety disorders believe their fears are earth shattering and will react in that way. Remember, the symptoms listed above are not always an indication of an anxiety disorder; however, if you feel your child’s behavior is interfering with daily functioning – having consistent behavioral outbursts, difficulty socializing/making friends, constant expression of worry/fears – a mental health professional can help you diagnose and treat the problem.

Brittany Zern, Psy.D., BCBA-D, is a licensed psychologist and board certified behavior analyst for engage behavioral health in Tampa. She specializes in the assessment and treatment of developmental and behavioral disorders in children and adolescents. Visit www.engagebehavioralhealth.com.

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